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[ { "answer_id": 714, "body": "<h2>How to identify migraine</h2>\n\n<p>Traditionally, if you had headaches you would discuss your symptoms with a doctor who would then classify the type of headache you had based on what you reported. If you didn't think of something to report, or didn't think (for example) that your nausea was related to your headaches (and so didn't report it), then your headache type may be misdiagnosed. Personally, I received several different \"headache diagnoses\" over the years, depending on how I reported my symptoms and the doctor I was seeing at the time.</p>\n\n<p>In 2003, a group of researchers published a study (Lipton) where they determined the ID Migraine test was a reliable screening test for determining whether a patient had migraine. This test was further validated by additional studies in 2011 (Cousins), and has since been translated into additional languages and studied further (Karli). </p>\n\n<p><strong>ID Migraine Test</strong></p>\n\n<p>The ID Migraine test is considered positive for migraine if the patient answers yes to 2 or more of the following 3 questions:</p>\n\n<ul>\n<li>Has a headache limited your activities for a day or more in the last three months?</li>\n<li>Are you nauseated or sick to your stomach when you have a headache?</li>\n<li>Does light bother you when you have a headache?</li>\n</ul>\n\n<p><strong>Migraine Symptoms</strong> </p>\n\n<p>More generally, the <a href=\"http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/symptoms/con-20026358\" rel=\"nofollow noreferrer\">symptoms of migraine</a> may include:</p>\n\n<ul>\n<li>Pain on one side or both sides of your head</li>\n<li>Pain that has a pulsating, throbbing quality</li>\n<li>Sensitivity to light, sounds and sometimes smells</li>\n<li>Nausea and vomiting</li>\n<li>Blurred vision</li>\n<li>Lightheadedness, sometimes followed by fainting</li>\n<li>Aura \n\n<ul>\n<li>Visual phenomena, such as seeing various shapes, bright spots or flashes of light</li>\n<li>Vision loss</li>\n<li>Pins and needles sensations in an arm or leg</li>\n<li>Speech or language problems (aphasia)</li>\n</ul></li>\n</ul>\n\n<h2>How to classify severity of migraine</h2>\n\n<p>Severity of migraine is usually judged based on how the symptoms affect the patient's ability to conduct daily activities. There are several scales available to test this, but the two most popular seem to be the Migraine Disability Assessment (MIDAS) and the Headache Impact Test (HIT).</p>\n\n<p><strong>MIDAS</strong></p>\n\n<p>MIDAS was developed in 2001 (Steward) and is based on asking the patient to count the number of days they have been impacted by their headaches (specifically addressing work, household, and social activities). The more days a person is impacted, the more severe their migraine is considered. MIDAS can be <a href=\"http://www.achenet.org/midas/\" rel=\"nofollow noreferrer\">found online</a> at the American Headache Society.</p>\n\n<p><strong>HIT</strong></p>\n\n<p>HIT is a newer test, developed in 2011 (Yang). It asks the patient to consider the impact of migraine on their activities in the past 4 weeks, on a five point scale that progresses from \"Never\" to \"Always\". Having more responses on the positive end of the scale (Sometimes/Very Often/Always) will indicate that a person is more severely affected by migraine. The HIT can be <a href=\"http://www.headaches.org/sites/default/files/uploaded_files/pdf/HIT-6.pdf\" rel=\"nofollow noreferrer\">found online</a> on the National Headaches Foundation.</p>\n\n<h2>References</h2>\n\n<p>Cousins G1, Hijazze S, Van de Laar FA, Fahey T. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/21649653\" rel=\"nofollow noreferrer\">Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis.</a> \nHeadache. 2011 Jul-Aug;51(7):1140-8. doi: 10.1111/j.1526-4610.2011.01916.x. Epub 2011 Jun 7.</p>\n\n<p>Karli, N, Mustafa Ertas, Betül Baykan, Ozlem Uzunkaya, Sabahattin Saip, Mehmet Zarifoglu, Aksel Siva, and MIRA study group. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3451667/\" rel=\"nofollow noreferrer\">The validation of ID migraine™ screener in neurology outpatient clinics in Turkey.</a> J Headache Pain. 2007 Sep; 8(4): 217–223. Published online 2007 Sep 24. doi: 10.1007/s10194-007-0397-4</p>\n\n<p>Lipton RB, Dodick D, Sadovsky R, Kolodner K, Endicott J, Hettiarachchi J, Harrison W; <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12913201\" rel=\"nofollow noreferrer\">A self-administered screener for migraine in primary care: The ID Migraine validation study.</a> Neurology. 2003 Aug 12;61(3):375-82.</p>\n\n<p>Stewart WF, Lipton RB, Dowson AJ, Sawyer J. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11294956\" rel=\"nofollow noreferrer\">Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability.</a> Neurology. 2001;56(6 Suppl 1):S20-8.</p>\n\n<p>Yang M, Rendas-Baum R, Varon SF, Kosinski M. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057423/\" rel=\"nofollow noreferrer\">Validation of the Headache Impact Test (HIT-6TM) across episodic and chronic migraine.</a> Cephalalgia. 2011;31(3):357-367. doi:10.1177/0333102410379890.</p>\n\n<p>A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks\nTerrin A, Mainardi F, Lisotto C, Mampreso E, Fuccaro M, Maggioni F, Zanchin G. <a href=\"https://doi.org/10.1177/0333102419877661\" rel=\"nofollow noreferrer\">A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks</a>Cephalalgia. 2019 <a href=\"https://doi.org/10.1177/0333102419877661\" rel=\"nofollow noreferrer\">https://doi.org/10.1177/0333102419877661</a></p>\n", "score": 4 }, { "answer_id": 141, "body": "<p>The migraine is a chronic neurological disease. Its main symptom is usually an intense headache that occurs at the front or on one side of the head and the pain could gets worse when you move and prevents you from carrying out normal activities.</p>\n\n<p>The symptoms of a migraine can usually last for few hours or few days. Other common symptoms could include: nausea, vomiting and increased sensitivity to light and sound, however not everyone experiences these additional symptoms. Some other could include sweating, poor concentration, feeling very hot or very cold, abdominal (tummy) pain and diarrhoea. Migraine headaches are often undiagnosed and untreated.</p>\n\n<p>There are several types of migraine how it's categorised, such as^{<a href=\"http://www.nhs.uk/conditions/migraine/Pages/Introduction.aspx\" rel=\"nofollow noreferrer\">NHS</a>}:</p>\n\n<ul>\n<li><p>migraine with aura,</p>\n\n<p>This is when there are warning sings before migraine starts (such as flashing lights).</p></li>\n<li><p>migraine without aura,</p>\n\n<p>Where migraine occurs without warning sings.</p></li>\n<li><p>migraine aura without headache.</p>\n\n<p>Where other symptoms are experienced (such as aura), but without headache. </p></li>\n</ul>\n\n<p>And the main stages of a migraine (although not everyone goes through all of these) are^{<a href=\"http://www.nhs.uk/conditions/migraine/Pages/symptoms.aspx\" rel=\"nofollow noreferrer\">NHS</a>}:</p>\n\n<ol>\n<li><p><strong>'<a href=\"https://en.wikipedia.org/wiki/Prodrome\" rel=\"nofollow noreferrer\">Prodromal</a>' (pre-headache) stage</strong></p>\n\n<p>This early symptom can indicate the start of a disease. For example changes in mood, energy levels, behaviour and appetite can occur several hours or days before an attack. </p></li>\n<li><p><strong><a href=\"https://en.wikipedia.org/wiki/Aura_(symptom)\" rel=\"nofollow noreferrer\">Aura</a></strong></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Retinal_migraine\" rel=\"nofollow noreferrer\">Retinal migraine</a> (visual migraine) can be accompanied by visual disturbances such as flashes of light or blind spots, which can last for five minutes to an hour or even temporary blindness in one eye.</p>\n\n<p>It vary by individual experience (smells, lights, or hallucinations).</p></li>\n<li><p><strong>Headache stage</strong></p>\n\n<p>Throbbing or pulsatile pain on one side or both sides of the head lasting for few hours to 72 hours. Often accompanied by nausea, vomiting, and/or extreme sensitivity to bright light and loud sounds.</p></li>\n<li><p><strong><a href=\"https://en.wikipedia.org/wiki/Postdrome\" rel=\"nofollow noreferrer\">Postdrome</a></strong> (Resolution stage)</p>\n\n<p>When symptoms gradually fade away, you may till feel tired for a few days afterwards. During this time you may feel drained and washed out, some other people report feeling mildly euphoric.</p></li>\n</ol>\n\n<p>See also:</p>\n\n<ul>\n<li><a href=\"https://health.stackexchange.com/q/103/114\">What are the general causes of migraine and how can it be treated?</a></li>\n<li><a href=\"https://en.wikipedia.org/wiki/Tension_headache\" rel=\"nofollow noreferrer\">Tension headache</a> at Wikipedia</li>\n<li><a href=\"http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/symptoms/con-20026358\" rel=\"nofollow noreferrer\">Migraine Symptoms</a> by Mayo Clinic Staff</li>\n</ul>\n", "score": 2 } ]

[ "headache", "migraine", "neurology" ]

[ { "answer_id": 378, "body": "<p>Feeling cold can vary on our perception, age, race and hormonal concentrations.</p>\n\n<p>This has been shown in <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18215727\" rel=\"nofollow\">Gend Med study from 2007</a>:</p>\n\n<blockquote>\n <p><strong>More women than men had sensitivity to cold</strong>. Whereas the percentage of men who had sensitivity to cold significantly increased with aging (P &lt; 0.05), <strong>the percentage of women who had sensitivity to cold was already high</strong> (23.7%) at 50 to 60 years of age and did not change with aging.</p>\n</blockquote>\n\n<p>Therefore based on the numbers we can say that sensitivity increases with aging and it is different in men and women. And this was not not associated with circulating hormonal concentrations.</p>\n\n<p>These studies were tested only on Japanese men and postmenopausal women aged >=50 years, so if it's the evidence based on the numbers, it's up to you.</p>\n", "score": 3 } ]

[ "senses" ]

[ { "answer_id": 372, "body": "<p>Nitrates and nitrites cause a lot of consumer confusion. They're naturally occurring molecules in vegetables.</p>\n\n<p>Several foods are sources of <a href=\"https://en.wikipedia.org/wiki/Nitrate\" rel=\"nofollow\">nitrates</a> (salts) which are a normal part of the diet as they occur naturally and they're produced by a number of species of <a href=\"https://en.wikipedia.org/wiki/Nitrifying_bacteria\" rel=\"nofollow\">nitrifying bacteria</a>. Only excessive levels can cause any health problems (<a href=\"https://en.wikipedia.org/wiki/Methemoglobinemia\" rel=\"nofollow\">methemoglobinemia</a>).</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Nitrite#Nitrite_in_food_preservation_and_biochemistry\" rel=\"nofollow\">Sodium nitrite and potassium nitrite</a> (salts) are added to cured and processed meats as reducing agent (opposite of oxidation agent) to delay spoilage and pathogenic bacteria growth and to preserve its color.</p>\n\n<p>Historically nitrite and nitrate were considered harmful food additives where they were considered carcinogenic, however recent research has change our ideas about health effects of both nitrite and nitrate and newly studies show no association between its intake and stomach or ovarian cancer. Further more, they're now considered as essential nutrients for cardiovascular health by promoting <a href=\"https://en.wikipedia.org/wiki/Nitric_oxide\" rel=\"nofollow\">nitric oxide</a> (NO) production.^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20392889\" rel=\"nofollow\">2010</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/22889895\" rel=\"nofollow\">2012</a>}</p>\n\n<p>However under certain conditions, nitrite can form nitrosamines, molecules that cause cancer in lab animals. This happens when nitrites are exposed to high heat during cooking or strongly acidic conditions (stomach acids), they could form carcinogenic <a href=\"https://en.wikipedia.org/wiki/Nitrosamine\" rel=\"nofollow\">nitrosamines</a>^{<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16865769\" rel=\"nofollow\">2006</a>, <a href=\"http://www.sciencedirect.com/science/article/pii/S0309174007001994\" rel=\"nofollow\">2007</a>, <a href=\"https://en.wikipedia.org/wiki/Nitrosamine\" rel=\"nofollow\">wiki</a>}. As the result the U.S. Department of Agriculture established the safety limits on the amount of nitrites used in meat products in order to decrease cancer risk in the population. This could indicate that nitrosamines may be carcinogenic in humans.</p>\n\n<p>Although available evidence supports a positive association between nitrite and nitrosamine intake and gastric cancer (GC) and oesophageal cancer (OC), they're not conclusive^{<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4087738/\" rel=\"nofollow\">2006</a>, <a href=\"https://en.wikipedia.org/wiki/Nitrosamine#Cancer\" rel=\"nofollow\">wiki</a>}.</p>\n\n<p>The recent research suggests that nitrite preservatives have \"been found to be safe\"^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/22889895\" rel=\"nofollow\">2012</a>}. However it doesn't mean processed meats are healthy.</p>\n\n<p>See also:</p>\n\n<ul>\n<li><a href=\"http://www.livescience.com/36057-truth-nitrites-lunch-meat-preservatives.html\" rel=\"nofollow\">The Truth About Nitrite in Lunch Meat</a> (2011) at Live Science</li>\n</ul>\n", "score": 3 } ]

[ "diet", "cancer" ]

[ { "answer_id": 308, "body": "<p>The safest hand sanitizer from the perspective of reducing antibiotic resistance is the alcohol-based sanitizer. It's effective against a wide variety of microorganisms.</p>\n<p>Remember, though, that hand sanitizers don't remove dirt and chemicals from your skin, and all of the ingredients in hand sanitizers are left to fully absorb into your skin. Alcohol makes the skin a bit more permeable to chemicals, so the current recommendation in hospital workers is to wash with soap and water after a few uses of hand sanitizer. (See the first reference for the rest of us.)</p>\n<p>Hand sanitizers should primarily be used only as an optional follow-up to traditional hand washing with soap and water, except in situations where soap and water are not available. In those instances, use of an alcohol-based sanitizer is better than nothing at all. Alcohol-based hand sanitizer are about equal in their ability to remove or kill germs on hands, shown in many studies including one small one involving influenza:</p>\n<blockquote>\n<p>Hand hygiene with soap and water or alcohol-based hand rub is highly effective in reducing influenza A virus on human hands, although soap and water is the most effective intervention.</p>\n</blockquote>\n<p>Soap and water eliminated more virus than the three alcohol-based hand rubs, although the difference between these strategies was not great.</p>\n<p>While in theory this remains possible, research so far has not found evidence that use of triclosan leads to bacterial resistance.</p>\n<blockquote>\n<p>The [FDA] said there is no evidence to date suggesting that triclosan is hazardous to humans, but several studies have found that triclosan can contribute to the development of bacterial resistance (Aiello AE et al. Clin Infect Dis. 2007;45[suppl 2]:S137-S147). In addition, animal studies have found that the chemical can interfere with thyroid function (Paul KB et al. Toxicol Sci. 2010;113[2]:367-379).</p>\n</blockquote>\n<p>Pediatricians are recommending that it be avoided in homes with children. It has become almost ubiquitous in the environment, so it should probably be avoided in hand-cleansers, as most of it ends up not on out hands, but in our water supply, etc.</p>\n<p>The evidence is a only a bit clearer for quaternary ammonium compounds (such as benzalkonium chloride) because of a bacterial genetic element called an <em>integron</em>:</p>\n<blockquote>\n<p>In recent decades, various genetic mechanisms involved in the spread of resistance genes among bacteria have been identified. Integrons – genetic elements that acquire, exchange, and express genes embedded within gene cassettes (GC) – are one of these mechanisms. ...Initially studied mainly in the clinical setting for their involvement in antibiotic resistance, their role in the environment is now an increasing focus of attention.</p>\n</blockquote>\n<p>There is some evidence that QAC's may cause a selection pressure for bacteria carrying antibiotic resistance integrons:</p>\n<blockquote>\n<p>Class 1 integrons are genetic elements that carry antibiotic and quaternary ammonium compound (QAC) resistance genes that confer resistance to detergents and biocides. ...We show that prevalence of class 1 integrons is higher in bacteria exposed to detergents and/or antibiotic residues...</p>\n<p>Resistance toward QACs is widespread among a diverse range of microorganisms... Development of resistance in both pathogenic and nonpathogenic bacteria has been related to application in human medicine and the food industry. QACs in cosmetic products will inevitably come into intimate contact with the skin or mucosal linings in the mouth and thus are likely to add to the selection pressure toward more QAC-resistant microorganisms among the skin or mouth flora.</p>\n</blockquote>\n<p>_{<a href=\"http://edis.ifas.ufl.edu/fy732\" rel=\"noreferrer\">Hand Hygiene and Hand Sanitizers</a>} _{<strong>good overview</strong>}<br />\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321497/\" rel=\"noreferrer\">Integron Involvement in Environmental Spread of Antibiotic Resistance</a>}<br />\n_{<a href=\"http://www.nature.com/ismej/journal/v5/n8/abs/ismej201115a.html\" rel=\"noreferrer\">Impacts of anthropogenic activity on the ecology of class 1 integrons and integron-associated genes in the environment</a>}<br />\n_{<a href=\"http://cid.oxfordjournals.org/content/48/3/285.full\" rel=\"noreferrer\">Efficacy of Soap and Water and Alcohol-Based Hand-Rub Preparations against Live H1N1 Influenza Virus on the Hands of Human Volunteers</a>}<br />\n_{<a href=\"http://online.liebertpub.com/doi/abs/10.1089/mdr.2009.0120\" rel=\"noreferrer\">Does the wide use of quaternary ammonium compounds enhance the selection and spread of antimicrobial resistance and thus threaten our health?</a>}</p>\n", "score": 5 } ]

[ "bacteria", "sanitation", "hand-sanitizers", "antibacterial-resistance" ]

[ { "answer_id": 437, "body": "<p>The absolute key to know if <strong>ANY</strong> treatment is working would be to find out that things get better after such treatment started, in this particular case, you want hair-loss to <strong>decelerate</strong>. </p>\n\n<p>In order to register a change, you need to first register the previous state of affairs, so you'd have to <strong>calculate</strong> hair-loss rate both before and after the treatment was started.<br>\n<strong><em>First of all</em></strong> you wanna be sure it is actually a problem or if it isn't at all.<br>\nIf the rate of hair loss is not accelerating in a way that indicates some pathological problem, then there wouldn't be anything to worry about because humans normally lose some hair and grow some new.<br>\n<strong><em>Otherwise</em></strong>, if the hair is falling in an accelerating manner and the amount of new hair does not correlate, then a diagnose of the <em>cause</em> and a treatment may be necessary. </p>\n\n<p>The <em>cause</em> is beyond the scope of this question so <strong>I'll stay on topic by elaborating on measurement and calculations</strong>.</p>\n\n<p>This calculations shouldn't be done by means of human perception (e.g. photographs or simple observation) you want a method that's less fallible, there are other suggested \"practical\" methods like wearing a cap all day and then count the amount of hair that stays on the cap when you take the cap off and when you take a bath, this kind of methods are messy and there are multiple chances where mistakes can be made, so I'd say error-prone methods like this are useless. Not to mention, wearing a cap at all times is not practical and may even make things worse. </p>\n\n<p>I found some very interesting articles licensed under <a href=\"https://creativecommons.org/\" rel=\"nofollow\">Creative Commons</a> in the National Library of Medicine.\n<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938572/\" rel=\"nofollow\">The first one</a> describe a variety of methods, ranging from non-invasive to semi-invasive to invasive.</p>\n\n<blockquote>\n <p>Non-invasive methods</p>\n \n <p>e.g., Questionnaire, daily hair counts, standardized wash test, 60-s\n hair count, global photographs, dermoscopy, hair weight, contrasting\n felt examination, hair feathering test, phototrichogram and\n TrichoScan.</p>\n \n <p>Semi-invasive methods</p>\n \n <p>e.g., Trichogram and unit area trichogram (UAT).</p>\n \n <p>Invasive methods</p>\n \n <p>e.g., Scalp biopsy.</p>\n</blockquote>\n\n<p>A scalp biopsy seems way to invasive and not suitable to be doing it frequently in order to calculate a rate of acceleration/deceleration, so I investigated further on the Thrichogram option; it turns that method has been used and approached from different angles <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/2688520\" rel=\"nofollow\">since the 80s</a>:</p>\n\n<blockquote>\n <p>This personal technical adaptation gives an easily obtainable definition of five <strong>quantitative parameters</strong> analysing the hair on a given area of the scalp: density of implantation, telogen percentage, growth rate, mean anagen diameter and percentage of fine hair less than 40 mu in diameter. In the normal male adult our measurements gave the following results on the vertex: density 204 +/- 10 hair per square centimeter, telogen percentage 17.8 +/- 2.8 p. 100, growth rate 0.35 +/- 0.03 mm p. day, mean anagen diameter 76 +/- 5 mu, percentage of fine hair 9.2 +/- 1.8</p>\n</blockquote>\n\n<p>And there seems to have been <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681107/\" rel=\"nofollow\">some progress recently</a> in the development of <strong><em>instruments</em></strong> to aid in such methods:</p>\n\n<blockquote>\n <p>To properly assess the progression and treatment response of alopecia, one must measure the changes in hair mass, which is influenced by both the density and diameter of hair. Unfortunately, a convenient device for hair mass evaluation had not been available to dermatologists until the recent introduction of the <strong><em>cross-section trichometer</em></strong>, which directly measures the cross-sectional area of an isolated bundle of hair.</p>\n</blockquote>\n\n<p>The article mentions one particular trademarked device but there must be others. So there you have it, I'll venture to state with some confidence that the best approach is to use some device like that one and measure your scalp at least one time a day. And for security sake and professionalism sake, I'd recommend some expert assistance from a dermatologist. But if you have a <strong>Scientific Mind and a Hacker Spirit</strong>, do it yourself, why not.<br>\n(Just the measurement part, don't diagnose yourself.)</p>\n\n<p>So in this particular case, if vitamins don't decelerate your hair loss rate, then to hell with vitamins, you may need something else, so go to a doctor and get properly diagnosed.</p>\n", "score": 2 } ]

[ "diet", "alopecia", "hairloss", "scientific-method" ]

[ { "answer_id": 448, "body": "<p>Short answer: Yes. </p>\n\n<p><strong>Fused leaflets?</strong><br>\nThe condition you’re referring to is known as Congenital <a href=\"http://my.clevelandclinic.org/services/heart/disorders/valve/bicuspid_aortic_valve_disease\" rel=\"nofollow\">bicuspid aortic valve</a> (BAV). It is the most common congenital heart valve abnormality, present in 1-2% of live births. Normally there are three leaflets (a.k.a. cusps) comprising the aortic valve. BAV refers to the situation when there are only two cusps, a hemodynamically less favorable scenario. </p>\n\n<p>Although generally benign in itself, BAV has been associated with an increased risk of several serious complications. In particular, <a href=\"http://en.wikipedia.org/wiki/Aortic_stenosis\" rel=\"nofollow\">aortic stenosis</a>, a condition in which the blood flow exiting the heart is limited by a narrowed valve, is more common in individuals with BAV and often occurs at a younger age. Aortic stenosis in BAV patients is also frequently accompanied by <a href=\"http://en.wikipedia.org/wiki/Aortic_insufficiency\" rel=\"nofollow\">aortic insufficiency</a>, back flow through the valve. Both properties reflect the anatomic descriptor you give: <strong>ugly</strong>.</p>\n\n<p><strong>Is BAV hereditary?</strong><br>\nYes. This can be demonstrated by looking at familial clustering of the condition. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/9385911\" rel=\"nofollow\">In one study</a>, the researchers started with thirty patients diagnosed by echocardiography with congenital BAV.* All first-degree relatives were contacted, and 90% of them agreed to undergo echocardiography. Of those, 9% were found to have BAV. This is significantly higher than the baseline population risk (~1%). The distribution was compatible with an <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/002049.htm\" rel=\"nofollow\">autosomal dominant</a> inheritance pattern with incomplete <a href=\"http://ghr.nlm.nih.gov/glossary=penetrance\" rel=\"nofollow\">penetrance</a>.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15234422\" rel=\"nofollow\">A more recent study</a> used fancy math to determine the <a href=\"http://en.wikipedia.org/wiki/Heritability\" rel=\"nofollow\">heritability</a> of BAV.** They found that 89% of the risk for BAV is due to heritable factors. </p>\n\n<hr>\n\n<p>_{\n*This paper is available in full for free and provides a nice review of the background (summarized here) as well as the findings I presented: \n} </p>\n\n<p>_{\nHuntington K, Hunter AG, Chan KL. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/9385911\" rel=\"nofollow\"><em>A prospective study to assess the frequency of familial clustering of congenital bicuspid aortic valve.</em></a> J Am Coll Cardiol. 1997 Dec;30(7):1809-12.\n} </p>\n\n<p>_{\n**Cripe L, Andelfinger G, Martin LJ, Shooner K, Benson DW. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15234422\" rel=\"nofollow\"><em>Bicuspid aortic valve is heritable.</em></a> J Am Coll Cardiol. 2004 Jul 7;44(1):138-43.\n}</p>\n", "score": 5 }, { "answer_id": 1559, "body": "<p>I would just like to add one point. There are 3 important causes of aortic valve stenosis: congenitally bicuspid aortic valve, senile calcific aortic stenosis and rheumatic heart disease. In advanced stages of all 3 conditions, the morphology of aortic valve looks equally bad and it may difficult to ascertain the original pathology. Fusion of leaflets may occur in all 3 conditions. Senile degenerative aortic stenosis occurs mostly in the elderly, hence if the age of this patient is advanced, that is a very likely possibility and that condition is not familial or hereditary. Rheumatic heart disease is common in developing parts of the world and is most commonly associated with involvement of mitral valve also. Isolated aortic involvement is much less common in rheumatic heart disease. </p>\n\n<p>Not all patients with bicuspid aortic valve will progress to narrowing or regurgitation. Stenosis/regurgiation may occur after many years or may not occur at all. Also, milder degrees of valve dysfunction do not cause any symptoms and do not need surgery. </p>\n\n<p>Hope this helps.</p>\n\n<p>References:</p>\n\n<p><a href=\"http://www.mayoclinicproceedings.org/article/S0025-6196%2812%2961880-1/abstract?cc=y=\" rel=\"nofollow\">http://www.mayoclinicproceedings.org/article/S0025-6196%2812%2961880-1/abstract?cc=y=</a></p>\n\n<p><a href=\"http://www.sciencedirect.com/science/article/pii/004681779390267K\" rel=\"nofollow\">http://www.sciencedirect.com/science/article/pii/004681779390267K</a></p>\n\n<p><a href=\"http://circ.ahajournals.org/content/95/9/2262.short\" rel=\"nofollow\">http://circ.ahajournals.org/content/95/9/2262.short</a></p>\n\n<p><a href=\"http://circ.ahajournals.org/content/106/8/900.short\" rel=\"nofollow\">http://circ.ahajournals.org/content/106/8/900.short</a></p>\n", "score": 4 } ]

[ "cardiology", "heredity" ]

[ { "answer_id": 515, "body": "<p>I've worked on influenza in the past, and I've never heard <em>that</em> particular justification for missing a flu vaccine before. I confess I can't even find it when I Google for that particular belief.</p>\n\n<p>There are some viral diseases where it's true that prior vaccination (or natural exposure) may cause a severe overreaction of the immune system that results in more severe disease. However, the only common one I know of is <a href=\"http://newscenter.berkeley.edu/2011/12/21/dengue/\" rel=\"noreferrer\">Dengue fever</a>, where exposure to one strain makes infections from other strains much more severe.</p>\n\n<p>Were your friend's belief be true, all vaccines that miss a strain (which are functionally similar to not being vaccinated) would be serious problems for the next year, because everyone would be in the position you're describing - immunologically having missed a vaccine - and there's no evidence I can find of that, and absolutely no mention of it in most <a href=\"http://www.cdc.gov/flu/protect/whoshouldvax.htm\" rel=\"noreferrer\">influenza vaccination guidelines</a>.</p>\n", "score": 9 } ]

[ "vaccination", "influenza" ]

[ { "answer_id": 530, "body": "<p>There is a study <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243011/\">described at nih.gov</a> about the rate of absorption of caffeine through the skin and how hair follicles contribute to it (\"significantly\", is apparently the answer to that). Another study compared <a href=\"http://www.researchgate.net/publication/8571074_In_vitro_predictions_of_skin_absorption_of_caffeine_testosterone_and_benzoic_acid_a_multi-centre_comparison_study\">how three different substances, including caffeine traveled through different thicknesses of skin in humans and animals</a> </p>\n\n<p>The first-referenced article above has this summary about what was known at the beginning of the study:</p>\n\n<blockquote>\n <p>Recently, it has been shown that the hair follicles are responsible\n for a fast delivery of topically applied substances. After topical\n application, caffeine was already detected in the blood of the\n volunteers after 5 min, whereas, when the hair follicles were\n selectively blocked utilizing the newly developed Follicular Closing\n Technique (FCT), caffeine was detectable only after 20 min</p>\n</blockquote>\n\n<p>Faith Williams, a researcher who studies skin's permeability to chemicals, had this to say about caffeinated soap in <a href=\"http://www.theguardian.com/science/2003/nov/27/thisweekssciencequestions1\">a 2003 article for the Guardian</a>:</p>\n\n<blockquote>\n <p>Caffeine does go through the skin if you apply it to the surface in\n solution But I would have\n thought that not much would go through [from soap] because I don't\n think it would stay in contact for very long.</p>\n</blockquote>\n\n<p>Given that statement, you might experiment on yourself (after getting all the requisite sign-offs that you're complying with <a href=\"http://www.who.int/ethics/research/en/\">human subject research ethics</a> of course) by leaving the shampoo on your scalp for a longer time before rinsing.</p>\n", "score": 6 } ]

[ "caffeine" ]

[ { "answer_id": 588, "body": "<p>Our body needs sugar (carbohydrates) where most of our energy comes from. When you eat sugar, it's converted into glucose and carried in the blood to different parts including brain.</p>\n\n<p>If you eat too much sugar, it can cause ‘<a href=\"https://en.wikipedia.org/wiki/Reactive_hypoglycemia\" rel=\"noreferrer\">reactive hypoglycaemia</a>’ when your sudden rise of blood-glucose can trigger an over-production of insulin which in turn makes the blood-glucose levels fall too low. As result of excessive insulin release your brain is not receiving enough glucose and the symptoms could include headache and migraine.</p>\n\n<p>^{Source: <a href=\"http://www.migrainetrust.org/factsheet-hypoglycaemia-and-migraine-10907\" rel=\"noreferrer\">Migraine Fact Sheets</a> at Migraine Trust}</p>\n\n<p>To prevent <a href=\"https://en.wikipedia.org/wiki/Sugar_crash\" rel=\"noreferrer\">sugar/glucose crash</a> from happening, you should limit your sugar intake (e.g. by eating smaller portions). Also exercising regularly increases sugar uptake which decrease excessive insulin release.</p>\n", "score": 5 } ]

[ "sugar", "headache" ]

[ { "answer_id": 3332, "body": "<p>While I cannot comment on the issue of laying on your back causing acne, I hope my answer helps with your concern for prevention. </p>\n\n<p>There is some evidence that glycemic index (GI) is related to more severe acne. One study examining the diets of 287 people from ages 18-25 with no, mild or severe acne, found that those with worse acne had greater dietary (glycemic index). The foods which were significantly different among groups included servings of:</p>\n\n<ol>\n<li>Sugar</li>\n<li>Milk (with non-fat milk having more of an effect than whole milk)</li>\n<li>Saturated fat</li>\n<li>Trans Fat</li>\n<li>Fish (indicating higher fish consumption in those with no or less severe acne)</li>\n<li>Fruit and fruit juice equivalents (presumably because fruit juice has added sugar making them high GI foods)</li>\n</ol>\n\n<p>The authors propose that GI is related to acne development because of the effect on Insulin-Like Growth Factor-1 or (IGF-1), but also highlight conflicting evidence. I will avoid further biological discussion of how this is thought to happen in the body because that is not your question.</p>\n\n<p>The authors do propose that milk may be related to worse acne because it contains IGF-1 and its insulinemic response is much higher than would be expected because of its glycemic load alone so they hypothesize that the IGF-1 leads to (with a few steps omitted) greater sebaceous lipogenesis and sebum output, leading to acne.</p>\n\n<p>The authors also comment on the negative relationship between fish consumption and hypothesize that n-3 polyunsaturated fatty acids (omega-3 fatty acids) have a protective effect against acne.</p>\n\n<p>Study limitations include that the data are self-reported as was the acne severity. </p>\n\n<p>A recent review of the dietary and acne literature indicated that there haven't been any randomized controlled trials that can conclude causally that high glycemic load, dairy and n-3 polyunsaturated fatty acids have an effect on acne. The evidence is more convincing for glycemic load, and less robust or conclusive for milk and n-3 polyunsaturated fatty acids.</p>\n\n<p>The aforementioned data are inconclusive but worth taking note to see if reduction of these foods benefit your acne. See <a href=\"https://www.dovepress.com/linking-diet-to-acne-metabolomics-inflammation-and-comedogenesis-an-up-peer-reviewed-fulltext-article-CCID#ref156\">this</a> for a in-depth discussion of the above issues.</p>\n\n<p><strong>References</strong> </p></p>\n\n<ol>\n<li><p>Burris, J., Rietkerk, W., &amp; Woolf, K. (2013). Acne: the role of medical nutrition therapy. Journal of the Academy of Nutrition and Dietetics, 113(3), 416–430. </p></p></li>\n<li><p>Burris, J., Rietkerk, W., &amp; Woolf, K. (2014). Relationships of self-reported dietary factors and perceived acne severity in a cohort of New York young adults. Journal of the Academy of Nutrition and Dietetics, 114(3), 384–392. </p></li>\n</ol>\n", "score": 8 }, { "answer_id": 9074, "body": "<p>Pimples on the back can be either acne or staphylococcal folliculitis, that is a bacterial infection of the hair follicles, which can look very similar to acne - some <a href=\"https://www.google.com/search?q=staphylococcal%20folliculitis&amp;num=100&amp;newwindow=1&amp;biw=1366&amp;bih=643&amp;source=lnms&amp;tbm=isch&amp;sa=X&amp;ved=0ahUKEwiHhqSO0u3OAhWFdCwKHUmZDeoQ_AUICCgB\" rel=\"nofollow\">pictures here</a>. Staph folliculitis would heal on its own in few weeks or quicker with an antibiotic ointment, while acne are usually more persistent.</p>\n\n<p>Pressure upon the back skin might trigger back acne, but pressure on the cheeks when lying face down could then trigger facial acne. So...</p>\n\n<p>One proposed mechanism of acne development is increased activity of the androgen hormones <em>in the skin</em> (this does not necessary mean increased <em>blood</em> levels of the androgen hormones), triggered by:</p>\n\n<ul>\n<li>Psychological/emotional stress (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12873885\" rel=\"nofollow\">PubMed</a>) </li>\n<li>High intake of \"quick carbohydrates\" that is sugar and starch from sweets, fruit juices, soda, white bread and white rice, which results in frequent and high raises of blood glucose levels (glycemic load) (<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106357/\" rel=\"nofollow\">PubMed Central</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17448569\" rel=\"nofollow\">PubMed</a>)</li>\n<li>Dairy products (milk, ice cream, cheese), supposedly due to presence of bovine androgen hormones in milk (<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391699/\" rel=\"nofollow\">PubMed</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106357/\" rel=\"nofollow\">PubMed Central</a>)</li>\n</ul>\n\n<p>There is less evidence about high intake of saturated and trans fats as cause of acne. Fish oil supplements probably do not help to reduce acne (<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543297/\" rel=\"nofollow\">PubMed Central</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20338665/\" rel=\"nofollow\">PubMed</a>)</p>\n\n<p>A comprehensive review of acne causes and treatment (<a href=\"http://www.ehealthstar.com/conditions/acne-vulgaris\" rel=\"nofollow\">EhealthStar</a>)</p>\n", "score": 1 } ]

[ "hygiene", "acne" ]

[ { "answer_id": 745, "body": "<p>The phenomenon you are describing and the one shown in the picture is known as Reynaud's phenomenon. In cold temperatures, the body constricts the peripheral blood vessels to prevent losing heat from the blood to the outside air. In Reynaud's phenomenon, this constriction is exaggerated and may prevent blood flow to the fingers or toes (and sometimes other areas) giving rise to the pale appearance shown in your picture.</p>\n\n<p>Reynaud's phenomenon can be classified as primary or secondary. </p>\n\n<p>Primary Reynaud's phenomenon, often simply referred to as Reynaud's disease is where the phenomenon is not associated with any underlying disease, and the cause is ideopathic (unknown). Primary Reynaud's phenomenon is considered to be a benign condition.</p>\n\n<p>Secondary Reynaud's phenomenon occurs when there is an underlying disease that is causing the condition, the most common of which are connective tissue disorders such as lupus (SLE).</p>\n\n<p>For treating the phenomemon, your doctor will first want to ensure that you do not have secondary Reynaud's phenomenon, and if you do, the treatment will vary depending on the underlying disease.</p>\n\n<p>If you are found to have primary Reynaud's disease, then there are also a variety of treatment options available that should be discussed with your health care provider. Some of the options include:</p>\n\n<ul>\n<li>Vasodilators - Vasodilators relax blood vessels increasing blood flow. Creams such as nitroglycerin cream applied to base of fingers may help heal ulcers.</li>\n<li>Calcium channel blockers - Relax and open small blood vessels in your\nhands and feat, decreasing frequency of attacks.</li>\n<li>Alpha blockers - These drugs counter the actions of noradrenaline, a\nhormone that acts to constrict blood vessels.</li>\n</ul>\n\n<p>In addition, your doctor will likely advise you to not smoke (as smoking is associated with lower skin temperature due to constriction of blood vessels), exercise more (as exercising can increase circulation) and control stress (which may help avoid attacks).</p>\n", "score": 4 } ]

[ "hematology", "blood" ]

[ { "answer_id": 23023, "body": "<p>I have only anecdotal evidence; personally, I find the magic trackpad much better for most general purpose computing use and I believe it puts less strain on the whole lower arm structure. There are, however, certain tasks where I find using a mouse to be easier though, as I have now used the trackpad for some years and consequently become more adept, the difference is less marked than it was.</p>\n\n<p>One would hope that an ergonomist might have carried out some research.</p>\n", "score": 1 } ]

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

[ { "answer_id": 3875, "body": "<p>For mild cases, no treatment is needed. </p>\n\n<p>For more severe cases, ACE inhibitors and diuretics are used as medical treatments. The surgical options are aortic valve repair (valvuloplasty) or replacement with a mechanical or tissue valve. </p>\n\n<p>Replacement carries high risks (1 in 50 patients dies) as it is open heart surgery and also a risk the risk of blood clots and thus needs to be carefully considered, and patients need to take anti-blood clot medication afterwards. </p>\n\n<p>Sources:</p>\n\n<p><a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000179.htm\" rel=\"nofollow\">Medlineplus on Aortic Insufficiency</a></p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/basics/definition/con-20022523\" rel=\"nofollow\">Mayo Clinic on Aortic valve regurgitation</a> (different name for aortic insufficiency) </p>\n\n<p><a href=\"http://www.nhs.uk/conditions/aorticvalvereplacement/Pages/Whatisitpage.aspx\" rel=\"nofollow\">NHS page on aortic valve replacements</a></p>\n", "score": 3 } ]

[ "cardiovascular-disease" ]

[ { "answer_id": 778, "body": "<p><strong>Definition:</strong></p>\n\n<blockquote>\n <p>The term \"high fructose corn syrup\" is not a good descriptor of its\n composition, but the term was mandated to distinguish the newly\n developed fructose-containing corn syrup from traditional all-glucose\n corn syrups. Factors that may account for the different effects of\n fructose alone or a mixture of fructose and glucose could be its\n gastrointestinal effects and absorption characteristics. (5)</p>\n</blockquote>\n\n<p><strong>The Problem</strong></p>\n\n<p>Today we have too much access to energy that we don't need. This leads to the problem of obesity when people consume too many calories, pointing towards higher risks of cardiovascular diseases.</p>\n\n<p><strong>The Possible Culprit</strong></p>\n\n<p>High Fructose Corn Syrup (HFCS) contributes to this problem because when consumed, it does not stimulate the pancreas to produce insulin. In animal models, it even induces insulin resistance, leading to diabetes (1).</p>\n\n<blockquote>\n <p>\"the long-term consumption of diets high in fat and fructose is likely\n to lead to increased energy intake, weight gain, and obesity\" (1).</p>\n \n <p>Additionally, when ingested by itself, fructose is poorly absorbed\n from the gastrointestinal tract, and it is almost entirely cleared by\n the liver since it's absorbed through a different system than glucose.\n This puts more work on the liver. (2)</p>\n</blockquote>\n\n<p>Furthermore, HFCS </p>\n\n<blockquote>\n <p>\"did not suppress circulating ghrelin, a major appetite-stimulating\n hormone\" - (2)</p>\n</blockquote>\n\n<p>So even though you're taking in a massive amount of energy and overworking your liver, you don't feel full, which causes you to keep eating and drinking.</p>\n\n<p>For runners and other endurance athletes, this is ideal. They can store up massive amounts of energy without the need to stuff themselves until their stomachs are nearly exploding. For people who burn a massive amount of energy on a regular basis, HFCS comes as a good source for replenishing and preparing that energy for usage, but for everyone else who doesn't burn high levels of calories, this indicates a high influx of potential energy without anywhere to go. </p>\n\n<p><strong>The Counter</strong></p>\n\n<p>This short-term study notes,</p>\n\n<blockquote>\n <p>\"There were no differences in energy or macronutrient intake on day 2.\n The only appetite variable that differed between sweeteners was desire\n to eat\" (4)</p>\n</blockquote>\n\n<p>Another study notes that most of the testing has been done on rats, whereas in humans, </p>\n\n<blockquote>\n <p>for people with insulin resistance, diets\n with 50 grams or more per day (high consumption) may result in\n elevated triglycerides, but there is no effect with normal levels of\n fructose consumption. (5)</p>\n</blockquote>\n\n<p><strong>The Caution</strong></p>\n\n<blockquote>\n <p>Fructose is poorly absorbed from the digestive tract when it is\n consumed alone, but absorption improves when fructose is consumed in\n combination with glucose and amino acids. In addition, the principal\n sweetener in soft drinks in the US, HFCS, is not pure fructose but a\n mixture of fructose (55%) and glucose (45%). HFCS is predominately\n present as HFCS-55 (55% fructose, 41% glucose, and 4% glucose\n polymers) or HFCS-42 (42% fructose, 53% glucose and 5% glucose\n polymers) (5).</p>\n</blockquote>\n\n<p>Studies on humans hasn't been substantial enough to develop hard evidence. In fact, one of the studies indicates that fructose increased appetites while another claimed it inhibited appetite! </p>\n\n<p>If there's one thing that seems highly possible right now, it's that high fructose corn syrup gives energy, whether you need it or not. Since most people don't, that contributes to possible obesity (3).</p>\n\n<p><strong>Sources:</strong> </p>\n\n<p>(1) <a href=\"http://ajcn.nutrition.org/content/76/5/911.full\" rel=\"nofollow\">Fructose, weight gain, and the insulin resistance syndrome</a></p>\n\n<p>(2) <a href=\"http://ajcn.nutrition.org/content/86/4/895.full\" rel=\"nofollow\">How bad is Fructose?</a></p>\n\n<p>(3) <a href=\"http://www.princeton.edu/main/news/archive/S26/91/22K07/\" rel=\"nofollow\">A sweet problem: Princeton researchers find that high-fructose corn syrup prompts considerably more weight gain</a></p>\n\n<p>(4) <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17234503\" rel=\"nofollow\">Effects of high-fructose corn syrup and sucrose consumption on circulating glucose, insulin, leptin, and ghrelin and on appetite in normal-weight women.</a></p>\n\n<p>(5) <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991323/\" rel=\"nofollow\">Health implications of fructose consumption: A review of recent data</a></p>\n", "score": 6 }, { "answer_id": 16850, "body": "<p>Fructose does not stimulate production of incretin, which results in sweeteners with a high fructose content being metabolized differently.</p>\n\n<p>People taking GLP-1 agonists should avoid high levels of fructose, including the obvious - high fructose corn syrup.</p>\n\n<p>ref:\n<a href=\"https://www.physiology.org/doi/pdf/10.1152/ajpendo.00446.2012\" rel=\"nofollow noreferrer\">https://www.physiology.org/doi/pdf/10.1152/ajpendo.00446.2012</a> \nBurmeister, et al., Central glucagon-like peptide 1 receptor-induced anorexia requires glucose\nmetabolism-mediated suppression of AMPK and is impaired by central fructose] Am J Physiol Endocrinol Metab 304: E677–E685, 2013; doi:10.1152/ajpendo.00446.2012 </p>\n", "score": 0 } ]

[ "nutrition", "risks", "sugar", "fructose" ]

[ { "answer_id": 829, "body": "<p>Looking at this from the perspective of an infectious disease epidemiologist, the kind of person who often reads (and occasionally runs) studies of this type, I'm skeptical. A number of reasons why:</p>\n\n<ul>\n<li>The only results are a synopsis. More details and data are apparently available, but there is no manuscript, and their \"<a href=\"http://trials.boehringer-ingelheim.com/transparency_policy/policy.html#accordion-1-5\" rel=\"nofollow\">Transparency Policy</a>\" has a <em>lot</em> of caveats in it.</li>\n<li>It's not a peer reviewed study.</li>\n<li>Their treatment protocol is oddly variable - 4 mandatory days plus a possible additional six days based on...?</li>\n<li>Again, since they're not providing tables, this gets a little frustrating to try to consider, but their treatment arm is fairly heavily skewed toward women - they claim it's similar in the control arm, but they won't show you how similar.</li>\n<li>They fail at their primary endpoint, being the mean number of symptoms reported between the treatment and control. The mean number of symptoms are about half-a-symptom less between the treatment and control arms, but the result isn't statistically significant, they do some statistical adjustment I'm a little skeptical of - because they don't describe it - and they end up using somewhat...loose...language like \"was a strong trend in favour of Bisolviral®.\"</li>\n<li>This is all based on patient self-report of symptoms, and interestingly, there's <em>absolutely</em> not an effect for self-reported assessment of efficacy between the treatment and control arms. Further, looking at viral load assays, there's also no <em>biological</em> evidence that anything is happening.</li>\n</ul>\n\n<p>I can't find the specific language about the 92% claim you cite in your question, but my assessment of the overall evidence that this compound works would be \"Faint and preliminary, at best\".</p>\n", "score": 3 } ]

[ "common-cold", "clinical-study" ]

[ { "answer_id": 3306, "body": "<p>Blood pressure is often checked in lower limbs also. BP needs to be checked in all limbs if one is suspecting obstruction in the arteries. Takayasu's arteritis and atherosclerosis are 2 conditions that can result in unequal blood pressure in different limbs due to obstruction of arteries. </p>\n\n<p>In ankle-brachial index test, blood pressure is checked in the arm and at ankle to detect peripheral arterial disease (PAD: <a href=\"http://www.mayoclinic.org/tests-procedures/ankle-brachial-index/basics/definition/prc-20014625\" rel=\"nofollow\">http://www.mayoclinic.org/tests-procedures/ankle-brachial-index/basics/definition/prc-20014625</a> )</p>\n\n<p>Also, if coarctation of aorta (congenital narrowing of great artery in thorax) is supected, pressure in lower limbs will be lower than that in upper limbs.</p>\n\n<p>Aortic regurgitation (incompetence of aortic valve) leads to higher pressure in lower limb than in upper limb due to pressure wave reflection. Here also it is recommended that pressure is recorded in both upper and lower limb. The degree of change in lower limb correlates with severity of regurgitation (Hill's sign).</p>\n\n<p>Initially, blood pressure should be recorded in both upper limbs. If BP difference in 2 arms is more than 15 mm Hg (systolic), tests (e.g. Doppler ultrasound) should be done to rule out obstruction. For following up on treatment of high blood pressure in such cases, higher blood pressure should be taken and controlled with medication. </p>\n\n<p>Blood pressure can also be estimated using finger probes, but their accuracy and reliability is not well established. This will also be subject to diseases of arteries in the arm, forearm and hand. </p>\n\n<p>For checking blood pressure, one needs an area where the artery can be compressed and one needs to listen to the artery distal to this area as the pressure is released. Brachial artery lies in front part of elbow and can be heard over easily. On the other hand, the artery in knee lies posteriorly (behind the knee). </p>\n\n<p>Since arteries to upper limbs come out of aorta much earlier than arteries to lower limbs, the pressure in upper limbs would be much less subject to diseases of aorta or compression on it by masses in thorax or abdomen. This would be main reason to prefer arms over legs, in addition to simple convenience factor. </p>\n", "score": 4 }, { "answer_id": 3305, "body": "<p>The reason we use the upper arm is that the arteries at that level have the same pressure of blood as the outflow-tract from the left ventricle (i.e. where the blood leaves your heart).</p>\n\n<p>Because of the weight of the blood, your pressure in the main arteries in your leg is slightly higher and in your head is slightly lower. This effect is more pronounced when sitting upright or standing.</p>\n\n<p>I think that we also measure it there for practicality - for serial measurements to make sense we should measure it in the same place every time, and an arm is much more easy to get to than a thigh (you'd have to take your trousers off every time!).</p>\n\n<p>Measuring pressures at the end of limbs is only useful in very specific conditions (such as peripheral vascular disease).</p>\n", "score": 1 } ]

[ "blood-pressure" ]

[ { "answer_id": 5223, "body": "<p>Being diagnosed with type 1 diabetes (DM1) at the age of 54 is very rare. It's <a href=\"http://www.diabetes.org/diabetes-basics/type-1/\" rel=\"nofollow noreferrer\">usually diagnosed in children or teenagers</a> and used to even be called 'juvenile diabetes' because of that. The reason it's usually diagnosed this early is because it comes from the body's inability to produce insulin in the pancreas after the immune system has destroyed these cells. But it's not totally unheard of to be diagnosed late. (I'm just including this because the answer for <em>type 2 diabetes</em> would be different)</p>\n<p><em>Inheritance</em></p>\n<p>Diabetes isn't inherited <a href=\"https://ghr.nlm.nih.gov/condition/type-1-diabetes#inheritance\" rel=\"nofollow noreferrer\">in any kind</a> of <a href=\"http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html\" rel=\"nofollow noreferrer\">simple pattern</a>. You can't say &quot;if a parent has it, the child will have it with a 50% probability&quot; - or even that a child of two people with DM1 will have DM1 themselves.</p>\n<p><a href=\"http://www.joslin.org/info/genetics_and_diabetes.html\" rel=\"nofollow noreferrer\">The Joslin Diabetes Center</a> has a few numbers:</p>\n<blockquote>\n<ul>\n<li><p>If an immediate relative (parent, brother, sister, son or daughter) has type 1 diabetes, one's risk of developing type 1 diabetes is 10 to 20 times the risk of the general population</p>\n</li>\n<li><p>The risk for a child of a parent with type 1 diabetes is lower if it is the mother — rather than the father — who has diabetes</p>\n</li>\n</ul>\n</blockquote>\n<p>Since you don't know whether your mother had it, your risk is even harder to judge.</p>\n<p><em>Prevention</em></p>\n<p>There are risk factors other than genetics for DM1, but unfortunately generally, <a href=\"http://kidshealth.org/en/parents/prevention.html\" rel=\"nofollow noreferrer\">type 1 diabetes can't be prevented</a>. There are a few trials about this, the one I could find about <a href=\"http://care.diabetesjournals.org/content/27/suppl_1/s133.full\" rel=\"nofollow noreferrer\">injecting children with insulin</a> was unsuccessful.</p>\n<p>The good news is that if you are worried about having diabetes, <a href=\"http://www.mayoclinic.org/diseases-conditions/diabetes/basics/tests-diagnosis/con-20033091\" rel=\"nofollow noreferrer\">testing isn't very complicated</a> and can be done regularly with no adverse effects.</p>\n", "score": 6 } ]

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

[ { "answer_id": 990, "body": "<p>Well unfortunately, without a lot more detail on the changes you've made to your diet and how you go about your exercise, it is impossible to exactly pin-point where the problem is, but here are some facts and pointers to help you out.</p>\n\n<p>There are three main factors here:</p>\n\n<ul>\n<li>Hormone levels</li>\n<li>Diet changes</li>\n<li>How you exercise</li>\n</ul>\n\n<p><strong>Hormone Levels</strong></p>\n\n<p>Normally, training alone doesn't cause significant increases in testosterone for there to be an effect on skin / acne, but if you are taking any supplements for this (like testosterone boosters), or happen to be going through puberty, then you may want to look into this with a doctor / dermatologist. </p>\n\n<p><strong>Diet Changes</strong></p>\n\n<p>There are a lot of foods that you may have implemented in your new diet that can be causing acne. Dairy, for example, has had plenty of studies going back and forth as to the effects it has on acne, with a nice amount claiming certain amounts of dairy can cause it. </p>\n\n<p>For more information on dietary causes, please read <a href=\"http://www.webmd.com/skin-problems-and-treatments/acne/features/worst-foods-for-your-skin\" rel=\"nofollow\">this article</a> full of information and advice. It will help you spot any new foods you may have introduced into your diet.</p>\n\n<p><strong>How you Exercise</strong></p>\n\n<p>Just like the dairy studies, plenty of people have gone back and forth with studies and evidence on sweating clogging up your pores. </p>\n\n<p>The main principle behind this is that as you sweat, the sweat brings dirt and oils from the surface of your skin into your pores for them to get clogged. </p>\n\n<p><a href=\"http://health.howstuffworks.com/wellness/men/sweating-odor/does-sweating-cause-acne.htm\" rel=\"nofollow\">This article</a> gives more information on how sweat affects acne.</p>\n\n<p>And from personal experience, sweating caused me to develop some acne when I started training, so if this is the cause of your acne, you need to look at a few things:</p>\n\n<ul>\n<li>How soon after your exercise do you shower? Leaving the sweat on your face for a prolonged amount of time isn't recommended, and you should wash your face as soon as you finish. On the counter-side of this, do not wash your face too often, as dry skin can also give you skin issues / acne. </li>\n<li>While exercising, make sure you are using a clean towel free of dirt to dry your face. Do not reuse towels before washing them between workouts. The dirt and oil left on a towel can be detrimental in preventing acne developing when you sweat. </li>\n<li>When showering, try using an exfoliating face wash that will assist you in properly deep cleaning your pores after a workout. Any product you use should be tested first, and used sparingly. </li>\n</ul>\n\n<p>For more info on face washing, please check out <a href=\"http://www.acne.org/wash-face.html\" rel=\"nofollow\">this page</a> for good tips on how to, and also for further tips on products.</p>\n\n<p><strong>So in Conclusion:</strong> </p>\n\n<p>Your acne can be caused by a plethora of changes you can be making to your body through hormones, diet, and exercise. But pinpointing the issue from the tips above and reading the cited material will help you make the changes needed to prevent it and finding the cause. </p>\n", "score": 7 } ]

[ "exercise" ]

[ { "answer_id": 4466, "body": "<p><strong>Levels generally increase until the ages of 50-60, then fall.</strong></p>\n\n<p>In children, levels of LDL and HDL generally either rise or fall monotonically (i.e. continuously) over childhood; see <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19524157\">Dai et al. (2009)</a>. LDL-C was found to decrease in both genders, while HDL-C was found to increase in girls and fluctuate in boys.</p>\n\n<p><a href=\"http://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf\">The NIH says of adults</a></p>\n\n<blockquote>\n <p>Blood cholesterol begins to rise around age 20 and continues to go up until about age 60 or 65. Before age 50, men’s total cholesterol levels tend to be higher than those of women of the same age—after age 50, the opposite happens.\n That’s because with menopause, women’s LDL levels often rise.</p>\n</blockquote>\n\n<p>After about the age of 50, both men and women generally experience a fall in blood cholesterol levels (see <a href=\"http://circ.ahajournals.org/content/96/1/37.full\">Ferrara et al. (1997)</a>).</p>\n\n<p>Additionally, levels in all age groups may fluctuate according to the seasons (see <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15111372\">Ockene et al. (2004)</a> and cited studies therein). However, the reason for this is unknown.</p>\n", "score": 6 } ]

[ "blood", "cholesterol" ]

[ { "answer_id": 1199, "body": "<p>Like almost all products, there are some side effects that come with using chlorhexidine gluconate mouthwash (CGM). Luckily, they are usually very minor and the ones that are more serious are extremely rare. WebMD^{<a href=\"http://www.webmd.com/drugs/2/drug-5356/chlorhexidine-gluconate-mm/details/list-sideeffects\" rel=\"nofollow\">1</a>} lists some of the common side effects of using CGM, such as teeth and mouth discoloration, taste problems, and an increase of tartar formation in the teeth. There are also more serious side effects that can come from using CGM, but these are mostly allergic reactions to its ingredients and are very rare. The FDA^{<a href=\"http://www.fda.gov/safety/medwatch/safetyinformation/ucm330906.htm\" rel=\"nofollow\">2</a>} has also said that serious allergic allergic reactions can occur from using products with chlorhexidine gluconate.</p>\n\n<blockquote>\n <p>Anaphylaxis, as well as serious allergic reactions, have been reported during postmarketing use with dental products containing chlorhexidine.</p>\n</blockquote>\n\n<p>There are studies that agree with the information that WebMD has said. Many of them are older, but the results of them are still reliable. A 1988 study^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3127483\" rel=\"nofollow\">3</a>} testing out the difference between 0.1% and 0.2% CGM. It found that with both there were possible minor side effects like discoloration and loss of taste. The only noticeable difference between the two is that the test subjects preferred the taste of the 0.1% CGM.</p>\n\n<p>There are also two studies from the 1980's^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6985300\" rel=\"nofollow\">4</a>,} ^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6607936\" rel=\"nofollow\">5</a>} that suggest that CGM can also cause gingival bleeding. The studies did notice a slight increase in the frequency of gingival bleeding when using CGM as opposed to mechanical oral care.</p>\n\n<p>Though there are side effects that can occur from using CGM, they are most likely not going to be very severe. Also, it is most likely that the benefits of using CGM will outweigh the risks. A 2006 study on both topical chlorhexidine gluconate and CGM^{<a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0765.1970.tb00696.x/abstract\" rel=\"nofollow\">6</a>} found that the topical and mouthrinse both helped treat plaque and prevent gingivitis when used properly.</p>\n\n<p>Odds are, your dentist told you to use CGM because of the swelling of your gums, a sign of gingivitis. It is more than likely that the benefits of you using CGM will outweigh the risks. If you really are worried about getting bad side effects from CGM, ask your doctor and try to find out if you are allergic to any of the ingredients.</p>\n\n<hr>\n\n<p>^{<a href=\"http://www.webmd.com/drugs/2/drug-5356/chlorhexidine-gluconate-mm/details/list-sideeffects\" rel=\"nofollow\">1: WebMD - Chlorhexidine Gluconate Mouthwash Side Effects</a>}</p>\n\n<p>^{<a href=\"http://www.fda.gov/safety/medwatch/safetyinformation/ucm330906.htm\" rel=\"nofollow\">2: PerioChip (chlorhexidine gluconate)</a>}</p>\n\n<p>^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3127483\" rel=\"nofollow\">3: Side-effects and patient acceptance of 0.2% versus 0.1% chlorhexidine used as post-operative prophylactic mouthwash</a>}</p>\n\n<p>^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6985300\" rel=\"nofollow\">4: Gingival bleeding after chlorhexidine mouthrinses</a>}</p>\n\n<p>^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6607936\" rel=\"nofollow\">5: Gingival bleeding after chlorhexidine rinses with or without mechanical oral hygiene</a>}</p>\n\n<p>^{<a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0765.1970.tb00696.x/abstract\" rel=\"nofollow\">6: The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man</a>}</p>\n\n<p>^{<a href=\"http://www.drugs.com/mtm/chlorhexidine-gluconate-oral-rinse.html\" rel=\"nofollow\">chlorhexidine gluconate</a>}</p>\n\n<p>^{<a href=\"http://www.medicinenet.com/chlorhexidine-topicalmucous_membrane/article.htm\" rel=\"nofollow\">chlorhexidine gluconate oral rinse (Peridex, Periogard, Periochip)</a>}</p>\n", "score": 4 } ]

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

[ { "answer_id": 1225, "body": "<p>There is an adage in electrical safety that \"It is not the voltage that kills you, it is the current\". This was investigated at <a href=\"https://skeptics.stackexchange.com/questions/1664/is-it-the-current-that-kills-you-not-the-voltage\">Skeptics.SE</a>. A review of literature regarding electrocution suggests <a href=\"http://hypertextbook.com/facts/2000/JackHsu.shtml\" rel=\"nofollow noreferrer\">0.06 A to 0.07 A is fatal</a>. That said, because of Ohm's law, voltage does play a role. Ohm's law says that V=IR, where V is voltage, I is current, and R is resistance.</p>\n\n<p><a href=\"http://www.allaboutcircuits.com/textbook/direct-current/chpt-3/ohms-law-again/\" rel=\"nofollow noreferrer\">This analysis</a> measured R for the human body under various conditions (dry, damp, and with a metal ring) and calculated the various voltages needed to get lethal currents based on 17 mA across the chest being lethal. With clean dry skin you would need a voltage of 20 kV while with damp skin you need 340 V to kill you. If you are in contact with metal (e.g., wearing a ring), lethal currents can be generated at as low as 17 V. Even in the worst case scenario of a foot immersed in a conductive liquid with a total resistance of 100 Ohm, would mean that you would require 1.7 V to get a lethal current.</p>\n\n<p>With a 2V, 30 mA, AC power supply, under the right (or wrong) conditions, you could deliver an immediately lethal shock in excess of 17 mA across the chest. If we assume 100 Ohm is the lowest possible resistance, despite the 30 mA source, we are limited to 20 mA at 2 V. The exact impact of 20 mA will depend on the frequency of the source (AC and DC are different and 60 Hz AC is different from 10 kHz AC). With 20 mA at 60 Hz, you would probably lose voluntary muscle control and have pain (possibly sever) and would probably begin experiencing difficulty breathing.</p>\n", "score": 3 }, { "answer_id": 25832, "body": "<p>I'm not an electrician so there might be some inaccuracies here and I couldn't find an exact study about the long-term effects so take it with a grain of salt.</p>\n<p>Frequent damage to tissues can cause cumulative damage. We can extrapolate some data here:\nSome direct 200 mV pulses (0.6 mA) are enough to kill a cell. And 50 mV Pulse is enough to activate a nerve cell.\nThe question is whether the current reaches the cells. It probably varies based on where the current is applied.</p>\n<p>An educated guess is that you need 4 times (any scattering ignored - I'm not an electrician so idk) the voltage required for you to feel the current to actually kill a cell. So maybe around 25-35VAC could cause some minor damage- definitely much higher than 2 VAC.\nOnce you go over that threshold the exposure durations start to matter and could cause scarring if prolonged.</p>\n<p><a href=\"https://pubmed.ncbi.nlm.nih.gov/18600343/\" rel=\"nofollow noreferrer\">In vitro currents</a>\n<a href=\"https://www.asc.ohio-state.edu/physics/p616/safety/fatal_current.html\" rel=\"nofollow noreferrer\">Lowest perceptible Current</a></p>\n", "score": 0 } ]

[ "side-effects", "electricity" ]

[ { "answer_id": 1200, "body": "<p>As you alluded to in the question, medications used for migraine headaches generally fall into two categories, <em>prophylactic</em> (meds taken daily to prevent migraines) and <em>abortive</em> (meds taken when a migraine starts in order to stop it). Your question is about the second group.</p>\n\n<p>“Instantly” (as noted in the comments) is a little absurd; there is obviously some delay between the time of ingestion of the medication and its effect at receptors that provides relief of pain. However, you’re right to note that the time-to-onset of anti-migraine effect is relevant, and this is a case where the available medications do vary in this respect in a way that tempers their usefulness. </p>\n\n<p><strong>Relevant pharmacology: routes of administration</strong> </p>\n\n<p>Medications taken <strong>orally</strong> (by mouth) are generally the slowest to onset of action. Intravenous medications, introduced directly into the bloodstream, are generally the fastest. Perhaps less well-known are other methods that are nearly as fast as IV: <strong>sublingual</strong>, <strong>intranasal</strong>, and <strong>inhaled</strong>. In each of these cases, the medication is placed in apposition to blood vessels that are able to absorb it directly. This only works for certain types of medications (mostly <em>lipophilic</em> ones that can cross into blood vessels), but it’s fast and avoids some of the difficulties of oral administration.^* <strong>Subcutaneous</strong>, <strong>transdermal</strong> or <strong>intramuscular</strong> administration is generally also somewhat quicker to reach the bloodstream than oral medications.</p>\n\n<p><strong>Migraines: oral may not be best</strong> </p>\n\n<p>For reasons that are not fully understood, abortive medications are more effective when used early in the attack, so the quicker routes of administration are also expected to provide relatively more benefit. In addition, migraine headaches are often associated with severe nausea and vomiting which may limit the utility of oral medications. Even when vomiting is not present, migraines are associated with gastric stasis, meaning that the stomach is slow to empty into the duodenum, the part of the gut where medications are generally absorbed.</p>\n\n<p>Abortive medications for migraines: </p>\n\n<ul>\n<li><strong>Non-steroidal anti-inflammatory agents (NSAIDs)</strong>: particularly for mild attacks, aspirin, ibuprofen, naproxen, and other NSAIDs are all effective. The only NSAID available for non-oral use (at least in the US) is ketorolac, which is effective with IV or IM administration (ASA and ketorolac references given below; others available upon request.)</li>\n<li><strong>Triptans</strong>: This class of drugs is the mainstay of abortive treatment for moderate to severe migraines. Triptans are available for a variety of routes of administration. Sumatriptan can be given as a subcutaneous injection (usually via auto-injector in the thigh), as a nasal spray, or orally; a transdermal preparation is planned to be marketed in 2015. Zolmitriptan is available for both nasal and oral use. Non-oral routes of administration tend to be fastest. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232272/\" rel=\"noreferrer\">This pharmacokinetic paper</a> demonstrates that nicely:</li>\n</ul>\n\n<p><img src=\"https://i.stack.imgur.com/jBdeP.png\" alt=\"enter image description here\"></p>\n\n<p>_{\nImage from: <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232272/\" rel=\"noreferrer\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232272/</a> “Powder” here refers to an intranasal powder preparation.\n} </p>\n\n<ul>\n<li><strong>Ergots</strong>: These vasoconstricting medications have a similar receptor activity as Triptans but carry relatively more risk for those with hypertension and cardiovascular disease so are used less frequently. Dihydroergotamine has somewhat fewer side effects than ergotamine itself and is available for intravenous, intramuscular, subcutaneous, and intranasal use. </li>\n</ul>\n\n<hr>\n\n<p>_{\n<strong>Notes and references</strong>\n} </p>\n\n<p>_{\n*For practical purposes, all three of these routes tend to be not quite as quick as would be expected theoretically because a portion of the drug ends up swallowed and subject to all of the usual constraint of oral administration. \n} </p>\n\n<p>_{\nKirthi V, Derry S, Moore RA <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23633350\" rel=\"noreferrer\"><em>Aspirin with or without an antiemetic for acute migraine headaches in adults.</em></a> Cochrane Database Syst Rev. 2013;4:CD008041.\n} </p>\n\n<p>_{\nLipton RB, Stewart WF, Stone AM, Láinez MJ, Sawyer JP. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11086366\" rel=\"noreferrer\">*Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) Study: A randomized trial.</a> JAMA. 2000;284(20):2599.\n} </p>\n\n<p>_{\nTaggart E, Doran S, Kokotillo A, Campbell S, Villa-Roel C, Rowe BH. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23298250\" rel=\"noreferrer\"><em>Ketorolac in the treatment of acute migraine: a systematic review.</em></a> Headache. 2013 Feb;53(2):277-87.\n}</p>\n\n<p>_{\nTfelt-Hansen P, Saxena PR, Dahlöf C, Pascual J, Láinez M, Henry P, Diener H, Schoenen J, Ferrari MD, Goadsby PJ. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10611116\" rel=\"noreferrer\"><em>Ergotamine in the acute treatment of migraine: a review and European consensus.</em></a> Brain. 2000;123 ( Pt 1):9.\n} </p>\n\n<p>_{\nTfelt-Hansen P <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=9827244\" rel=\"noreferrer\"><em>Efficacy and adverse events of subcutaneous, oral, and intranasal sumatriptan used for migraine treatment: a systematic review based on number needed to treat.</em></a> Cephalalgia. 1998;18(8):532.\n} </p>\n", "score": 5 } ]

[ "pain", "migraine" ]

[ { "answer_id": 1203, "body": "<p>This question arises from your (correct) understanding that administration of exogenous (i.e. not produced by the body) glucocorticoids (GCs) can suppress the body’s ability to produce its own GCs in the adrenal glands. In order to understand the answer, a little background is necessary.</p>\n\n<p><strong>Why does the body become unable to produce cortisone?</strong><br>\nAs in many endocrine systems, negative feedback maintains homeostasis. Exogenous GCs exert negative feedback on the hypothalamic-pituitary-adrenal (HPA) axis (a series of hormones starting in the hypothalamus) that normally stimulates GC production in the adrenals. This negative feedback is almost immediately reversible. However, with extended administration of exogenous GCs, the lack of stimulation via the HPA axis leads to atrophy of the adrenal gland, and it becomes unable to produce the horomone <em>even when the feedback suppression is removed</em>. Your question is, <strong>how much exogenous GC is required to produce this effect?</strong></p>\n\n<p>It’s a very practical question because it affects how doctors prescribe steroids. <em>If</em> adrenal suppression is expected, they must be tapered slowly. <em>If not</em>, a “burst” can be administered and then immediately stopped. Because it’s such a practical question, people thought to study it quite a while ago, and the relevant literature is mostly pretty old (relative to most biomedical data, at least). (See below.)</p>\n\n<p>The time required to achieve suppression depends upon: </p>\n\n<ul>\n<li>the dose; </li>\n<li>the length of time administered; and </li>\n<li>factors unique to each patient, probably resulting from (ultimately genetic) differences in their rates of GC metabolism.</li>\n</ul>\n\n<p><strong>Who is likely to be suppressed: some general guidelines</strong></p>\n\n<p><strong>Not suppressed</strong> </p>\n\n<ul>\n<li>GC treatment (any dose) for less than three weeks. </li>\n<li>Treatment with less than 10 mg total daily dose (prednisone equivalents) for any time period.</li>\n</ul>\n\n<p><strong>Suppressed</strong></p>\n\n<ul>\n<li>Oral GC treatment of >20 mg prednisone daily (or equivalent) for >3 weeks </li>\n<li>Any patient with clinical Cushing’s syndrome (see <a href=\"https://health.stackexchange.com/a/307/165\">this answer</a> for description)</li>\n</ul>\n\n<p><strong>Uncertain suppression</strong>: The degree of suppression in this intermediate group is related to individual metabolism parameters that are not (yet!) established in a way that can be measured and used clinically. </p>\n\n<ul>\n<li>Less than 20 mg prednisone daily (or equivalent) for >3 weeks.</li>\n<li>Any dose for >3 weeks administered every other day.</li>\n</ul>\n\n<p>The rule of thumb I learned (which is fairly conservative): >10 mg for >3 weeks requires tapering. </p>\n\n<p>In those patients who fall into the uncertain category, there is something called a \"cosyntropin stimulation test” that helps make the distinction. In this test, a doctor administers a hormone (cosyntropin, a.k.a. ACTH) that stimulates the adrenal gland and measures plasma cortisol concentrations to see if it responds appropriately.</p>\n\n<p>I’ve been talking in prednisone “equivalents.” There are <a href=\"http://www.medcalc.com/steroid.html\" rel=\"nofollow noreferrer\">steroid equivalent converters</a> around. In general, prednisolone and prednisone have a 1:1 dosing relationship. </p>\n\n<p>The answer to your question, then, is <strong>no</strong>. Seven days is a common prescription for a steroid “burst”, and tapering is generally considered to be unnecessary. </p>\n\n<hr>\n\n<p>_{\nAckerman GL, Nolsn CM. <a href=\"http://www.nejm.org/doi/full/10.1056/NEJM196802222780801\" rel=\"nofollow noreferrer\">Adrenocortical responsiveness after alternate-day corticosteroid therapy.</a> N Engl J Med. 1968;278(8):405. \n} </p>\n\n<p>_{\nChristy NP. <em>Corticosteroid withdrawal.</em> In: Current Therapy in Endocrinology and Metabolism, 3rd Ed, Bardin CW (Ed), BC Decker, New York 1988. p.113.\n} </p>\n\n<p>_{\nDanowski, et al. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/14175832\" rel=\"nofollow noreferrer\"><em>Probabilities of pituitary-adrenal responsiveness after steroid therapy.</em></a> Ann Intern Med. 1964;61:11.\n} </p>\n\n<p>_{\nMyles AB, Bacon PA, Daly JR. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/4328107\" rel=\"nofollow noreferrer\"><em>Single daily dose corticosteroid treatment. Effect on adrenal function and therapeutic efficacy in various diseases.</em></a> Ann Rheum Dis. 1971;30(2):149.\n} </p>\n", "score": 6 } ]

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

[ { "answer_id": 1240, "body": "<p>Before I answer your question: <strong>40 years is a very long time.</strong> Your ointment should have an expiration date. You should not use it past that date. Not just that microbiological quality can't be guaranteed after that much time (not even with phenol which might have preserved it to a point, but not for 40 years), but also the chemical composition might have changed - both the active substances and the excipients might have underwent various chemical reactions - and no one can say with any certainty what you've got in there now.</p>\n<hr />\n<p>Now, onto your question: <em>How important is the amount of active ingredient in an ointment?</em></p>\n<p>It depends on the ingredient. The <strong>concentration</strong> is important because both safety and efficacy/effectiveness depend on it. Some ingredients have a very wide range of concentrations in which they are proven to be both safe and effective; others have a very narrow range of concentrations in which they should/(are recommended to) be used; some are somewhere in between. You are asking about an ointment with lesser concentrations of active substance than the one you previously used, so the efficacy of the 'new' ointment is what you are concerned with.</p>\n<h2>Phenol</h2>\n<p>Phenol is used as an antiseptic in your ointments. The efficacy of antiseptics depends on many factors including:</p>\n<ul>\n<li>concentration</li>\n<li>acidity (pH value) of the solution/medium/preparation</li>\n<li>duration of exposure</li>\n<li>the type(s) and number of microorganisms present</li>\n<li>presence of organic matter (especially in forming a biofilm)</li>\n</ul>\n<p>So, the concentration is important, but there are other factors to be taken into account.</p>\n<p>According to Martindale, The Complete Drug Reference (34th edition), the Phenol monograph:</p>\n<blockquote>\n<p>Aqueous solutions up to 1% are bacteriostatic while stronger solutions are bactericidal.</p>\n</blockquote>\n<p>Both ointments you used contain phenol in bacteriostatic (inhibits growth of bacteria) and not bacteriocidal (kills bacteria) concentrations.</p>\n<p>There is various research on a MIC (minimal inhibitory concentration) of phenol:</p>\n<p>According to <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88911/\" rel=\"nofollow noreferrer\">Antiseptics and Disinfectants: Activity, Action, and Resistance</a> G. McDonnell, A. D. Russell</p>\n<blockquote>\n<p><em>Pulvertaft and Lumb (386) demonstrated that low concentrations of phenols (0.032%, 320 μg/ml) and other (nonphenolic) agents lysed rapidly growing cultures of E. coli, staphylococci, and streptococci</em></p>\n</blockquote>\n<p>From the same source (based on references 226 and 440 provided in that research paper):</p>\n<blockquote>\n<p>the MIC of phenol against <em>S. aureus</em>, <em>E. coli</em> and <em>P. aeruginosa</em> is 2,000 μg/ml (which is <strong>0.2%</strong>)</p>\n</blockquote>\n<p>In <a href=\"http://link.springer.com/article/10.1007/BF00257609#page-1\" rel=\"nofollow noreferrer\">Protection of bacteria against toxicity of phenol by immobilization in calcium alginate</a> Heribert Keweloh, Hermann-Josef Heipieper, Hans-Jürgen Rehm have used solutions of phenol in both 1 g/l (0.1%) and 2 g/l (0.2%) concentrations and got inhibition of growth of some bacteria (although they were testing something else, and I can't access the whole article).</p>\n<p><strong>Conclusion: concentration of phenol in your ointment is close to or over the ones I found in these references, and should be sufficient to exibit bacteriostatic activity if other conditions (such as pH, lipophilicity/hydrophilicity of the preparation etc) are favourable.</strong></p>\n<h2>ZnO</h2>\n<blockquote>\n<p><em>Zinc oxide is mildly astringent and is used topically as a soothing and protective application in eczema and slight excoriations, in wounds, and for haemorrhoids</em> (Martindale).</p>\n</blockquote>\n<p>It is used in concetrations of up to 50% (Deutscher Arzneimittel Codex – DAC), but technical literature doesn't specify a minimal concentration at which it should be used.</p>\n<hr />\n<blockquote>\n<p><em>Perhaps I could just use more each time?</em></p>\n</blockquote>\n<p><strong>You could, but you shouldn't. Follow the instructions included in the patient information leaflet.</strong> (Using more most likely wouldn't enhance the efficacy anyway).</p>\n<hr />\n<p>In the end if a product is marketed as a <strong>medicine/drug</strong> in your country, it has to be submitted to rigorous procedures before it is approved, i.e. authorised for sale.</p>\n<blockquote>\n<p><em>Before drug products are authorized for sale in Canada, Health Canada reviews them to assess their safety, efficacy and quality. Drug products include prescription and non-prescription pharmaceuticals, disinfectants and sanitizers with disinfectant claims.</em></p>\n<p><em>Prior to being given market authorization, a manufacturer must present substantive scientific evidence of a product's safety, efficacy and quality as required by the Food and Drugs Act and Regulations.</em></p>\n</blockquote>\n<p>From: <a href=\"http://www.hc-sc.gc.ca/dhp-mps/prodpharma/index-eng.php\" rel=\"nofollow noreferrer\">Health Canada</a> webpage.</p>\n<p>They have a database of products, but I suppose that you can always contact them if you have questions or concerns regarding a particular product on Canadian market.</p>\n<hr />\n<p>Please note that it is very difficult (if not impossible) to directly compare concentrations in in an ointment (especially a lipid-based one) and in water or aqueous medium. The ultimate burden of testing the efficacy is on the manufacturer; the ultimate burden of ensuring that such tests have been conducted and gave sufficient results in on the regulatory agency responsible for a certain market.</p>\n<hr />\n<p>References:</p>\n<ol>\n<li>Sweetman SC (Ed), Martindale: The Complete Drug Reference. London: Pharmaceutical Press. Electronic version, (34th Edition [2005]).</li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88911/\" rel=\"nofollow noreferrer\">Antiseptics and Disinfectants: Activity, Action, and Resistance</a> Gerald McDonnell, A. Denver Russell, Clin Microbiol Rev. 1999 Jan; 12(1): 147–179.</li>\n<li><a href=\"http://link.springer.com/article/10.1007/BF00257609#page-1\" rel=\"nofollow noreferrer\">Protection of bacteria against toxicity of phenol by immobilization in calcium alginate</a> Heribert Keweloh, Hermann-Josef Heipieper, Hans-Jürgen Rehm, Applied Microbiology and Biotechnology September II 1989, Volume 31, Issue 4, pp 383-389</li>\n<li><a href=\"http://www.hc-sc.gc.ca/ahc-asc/index-eng.php\" rel=\"nofollow noreferrer\">Health Canada</a> official website</li>\n</ol>\n", "score": 3 } ]

[ "medications", "wound-care" ]

[ { "answer_id": 1228, "body": "<p>The timing of the first defibrillation attempts depends mostly on when defibrillation is detected. If it is witnessed - that is, the patient is being monitored and the alarm goes off, you're right there at the bedside, and the patient is in V Fib, it's fine to shock first.</p>\n\n<p>However, whereas this used to be the norm - shock first - it no longer is, partly because the goals of CPR and ACLS (advanced cardiac life support) are changing. A bit over a decade ago, the goal was restoration of a perfusing rhythm. </p>\n\n<p>The new Advanced Cardiac Life Support guidelines call for CPR to be initiated immediately, assuming the paddles aren't right there and ready to go the moment someone goes into VFib. It needs to be noted, though, that this recommendation does not rest on defibrillation with the aim of return of spontaneous circulation (ROSC), but on improved neurological outcomes. </p>\n\n<p>If the heart is in V Fib, there is no effective blood circulation; the heart and all the other organs are starving for oxygen. While setting up to defibrillate, the hypoxia continues, and the damage becomes more severe, especially to sensitive tissue like the brain. Compressions circulate blood; even blood with lower oxygen saturation is better than none. The brain is less hypoxic, then, and neurological outcomes improve if defibrillation is successful.</p>\n\n<p>This, not ROSC, is what the new ACLS recommendations are based on, because ACLS is not considered highly successful if the patient leaves the hospital only to be hospitalized elsewhere in a persistent vegetative state. And CPR first has been shown to provide better neurological outcomes.</p>\n\n<p>_{<a href=\"http://acls-algorithms.com/vfpulseless-vt/\" rel=\"nofollow\">VF/Pulseless VT</a>}<br>\n_{<a href=\"http://jama.jamanetwork.com/article.aspx?articleid=196200\" rel=\"nofollow\">Delaying Defibrillation to Give Basic Cardiopulmonary Resuscitation to Patients With Out-of-Hospital Ventricular Fibrillation A Randomized Trial</a>}</p>\n", "score": 6 } ]

[ "emergency", "medical-device", "cpr" ]

[ { "answer_id": 1227, "body": "<p>The easiest way to find out what might be wrong is to take the apparatus to a healthcare practitioner's office with you, and have your BP measured by someone trained to do so correctly, then use the cuff, and see how closely they match. Then adjust the looseness/tightness of the cuff, the position, etc., until you get matching BP's consistently.</p>\n\n<p>Accurate BP measurements depend on a number of things, but one that is really important is the rate at which the cuff deflates. If it deflates too quickly, it will give you falsely low BP's, in addition to BP's \"all over the place\" (some accurate, some not, some with a normal systolic pressure, but an abnormal diastolic pressure, etc.</p>\n\n<p>If you can't find out what's wrong by correlating with manual BP readings, the apparatus is unreliable, therefore worthless.</p>\n", "score": 6 } ]

[ "blood-pressure", "quantified-self", "home-medical-equipment" ]

[ { "answer_id": 5561, "body": "<p>There are currently no studies catalogued in PubMed (the largest repository of medical articles) that cover <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=probiotics%20AND%20overdose\" rel=\"nofollow noreferrer\">probiotics and overdoses</a> at the time of this answer. (Clicking that link will rerun the search. The one result that comes up is unrelated.)</p>\n\n<p>Theoretically, there should be little to no danger from \"overdosing\" on probiotic as probiotics are supposed to represent a balance of microflora. The challenge is that our microbiome has been found to be correlated with <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616309\" rel=\"nofollow noreferrer\">obesity, type 2 diabetes, steatosis, cardiovascular diseases, inflammatory bowel diseases</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=microbiome%20AND%20depression\" rel=\"nofollow noreferrer\">depression</a>, and other mental conditions. Edit: <a href=\"https://simpleskincarescience.com/probiotics-for-skin/\" rel=\"nofollow noreferrer\">probiotics can also have profound effects on the skin</a> as newer research is revealing.</p>\n\n<p>As a result, it is not yet fully clear how changing our microbiome affects our mental state and health. </p>\n\n<p>Companies like <a href=\"http://ubiome.com\" rel=\"nofollow noreferrer\">uBiome.com</a> are attempting to answer that question now. </p>\n", "score": 2 } ]

[ "medications", "bacteria", "probiotics" ]

[ { "answer_id": 5225, "body": "<p>Probably yes on lung cancer, no for other diseases, but it's <em>really</em> hard to say.</p>\n\n<p>Apparently, this 'trend' isn't very new - <a href=\"http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/low_yield_cigarettes/\" rel=\"nofollow\">it goes back to the 1960s</a>, though back then low-tar cigarettes contained more tar than you specify in your question. The National Cancer Institute has a looong monograph on this with data from the past decades: <a href=\"http://cancercontrol.cancer.gov/brp/tcrb/monographs/13/m13_complete.pdf\" rel=\"nofollow\">Risks Associated with Smoking Cigarettes with Low Machine Measured Yields of Tar and Nicotine</a>. I am not even going to pretend I read all of that. </p>\n\n<p>The chapter <a href=\"http://cancercontrol.cancer.gov/brp/tcrb/monographs/13/m13_4.pdf\" rel=\"nofollow\">Smoking Lower Yield Cigarettes and Disease Risks</a> is in itself 94 pages long, but is summarized in the paper <a href=\"http://tobaccocontrol.bmj.com/content/10/suppl_1/i4.full\" rel=\"nofollow\">Health impact of “reduced yield” cigarettes: a critical assessment of the epidemiological evidence</a>.</p>\n\n<p>Apparantly, it's not very clear-cut, the primary problem being that there's so many confunders when looking at epidemiological (population-based) data:</p>\n\n<ul>\n<li>smokers who choose to smoke cigarettes with less tar/nicotine might be more concerned about their health in general</li>\n<li>smoker who choose to smoke cigarettes with less tar/nicotine 'compensate' by smoking more, see the linked paper where figure 2 illustrates that lower nicotine content often corresponds with a higher amount of cigarettes smoked. This is often ignored in studies by matching subjects by number of cigarettes smoked (so they compare people who smoke 10 high-yield cigarettes a day with those who smoke 10 low-yield cigarettes a day)</li>\n</ul>\n\n<p>From the conclusions, emphasis mine:</p>\n\n<blockquote>\n <p>Epidemiological studies have not consistently found lesser risk of diseases, <strong>other than lung cancer</strong>, among smokers of reduced yield cigarettes. Some studies have found lesser risks of lung cancer among smokers of reduced yield cigarettes. Some or all of this reduction in lung cancer risk may reflect differing characteristics of smokers of reduced-yield compared to higher-yield cigarettes.</p>\n</blockquote>\n\n<p>Now, the National Cancer Institute is not generally a fan of cigarettes, so they are probably going to recommend against low-tar/nicotine cigarettes in any case. It does seem to be the case that if the number of cigarettes is kept constant, the risk of lung cancer decreases with tar content. The same is not necessarily the case for other risks, like that of coronary heart disease, stroke, or chronic obstructive pulmonary disease.</p>\n", "score": 2 } ]

[ "smoking" ]

[ { "answer_id": 1315, "body": "<p>There several concerns related to MSG (monosodium glutamate):</p>\n\n<ul>\n<li>it contains <strong>sodium</strong>, so it might rise the blood pressure leading to <strong>hypertension</strong>, a risk factor of cardiovascular diseases. (<a href=\"http://www.who.int/dietphysicalactivity/publications/trs916/en/\" rel=\"nofollow\">1</a>)</li>\n<li>it has been found to be strictly related to <strong>overweight and obesity</strong> (<a href=\"http://ajcn.nutrition.org/content/93/6/1328.short\" rel=\"nofollow\">2</a>), possibly because it improves the palatability of food (= it makes you feel you like it, and you want more) (<a href=\"http://www.sciencedirect.com/science/article/pii/S0031938407005021\" rel=\"nofollow\">3</a>)</li>\n<li>in relation to <strong>cancer</strong>, I couldn't find much information about the topic. I would suggest you to visit whe webpage <a href=\"http://www.msgtruth.org/cancer.htm\" rel=\"nofollow\">http://www.msgtruth.org/cancer.htm</a> . On the same page there are several links on the right side showing connections of MSG to <strong>other diseases</strong>.</li>\n</ul>\n", "score": 3 } ]

[ "nutrition", "cancer" ]

[ { "answer_id": 5019, "body": "<p>You can use pictures of the patients family with captions saying who they are and their relationship to the individual.</p>\n\n<p>If they are still able (but forgetful) in the kitchen put pictures on the cupboard fronts to show what is in them. If they can't get the right order of a task e.g puts water in the teacup and then switches on the kettle. Try putting together a storyboard of the task;\n1 Put water in the kettle\n2 Switch the kettle on.\n3 Take Mug from cupboard\nand so on.</p>\n\n<p>If you are in the UK the Alzheimer's Society has information and Resources to help. No doubt similar information exists in other countries.</p>\n\n<p>A friend of my father-in-law would forget to take her medication - so a dosage box was obtained that could be programmed to open the section for today at the appropriate time the tablet should be taken. Of course they can still forget what the opening of the dosage box means for them, if no one is with them.</p>\n\n<p>If they are forgetting their husband or wife they can get distressed by that partner getting frustrated by the fact they are not remembering who the patient is married to. As hard as it is, just keep calm and cool and keep saying each time I'm Fred\\Bill\\Mary (insert name here) your husband\\wife.</p>\n", "score": 2 } ]

[ "mental-health", "dementia", "brain-exercises", "short-term-memory-loss", "forgetfulness" ]

[ { "answer_id": 1397, "body": "<p>The generally accepted medical wisdom seems to be that sweat is an insignificant mechanism for toxin elimination. However, there have been studies that suggest that wisdom may not be entirely correct.</p>\n\n<p>For example, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23213291\" rel=\"nofollow\">Genuis et al.</a> found that some toxic elements were preferentially excreted in sweat, including elements that were not found in blood serum. That suggests those elements are bound in tissues and therefore not readily removed by the liver and kidneys. </p>\n\n<p>They conclude that:</p>\n\n<blockquote>\n <p>Sweat analysis should be considered as an additional method for\n monitoring bioaccumulation of toxic elements in humans.</p>\n</blockquote>\n\n<p>Note that they do <strong>not</strong> conclude that sweating plays a significant role in toxin elimination. </p>\n\n<p>Note also that the sample size in this study was very small, and the author has numerous publications based on this single study.</p>\n\n<p>A <a href=\"http://www.hindawi.com/journals/jeph/2012/184745/\" rel=\"nofollow\">literature review</a> of the subject found support for the idea that certain toxins are excreted in sweat, sometimes in higher concentrations than urine. They also noted as Genuis did that concentrations of some elements can be found in sweat that aren't detected in plasma.</p>\n\n<blockquote>\n <p>In individuals with higher exposure or body burden, sweat generally\n exceeded plasma or urine concentrations, and dermal could match or\n surpass urinary daily excretion. Arsenic dermal excretion was\n severalfold higher in arsenic-exposed individuals than in unexposed\n controls. Cadmium was more concentrated in sweat than in blood plasma.</p>\n</blockquote>\n\n<p>What I cannot find is research showing that sweating produces any clinically significant benefit. Just because a compound can be found in sweat does not necessarily mean that sweating more will have a beneficial effect, and in fact no benefit to excessive sweating is known while there are known negative consequences, including potentially lethal ones.</p>\n\n<p>I conclude from my research that the question can't be answered at this time, but there is sufficient evidence to justify additional research. I suspect that the most likely outcome will be new and/or improved testing methods rather than treatment methods.</p>\n", "score": 4 } ]

[ "toxicity", "sweat", "detox-purge" ]

[ { "answer_id": 1744, "body": "<p>It seems that SAStid contains salicylic acid. Salicylic acid a keratolytic: it helps to peel the outer layers of the thick skin <a href=\"https://en.wikipedia.org/wiki/Keratolytic\" rel=\"nofollow\">(1)</a>. As so it is helpful in the treatment of warts and psoriasis <a href=\"http://emedicine.medscape.com/article/1943419-treatment#d9\" rel=\"nofollow\">(2)</a>. </p>\n\n<p>With eczema there is no skin thickening or dandruff. So I see no real benefits with that soap. It is obvious that when the outermost layer of your skin is peeled off it increases the loss of humidity from skin resulting to dryness. Since the most common problem with eczema is the dryness of the skin it only makes it worse <a href=\"http://nationaleczema.org/eczema/treatment/bathing/taking-care-of-dry-skin/\" rel=\"nofollow\">(3)</a>.</p>\n", "score": 2 } ]

[ "dermatology", "eczema", "soap", "drug-withdrawal" ]

[ { "answer_id": 1444, "body": "<p>There are several types of HSV tests, with varying benefits and drawbacks. To address your questions regarding the antibody test:</p>\n\n<ul>\n<li>Can it detect an inactive infection: Yes. The antibody test isn't actually looking for the virus, it's looking for signs that your body has responded to an infection and produced antibodies for it. As such, infections in the past that are now inactive <em>may</em> produce a positive antibody test, though this depends on a lot of factors, like how long ago the infection took place, etc.</li>\n<li>If that test finds antibodies, does it mean I carry this virus for sure? No. All diagnostic tests have a false positive rate. That being said, based on the literature I can find for people without symptoms, <a href=\"http://cid.oxfordjournals.org/content/35/Supplement_2/S173.full\" rel=\"nofollow\">this rate appears to be fairly low</a>.</li>\n</ul>\n\n<p>It should be noted that <a href=\"http://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm\" rel=\"nofollow\">\"CDC does not recommend screening for HSV-1 or HSV-2 in the general population.\"</a></p>\n", "score": 4 } ]

[ "infection", "blood-tests", "virus", "herpes" ]

[ { "answer_id": 14036, "body": "<p>One’s mental state has a major effect on bowel function. In fact, there is a high correlation between IBS and stress. </p>\n\n<p>Given the high levels of anxiety and stress commonly seen in patients with <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095723/\" rel=\"nofollow noreferrer\">Irritable Bowel Syndrome</a>, evidence suggests that the syndrome may be linked to a disruption of the stress system. The stress response in the body involves the sympathetic nervous system which has been shown to operate abnormally in IBS patients.</p>\n\n<p>In an article by <a href=\"http://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-brain-gut-connection\" rel=\"nofollow noreferrer\">Johns Hopkins School of Medicine</a>, scientists are inferring that ‘<em>the little brain</em>’, or enteric nervous system (ENS) is the link between what's going on in the gut and it's effect on the brain, or the relationship between digestion and mood.</p>\n\n<blockquote>\n <p>Anxiety and depression have been thought to contribute to gastro conditions like irritable bowel syndrome (IBS).</p>\n</blockquote>\n\n<p>Jay Pastricha, MD, Director of the Johns Hopkins Center for Neurogastroenterology states that the main role of the ENS is:</p>\n\n<blockquote>\n <p>\"...controlling digestion, from swallowing to the release of enzymes that break down food, to the control of blood flow that helps with nutrient absorption to elimination.\"</p>\n</blockquote>\n\n<p>As described in <a href=\"https://books.google.com/books?id=32dHPgAACAAJ&amp;dq=0321541308\" rel=\"nofollow noreferrer\">Human Physiology: An Integrated Approach</a>, when your sympathetic nervous system is activated by a stressful event, for example, it initiates a “fight or flight” response -- a mechanism that primes the body for action, particularly in situations that threaten survival. Activation of the sympathetic nervous system causes vasoconstriction of most blood vessels, including those in the digestive tract. Because the blood vessels in the gastrointestinal organs constrict, the digestive tract will inhibit peristalsis (digestion) and result in a variety of GI symptoms.</p>\n\n<p>The GI tract is generally sensitive to emotion in most people (even those who do not have IBS) as anger, anxiety, sadness, and elation (among others) can all trigger symptoms in the gut. For example, you've likely heard or even spoken the words \"going with your gut\" when making a decision or feeling like you have \"butterflies in your stomach\" when feeling nervous. In people who suffer from IBS however, the ENS may trigger big emotional shifts which can lead to functional bowel problems such as <strong>constipation</strong>, <strong>diarrhea</strong>, bloating, pain, and stomach upset. </p>\n\n<p>People with IBS can experience either constipation, diarrhea, or both depending on the individual and how their emotionally triggered symptoms present. According to <a href=\"https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064\" rel=\"nofollow noreferrer\">Mayo Clinic</a>: </p>\n\n<blockquote>\n <p>For the purpose of treatment, IBS can be divided into three types based on your symptoms: constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), or mixed.</p>\n</blockquote>\n\n<p>Research also suggests that digestive system activity may affect cognition (thinking skills and memory). As explained by a <a href=\"https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection\" rel=\"nofollow noreferrer\">Harvard Health</a> article:</p>\n\n<blockquote>\n <p>The brain has a direct effect on the stomach. A troubled intestine can send signals to the brain, just as a troubled brain can send signals to the gut. Therefore, a person’s stomach or intestinal distress can be the cause <em>or</em> the product of anxiety, stress, or depression.</p>\n</blockquote>\n\n<p>In an effort to provide further evidence in response to \"How does your mental state actually affect the functioning of the bowel?\":</p>\n\n<p>Psychological factors influence the actual physiology of the gut, as well as presenting symptoms. As it relates to IBS, stress can affect movement and contractions of the GI tract or can increase inflammation. Additionally, people with IBS may perceive pain more acutely than other people do because their brains do not properly regulate pain signals from the GI tract. When faced with a stress-causing event, the existing pain can feel worse. As stated in the article, <a href=\"http://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-brain-gut-connection\" rel=\"nofollow noreferrer\">'The Brain-Gut Connection'</a>: </p>\n\n<blockquote>\n <p>Irritation in the gastrointestinal system may send signals to the CNS that trigger mood changes, which is why a higher than normal percentage of people with IBS and other bowel disorders develop depression and anxiety. </p>\n</blockquote>\n", "score": 5 } ]

[ "side-effects", "anxiety-disorders" ]

[ { "answer_id": 1580, "body": "<p>I think the centre of confusion for you is this question:</p>\n\n<blockquote>\n <p>If the active substance finally goes to the brain, where is the weight's role in this process?</p>\n</blockquote>\n\n<p>The thing is, when a substance has a systemic effect (as opposed to local) it somehow has to get from the point where it is applied to the site of action. So, if one ingests something that affects the brain, it has to travel from the stomach to the head somehow - and substances do this via blood. So <strong>the substance is liberated from the form in which one took it, then dissolved and absorbed into the bloodstream.</strong> Since blood reaches all parts of the body, so does the substance. We usually see most of its effects on one body part/organ, but it gets distributed (more or less) everywhere.</p>\n\n<ul>\n<li><strong>What does this have to do with body mass?</strong></li>\n</ul>\n\n<p>To answer this, we must look into the process in which a substance passes from the blood stream to a tissue. This can be done by several mechanisms such as: diffusion, active transport, pinocitosis etc. For many <a href=\"https://en.wikipedia.org/wiki/Xenobiotic\" rel=\"noreferrer\">xenobiotics</a> (substances foreign to our body) the route of transport is diffusion through cellular membranes. <strong>The rate and the extent of diffusion are proportional to concentration gradient.</strong><br>\nThis means two things:</p>\n\n<ul>\n<li>The higher the difference in the <strong>concentrations</strong> between the blood and the other tissue, the higher the rate and extent of diffusion will be.</li>\n<li>This process doesn't depend solely on the total amount of the substance taken; it depends on concentration.</li>\n</ul>\n\n<p>And since: <strong>c = amount/V</strong></p>\n\n<p>we can see that, if we dissolve the same amount of a substance if different volumes (of blood e.g.) we will get different concentrations. Which brings us to the fact that <strong>blood volume is important</strong>. Among other factors, <strong>blood volume depends on body mass</strong>. The mass of the blood amounts for roughly 7% of our body mass, and the volume is proportional to that.*</p>\n\n<ol>\n<li><em>Bigger body mass => higher blood volume => lesser substance concentration => lesser the rate and the extent of diffusion into the target organ (such as the brain)</em></li>\n</ol>\n\n<p>When the substance gets into a tissue, depending on its chemical structure it can: find a target protein and have an effect (note that this doesn't have to be the \"desired\" effect); it can dissolve in fat tissue; it can bind to proteins or other structures such as bones. Again the strength of these bonds depends on the chemical structure of the substance (among other factors) - it can bind reversibly and soon be on its way again or it can get deposed in a tissue it has chemical affinity for. We say that the substance is distributed to various compartments**. If the size of these compartments is bigger, than there is more \"room\" for the substance to be distributed, and potentially \"stored\", so to speak.</p>\n\n<ol start=\"2\">\n<li><em>Bigger body mass => (usually proportionally) bigger mas of many tissues => bigger volume to distribute the substance and potentially bigger deposing capacity.</em> \n<img src=\"https://i.stack.imgur.com/VsCm9.png\" alt=\"enter image description here\"></li>\n</ol>\n\n<p>Source: ref. 4</p>\n\n<ul>\n<li><strong>The catch</strong></li>\n</ul>\n\n<p>Things get complicated because many substances in our blood bind to plasma proteins (usually albumin) and the bound fraction is in equilibrium with the unbound (free fraction). It is only the free fraction of the substance that can diffuse through cell membranes (protein-substance complex is too large). Various substances have different binding potential, and they compete with each other for the same binding sites, and affect each other's kinetics. What's more, Liberation, Absorption and Distribution are followed by Metabolism and Excretion (the so called LADMER system). All these processes happen simultaneously after a (usually short) lag time. </p>\n\n<p>This means that <strong>the concentration of a substance in blood depends on many factors</strong>. We calculate most of these factors in, based on information we get from testing on animals and from clinical trials, and use mathematical models and computer simulations to determine the dose and dosage which would achieve and maintain the concentration of a substance in blood in a certain range, and assume that this will have a predicted effect. <strong>All these calculations are approximations. Although body mass is an important factor in them, calculating a dose of a substance based only on total body mass is a very rough approximation.</strong></p>\n\n<p>Another catch for controlled substances: there is significantly less data on the kinetics of these substances than on medicines (which are intended to cure or manage a disease). So the \"calculations\" are limited. On the other hand when these substances reach other parts of the body, and are metabolised, aside from their psychoactive effects they can affect other organs as well, causing liver or kidney failure, for instance.</p>\n\n<hr>\n\n<p>*Gender, body structure (especially lean body mass), age and other factors determine the exact mass and volume of the blood; still total body mass is strongly correlated with the amount of blood in the body.</p>\n\n<p>** The division into compartments is theoretical, designed to make the calculations easier. It is based on the fact that the concentrations of a substance change differently in different compartments. In reality, all \"compartments\" are connected, and interact with each other at all times. </p>\n\n<p>*** This explanation is simplified for general public. The equation above is for concentration in general. Blood concentration of a substance is never equal to simple quotient of the quantity and volume (remember to take point 2 and the catch into account). The theoretical term <em>volume of distribution</em> or <em>apparent volume of distribution</em> is not equal to blood volume - it is calculated by considering various factors. </p>\n\n<hr>\n\n<p>References:</p>\n\n<ol>\n<li><a href=\"https://books.google.rs/books?id=YKPjtT-8GV8C&amp;printsec=frontcover&amp;dq=pharmacokinetics&amp;hl=en&amp;sa=X&amp;redir_esc=y#v=onepage&amp;q=disposition&amp;f=false\" rel=\"noreferrer\">Biopharmaceutics and Clinical Pharmacokinetics: An Introduction, Fourth Edition</a>, Notari, CRC Press, 1986; chapter 2, pages 48-49</li>\n<li><a href=\"https://books.google.rs/books?id=9fwUQvF4r-cC&amp;printsec=frontcover&amp;dq=pharmacokinetics&amp;hl=en&amp;sa=X&amp;redir_esc=y#v=onepage&amp;q=chapter%201&amp;f=false\" rel=\"noreferrer\">Pharmacokinetics and Pharmacodynamics of Abused Drugs</a>\nedited by Steven B. Karch, MD, FFFLM, CRC Press, 2007 - chapter 1 (especially: 1.2.1, 1.2.2 and 1.6)</li>\n<li><a href=\"http://www.columbia.edu/itc/gsas/g9600/2004/GrazianoReadings/Drugabs.pdf\" rel=\"noreferrer\">DRUG ABSORPTION, DISTRIBUTION AND ELIMINATION; \nPHARMACOKINETICS</a> - pages 25-26</li>\n<li><a href=\"https://www.us.elsevierhealth.com/media/us/samplechapters/9781416066279/Chapter%2002.pdf\" rel=\"noreferrer\">Pharmacology 3rd Edition</a>, By George M. Brenner, PhD, Professor Emeritus of Pharmacology, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK; and Craig Stevens, PhD, Professor of Pharmacology, Oklahoma State University, Tulsa, OK</li>\n<li><a href=\"http://reference.medscape.com/calculator/estimated-blood-volume\" rel=\"noreferrer\">Estimated blood volume</a></li>\n</ol>\n", "score": 12 } ]

[ "medications" ]

[ { "answer_id": 1626, "body": "<p>Artificial sweeteners are used in toothpastes. Mostly Xylitol or Sacharin. They don´t promote tooth decay. The sweetness in toothpaste are added in order to make more people brush their teeth on a daily basis. </p>\n\n<hr>\n\n<p>^{<a href=\"http://www.livestrong.com/article/79281-saccharin-safety-toothpaste/\" rel=\"noreferrer\">Livestrong - Saccharin Safety in Toothpaste</a>}</p>\n\n<p>^{<a href=\"http://www.sharecare.com/health/healthy-oral-hygiene/what-makes-toothpaste-sweet\" rel=\"noreferrer\">What makes toothpaste sweet?</a>}</p>\n\n<p>^{<a href=\"http://www.nytimes.com/1981/10/06/science/q-why-is-toothpaste-sweet-and-what-is-it-sweetened-with.html\" rel=\"noreferrer\">Why is toothpaste sweet and what is it sweetened with?</a>}</p>\n", "score": 7 } ]

[ "dentistry" ]

[ { "answer_id": 3458, "body": "<p>I am going to try and tackle this. If anything isn't covered or is unclear, please leave a comment. </p>\n\n<blockquote>\n <p>1) Initial Consultation </p>\n</blockquote>\n\n<p>That is, I assume, just the initial doctor's visit - taking your wife's health history, weight, blood pressure, etc. That is, of course, completely reasonable. </p>\n\n<blockquote>\n <p>2) Initial Consult - Fetal Medicine</p>\n</blockquote>\n\n<p>I am not completely sure what is meant with this. It might be giving you information on how to have a healthy pregnancy (what to do, what to avoid), or on how to deal with problems with the fetus if they occur. I'd need more information on this. </p>\n\n<blockquote>\n <p>3) Follow up Visits -(11 visits)</p>\n</blockquote>\n\n<p>Reasonable. Over the course of 36 weeks (from initial visit to estimated due date), a normal schedule for a healthy is one visit every month until the last trimester, where visits might be every two and later every week (when going over the due date, for example). One visit during month 3, 4, 5, 6 = 4 visits. Every two weeks during months 7, 8, and 9= about 7,which works out to more or less 11. It could also be 12 or more if problems arise or there are risk factors, but I am assuming a pregnancy with no risk factors here. For comparison, the NHS lists <a href=\"https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/Pages/prenatal-visits.aspx\" rel=\"nofollow\">10 such visits in its example schedule</a>.The <a href=\"https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/Pages/prenatal-visits.aspx\" rel=\"nofollow\">NIH lists a few more, with one weekly appointment in the last month. </a></p>\n\n<blockquote>\n <p>4) Routine Laboratory tests: \n a) CBC -(2 tests)</p>\n</blockquote>\n\n<p>Yes, reasonable. This is a complete blood count, for detecting things like anemia (low hemoglobin), which can be used problem during pregnancy, or high infection markers. <a href=\"http://www.nhs.uk/Conditions/Blood-tests/Pages/What-it-is-used-for.aspx\" rel=\"nofollow\">Again, the NHS has more information on this</a> (they call it FBC - full blood count) .</p>\n\n<blockquote>\n <p>b) Blood Type &amp; Antibody</p>\n</blockquote>\n\n<p>Blood Type - reasonable. At the very least you need to know your wife's rhesus type to know if <a href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/rh\" rel=\"nofollow\">rhesus incompatibility</a> could be a problem.</p>\n\n<p>\"Antibody\" is not enough information. I'd need to know what antibody tests this means.</p>\n\n<blockquote>\n <p>c) HIV </p>\n</blockquote>\n\n<p>HIV status is usually checked during pregnancy to prevent <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2529420/\" rel=\"nofollow\">passing HIV to the child</a>. </p>\n\n<blockquote>\n <p>d) Hepatitis B</p>\n</blockquote>\n\n<p><a href=\"http://www.hepb.org/patients/pregnant_women.htm\" rel=\"nofollow\">Same with hepatitis B</a></p>\n\n<blockquote>\n <p>e) Rubella </p>\n</blockquote>\n\n<p>Rubella infection during pregnancy is <a href=\"http://www.m.webmd.com/a-to-z-guides/rubella-test\" rel=\"nofollow\">very dangerous for the fetus</a>, checking whether the mother is immune helps determining whether the mother needs to be careful to stay away from people who might have it.</p>\n\n<blockquote>\n <p>f) C/S Urine </p>\n</blockquote>\n\n<p>This is for diagnosing urinary tract infections. I think it might be argued whether this is really necessary to do at the beginning of a pregnancy, but it's also not invasive and treating a UTI means it can't turn into a worse infection. </p>\n\n<blockquote>\n <p>g) Urinalysis Dip Sticks – ( 11 Sticks )</p>\n</blockquote>\n\n<p>Reasonable. A Urinalysis at every visit can detect issues such as <a href=\"http://americanpregnancy.org/prenatal-testing/urine-test/\" rel=\"nofollow\">diabetes, kidney problems, or pre-eclampsia</a>. These issues need to be treated, and can turn dangerous (especially pre-eclampsia). </p>\n\n<blockquote>\n <p>5) Ultra Sound Examinations -( 3 Scans) </p>\n</blockquote>\n\n<p>Three ultrasound examinations are standard <a href=\"https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/Pages/prenatal-visits.aspx\" rel=\"nofollow\">with the NHS</a>. More may be needed for complicated pregnancies. Ultrasounds are <a href=\"http://www.nhs.uk/conditions/pregnancy-and-baby/pages/ultrasound-anomaly-baby-scans-pregnant.aspx\" rel=\"nofollow\">not harmful for baby or mother</a>. This seems reasonable. </p>\n\n<blockquote>\n <p>6) Glucose Screening</p>\n</blockquote>\n\n<p>This is screening for pregnancy/gestational diabetes. As mentioned above, diabetes during pregnancy [can be dangerous], but can be treated when detected. It's only recommended by <a href=\"http://www.nhs.uk/Conditions/gestational-diabetes/Pages/Diagnosis.aspx\" rel=\"nofollow\">the NHS</a> <a href=\"http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/tests-diagnosis/con-20014854\" rel=\"nofollow\">and the Mayo Clinic</a> if risk factors are present. Talk to your doctor if you are unsure, but the test itself is non-invasive (if not particularly pleasant, or so I hear). </p>\n\n<blockquote>\n <p>7) Vaginal Swab </p>\n</blockquote>\n\n<p>For ruling out <a href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa0806820\" rel=\"nofollow\">Group B Strep</a> and STDs, which may affect the infant during delivery. A PAP smear is <a href=\"http://americanpregnancy.org/womens-health/pap-smear/\" rel=\"nofollow\">routine during pregnancy and not dangerous</a>. </p>\n\n<blockquote>\n <p>8) RPR </p>\n</blockquote>\n\n<p>This is a test for syphilis. Many US states <a href=\"http://www.cdc.gov/std/tg2015/syphilis-pregnancy.htm\" rel=\"nofollow\">mandate screening for this at the first prenatal visit. </a>. Syphilis during pregnancy should be treated. </p>\n\n<p>All in all, I think this looks reasonable and doesn't differ too much from recommendations in other countries, for example the <a href=\"http://www.nhs.uk/conditions/pregnancy-and-baby/pages/antenatal-care-checks-tests.aspx\" rel=\"nofollow\">NHS guidelines. </a></p>\n", "score": 4 } ]

[ "blood-tests", "obstetrics", "1st-trimester", "parenting" ]

[ { "answer_id": 3241, "body": "<p>The most common ways to diagnose endometriosis are as follows:</p>\n\n<ul>\n<li>Palpation/physical exam</li>\n<li>Imaging test (MRI, Ultrasound)</li>\n<li>Laparoscopy*</li>\n</ul>\n\n<p>Laparoscopy, where the doctor makes a small incision to insert a camera tube into the pelvic area for a visual examination, is the only definitive way to diagnose endometriosis. In each case, the doctor is looking for cysts or scars outside the uterus, due to tissue (endometrium) growing where it shouldn't.</p>\n\n<p>If you suspect that she has this, I would suggest talking to her doctor and asking specifically about exams to rule it out, especially given her age and pain during menstruation. (I would also suggest it if the pain is new. If she has had painful menstruation all her life, it's less likely but still can't be ruled out.)</p>\n\n<p><a href=\"http://www.nhs.uk/Conditions/Endometriosis/Pages/Diagnosis.aspx\">http://www.nhs.uk/Conditions/Endometriosis/Pages/Diagnosis.aspx</a></p>\n\n<p><a href=\"http://www.womenshealth.gov/publications/our-publications/fact-sheet/endometriosis.html\">http://www.womenshealth.gov/publications/our-publications/fact-sheet/endometriosis.html</a></p>\n", "score": 8 } ]

[ "pain", "gynecology", "diagnosis", "menstrual-cycle", "endometriosis" ]

[ { "answer_id": 4091, "body": "<p>As previously said, this is dependent on the product. However, there is at least one study available comparing the bioavailability (which is what you are asking about - in this case, how much diclofenac permeates into the skin) of several of these patches and the differences don't look too big to me. </p>\n\n<p>Patel, Kunal N., Hetal K. Patel, and Vishnu A. Patel. \"<a href=\"http://www.ijppsjournal.com/Vol4Issue1/2992.pdf\" rel=\"nofollow noreferrer\">Formulation and characterization of drug in adhesive transdermal patches of diclofenac acid.</a>\" Int. J. Pharm. Pharm. Sci 4.1 (2012): 296-299.</p>\n\n<p>What you are interested in is table 2:</p>\n\n<p><a href=\"https://i.stack.imgur.com/OZaWY.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/OZaWY.jpg\" alt=\"Bioavailability of diclofenac for four patches\"></a></p>\n\n<p>As you can see, they do look rather similar, and an obvious feature is that the bioavailability for the first hours isn't as \"good\" as later. So in my nonexpert opinion, keeping a 24 hour patch on for 24 hours would be preferable to switching after 12. </p>\n", "score": 4 }, { "answer_id": 1786, "body": "<p>Basically this depends of the product you use. Your question does not give enough information to provide a \"curve\", as this has many variants including the produc you use, skin temperature(!), humidity and other influences. Read product instructions. These patches are generally made to provide a more or less constant uptake of the used drug, so in a perfect world with given temperature, humidity and skin type it should be more or less constant for some hours. The amount of hours depend on the specific product. </p>\n\n<p>As you seem to assume right the effect decreases after some time, so if you change every 12 hours you may get more effect than every 24 hours, but most producs seem to be made to work for 24 hours. </p>\n\n<p>In conclusion, if you use a 24-hour patch it won't make much difference to apply it every 12h, because the drug intake/hour should be more or less constant. If you leave your 24h patch for a longer time, like 72h, it is to be expected that the effect decreases. </p>\n\n<p><a href=\"http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021234s005lbl.pdf\" rel=\"nofollow\">http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021234s005lbl.pdf</a> gives you some information, but better you search for the product you use.</p>\n", "score": 2 } ]

[ "medications", "tendinopathy", "diclofenac" ]

[ { "answer_id": 1910, "body": "<p>Biotin or vitamin B7 is a very common vitamin. It is widely available in all kinds of foods and what is more important intestinal bacteria produces biotin. As so true, acquired deficiency of biotin in modern world is practically non-existent (<a href=\"https://en.wikipedia.org/wiki/Biotin#General_overview\">Wikipedia</a>). </p>\n\n<p>There are however some genetic mutations which can lead to biotin deficiency (<a href=\"https://en.wikipedia.org/wiki/Biotin_deficiency\">Wikipedia</a>). One of the prominent symptoms of inborn biotin deficiency is alopecia or hair loss. Due to this biotin supplements are often marketed as a treatment for hair loss. </p>\n\n<p>A recent review in a high quality dermatology journal recaps the current treatments for male and female hair loss (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18793935\">PubMed</a>). Authors conclude that \"No clinical trials showing efficacy treating hair loss; in vitro studies show no influence of biotin on cultured human follicular keratinocytes\".</p>\n\n<p>I would not waste my money on biotin supplement due to the very negligible likelihood of biotin deficiency causing hair loss.</p>\n", "score": 7 } ]

[ "hairloss" ]

[ { "answer_id": 13655, "body": "<p>If all other variables are constant then yes.\nIn real life it depends.\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098122/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098122/</a></p>\n", "score": 1 } ]

[ "exercise", "lifestyle", "benefits", "environmental-conditions", "walking" ]

[ { "answer_id": 3169, "body": "<p>Off-label prescribing of medicines - that is, prescribing medicines for indications, age groups or other circumstances for which they are not approved, is not prohibited by the FDA. FDA regulates approval of medicines for marketing, but it does not regulate the practice of medicine. Hence, once the medicine is on the market for certain indications it is up to physicians how they will describe them. (1,2).</p>\n\n<p>However, this is not an unregulated field. The FDA does state that <strong>off-label use must be distinguished from clinical trials</strong> - which means when physicians prescribe medicines under off-label circumstances they are not experimenting on their patients. Furthermore, FDA stresses that <strong>this practice must benefit the patient and be in line with Good medical practice</strong>. In their own words (3):</p>\n\n<blockquote>\n <p><em>Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgement. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product's use and effects. Use of a marketed product in this manner when the intent is the \"practice of medicine\" does not require the submission of an Investigational New Drug Application (IND), Investigational Device Exemption (IDE) or review by an Institutional Review Board (IRB). However, the institution at which the product will be used may, under its own authority, require IRB review or other institutional oversight.</em></p>\n</blockquote>\n\n<p>Even though such practice isn't prohibited and is in fact sometimes necessary (1, 4), it still opens physicians to potential liability. Legal complaints are usually phrased as medical malpractice due to negligence or due to lack of an informed consent, which is recommended, but not mandatory (1, 2). </p>\n\n<p>What physicians can do to protect themselves from liability is take care that their off label prescribing is (2):</p>\n\n<blockquote>\n <ol>\n <li><p>made with the \n patient’s knowledge that a drug is being \n prescribed for an off-label use; </p></li>\n <li><p>principally motivated by a desire to diagnose, \n treat and directly benefit the patient for whom a drug is prescribed; </p></li>\n <li><p>based on the doctor’s own expert medical opinion; </p></li>\n <li><p>supported by reputable peer reviewed literature reflecting sound scientific evidence; </p></li>\n <li><p>generally supported by the opinions of the physician’s local colleagues</p></li>\n </ol>\n</blockquote>\n\n<p>The situation is, however, different with the industry - promotion of off label use of medicines is prohibited. FDA has issued a draft document on it's viewpoint on industry providing information about off label use of their medicines. The request for information must be unsolicited (i.e. the company or its permanent or temporary employees should not prompt these requirements), and whether the request is public or not, the information should be provided in one-on-one communication (5). Furthermore, this document states:</p>\n\n<blockquote>\n <p><em>FDA has long taken the position that firms can respond to unsolicited requests for information about FDA-regulated medical products by providing truthful, balanced, non-misleading, and non-promotional scientific or medical information that is responsive to the specific request, even if responding to the request requires a firm to provide information on unapproved or uncleared indications or conditions of use.</em></p>\n</blockquote>\n\n<hr>\n\n<p>References: </p>\n\n<ol>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538391/#bib45\">Ten Common Questions (and Their Answers) About Off-label Drug Use</a></p></li>\n<li><p><a href=\"https://www.mcguirewoods.com/news-resources/publications/health_care/Off_Label.pdf\">Physicians’ liability for off-label prescriptions</a></p></li>\n<li><p><a href=\"http://www.fda.gov/RegulatoryInformation/Guidances/ucm126486.htm\">FDA: \"Off-Label\" and Investigational Use Of Marketed Drugs, Biologics, and Medical Devices - Information Sheet</a></p></li>\n<li><p><a href=\"http://www.fda.gov/forpatients/other/offlabel/default.htm\">FDA: Understanding Investigational Drugs and Off Label Use of Approved Drugs</a></p></li>\n<li><p><a href=\"http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm285145.pdf\">FDA: Guidance for Industry Responding to Unsolicited Requests for \nOff-Label Information About \nPrescription Drugs and Medical Devices</a></p></li>\n</ol>\n", "score": 9 } ]

[ "prescription" ]

[ { "answer_id": 4022, "body": "<p>What you are hearing about is probably based on two articles:</p>\n\n<ol>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23531502\" rel=\"nofollow\">Interaction of cinnamaldehyde and epicatechin with tau: implications of beneficial effects in modulating Alzheimer's disease pathogenesis</a></p></li>\n<li><p><a href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016564\" rel=\"nofollow\">Orally Administrated Cinnamon Extract Reduces β-Amyloid Oligomerization and Corrects Cognitive Impairment in Alzheimer's Disease Animal Models</a></p></li>\n</ol>\n\n<p>They led to such headlines as </p>\n\n<ul>\n<li><a href=\"http://www.news.ucsb.edu/2013/013539/uc-santa-barbara-scientists-discover-cinnamon-compounds-potential-ability-prevent\" rel=\"nofollow\">UC Santa Barbara Scientists Discover Cinnamon Compounds' Potential Ability to Prevent Alzheimer's</a></li>\n<li><a href=\"http://www.huffingtonpost.com/2013/05/27/cinnamon-alzheimers-cinnamaldehyde-epicatechin_n_3333403.html\" rel=\"nofollow\">Cinnamon Compounds Could Help Protect Against Alzheimer's, Study Finds</a></li>\n<li>and to NaturalNews even exclaiming <a href=\"http://www.naturalnews.com/036607_cinnamon_Alzheimers_prevention.html\" rel=\"nofollow\">Cinnamon beats Alzheimers</a> (and there are a lot of other headlines along those lines) </li>\n</ul>\n\n<p>That's a bit of an overreaction to what these studies found. </p>\n\n<p>Study 2 found that in mice, cinammon bark extract led to the formation of less aggregates of amyloid beta proteins, something that occurs in Alzheimer's disease. The mice also showed improvement in cognitive function. Mice are often used as model organism's in Alzheimer's studies, because we have transgenic mice that show symptoms of nerve degeneration. For some reason, this research used a different strain of mice that shows nerve degeneration as early as two months. Usually in Alzheimer's studies in mice, another strain is used that shows symptoms much later. That doesn't need to be a bad thing, just something I found interesting. The authors are optimistic about their study, but do recommend caution:</p>\n\n<blockquote>\n <p>These characteristics could be a disadvantage for evaluating drug candidates that are moderately efficacious and could be overlooked when tested in such an aggressive model, as opposed to the common more moderate models which may recapitulate the slower progression of AD in humans. However, (...) dramatically improved their cognitive performance suggests that CEppt may be likewise effective in the more typical AD mice models and in human patients.</p>\n</blockquote>\n\n<p>The other study, which from what I found received even more press attention, was an <em>in vitro</em> study, so done on cells in a laboratory. In that setting, compounds found in cinnamon reduced the formation of aggregates of the protein tau, which is also involved in the <a href=\"http://www.nature.com/nrn/posters/ad/index.html\" rel=\"nofollow\">formation of Alzheimer's</a>. </p>\n\n<p>Basically, both studies suggest that some ingredients in cinammon can reduce two factors that we believe are involved in how Alzheimer's Disease progresses : \naccumulation of the amyloid-β peptide, and formation of neurofibrillary tangles of tau protein. </p>\n\n<p>It's promising, but so far, no study in humans has been done and we can't say for certain whether these compounds can slow down or even halt the progression of Alzheimer's. We especially can't say in what doses an effect would occur. </p>\n\n<p><strong>Further sources</strong></p>\n\n<p><a href=\"http://www.nhs.uk/news/2011/06June/Pages/cinnamon-and-dementia.aspx\" rel=\"nofollow\">NHS News: Cinnamon treats Alzheimer's ... in mice</a></p>\n", "score": 5 } ]

[ "nutrition", "neurology", "supplement", "alzheimers" ]

[ { "answer_id": 5858, "body": "<p>It looks they are relevant according to these two researches: </p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538725/\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538725/</a></p>\n\n<blockquote>\n <p>Results:</p>\n \n <p>Both soccer players and controls had genu varum. However, the\n incidence of genu varum was higher in the soccer players (P = 0.0001)\n and it was more prevalent in the 16-18 year age group (P = 0.0001).\n The results revealed a statistically significant association between\n the degree of practices and the prevalence of genu varum (P = 0.0001).\n Moreover, previous trauma to the knees and practicing in load-bearing\n sports led to an increase in the degree of genu varum (P = 0.0001).</p>\n</blockquote>\n\n<p>and</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19183958\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/19183958</a></p>\n\n<blockquote>\n <p>Little is known about the relationship between sport participation and\n body adaptations during growth. Our aim was to investigate whether\n soccer participation in youth is associated with the degree of genu\n varum. The design was a retrospective cohort study. Three hundred and\n thirty-six male soccer players, and 458 male non-soccer players (aged\n from 8 to 18) were recruited and included in the study. The\n intercondylar (IC) or intermalleolar (IM) distance were clinically\n measured with a specifically designed instrument. The results of this\n study revealed a statistically significant increase in degree of genu\n varum in both groups from the age of 14. However, at the age of 16-18\n years a significant higher degree of genu varum was observed in the\n soccer players compared to the non-soccer players (P = 0.028). Intense\n soccer participation increases the degree of genu varum in males from\n the age of 16. Since genu varum predisposes to injuries, efforts to\n reduce the development of genu varum in male soccer players are\n warranted.</p>\n</blockquote>\n", "score": 1 } ]

[ "sports", "knee", "ankle", "gait-walk-abnormalities" ]

[ { "answer_id": 15156, "body": "<p>The answer to your question is thirdhand smoking (THS):</p>\n\n<p>From the American Nonsmoker's Right Foundation (ANRF), \"Thirdhand smoke consists of the tobacco residue from cigarettes, cigars, and other tobacco products that is left behind after smoking and builds up on surfaces and furnishings.\" </p>\n\n<p>So the chemicals from smoking do stick to a person and persist in the area.\nIn regards to whether they pose a threat, research is still continually being done to assess the harm/adverse effects on health. So far, researchers have found that the leftover nicotine from smoking can react with nitrous acid (in indoor air) to form carcinogenic compounds. A different paper reported the reduction in body mass when mice were exposed to THS, explaining the potential for harm in humans. </p>\n\n<p>From what I've read, there hasn't been any strong claims on the threat as seen in secondhand smoke. But it might be wise to consider \"There is no safe level of exposure to tobacco smoke.\", a view that is supported in the final two papers of my references. </p>\n\n<hr>\n\n<p>References:</p>\n\n<p><a href=\"http://www.no-smoke.org/learnmore.php?id=671\" rel=\"nofollow noreferrer\">American Nonsmokers' Rights Foundation (ANRF) Page on Thirdhand Smoke</a></p>\n\n<p><a href=\"https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791\" rel=\"nofollow noreferrer\">Mayo Clinic's Quick Intro. to Thirdhand Smoke</a></p>\n\n<p><a href=\"http://www.pnas.org/content/early/2010/02/04/0912820107?sid=a9fa8602-2b11-433d-a6cd-173e01d3e409\" rel=\"nofollow noreferrer\">Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards</a></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291208/\" rel=\"nofollow noreferrer\">Early exposure to thirdhand cigarette smoke affects body mass and the development of immunity in mice</a></p>\n\n<p><a href=\"http://pediatrics.aappublications.org/content/123/1/e74?sso=1&amp;sso_redirect_count=1&amp;nfstatus=401&amp;nftoken=00000000-0000-0000-0000-000000000000&amp;nfstatusdescription=ERROR%3a+No+local+token\" rel=\"nofollow noreferrer\">Beliefs About the Health Effects of “Thirdhand” Smoke and Home Smoking Bans</a></p>\n\n<p><a href=\"https://www.cancer.gov/news-events/press-releases/2016/low-intensity-smoking-risk\" rel=\"nofollow noreferrer\">No Safe Level of Smoking: Even low-intensity smokers are at increased risk of earlier death</a></p>\n", "score": 1 } ]

[ "smoking", "second-hand-smoke", "smoke-inhalation", "carbon-dioxide" ]

[ { "answer_id": 3437, "body": "<p>Mental disorders are often accompanied by physical symptoms. However, it is of course difficult to determine whether this is the mental disorder causing the symptoms or it usually \"co-appearing\" together with other conditions. There are many physical conditions that appear more often in people with certain psychological conditions. Here are a few studies you might want to look at:</p>\n\n<blockquote>\n <p>For patients treated in typical care settings, PPS were associated with depression severity. However, patients with mild and moderate depression also exhibited PPS. Clinicians should be aware that PPS are present, and may warrant treatment, across depression severities.</p>\n</blockquote>\n\n<p>(PPS is \"painful physical symptoms\")</p>\n\n<p><a href=\"http://www.tandfonline.com/doi/abs/10.1185/03007995.2012.748654http://www.tandfonline.com/doi/abs/10.1185/03007995.2012.748654?journalCode=icmo20#/doi/abs/10.1185/03007995.2012.748654?journalCode=icmo20\" rel=\"noreferrer\">Major depressive disorder severity and the frequency of painful physical symptoms: a pooled analysis of observational studies</a></p>\n\n<blockquote>\n <p>Subjects with BD had a significantly higher prevalence of MetS when compared to subjects with MDD and non-psychiatric controls</p>\n</blockquote>\n\n<p>(MetS: metabolic syndrome, BD: bipolar disorder, MDD: major depressive disorder)</p>\n\n<p><a href=\"http://www.jpsychores.com/article/S0022-3999(15)00049-5/abstract\" rel=\"noreferrer\">Metabolic syndrome in patients with bipolar disorder: Comparison with major depressive disorder and non-psychiatric controls</a></p>\n\n<blockquote>\n <p>Depressed adolescents had a significantly lower reactive hyperaemia index and shorter PTT, suggesting deterioration in vascular integrity and structure. Higher fasting glucose and triglyceride levels were also observed in the depressed group</p>\n</blockquote>\n\n<p><a href=\"http://www.jad-journal.com/article/S0165-0327(15)30274-3/abstract\" rel=\"noreferrer\">Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder.</a></p>\n\n<p>The \"classical\" example is extreme fatigue and insomnia in depressive patients:</p>\n\n<blockquote>\n <p>Severe insomnia is common in patients with MDD. It is closely related with low educational qualification, subjective depression and anxiety severity, and poor physical health. These findings may implicate the treatment of comorbid MDD and severe insomnia, for example, sleep hygiene education, pharmacological treatment</p>\n</blockquote>\n\n<p><a href=\"http://www.jad-journal.com/article/S0165-0327(15)30274-3/abstract\" rel=\"noreferrer\">Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder</a></p>\n\n<blockquote>\n <p>Fatigue and sleepiness (hypersomnia) are symptoms that are highly prevalent in patients with major depressive disorder (MDD)</p>\n</blockquote>\n\n<p><a href=\"http://europepmc.org/abstract/med/16848671\" rel=\"noreferrer\">Symptoms of fatigue and sleepiness in major depressive disorder.</a></p>\n\n<p>I think you'll also find much more in the references of these articles, but I'll stop here. Symptoms such as fatigue and insomnia will lead to other physical symptoms, such as <a href=\"http://www.m.webmd.com/sleep-disorders/daytime-fatigue\" rel=\"noreferrer\">heart disease, high blood pressure or stroke </a></p>\n\n<p>Now, in your question you talk about \"physical deformations\" and what I just cited might not qualify as a \"deformation\", especially if you mean things that would be highly visible from the outside. But physical symptoms are often present with mental disorders. </p>\n", "score": 7 } ]

[ "mental-health", "depression", "psychosomatic-illness" ]

[ { "answer_id": 3225, "body": "<p>PCOS can make your body resistant to insulin. When your body's cells become too resistant to insulin, that's called type 2 diabetes. Metformin makes your body more sensitive to insulin, so it can help prevent type 2 diabetes in PCOS patients who do not yet have it.</p>\n\n<p>Metformin doesn't treat PCOS itself, and it's not approved by the FDA to treat PCOS. Its use is appropriate when the patient shows early signs of insulin resistance, a condition called prediabetes.</p>\n\n<p>This page has some good info: <a href=\"http://youngwomenshealth.org/2014/02/25/metformin/\" rel=\"nofollow\">http://youngwomenshealth.org/2014/02/25/metformin/</a>.</p>\n\n<p>Incidentally, some physicians &amp; scientists believe that metformin can be used to treat other symptoms of PCOS. If you're interested in a critical review of those claims, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475283/\" rel=\"nofollow\">see this paper</a>. Here's a key paragraph from the conclusion:</p>\n\n<blockquote>\n <p>The use of metformin in PCOS has received a lot of attention for\n obvious reasons. Once thought of as a wonder drug, the accumulating\n evidence on the efficacy of metformin has been disappointing. The lack\n of an emphatic or overwhelming efficacy is largely due to the\n patients' variability in phenotypes and their metabolic parameters.\n Some studies have tried to identify the patients that are most likely\n to benefit from metformin, yet again the results have not been\n forthcoming. Consequently the burden falls back on the clinician who\n should be familiar with the gist of the available evidence to be able\n to identify the right patient for the treatment in hand. Obtaining an\n evidence of IR [insulin resistance] is a good starting point prior to recommending its use.</p>\n</blockquote>\n\n<p>Please keep in mind PCOS is a very heterogenous disorder, meaning that any two women can have PCOS with totally different clinical manifestations and also metabolic consequences. Not everyone will need metformin, because not everyone has the same metabolic consequences of PCOS.</p>\n", "score": 6 } ]

[ "treatment", "endocrinology", "gynecology", "pcos", "metformin" ]

[ { "answer_id": 3340, "body": "<p>For any reasonable risk, the answer is no. Virtually all tumors are non-transmissible under normal (non-laboratory) circumstances (three exceptions, discussed below, none in humans), so you could not possibly get the cancer the animal had.</p>\n\n<p>However some cancers arise because of environmental factors which may still be present in the animal. For example, an animal exposed to polychlorinated biphenyls (PCBs) would be at a higher risk of developing cancer, and PCBs also tend to stay around in the animal for some time. It is at least possible that environmental exposure which gave the animal cancer is still around to increase the risk to you. In general, this is probably a pretty low risk from any one instance of eating a tumorous animal. However if you were to eat animals which were routinely contaminated with something carcinogenic, it could become a problem. </p>\n\n<p>A similar story could be told about oncoviruses, that is viruses which can cause tumors or cancer. However all the oncoviruses known to date are restricted to humans. Further, if there were an hitherto unknown oncovirus which caused the tumor in the animal and still could cause an infection and neoplasm in humans, it would have to survive cooking and consumption. This route seems improbable.</p>\n\n<p>The least probable route would be a directly transmissible tumor. There are two such tumors known: Tasmanian devil facial tumor disease and canine transmissible venereal tumor. A third variety was discovered this year (<a href=\"http://www.cell.com/cell/abstract/S0092-8674%2815%2900243-3?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867415002433%3Fshowall%3Dtrue\" rel=\"noreferrer\">Metzger 2015</a>), which is found in clams. None affects humans. Further, the chances of such a disease being able to transmit across species seems very improbable. Finally, food preparation is almost certain to kill off the tumor cells.</p>\n\n<p>In summary, it is very improbable that eating an animal which had a neoplasm would pose any risk.</p>\n", "score": 6 } ]

[ "cancer" ]

[ { "answer_id": 3322, "body": "<p>I could not find a report where this has been formally studied but it is highly likely that persons coming to plains after staying at high altitude will feel more energetic, for a few days at least. This is even used by many sports organizations. Quoting from <a href=\"http://anthro.palomar.edu/adapt/adapt_3.htm\" rel=\"nofollow noreferrer\">\"Human Biological Adaptability: Adapting to High Altitude\"</a>: </p>\n\n<blockquote>\n <p>On returning to sea level after successful acclimatization to high\n altitude, the body usually has more red blood cells and greater lung\n expansion capability than needed. Since this provides athletes in\n endurance sports with a competitive advantage, the U.S. maintains an\n Olympic training center in the mountains of Colorado. Several other\n nations also train their athletes at high altitude for this reason. \n However, the physiological changes that result in increased fitness\n are short term at low altitude. In a matter of weeks, the body\n returns to a normal fitness level. </p>\n</blockquote>\n\n<p>Following figure accompanies above description: </p>\n\n<p><a href=\"https://i.stack.imgur.com/XSuSe.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/XSuSe.gif\" alt=\"enter image description here\"></a></p>\n\n<p>A number of factors may be responsible for this:</p>\n\n<ul>\n<li><p>Increased hemoglobin level stimulated by lower oxygen level in air at high altitude</p></li>\n<li><p>Bartsch &amp; Gibbs (<a href=\"http://circ.ahajournals.org/content/116/19/2191.full\" rel=\"nofollow noreferrer\">http://circ.ahajournals.org/content/116/19/2191.full</a>) have documented a number of changes in the body that occur on high altitudes exposure from 1 to several days or weeks as in tourists or trekkers. These changes indicate that several systems (especially heart, lungs, muscles and other tissues) are under stress. There are many other reports also documenting these changes. The relief of this stress on returning to plains will give a sense of greater energy and stamina. </p></li>\n<li><p>The paths in hilly areas are commonly going up and down and it is more exertional than moving around in the plains. Hence, a stay at high altitude often builds exercise capacity. It is like gentle trekking most of the time.</p></li>\n<li><p>Hilly areas generally have lesser pollution than cities in the plains.</p></li>\n<li><p>The temeperature and humidity conditions are generally more pleasant in hilly areas. </p></li>\n<li><p>Psychological factors including relief from anxiety and stress of routine life. It is like one feels rejuvenated after having been on a holiday. </p></li>\n</ul>\n\n<p>Because of above factors one may feel better stamina, at least for some time, after returning from a sojourn at high altitude. </p>\n\n<p>You may also be interested in my answer on how to avoid acute mountain sickness and its complications (<a href=\"https://health.stackexchange.com/questions/3111/avoiding-acute-mountain-sickness-high-altitude-pulmonary-cerebral-edema/3119#3119\">Avoiding acute mountain sickness, high altitude pulmonary &amp; cerebral edema</a>).</p>\n", "score": 7 }, { "answer_id": 3294, "body": "<p>I am going to answer this purely anecdotally based on personal experience having lived in Boston, but spending winter holidays in Colorado, ranging in altitude from ~5000 to 9000 ft.</p>\n\n<p>Assuming our hypothetical persons conditioning remains the same, yes, they'll have a short period of time when they return to sea level when they've got greater stamina due to greater oxygenation. It's a particularly pleasant sensation - for example, I was able to sprint up the large hill that separated the lower and upper part of my campus, while this was manifestly not possible in my \"normal\" shape.</p>\n\n<p>That being said, it tapers off quickly.</p>\n", "score": 0 } ]

[ "exercise", "blood" ]

[ { "answer_id": 8981, "body": "<p>Talking to a cardiologist at my hospital he said now almost all percutaneous coronary interventions can be done through radial access. He mentioned that he does still do certain procedures (valve repair, right heart ablations, etc.) through femoral access. His reasoning was that femoral access can be faster for certain procedures vs radial and this means that less x-rays will be used and less exposure to the patient. He did mention that most cardiologists have developed their own preferences for when to still use femoral access (some even choosing not to do them at all).</p>\n\n<p>Radial seems to have become the main method because of decreased risk of bleeding and complications. This also allows patients to be ambulatory in less time than with femoral access, resulting in lower costs both to the hospital and the patient. However, the development of vascular closure devices (VCD's) have reduced the bleeding risks associated with femoral access.</p>\n\n<p>This study did show no significant difference in death, myocardial infarction, and stroke between access sites.</p>\n\n<pre><code>Gersh, B.j. \"Radial versus Femoral Access for Coronary Angiography and Intervention in Patients with Acute Coronary Syndromes (RIVAL): A Randomised, Parallel Group, Multicentre Trial.\" Yearbook of Cardiology 2012 (2012): 235-38. Web.\n</code></pre>\n\n<p>In a large (8404) multicenter, randomized, superiority <a href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960292-6/abstract\" rel=\"nofollow\">study</a>, patients with radial access had less incidence of major adverse cardiovascular events: 8.8% radial vs 10.3% femoral (not significant)</p>\n\n<p>In the same study, radial access had less \"net adverse clinical events\": 9.8% radial vs 11.7% femoral (significant)</p>\n\n<p>The study concluded: </p>\n\n<blockquote>\n <p>In patients with acute coronary syndrome undergoing invasive management, radial as compared with femoral access reduces net adverse clinical events, through a reduction in major bleeding and all-cause mortality.</p>\n</blockquote>\n\n<p><a href=\"http://www.cathlabdigest.com/articles/Back-Basics-Femoral-Artery-Access-Hemostasis\" rel=\"nofollow\">Femoral access review</a></p>\n", "score": 2 } ]

[ "health-outcomes", "angioplasty", "angiography" ]

[ { "answer_id": 5396, "body": "<p>Wrinkling is an adaptative response of the skin, allowing for better grasp on objects when the skin is wet. The skin is a barrier of stacked cells mostly made of keratin and lipids. It is covered in aqueous and oily secretions (sweat, sebum) containing salts, acids, peptides, squalene, steroids, etc, as well as bacteria forming a biofilm and that defend you against pathogens. </p>\n\n<p>If you are soaking continuously in water, these components are being washed away. One problem I immediately think of is fungal infection. \nAlso, in warm water the skin is only semi-permeable, which is the basis of balneotherapy (absorbing minerals through the skin).</p>\n\n<p>With time, water would disrupt the statum corneum, making the skin permeable, resulting in irritations, ulcerations, infections, loss of electrolytes, etc. </p>\n\n<p>Look up \"trench foot\" or \"immersion syndrome\" , eg. <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0536.1999.tb06990.x/abstract;jsessionid=A71258961B2A73795CF1A2282A8AFB26.f02t02\" rel=\"nofollow\">How irritant is water? An overview.</a> These disorders can leave permanent damage on the skin or the organs underneath. Stay dry.</p>\n", "score": 2 } ]

[ "water", "wrinkles", "bath", "texture", "tactile-touch" ]

[ { "answer_id": 3501, "body": "<p>No one can prove that quitting smoking <em>doesn't</em> cause frequent bowel movements in a particular individual, but it's not a symptom generally associated with quitting smoking. <a href=\"http://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/withdrawal-fact-sheet\">The usual symptoms</a> are:</p>\n\n<blockquote>\n<pre><code>Nicotine cravings.\nAnger, frustration, and irritability.\nAnxiety.\nDepression.\nWeight gain.\n</code></pre>\n</blockquote>\n\n<p>As a former smoker, I would add increased appetite and difficulty sleeping to that list. But as you can see, nothing in the list even hints at gastrointestinal disturbances or changes in bowel habits.</p>\n\n<p>But most important is your mention of blood in the stool. Frequent bowel movements in and of themselves don't cause blood in the stool, nor does quitting smoking. Bleeding somewhere within the gastrointestinal (GI) tract is what causes blood in the stool.</p>\n\n<p><a href=\"http://www.iffgd.org/site/manage-your-health/symptoms-causes/alarm-symptoms\">The possible reasons</a> for blood in the stool are numerous:</p>\n\n<blockquote>\n <p>benign and malignant tumors; inflammation such as infectious colitis\n or inflammatory bowel disease (IBD); ulcers such as peptic ulcers;\n esophagitis; or a traumatic tear such as may occur in the anus\n (fissure) or the lower end of the esophagus.</p>\n</blockquote>\n\n<p>The article quoted above goes on to say:</p>\n\n<blockquote>\n <p>Intestinal bleeding is potentially serious and demands investigation –\n often as an emergency.</p>\n</blockquote>\n\n<p>Trying to guess what the cause is on an internet forum is impossible since even doctors with intimate access to the patient often have difficulty diagnosing the cause of bloody stools. However, seeing a doctor about the frequent bowel movements and especially the bloody stools is exactly what the person needs to do, and the sooner, the better.</p>\n", "score": 8 }, { "answer_id": 3518, "body": "<p>When quitting cigarettes a person will likely increase food/fluid consumption.This is to compensate for the loss of hand to mouth activity each puff you take from the cigarette is now absent from the body's normal activity so a person tends to snake more not knowing that they are not more hungry just pleasing the bodies addictiveness to a hand to mouth movement it has grown used too.So more eating and drinking than normal is the reason for more bowel movement not the lack of nicotine or additives in cigarettes. </p>\n", "score": 0 } ]

[ "smoking", "stomach" ]

[ { "answer_id": 3502, "body": "<p>Yes, it can.</p>\n\n<p>The \"master clock\" of your body is the <strong>suprachiasmatic nucleus</strong> of the hypothalamus. It receives:</p>\n\n<ul>\n<li>Neuronal input from the retina, through the retino-hypothalamic tract.</li>\n<li>Hormonal input, as the suprachiasmatic nucleus expresses melatonin receptors. Melatonin is a hormone secreted by the pineal gland in response to the absence of light. The pineal gland itself does not contain light receptors, but it received information indirectly: the retino-hypothalamic tract sends the information from the retina to the suprachiasmatic nucleus. From there, the information is sent to the intermediolateral column of the spine cord, where there are synapses with pre-ganglionic neurons which also synapse with post-ganglionic neurons of the superior cervical ganglion. The superior cervical ganglion then sends the information through the carotid plexus and to the pineal gland [Retina -> Suprachiasmatic Nucleus -> Intermediolateral Column -> Superior Cervical Ganglion -> Carotid Plexus -> Pineal Gland].</li>\n</ul>\n\n<p>Through these signals, the suprachiamastic nucleus is capable of setting the circadian clock. In the absence of these input, the internal circadian clock is actually 25,3 hrs long, instead of the usual 24 hrs that our day has. You might want to read the work by <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6780913\">Turek et al.</a> and <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/7232967\">Czeisler et al</a>.</p>\n\n<p>Regarding the basics of the suprachiasmatic nucleus, there are good reviews, I recommend an article by Moore RI (Organization and function of a central nervous system circadian oscillator: the suprachiasmatic hypothalamic nucleus) or even the book \"Suprachiasmatic Nucleus: The Mind's Clock\".</p>\n", "score": 5 } ]

[ "sleep-cycles" ]

[ { "answer_id": 5559, "body": "<p>Yes. Body temperature <a href=\"http://www.sleepdex.org/thermoregulation.htm\" rel=\"nofollow\">drops at night</a> almost 2 degrees fahrenheit. </p>\n\n<p>Cranial cooling has been showing to <a href=\"https://xenophilius.wordpress.com/2011/06/13/cant-sleep-cooling-your-brain-may-be-a-natural-and-effective-treatment-for-insomnia/\" rel=\"nofollow\">lead to deeper sleep and help insomniacs</a>.</p>\n\n<p>Higher body temperatures during sleep are <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/9209729\" rel=\"nofollow\">associated with depression</a>.</p>\n\n<p>As a physician, I have a seen previous studies suggesting that taking a lukewarm shower before sleeping has been shown to help people get to sleep faster [reference needed]. </p>\n\n<p>Anecdotally, I have patients who report that walking around without socks on the floor until their feet feel cold also report falling asleep faster. </p>\n", "score": 3 } ]

[ "sleep", "body-temperature", "contributing-factors" ]

[ { "answer_id": 4081, "body": "<p>Most wounds leave some kind of scar. It's just that we sometimes can't really tell because it's so small. </p>\n\n<p>Here's how wound healing generally works: </p>\n\n<ol>\n<li>Blood clots and forms a scab (this may not happen, for example in burns and puncture wounds that didn't draw blood </li>\n<li>White blood cells (macrophages) \"clean\" the wound - the wound may appear to be oozing some fluid. Blood flow increases, the macrophages produce growth factors. </li>\n<li>Blood flow increases more, red blood cells deliver more oxygen. Cells at the edge of the wound secrete <em>collagen</em>. The wound fills with tissue called <em>granulation tissue</em>. </li>\n<li>New skin grows over that tissue. </li>\n</ol>\n\n<p>These stages are called hemostasis, inflammation, proliferation, and remodeling. This process can take weeks to years depending on size and location of the wound. </p>\n\n<p>Now, what's a scar? Scars look different from \"normal\" skin because of <em>collagen</em>. Collagen is a protein on the outside of the skin cells holding them together and making skin strong (it's also a major part of tendons). In normal skin the collagen sort of forms a \"criss-cross\" pattern, while in scar tissue it's more parallel. That probably comes from the wound healing process. </p>\n\n<p>In small wounds, you won't notice that the skin looks different because of that. In larger wounds, it's very apparent at first, though scars also start looking less noticeable with age. </p>\n\n<p><em>Sources</em></p>\n\n<p><a href=\"http://m.hopkinsmedicine.org/healthlibrary/conditions/surgical_care/how_wounds_heal_134,143/\" rel=\"nofollow\">How Wounds Heal, John Hopkins Health Library</a> </p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/\" rel=\"nofollow\">Factors Affecting Wound Healing</a> (introductory section) </p>\n\n<p><a href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000741.htm\" rel=\"nofollow\">How wounds heal - US National Library of Medicine</a> </p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12880721\" rel=\"nofollow\">Collagen morphology in human skin and scar tissue: no adaptations in response to mechanical loading at joints</a>.</p>\n", "score": 2 } ]

[ "dermatology", "wound" ]

[ { "answer_id": 3620, "body": "<p><strong>Short answer</strong><br />\nThe consensus is that sub-optimal lighting does not permanently damage the eye.</p>\n<p><strong>Background</strong><br />\nSub-optimal lighting can create a sensation of having difficulty in focusing. It also decreases the rate of blinking and this possibly to discomfort from dry eyes. These complaints <strong>do not persist</strong>. The majority consensus in ophthalmology is that reading in dim light does not damage your eyes; <strong>it is a myth</strong>. Although it can cause eye strain with multiple temporary negative effects, it is unlikely to cause a permanent change to the function or structure of the eyes <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151163/\" rel=\"nofollow noreferrer\">(Vreeman &amp; Caroll, 2007)</a>.</p>\n<p>If you Google your question many credible sources outside the scientific literature seem to agree that it is a myth busted, including <a href=\"http://www.webmd.com/eye-health/features/reading-in-dim-light\" rel=\"nofollow noreferrer\">WebMD</a>, <a href=\"http://www.webmd.com/eye-health/features/reading-in-dim-light\" rel=\"nofollow noreferrer\">ABC</a> and <a href=\"http://www.wsj.com/articles/SB10001424127887323646604578404581544768850\" rel=\"nofollow noreferrer\">Wall Street Journal</a>.</p>\n<p>_{<strong>Reference</strong><br />\n<strong>-</strong> <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151163/\" rel=\"nofollow noreferrer\">Vreeman &amp; Caroll, <em>BMJ</em> (2007); <strong>335</strong></a>}</p>\n", "score": 8 } ]

[ "light", "pathophysiology" ]

[ { "answer_id": 3669, "body": "<p>I think you are onto something. In the past few years, there have been much research that questions or contradicts the supposedly well-established concensus that we should eat less than 2.3 grams of sodium (included in table salt) per day and preferably even less (1.5 grams per day). There are several excellent NYT articles on the subject including <a href=\"http://www.nytimes.com/2014/04/22/health/study-linking-illness-and-salt-leaves-researchers-doubtful.html?_r=0\" rel=\"nofollow\">Study Linking Illness and Salt Leaves Reserachers Doubtful</a> and <a href=\"http://www.nytimes.com/2013/05/15/health/panel-finds-no-benefit-in-sharply-restricting-sodium.html\" rel=\"nofollow\">No Benefit Seen in Sharp Limits on Salt in Diet</a>. Thus, based on those mentioned studies within the NYT articles you can probably feel comfortable taking in more sodium (included in table salt) than the standard recommendations. One of the NYT articles mentioned that review of extensive research indicated that the most favorable health outcomes were associated with sodium intake ranging from 2.645 to 4.945 grams per day. That's about twice the recommended range mentioned above. </p>\n\n<p>However, independent of high blood pressure alone, sodium/salt does play a role in kidney health. The following study has some information on this issue <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12113591\" rel=\"nofollow\">Salt Intake and Kidney Disease</a>. If you belong to a \"salt-sensitive\" demographic group (defined in the study as \"elderly, obese, diabetic or black patients\") you may have to watch out your salt intake somewhat more carefully. Otherwise, you may be just fine intaking sodium/salt within the mentioned range by the NYT article. </p>\n", "score": 2 } ]

[ "blood-pressure", "heart-disease", "salt" ]

[ { "answer_id": 9773, "body": "<p>There is no known way to absolutely prevent sleepwalking; however, certain steps can be taken to minimize one's risk. These include:</p>\n\n<ul>\n<li>Get adequate sleep.</li>\n<li>Limit stress. Meditate or do relaxation exercises.</li>\n<li>Avoid any kind of stimulation (auditory or visual) prior to bedtime.</li>\n</ul>\n\n<p><a href=\"http://www.webmd.com/sleep-disorders/how-is-sleepwalking-treated#1\" rel=\"nofollow noreferrer\">http://www.webmd.com/sleep-disorders/how-is-sleepwalking-treated#1</a></p>\n", "score": 1 } ]

[ "medications", "sleep", "treatment-options", "sleep-walking" ]

[ { "answer_id": 4231, "body": "<p><em>The hygiene hypothesis</em></p>\n\n<blockquote>\n <p>For some reason I hold the opinion that the immune system needs to be kept busy so it wont get weak</p>\n</blockquote>\n\n<p>In scientific terms, this is known as the <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448690/\">hygiene hypothesis</a>. It was proposed in 1989 by Strachan and is about whether people who have been exposed to a lower amount of pathogens in their childhood are more likely to develop autoimmune or hypersensitivity (allergy) disorders later in life. Strachan actually didn't propose it in the context of hygiene, but in the context of families having less children and thus <a href=\"http://thorax.bmj.com/content/55/suppl_1/S2\">children being exposed to their siblings' infections less often</a>, though. He found that children with fewer siblings had a higher incidence of asthma and hayfever and came up with the hypothesis to explain his observation. The name has stuck, though.</p>\n\n<p>Is it true? Possibly.</p>\n\n<p>Chromic inflammatory diseases are in fact <a href=\"http://emph.oxfordjournals.org/content/2013/1/46\">more prevalent in the so-called developed world</a>. As Ghana got richer and presumably 'cleaner', the <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808098/\">rates of allergies and asthma increased</a>.</p>\n\n<p><em>The role of vaccinations</em></p>\n\n<blockquote>\n <p>letting your kids get low-risk childhood sicknesses like mumps, rubella or chickenpox is \"training\" their immune systems</p>\n</blockquote>\n\n<p>Basically, no, even despite the hygiene hypothesis.</p>\n\n<p>First of all, whether these are not low-risk diseases is in fact debatable, but outside the scope of this question, I think. Mumps and measles can end in encephalitis. Since you can not guarantee that every child who isn't vaccinated will get the disease 'naturally', not vaccinating compromises <a href=\"http://www.vaccines.gov/basics/protection/\">herd immunity</a> and can lead to the more vulnerable members of society (small children, immunocompromised patients, pregnant women) being exposed, which can lead to severe consequences.</p>\n\n<p>The mechanism by which all of this works is a lot more complicated than that the immune system needs to be kept <strong>busy</strong>, though. It depends on <a href=\"http://www.sciencemag.org/content/296/5567/490.short\">what the infections are, when they are, and what kind of immune response they raise</a>.</p>\n\n<p>Scientists have tried to determine <em>which</em> pathogens play a role in the hygiene hypothesis, and the result is now called the <em>old friends hypothesis</em>. From the summary of the <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2249.2010.04133.x/full\">99^th Dahlem Conference on Infection, Inflammation and Chronic Inflammatory Disorders</a>:</p>\n\n<blockquote>\n <ul>\n <li>The most relevant organisms are those that co-evolved with mammals, and already accompanied early hominids in the Paleolithic.</li>\n <li>More recently evolved ‘childhood infections’ are not likely to have evolved this role, and recent epidemiology supports this contention.</li>\n </ul>\n</blockquote>\n\n<p>Pathogens usually indicated in research are <a href=\"http://www.sciencemag.org/content/296/5567/490.short\">worm/parasite infections</a>, and general exposure to bacteria from the environment. Household hygiene is likely to <a href=\"http://www.ifh-homehygiene.org/best-practice-review/hygiene-hypothesis-and-its-implications-home-hygiene-lifestyle-and-public-0\">only play a small part in the process</a>, while an larger part is played by letting children be exposed to things outside of an urban environment. Diseases we vaccinate against don't seem to play a role.</p>\n", "score": 8 } ]

[ "immune-system", "vaccination", "hygiene", "infectious-diseases" ]

[ { "answer_id": 5195, "body": "<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2516429/\" rel=\"nofollow noreferrer\">The Impact Of Long-Term Lithium Treatment On Renal Function In An Outpatient Population</a></p>\n<blockquote>\n<p>Lithium is known to affect renal concentrating ability, and\nlithium-induced polyuria is not uncommon, estimated to affect\napproximately 20% of patients, but this is rarely clinically\nsignificant. It is less clear, however, whether or not the protracted\nuse of lithium can cause progressive deterioration in renal function,\nculminating in renal failure</p>\n</blockquote>\n<p><a href=\"https://www.kidney.org/atoz/content/lithium\" rel=\"nofollow noreferrer\">How can I avoid kidney damage due to lithium?</a></p>\n<blockquote>\n<ol>\n<li><p>Avoid levels of lithium that are toxic</p>\n</li>\n<li><p>Check blood levels of lithium to see if you are taking the lowest amount that still works for you</p>\n</li>\n<li><p>Check creatinine every year. Get medical help if your creatinine level stays above 1.6 mg/dl.</p>\n</li>\n<li><p>If possible, take lithium once a day.</p>\n</li>\n</ol>\n</blockquote>\n<p><em><strong>Some of these are interventions that your health care provider would utilize. So make sure you follow up with your healthcare provider.</strong></em></p>\n<p><a href=\"http://emedicine.medscape.com/article/242772-overview\" rel=\"nofollow noreferrer\">Lithium Nephropathy</a></p>\n<blockquote>\n<p>Evidence of chronic renal disease is an indication for discontinuation\nof the drug being administered and for consideration of alternative\nmedications for treatment of the patient's psychiatric disorder.</p>\n</blockquote>\n<p><a href=\"http://emedicine.medscape.com/article/242772-treatment\" rel=\"nofollow noreferrer\">Treatments:</a></p>\n<p>Polyuria --&gt; Thiazide Diuretics &amp; NSAIDs</p>\n<p>Hypovolemia --&gt; Parenteral Fluids</p>\n<p>Dialysis may be indicated</p>\n<p>The ICU may be indicated</p>\n", "score": 2 } ]

[ "medications", "side-effects", "mental-health", "renal", "lithium" ]

[ { "answer_id": 17868, "body": "<blockquote>\n <p>The specific cause of astigmatism is unknown. It can be hereditary and is usually present from birth. It can decrease or increase over time. - <a href=\"https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/astigmatism\" rel=\"noreferrer\">American Optometric Association</a></p>\n</blockquote>\n\n<p>You might've had it since birth but without noticeable defect and has progressed rapidly enough to produce a defect in your vision during your early 20's.</p>\n\n<p>Other factors that would affect the development and progression of astigmatism would be ethnicity, the presence of myopia, axis, and subtype of astigmatism. \n- <a href=\"https://iovs.arvojournals.org/article.aspx?articleid=2124328\" rel=\"noreferrer\">Investigative Ophthalmology and Visual Science Journals</a></p>\n", "score": 6 } ]

[ "eye", "vision", "astigmatism", "cornea", "keratoconus" ]

[ { "answer_id": 5113, "body": "<p>To begin, I should say that overall the evidence is conflicting and not good with respect to your time frame (long term, \"rest of their life\").</p>\n\n<p>Studies <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=6202406\" rel=\"nofollow\">A</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6205617\" rel=\"nofollow\">B</a>, and <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6185024\" rel=\"nofollow\">C</a> reveal animal models that show damage acutely (with recent administration of bleomycin) but also no syngery after 1 month. Of course this is an animal model. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=77697\" rel=\"nofollow\">D</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=1704473\" rel=\"nofollow\">E</a>, and <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=2410201\" rel=\"nofollow\">F</a> suggest that <strong>after</strong> bleomycin therapy (not recent administration), there is still a risk with supplemental oxygen in humans, though this is weak evidence. On the contrary, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=24485131\" rel=\"nofollow\">G</a> and <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=9751352\" rel=\"nofollow\">H</a> suggest no correlation.</p>\n\n<p>Regardless, because of some anecdotal evidence and animal model evidence, patients who have had prior exposure to supplemental oxygen may face providers who are more cautious with over-supplementing with O2 (they may target a lower, but safer, oxygen saturation percentage). They may also be more conservative in the OR when giving fluids as to not flood the lungs.</p>\n\n<p>The answer is that evidence is unclear but the current practice is the above.</p>\n", "score": 2 } ]

[ "cancer", "lasting-effects-duration", "lungs", "chemotherapy", "oxygen" ]

[ { "answer_id": 4036, "body": "<ol>\n<li><p>No, it is not compulsory for all the patients to have/develop a scar which is most probably the <a href=\"https://en.wikipedia.org/wiki/Pulmonary_fibrosis\" rel=\"nofollow\">pulmonary fibrosis</a> or might be <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24670573\" rel=\"nofollow\">residual parenchymal lesions</a>.</p>\n\n<ul>\n<li>In certain cases, it is due to not doing the breathing exercises while taking the standard regime of HREZ (isoniazid, rifampicin, ethambutol, pyrazinamide) <br></li>\n</ul></li>\n<li><p>Yes, it can get better(not completely removed) with time if the person does variety of <a href=\"http://www.livestrong.com/article/327849-controlled-breathing-exercises-for-pulmonary-fibrosis/\" rel=\"nofollow\">breathing exercises</a> like:</p>\n\n<ul>\n<li>Yoga (pranayam).</li>\n<li>Deep breathing, using props like balloons.</li>\n<li>Aerobics, morning walks, etc.</li>\n</ul></li>\n<li><p>In tuberculosis, weight gain is a healthy indication that the medicines are working. <br> The medicines are given keeping in mind the current weight of the patient. The importance of maintaining a proper BMI(Body Mass Index) is revealed in case studies of relapses. <br>\nPlease read this: <a href=\"http://www.who.int/tb/TBnutrition.pdf\" rel=\"nofollow\">WHO report on TB</a></p></li>\n</ol>\n", "score": 2 }, { "answer_id": 4146, "body": "<p><em>Tuberculosis and scarring</em></p>\n\n<p>That scar on the X-rays is likely <a href=\"http://www.sciencedirect.com/science/article/pii/S0720048X04000890\" rel=\"nofollow\">a leftover from either a lymphadenopathy or a lung cavity</a>. A lymphadenopathy is a swelling of the lymph nodes and appears in almost all patients, a lung cavity occurs in about half the patients. </p>\n\n<p>Most people <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000077.htm\" rel=\"nofollow\">recover from tuberculosis with no further negative effects</a>, but <a href=\"http://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/basics/causes/con-20029091\" rel=\"nofollow\">some scarring may remain behind in the lungs</a>. The scarring you are asking about is likely caused by the lymph nodes:</p>\n\n<blockquote>\n <p>The lymphadenopathy usually resolves slower than the pulmonary lesions, with no residual features. The nodes decrease in size after 3 months of treatment, though in some cases a paradoxical, transitory increase in size is seen in the first period of treatment. In one-third of cases, the lung infiltrates leave some kind of <strong>parenchymal scar</strong>, such as a nodule (tuberculoma), which can calcify forming the Ghon focus, or an area of fibrosis.</p>\n</blockquote>\n\n<p>A parenchymal scar is a scar in the lungs. No surgery is done to remove it.</p>\n\n<p><em>Tuberculosis and weight</em></p>\n\n<p>Tuberculosis leads to weight loss and malnutrition. Weight <em>gain</em> is a positive sign <a href=\"http://www.who.int/tb/TBnutrition.pdf\" rel=\"nofollow\">that a patient is recovering from tuberculosis and the risk of a relapse is small</a>. Weight <em>loss</em> indicates that something is wrong, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20875187\" rel=\"nofollow\">for example with the liver</a>.</p>\n", "score": 2 } ]

[ "medications", "infection", "disease", "infectious-diseases", "tuberculosis" ]

[ { "answer_id": 5527, "body": "<p>You can screen for occult bowel inflammation using the stool test <a href=\"https://www.nice.org.uk/guidance/dg11\" rel=\"nofollow\">fecal calprotectin</a>. However, a normal test doesn't exclude inflammatory bowel disease and a positive test is highly suggestive. <a href=\"http://www.mayoclinic.org/tests-procedures/capsule-endoscopy/basics/why-its-done/prc-20012773\" rel=\"nofollow\">Capsule endoscopy</a> is a procedure when a person swallows a camera in a pill that allows pictures to be taken of the bowel. This can also aid in the diagnosis of inflammatory bowel disease.</p>\n", "score": 1 }, { "answer_id": 5872, "body": "<p>The first line of investigation for diagnosis of Crohn's disease is endoscopy (gastroduodenoscopy and ileocolonoscopy). Endoscopic remission (healing of mucosal lesions) does not necessarily correlate with clinical remission (disappearance of symptoms), and endoscopy would therefore still be indicated as a first-line diagnostic test if there is a very high suspicion for the disease based on previous symptoms. </p>\n\n<p>For example, take a 21 year old man of Ashkenazi Jewish ancestry, with two sisters having Crohn's disease, who has a resolved history of bloody diarrhea 1 year ago, and is found to be anemic and B12 deficient on blood tests. This patient would warrant endoscopy even if asymptomatic at the time of presentation.</p>\n\n<p>As the other answer notes, fecal markers of inflammation (fecal calprotectin) and serologic markers of inflammation (ESR, CRP) could be used. In this situation, their utility would be as a \"rule out\" test if the suspicion for the disease is rather low and the goal is to avoid having to perform an endoscopy. If those markers are negative, and there are no symptoms, it may be appropriate to defer performing endoscopy until symptoms re-appear.</p>\n\n<p>Finally, capsule enteroscopy, CT enterography and MRI enterography are non-invasive tests that can be used to evaluate the small bowel, which may show mucosal disease despite the absence of symptoms. CT and MRI can also delineate other complications of Crohn's disease such as fistula, abscess, or bowel perforation, though these would definitely present with symptoms.</p>\n\n<p>Ref: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23598817\" rel=\"nofollow\">Inflamm Bowel Dis. 2013 Jul;19(8):1645-53.</a></p>\n", "score": 1 } ]

[ "gastroenterology", "diagnosis", "crohns" ]

[ { "answer_id": 4422, "body": "<p><a href=\"http://www.cancer.gov/about-cancer/causes-prevention/risk/age\" rel=\"nofollow noreferrer\">The National Cancer Institute</a> states</p>\n\n<blockquote>\n <p>Advancing age is the most important risk factor for cancer overall, and for many individual cancer types. According to the most recent statistical data from NCI’s Surveillance, Epidemiology, and End Results program, the median age of a cancer diagnosis is 66 years. This means that half of cancer cases occur in people below this age and half in people above this age. One-quarter of new cancer cases are diagnosed in people aged 65 to 74.</p>\n</blockquote>\n\n<p>Lung cancer, breast cancer, and prostate cancer all have median ages of diagnosis between 61 and 70 years. That said, the NCI does note that some cancers occur more often in younger age groups, citing bone cancers (where the most at-risk age group is adolescents under 20) and leukemias.</p>\n\n<p>The NCI also provides a bar graph showing the percentage of new cancers in various age groups, broken down mostly in ten-year increments:</p>\n\n<p><a href=\"https://i.stack.imgur.com/gZAP3.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/gZAP3.png\" alt=\"\"></a></p>\n\n<p>This would seem to indicate that your cancer risk goes down after about the age of 70. However, this is clearly misleading, because fewer and fewer people survive to reach these higher age groups. Thus, with fewer people in that group alive, there is going to be a significant drop in the percentage of cancers that occur in that group.</p>\n\n<p><a href=\"http://seer.cancer.gov/csr/1975_2012/results_merged/topic_lifetime_risk.pdf#13\" rel=\"nofollow noreferrer\">More accurate tables</a> exist, which show the chance of developing cancer within a certain amount of time at a given age (data from 2010-2012). Table 2.12 in the linked document shows that the chances of developing cancer within 10, 20, or 30 years increases with age (although long-term data is not available for the higher age groups, as most people at the age of 80 do not live for 20 or 30 more years.</p>\n\n<p>An interesting effect, though, is that the chance of ever developing cancer does change, increasing by small - negligible, even - amounts from the age of 0-30, and decreasing by the same small amounts from there, until there is a sharp drop-off at the age of 60. The table shows that if, for example, you're 70 years old, then you're less likely to get cancer during the rest of your life than someone 40 years old. The reason for this, of course, is more morbid: other diseases that are more common or more deadly in old age will set in at older ages. Less time to live implies less time to develop cancer.</p>\n\n<p>To make this less confusing, at younger ages, your risk of developing cancer within a small amount of time - your instantaneous risk - steadily increases. At ages past 30, however, your risk of developing cancer throughout the rest of your life steadily decreases.</p>\n\n<p>I would assume that your question is better answered by the first statistic, rather than the second.</p>\n", "score": 2 } ]

[ "cancer", "statistics" ]

[ { "answer_id": 5625, "body": "<p>I have had back pain (mid to upper) as well as related pain issues for a few years now. I <em>cannot</em> sleep without some sort of lumbar support any more, and I have a pillow I use every night.</p>\n\n<p>I previously used to roll up a small-ish towel and place it directly under my back for lumbar support, I did this for several years. I have since moved on to pillows dedicated to this use case (NOT affiliate links):</p>\n\n<ul>\n<li><a href=\"http://rads.stackoverflow.com/amzn/click/B00L8C290S\" rel=\"nofollow\">http://www.amazon.com/Lumbar-Support-Pillow-Sleeping-Sitting/dp/B00L8C290S</a> – a bit small, but this is my primary lumbar support while sleeping</li>\n<li><a href=\"http://rads.stackoverflow.com/amzn/click/B001AFDAX8\" rel=\"nofollow\">http://www.amazon.com/Carex-Health-Brands-P10700-Pillow/dp/B001AFDAX8</a> – too big for lumbar support, but I use this for under my legs or neck from time to time</li>\n</ul>\n\n<p>This is what has helped me, but of course, YMMV.</p>\n", "score": 1 }, { "answer_id": 5644, "body": "<p>I think it's worth mentioning, that the mattress you use should fit your sleeping position - as well as your cushion.</p>\n\n<p>The way you sleep (back, side, belly) influences the need for individual support or softness in the different areas of your body.\nFor example, people (esp. women) who sleep on their stomach and use a mattress that is too soft in the belly region, often experience backpain, because the lower back is in a hyper-lordothic position (sorry if the term is not correct, I'm not a native-speaker - I think hollow-back is also a word for it). Also those people shouldn't use a cushion, that is too high for the same reason.\nSo every sleeping position has special problems and individual needs.</p>\n\n<p>If your sleep is not relaxing, it impairs your quality of life. If you already experience pain, your body signals you to change something. As a physical therapist I'd recommend you to get informed in a local store, that sells mattresses and maybe is into health and fitness stuff.</p>\n\n<p>Furthermore you can start doing sports like yoga, pilates, muscle training (core stability) to further improve your health and prevent increasing pain.</p>\n", "score": 0 } ]

[ "sleep", "pain" ]

[ { "answer_id": 4165, "body": "<p>Smoking in general is unhealthy. Smoking can result in emphysema, COPD, pulmonary hypertension and other ugly diseases [1,2,3]. After a workout your heart and respiration rates are higher than at basal levels. Although I do not have data to back me on this, based on scientific evidence on cardiopulmonary effects [4] after a workout and the hazards of smoking [1,2,3], I would deduce you would have higher nicotine intake, as well as other terrible chemicals that are in cigarettes. I am not sure if cardiac arrest would be a primary concern with smoking but rather a secondary event to pulmonary hypertension [2,3]. In short I would seek advice and support on quitting smoking.</p>\n\n<hr>\n\n<ol>\n<li><a href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407211\">Smoking and Mortality — Beyond Established Causes</a></li>\n<li><a href=\"http://www.atsjournals.org/doi/abs/10.1164/rccm.200401-006OC#.VntWDXUrKfg\">Severe Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease</a></li>\n<li><a href=\"http://www.atsjournals.org/doi/pdf/10.1513/pats.200407-037MS\">Pulmonary Hypertension and Right Heart Failure in Chronic Obstructive Pulmonary Disease</a></li>\n<li><a href=\"http://archinte.jamanetwork.com/article.aspx?articleid=610608\">Cardiopulmonary Exercise Testing - The Clinical Value of Gas Exchange Data</a></li>\n</ol>\n", "score": 8 } ]

[ "exercise", "smoking", "nicotine" ]

[ { "answer_id": 19445, "body": "<p>This all falls to a matter of degree - most importantly <em>mechanism of injury</em>. I'll explain the physics in allegorical terms first and then explain as it relates to medicine. </p>\n\n<p>The <em>mechanism</em> refers to the amount of <em>force</em> experienced in the injury process which allows us to predict injury patterns. </p>\n\n<p><strong>For example</strong>: A motor vehicle collision at highway speed has a very high <strong>mechanism of injury</strong> as there are a lot of forces involved (mainly <em>kinetic energy</em>). Stubbing your toe has a very low mechanism as the force involved is exponentially less (although it still hurts and can still cause a fracture).</p>\n\n<p>In the case of kicking or punching specifically; I think we must consider the <em>physics</em>. The forces involved are <strong>not</strong> from an <strong>outside</strong> source and occur as a result of your <strong>own</strong> body mechanics. </p>\n\n<p>*Essentially**: </p>\n\n<h2><em>Your body is designed to withstand the forces of movement, even in extreme settings such as: fighting a predator or attempting to flee from one.</em></h2>\n\n<p>Generally when you punch something you do so by first <em>loading the hips</em> with <em>potential energy</em> and then converting it to <em>kinetic energy</em> which is then <strong>transferred</strong> into the object being hit. Some of it does get reflected back but most of that is absorbed and (with good biomechanics) transferred into the floor through the long bones - just like a bicycle spoke. Our flexible neck also allows our body to move independently of the head to absorb/redirect <em>kinetic energy</em> <strong>away</strong> from our vital organs. </p>\n\n<p>In the case of the <strong>football player</strong>, however; things are <strong>different</strong>. <strong>Outside</strong> forces are at work which our bodies are not necessarily equipped for. A 260 lb football player in full equipment who is running head-on toward you, bracing right before the hit, and doing so with the <strong>intention of transferring that energy</strong> to you is more than your body can effectively compensate. This is where <strong>injury</strong> occurs and this <strong>will</strong> have a negative effect.</p>\n\n<p><em>Now to dive into the medical terminology a bit:</em></p>\n\n<p>Brain injury is caused by <strong>4 main mechanisms</strong>: </p>\n\n<ul>\n<li><em>Sudden Impact</em> </li>\n<li><em>Rapid Acceleration/Deceleration</em> </li>\n<li><em>Penetration Blast Injury</em></li>\n</ul>\n\n<p>They are also classed in <strong>3 different categories</strong>:</p>\n\n<ul>\n<li><em>Diffuse Axonal Injury</em> </li>\n<li><em>Focal Contusions</em> </li>\n<li><em>Hematomas (bleeding, in or around the brain)</em></li>\n</ul>\n\n<p>Milder impacts usually are limited to Diffuse Axonal injuries. The white matter is injured diffusely at the cellular level, damaging the axon terminals of many neurons throughout the brain. These occur primarily from sheering forces related to sudden acceleration/deceleration.</p>\n\n<p>Even though you may experience this in something like gymnastics, it is <strong>generally minor in nature</strong> and does not cause enough damage to actually bruise the brain. If you fall while doing gymnastics and <strong>hit</strong> your head on something <strong>directly</strong> ( like being tackled helmet to helmet) it could <strong>bruise</strong> the brain by causing a <em>coux and/or contre-coux injury.</em> </p>\n\n<p>Our brains are insulated with a layer of fluid between it and the skull - but a <strong>strong</strong> and <strong>sudden impact</strong> can cause the brain to hit the skull.</p>\n\n<p>When the head moves too quickly for the brains <em>resting inertia</em> to smoothly go with it the brain hits the skull's interior wall. Much the same way you may hit your face on the dash of a car if someone slams the brakes and you aren't ready and wearing a seat-belt. </p>\n\n<p>On top of this there is also another impact of the brain against the <strong>opposite</strong> side of the skull as the brain by itself cannot dissipate that recoiled energy from the first impact. The result is said to be a <em>coux-contrecoux impact/injury.</em> This results in a bruising of the brain at the point of initial impact, as well as the point opposite.</p>\n\n<p>If the mechanism is high enough it can even cause a <em>hematoma</em>, which is basically a brain bleed and is a <strong>medical emergency</strong>. If left unchecked these can often be <strong>fatal</strong>. As pressure in the head increases due to blood accumulation in the closed <em>intracranial cavity</em> the brain will eventually begin to <em>herniate</em> through the base of the skull.</p>\n\n<p>I hope that answers your question. If you want more information about intracranial bleeds I suggest researching \"Cushing's Reflex/Triad\". </p>\n\n<p>Here's a link to a video explaining it further as well as a reference for more detailed information : <a href=\"https://www.youtube.com/watch?v=U9x_s6c0EGQ\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=U9x_s6c0EGQ</a></p>\n\n<p><a href=\"https://tbi.cemmlibrary.org/Mild-TBI-Concussion/Mechanisms-of-TBI\" rel=\"nofollow noreferrer\">https://tbi.cemmlibrary.org/Mild-TBI-Concussion/Mechanisms-of-TBI</a>\n<a href=\"https://tbi.cemmlibrary.org/Mild-TBI-Concussion/Mechanisms-of-TBI\" rel=\"nofollow noreferrer\">https://tbi.cemmlibrary.org/Mild-TBI-Concussion/Mechanisms-of-TBI</a></p>\n", "score": 1 } ]

[ "brain", "sports", "trauma", "brain-damage", "concussion" ]

[ { "answer_id": 4541, "body": "<p>So there are a few things making this a difficult question to answer. Much of the in-depth research hasn't been done on healthy individuals (biomechanics of the foot), but where there's something wrong (pathomechanics of the foot). There is also a difference between what is theoretically best (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3818677\" rel=\"nofollow noreferrer\">found here</a>) and what people actually do (<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1173105/\" rel=\"nofollow noreferrer\">sort of found here</a>). Also, the search terms might not be readily apparent because the biomechanical word for \"standing\" is \"stance\" (eg \"load distribution in stance\").</p>\n\n<p>The best models and papers I found were also behind pay walls (which my institution has access to), but I can summarize the information as follows:</p>\n\n<p>There are 6 main points of pressure in the healthy foot: the heel, and the head of each (5) <a href=\"https://en.wikipedia.org/wiki/Metatarsus\" rel=\"nofollow noreferrer\">metatarsals</a>:</p>\n\n<p><a href=\"https://i.stack.imgur.com/K7erA.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/K7erA.png\" alt=\"Image of load points of the foot.\"></a></p>\n\n<p>The metatarsal head of the hallux (big toe, labeled 2 above) should take about 2x the pressure as the other 4 heads, which roughly balances the left to right load on the foot.</p>\n\n<p>As far as front to back, the only reference I found that calculated an ideal position was the one I <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3818677\" rel=\"nofollow noreferrer\">mentioned before</a>, and seemed to indicate the heel should receive 52.6% +/- 1.36% of the load of the foot (Fig 7). Presumably the rest of the weight would then be distributed to the metatarsal heads as mentioned above.</p>\n\n<p>I will say that was calculated with math I don't quite understand, and on a very idealized adult foot. It might be much more useful to ask the question: \"How do people with healthy feet and gates distribute the load on their feet?\"</p>\n\n<p>That would go back to my <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1173105/\" rel=\"nofollow noreferrer\">second reference</a> and give us this lovely figure: [Fig 1]</p>\n\n<p><a href=\"https://i.stack.imgur.com/Dag9K.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Dag9K.jpg\" alt=\"Load of adult and children taken at stance\"></a></p>\n\n<p>My final conclusion is that if you are concerned about your gate you should see an OT or PT. Check for uneven wear on the feet, and try to stay \"balanced.\"</p>\n", "score": 6 } ]

[ "posture", "feet" ]

[ { "answer_id": 4399, "body": "<p>It's so that the correct dosage of medication to be administered can be drawn in the syringe and to get rid of any air bubbles incidentally drawn.</p>\n\n<p>The syringe has milliliter (and fractions thereof) markers on the barrel. In order to get the right volume of medication from the vial/ampule, one has to get rid of any air bubbles incidentally drawn in. By holding the syringe vertically and tapping it, you encourage bubbles to float to the top of syringe, then pushing the plunger expels any air bubbles and extra medication that might be in the syringe.</p>\n\n<p>A tiny bit of air injected into a vein will not usually do any harm to a normal person. It merely gets dissolved in the blood or tissue it is injected into. </p>\n\n<p>If you are interested in knowing more about it, you can read this <a href=\"http://emedicine.medscape.com/article/761367-overview\">Medscape</a> article, which states:</p>\n\n<blockquote>\n <p>...it has been estimated that more than 5 mL/kg of air displaced into the intravenous space is required for significant injury (shock or cardiac arrest) to occur. However, complications have been reported with as little as 20 mL of air.</p>\n</blockquote>\n\n<p>_{<a href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000530.htm\">Drawing medicine out of a vial</a>}</p>\n", "score": 9 } ]

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

[ { "answer_id": 4554, "body": "<p>In my experience most anesthesiologists use 5 hours as the minimum time necessary for the stomach to be sufficiently empty to make it safe to administer anesthesia. However, their criteria is quite stringent because the consequences of the stomach not actually being empty can be severe (aspiration of vomit). </p>\n\n<p>The National Health Service (UK) offers <a href=\"http://www.nhs.uk/chq/pages/861.aspx?categoryid=73&amp;subcategoryid=103\" rel=\"noreferrer\">this guideline</a>:</p>\n\n<blockquote>\n <p>As a general rule, medicines that are supposed to be taken on an empty\n stomach should be taken about an hour before a meal, or two hours\n after a meal.</p>\n</blockquote>\n\n<p>I've seen that guideline used in medication instructions so I believe it is widely accepted.</p>\n", "score": 6 } ]

[ "medications", "digestion" ]

[ { "answer_id": 10603, "body": "<p>The WHO recommended duration of breastfeeding is not six months, but <strong>a minimum</strong> of six months. The paper you link to does not say whether the breastfeeding mothers had low serum iron and ferritin or not. Low serum iron and ferritin will certainly result in low breastmilk iron.</p>\n\n<p>To answer your question: no, iron deficiency anemia \"per se\" is not a serious threat to breastfed infants. (by serious I mean a potentially lethal condition). </p>\n", "score": 1 } ]

[ "nutrition", "infant", "iron", "breastfeeding", "who-world-health-org" ]

[ { "answer_id": 14349, "body": "<p>This is only a partial answer. Actual studies on this are indeed hard to find.</p>\n\n<p>First of all: the healing information waves of the herbs you bring near your astral body and other such nonsense will feature in some related answers; not here. </p>\n\n<p><a href=\"https://sew4home.com/tips-resources/sewing-tips-tricks/organic-fillers-warming-pads-we-compare-rice-corn-and-flaxseed\" rel=\"nofollow noreferrer\">Grain bags</a> or cherry pit pillows are indeed used as a heat storage and delivery device. Only for heat delivery they <a href=\"http://www.leitlinien.de/nvl/html/kreuzschmerz/kapitel-5\" rel=\"nofollow noreferrer\">currently feature as \"doesn't hurt, may help, increases comfort and well being\" for physician guidelines for lower back pain.</a></p>\n\n<p>For the primary effect they are intended to deliver there might be even more convincing findings behind them:</p>\n\n<blockquote>\n <p><a href=\"https://www.livescience.com/890-study-heating-pads-relieve-internal-pain.html\" rel=\"nofollow noreferrer\">When heat over 104 degrees Fahrenheit (40 Celsius) is applied to the skin, heat receptors deeper down, where the pain is, are switched on. The heat receptors in turn block the effect of chemical messengers that cause pain to be detected by the body</a>.<br>\n Specifically, King and his colleagues discovered that a heat receptor called TRPV1 can block P2X3 pain receptors.</p>\n</blockquote>\n\n<p><strong>The filling of these bags or pillows actually does matter for a variety of reasons.</strong></p>\n\n<p>In the past they were most <a href=\"http://tipnut.com/make-your-own-microwave-heating-pad/\" rel=\"nofollow noreferrer\">popularly</a> filled with <a href=\"https://sew4home.com/tips-resources/sewing-tips-tricks/organic-fillers-warming-pads-we-compare-rice-corn-and-flaxseed\" rel=\"nofollow noreferrer\">simple</a> grains like wheat, rice or barley. <a href=\"https://www.sciencedaily.com/releases/2013/04/130417091648.htm\" rel=\"nofollow noreferrer\">This provides</a> a nice and even, down-weighing sensation of heat. But these are problematic because of their moisture content and inherent instability. They break down and dehusk, releasing <a href=\"https://familydoctor.org/condition/occupational-respiratory-disease/?adfree=true\" rel=\"nofollow noreferrer\">harmful dust and particles</a>. </p>\n\n<p>If used in this way they also tend to rot and mould quickly. Also <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12669902\" rel=\"nofollow noreferrer\">the</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11957384\" rel=\"nofollow noreferrer\">allergenic</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/5365019\" rel=\"nofollow noreferrer\">potential</a> of the ingredients is concerning. This is another reason for not using them to apply cold: moulding will be even quicker then. For a quick make-shift heat applicator they might still be an option, just discard them after some very few uses to make sure.</p>\n\n<p>Cherry pits seem less problematic in both regards, being described as a much \"drier heat\" but they too <a href=\"https://www.aerztezeitung.de/panorama/article/588757/heisses-koernerkissen-setzt-bett-brand.html\" rel=\"nofollow noreferrer\">can</a> be <a href=\"http://www.telegraph.co.uk/news/health/elder/10638872/Alert-over-dangers-of-wheat-bags-after-pensioner-dies.html\" rel=\"nofollow noreferrer\">quite</a> a <a href=\"https://www.productsafety.gov.au/news/wheat-bag-fire-hazards\" rel=\"nofollow noreferrer\">surprising fire hazard</a> when brought to <a href=\"https://www.choice.com.au/home-and-living/heating/home-heating/articles/heat-wheat-bag-danger-and-new-voluntary-standard-140616\" rel=\"nofollow noreferrer\">heat in a microwave</a>. </p>\n\n<p>From the <a href=\"http://mitrade.in/product/cherry-stone-pillow-for-adults/\" rel=\"nofollow noreferrer\">manufacturer</a> of a cherry stone pillow sold as medical equipment:</p>\n\n<blockquote>\n <p>Attention: Important safety information:<br></p>\n \n <ul>\n <li>Please do observe the specified heating instructions. Prolonged heating can cause higher energy and damage the pillow (ignition hazard)!</li>\n <li>Please warm the pillow under supervision and ensure it is not humid!</li>\n <li>Let the pillow cool before the next heating!\n […]</li>\n <li><p>Important Note:\n While using the cherry stone pillow for babies / children, please also note the following:\n Make sure the product is intact and sealed properly! For loose cherry stones can cause choking hazard and suffocation!\n Use only under close adult supervision!\n Check for the suitable temperature for your child using your elbow (max. 41°C)![…]</p>\n \n <p>Special instructions: To prevent decay/ formation of mold:</p></li>\n <li>Do not wash the Cherry stone pillows.</li>\n <li>Store product dry! Protect from moisture!</li>\n </ul>\n</blockquote>\n\n<p><strong>The heat storing and distribution properties of <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16856441\" rel=\"nofollow noreferrer\">different</a> <a href=\"https://www.sciencedaily.com/releases/2013/04/130417091648.htm\" rel=\"nofollow noreferrer\">fillers</a> is an obvious variable to consider. Together with a parameter that is less easy to measure: coziness.</strong></p>\n\n<p>Adding other flowers, herbs and spices is often done for the non-part of this answer from the first paragraph. But when using it for delivering heat they obviously can relase volatile substances like essential oils which can have a variety of effects. Adding <a href=\"https://en.wikipedia.org/wiki/Lavender_oil\" rel=\"nofollow noreferrer\">lavender</a> flowers will smell beautifully and calm you down. However, all those additives I saw added to these pillows substantially increase the mould, allergy and fire hazards. If they are known or even just suspect to be effective and wanted it's probably best to use them isolated. </p>\n\n<p>So, yes: the content of the bags does matter quite a bit. Using hard and dry kernels – like cherry pits or grape seeds – seems as good as using just pure sand; and both are better than grains or colourful mixtures of sometimes dubious effect.</p>\n", "score": 3 } ]

[ "natural-remedy", "massage" ]

[ { "answer_id": 4608, "body": "<p>Unless there have been animals around it recently, it's unlikely there are any viruses on it. As for bacteria, or more specifically <a href=\"https://en.wikipedia.org/wiki/Bacterial_spore\" rel=\"nofollow\">bacterial <em>spores</em></a>, wet heat is a far better sanitizer than alcohol. A half hour at a full boil should kill anything particularly nasty, like clostridium tetani.</p>\n\n<p>If you want absolute peace of mind this should do the trick, although I'm not sure if that handle will make it through this process:</p>\n\n<ol>\n<li>Scrub off any large debris.</li>\n<li>Put it in an <a href=\"https://en.wikipedia.org/wiki/Autoclave\" rel=\"nofollow\">autoclave</a>. If you don't have an autoclave, a <a href=\"https://en.wikipedia.org/wiki/Pressure_cooking\" rel=\"nofollow\">pressure cooker</a> should do the trick.</li>\n<li>Run the device according to the directions. It's pressurized steam, after all, you don't want to blow up or burn up.</li>\n<li>Wait for it to cool, then use as normal.</li>\n</ol>\n", "score": 2 } ]

[ "sanitation", "contaminate" ]

[ { "answer_id": 4595, "body": "<p><strong>They're successful about two thirds of the time, which is better than other techniques.</strong></p>\n\n<p>In general, success rates of diagnosis using wireless capsule endoscopy (WCE) range from ~61%-71%, but hover around ~66%. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16696781\" rel=\"nofollow\">Triester et al. (2006)</a> wrote a meta study comparing detection rates using WCE with rates from other methods, including</p>\n\n<ul>\n<li>barium radiography</li>\n<li>ileoscopy</li>\n<li>computer tomography enterography/enteroclysis</li>\n<li>small bowel MRI</li>\n</ul>\n\n<p>In all cases, WCE proved superior to other technologies, often by a significant amount.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16373764\" rel=\"nofollow\">Hara et al. (2006)</a> also compared techniques, finding a 71% success rate for WCE, a 65% success rate for ileoscopy, a 53% success rate for CT enterography, and a 24% success rate for small bowel follow through methods. In this case, the margin of difference of success rate was much smaller.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/14648412\" rel=\"nofollow\">Voderholzer et al. (2003)</a> did a general study on several related diseases and found a pathological lesion detection rate of 59%. However, the threshold for the number and type of lesions to qualify as Crohn's disease is often subjective, and this is not necessarily indicative of diagnosis rates.</p>\n\n<p>The bottom line, though, is that WCE is pretty effective, especially compared to other methods.</p>\n", "score": 4 } ]

[ "diagnostics", "irritable-bowel-syndrome", "crohns", "endoscopy" ]

[ { "answer_id": 4607, "body": "<blockquote>\n <p><strong>Does carbon monoxide poisoning make you tired before it kills you?</strong></p>\n</blockquote>\n\n<p>The symptoms of carbon monoxide poisoning can vary per person it affects, and it can also depend on the the levels of exposure to each person. The short answer would be <strong>yes</strong>, general fatigue and tiredness can be a symptom of carbon monoxide poisoning. </p>\n\n<p>I believe this is accurate for one being based on <strong>a symptom being weakness</strong>(2) which weakness can correlate to fatigue or tiredness.</p>\n\n<p>Furthermore, based on the bio-molecular\\bio-mechanical explanation of </p>\n\n<blockquote>\n <p>Once inhaled, carbon monoxide passes from your lungs into your bloodstream, where it attaches to the hemoglobin molecules that normally carry oxygen. Oxygen can't travel on a hemoglobin molecule that already has carbon monoxide attached to it. As exposure continues, the gas hijacks more and more hemoglobin molecules, and the blood gradually loses its ability to carry enough oxygen to meet your body's needs. Without enough oxygen, individual cells suffocate and die, especially in vital organs such as the brain and heart.(1). </p>\n</blockquote>\n\n<p>This correlates to oxygen being depleted and <a href=\"http://hyperphysics.phy-astr.gsu.edu/hbase/biology/celres.html\" rel=\"nofollow\">cellular respiration</a> not taking place to produce energy for the human body to optimally function; thus, another reason general fatigue and tiredness would occur. </p>\n\n<ul>\n<li><a href=\"http://www.dailymail.co.uk/health/article-1357042/Why-feeling-tired-time-mean-theres-killer-house.html\" rel=\"nofollow\"><strong>Why-feeling-tired-time-mean-theres-killer-house</strong></a></li>\n<li><a href=\"http://www.drugs.com/health-guide/carbon-monoxide-poisoning.html\" rel=\"nofollow\"><strong>Carbon Monoxide Poisoning</strong></a>(1)</li>\n</ul>\n\n<blockquote>\n <h2><a href=\"http://www.mayoclinic.org/diseases-conditions/carbon-monoxide/basics/symptoms/con-20025444\" rel=\"nofollow\"><strong>Carbon monoxide poisoning</strong></a>(2)</h2>\n \n <p>Signs and symptoms of carbon monoxide poisoning may include:</p>\n \n <ul>\n <li>Dull headache</li>\n <li>Weakness</li>\n <li>Dizziness</li>\n <li>Nausea or vomiting</li>\n <li>Shortness of breath</li>\n <li>Confusion</li>\n <li>Blurred vision</li>\n <li>Loss of consciousness</li>\n </ul>\n \n <p>Carbon monoxide poisoning can be especially dangerous for people who\n are sleeping or intoxicated. People may have irreversible brain damage\n or even be killed before anyone realizes there's a problem.</p>\n \n <p><strong>When to see a doctor</strong></p>\n \n <p>The warning signs of carbon monoxide poisoning can be subtle. But the\n condition is a life-threatening medical emergency. If you think you or\n someone you're with may have carbon monoxide poisoning, get into fresh\n air and seek emergency medical care.</p>\n</blockquote>\n", "score": 5 } ]

[ "brain", "oxygenation", "pulmonology", "drowsy", "carbon-monoxide-poisoning" ]

[ { "answer_id": 4759, "body": "<p><strong>Pre-Update:</strong></p>\n\n<p>Your question is misleading in two regards: </p>\n\n<ol>\n<li>The title head of the question, combined with the tag, assumes that there's some age limit to who can receive this virus. <strong>There is currently no proven age limit for contracting the zika virus.</strong> <a href=\"http://www.cdc.gov/zika/disease-qa.html\" rel=\"nofollow\">http://www.cdc.gov/zika/disease-qa.html</a> </li>\n</ol>\n\n<p>It's transmittable through mosquitoes and sex. <a href=\"http://wwwnc.cdc.gov/travel/notices/alert/zika-virus-cape-verde\" rel=\"nofollow\">http://wwwnc.cdc.gov/travel/notices/alert/zika-virus-cape-verde</a></p>\n\n<ol start=\"2\">\n<li>\"Health authorities and agencies are now investigating the potential connection between microcephaly and Zika virus, in addition to other possible causes. However <strong>more investigation and research is needed before we will be able to better understand any possible link.</strong>\" <a href=\"http://www.who.int/features/qa/zika/en/\" rel=\"nofollow\">http://www.who.int/features/qa/zika/en/</a></li>\n</ol>\n\n<p>Unfortunately, according to the CDC, not enough research has been done to address when a developing fetus is safe from microcephaly, as of writing this.</p>\n\n<p>Fortunately, the symptoms are treatable with fluid, rest, and tylenol (to relieve fever and pain). \n<a href=\"http://www.cdc.gov/zika/symptoms/index.html\" rel=\"nofollow\">http://www.cdc.gov/zika/symptoms/index.html</a></p>\n\n<p>These are the places currently recorded to have Zika virus.\n<a href=\"http://www.cdc.gov/zika/geo/index.html\" rel=\"nofollow\">http://www.cdc.gov/zika/geo/index.html</a></p>\n\n<p>And here are some facts on prevention to protect yourself in case you live in one of those areas.\n<a href=\"http://www.cdc.gov/zika/prevention/index.html\" rel=\"nofollow\">http://www.cdc.gov/zika/prevention/index.html</a></p>\n\n<p><strong><em>Post-Update:</em></strong>\nI edited your question a bit to clarify and as Carey Gregory already mentioned, <em>microcephaly only occurs in developing children. Since your children are out of the womb, they are no longer at risk of this birth defect.</em></p>\n", "score": 5 }, { "answer_id": 4763, "body": "<p>DaveL already covered the Zika aspects, so I'll just add this.</p>\n\n<p>Microcephaly is a birth defect that happens to developing fetuses, not children. Your children were safe from microcephaly the day they were born without it.</p>\n\n<p><a href=\"http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html\">http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html</a></p>\n", "score": 5 } ]

[ "virus", "infant", "zika-virus", "microcephaly" ]

[ { "answer_id": 14266, "body": "<p>I'm not aware of any work done in this area. A whole blood transfusion is not going replace circulating defective lymphocytes.</p>\n\n<p>On the other hand Hematopoietic Stem Cell Transplantation has some promise in patients with deteriorating lung function.</p>\n\n<blockquote>\n <p>Autologous HSCT could “reset” the host immune system to a point in time when the antigenic triggers of autoimmunity were not present (41). Illustrative of this point, is the fact that pre-HSCT immunity wanes and often disappears after autologous HSCT. In recipients of TBI conditioning and autologous HSCT, the T-cell receptor (TCR) repertoire diversity was shown to normalize after lymphoablation and autologous transplant (42). </p>\n</blockquote>\n\n<p>...</p>\n\n<blockquote>\n <p>But do the benefits of autologous HSCT outweigh the risks? Likely not in autoimmune diseases with low associated mortality, but for scleroderma lung disease the benefits appear compelling. Replicated in multiple phase II reports from Europe and the US, dramatic and durable improvements in skin fibrosis and quality of life measures have been observed along with stabilization of PFTs. Three prospective, randomized clinical trials in patients with SSc and internal organ involvement have compared autologous HSCT treatment to high-dose IV pulse CYC given for up to 12 months. The SCOT trial is still following all subjects through the 54th month primary endpoint, but as detailed above the ASSIST and ASTIS randomized trials have been completed and both report statistically significant clinical benefits after stem cell transplantation.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/mid/NIHMS787239/\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/mid/NIHMS787239/</a></p>\n", "score": 5 } ]

[ "blood", "immune-system", "autoimmune-disease", "blood-donation" ]

[ { "answer_id": 20221, "body": "<p>A quick way to know if a certain treatment method is supported by scientific evidence without asking a physician is to check some free and easy-to-read <strong>evidence-based medical articles</strong> on sites like:</p>\n\n<ul>\n<li><strong>American Family Physician</strong> has articles about many diseases, for example, about <a href=\"https://www.aafp.org/afp/2018/0401/p455.html\" rel=\"nofollow noreferrer\">management and treatment of rheumatoid arthritis</a>; you can see the tables with estimations of strength of evidence.</li>\n<li><strong>Centers of Disease Control and Prevention</strong> has up-to-date articles, mainly about infections, for example, about <a href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\" rel=\"nofollow noreferrer\">flu vaccines</a>.</li>\n<li><a href=\"https://nccih.nih.gov/health/atoz.htm\" rel=\"nofollow noreferrer\"><strong>National Center for Complementary and Integrative Health</strong></a> provides evidence about alternative treatments, acupuncture, herbs, allergies, etc.</li>\n<li><strong>MedlinePlus</strong> has articles about <a href=\"https://medlineplus.gov/druginfo/herb_All.html\" rel=\"nofollow noreferrer\">natural medicines (herbs and supplements)</a>; data are from <em>Natural Medicines Comprehensive Database.</em> </li>\n<li><strong>Cochrane</strong> has thorough summarized reviews, mainly about treatments, for example, about the <a href=\"https://www.cochrane.org/CD011523/UPPERGI_medical-or-operative-treatment-ulcers-stomach-and-upper-small-intestine-resistant-medical-treatment\" rel=\"nofollow noreferrer\">treatment of resistant peptic ulcers</a>.</li>\n</ul>\n\n<p>Paid evidence-based articles:</p>\n\n<ul>\n<li><strong>UpToDate</strong> covers many topics, mainly for clinicians, for example about <a href=\"https://www.uptodate.com/contents/diuretics-and-calcium-balance\" rel=\"nofollow noreferrer\">Diuretics and calcium balance</a>.</li>\n<li><a href=\"https://ebm.bmj.com/\" rel=\"nofollow noreferrer\"><strong>BMJ Evidence-Based Medicine</strong></a> is mainly for researchers. </li>\n</ul>\n", "score": 3 } ]

[ "treatment", "data" ]

[ { "answer_id": 4773, "body": "<p>You have no lack of gut bacteria, that much is very safe to say. Everyone has gut bacteria in spades. The gut bacteria that you do have may not be the optimal, but <em>no one even knows what the optimal gut microbiome/microbiota is.</em> The study of the effects of different populations of gut flora is in its infancy. The most intensive studies are being carried out in animal models, and their applicability to humans is not yet guaranteed.</p>\n\n<p>Can a person change their microbiome with probiotics? Researchers are still dubious. There is a lot of research that indicates that the intestinal flora you carry throughout your life is largely determined in early infancy. Others believe that the microbiome changes over time; this has been shown to occur especially due to illness or antibiotic use.</p>\n\n<p>The two areas of greatest study in humans is <em>obesity</em> (associated with certain strains of gut bacteria in certain populations) and as a treatment for Clostridium Difficile colitis, and none of the findings can be generalized yet to the \"normal\" population. Inflammatory Bowel Disease had been studied as well, and some other disorders, to a lesser extent. But how to change our microbiomes is far from a known fact.</p>\n\n<p>However, what scientists who study the gut microbiome do agree on is that <em>a healthy diet is a better way to cultivate a healthy gut microbiome than taking supplements or eating a particular kind of food</em>. Most specialists do not recommend, for example, eating yogurt as an effective way to ingest probiotics. Most yogurts (including those with live cultures) don't have enough CFU's/serving to make a difference, and don't have a diversity of active cultures.</p>\n\n<p>By a healthy diet, they mean a diet rich in plant-based foods, low in processed foods, and (using the average Western diet as a basis) decreased amounts of red meat, high-fat food, and sugars.</p>\n\n<p>In other words, a probiotic is not proven or even likely to help you, whereas a healthier diet is. </p>\n\n<p>Of course, you should seek the opinion of a doctor for your digestion problem. In the meantime, a food/symptom diary is a good idea. There may be a food allergy or sensitivity at the root of your problem, and a food/symptom diary could help determine that.</p>\n\n<p>_{<a href=\"https://jid.oxfordjournals.org/content/197/3/435.full\">Decreased Diversity of the Fecal Microbiome in Recurrent Clostridium difficile—Associated Diarrhea </a>}<br>\n_{<a href=\"http://www.nature.com/nature/journal/v474/n7351/abs/nature10213.html\">Human nutrition, the gut microbiome and the immune system</a>}<br>\n_{<a href=\"http://www.mdpi.com/2072-6643/5/1/234/htm\">Diet-Microbiota Interactions and Their Implications for Healthy Living</a>}<br>\n_{<a href=\"http://physrev.physiology.org/content/90/3/859.short\">Gut Microbiota in Health and Disease</a> &lt;- Excellent (and long) review article.}<br>\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0092867412001043\">The Impact of the Gut Microbiota on Human Health: An Integrative View</a>}</p>\n", "score": 7 } ]

[ "digestion", "bacteria", "gastroenterology", "gut-microbiota-flora" ]

[ { "answer_id": 4955, "body": "<p>There's nothing else to be released, because when microwave production is stopped the waves cease to exist.</p>\n\n<p>From the <a href=\"http://www.fda.gov/Radiation-EmittingProducts/ResourcesforYouRadiationEmittingProducts/ucm252762.htm#Microwave_Oven_Safety_Standard\" rel=\"noreferrer\">FDA's FAQ about microwave safety</a>: </p>\n\n<blockquote>\n <p>systems that stop the production of microwaves the moment the latch is released or the door opened. In addition, a monitoring system stops oven operation in case one or both of the interlock systems fail. The noise that many ovens continue to make after the door is open is usually the fan. The noise does not mean that microwaves are being produced. There is no residual radiation remaining after microwave production has stopped. In this regard a microwave oven is much like an electric light that stops glowing when it is turned off.</p>\n</blockquote>\n\n<p>Provided that your microwave meets regulations regarding the double locking mechanism, more radiation is leaked when the door is closed and the microwave is on than when the door is opened and the microwave is off.</p>\n", "score": 6 } ]

[ "microwaves" ]

[ { "answer_id": 4909, "body": "<blockquote>\n <p>Is there any truth behind chemotherapy actually <strong>curing</strong> Multiple Sclerosis?</p>\n</blockquote>\n\n<p><strong>Unfortunately, no</strong>. Multiple sclerosis (MS) is a chronic illness - meaning that it cannot be completely cured. There are, however, various therapeutic options for patients suffering from MS. Some of them include chemotherapeutics - but not as the first-line treatment.</p>\n\n<p>The important thing to understand is that there are many forms of MS, which can roughly be categorised in four groups:</p>\n\n<ol>\n<li>Relapsing - remitting (RR)</li>\n<li>Primary progressive</li>\n<li>Progressive relapsing</li>\n<li>Secondary progressive</li>\n</ol>\n\n<p>Severity, clinical manifestations and treatment options differ across these types. The most common type is RR. </p>\n\n<hr>\n\n<h2>RR therapeutic approach</h2>\n\n<p>For RR there are two sorts of treatment:</p>\n\n<ol>\n<li>Treatment in an acute <a href=\"https://en.wikipedia.org/wiki/Relapse\" rel=\"noreferrer\">relapse</a>, where short-term corticosteroid treatment is used to stop the attack</li>\n<li>Disease modifying treatment - which is used regularly in order to reduce the frequency and severity of relapses, and improve prognosis.</li>\n</ol>\n\n<p>It is the second group, where chemotherapy can be used, but, as mentioned above not as a first-line treatment. This means that other therapeutic options should be tried first. These are predominantly glatiramer acetate or interferon beta. If they don't work some other medicines are considered. Only if they don't work either, the next option is using chemotherapeutic agents.</p>\n\n<hr>\n\n<h2>How would a chemotherapeutic work in MS?</h2>\n\n<p>There are, again two approaches. The first one is to use these medicines, at lower doses than to treat cancer, to suppress the immune system. Since MS is an autoimmune disease, immune suppression reduces the inflammation and damage to the myelin sheet. Another approach is to use these medicines to ablate the immune system prior to autologous stem cell transplant, where the patient's bone marrow is replaced with their stem cells. This line of treatment is, however, still in experimental phase and has not been approved. There are many complications, difficulties and side-effects of this procedure, and thus far the risks outweigh the benefits. </p>\n\n<hr>\n\n<h2>Examples</h2>\n\n<p>Some sorts of chemotherapeutic agents that have been used or tested for MS:</p>\n\n<ul>\n<li><p>Cladribine has been tested for MS and even approved in some countries, but after it was rejected by the FDA and EMeA on the basis of lacking evidence for benefits outweighing the risks, the manufacturer stopped marketing applications, since new clinical trials would be costly. </p></li>\n<li><p>Cyclophosphamide has also been investigated. Efficacy in aggressive form of disease was reported, but so were some serious adverse effects. Further research in necessary, and official guidelines, such as those by the National Institute for Health and Care Excellence (NICE) do not recommend use of cyclophosphamide in MS treatment. </p></li>\n<li><p>Methotrexate has shown no significant efficacy in primary progressive MS, and was less effective than interferon beta in RR.</p>\n\n<hr></li>\n</ul>\n\n<p>References:</p>\n\n<p>_{<a href=\"https://www.cadth.ca/sites/default/files/pdf/TR0004_RRMS_PiB_e.pdf\" rel=\"noreferrer\">Drug Therapies for Relapsing-Remitting Multiple Sclerosis</a>}</p>\n\n<p>_{<a href=\"https://www.cadth.ca/sites/default/files/pdf/TR0004_RRMS_RecsReport_TR_e.pdf\" rel=\"noreferrer\">Recommendations for Drug Therapies for Relapsing-Remitting Multiple Sclerosis</a>}</p>\n\n<p>_{<a href=\"http://www.aafp.org/afp/2014/1101/p644.html\" rel=\"noreferrer\">Multiple Sclerosis: A Primary Care Perspective</a>}</p>\n\n<p>_{<a href=\"http://journals.cambridge.org/download.php?file=%2FCJN%2FCJN40_03%2FS0317167100014244a.pdf&amp;code=d511780b3c65cd6bb38b329bcd41b762\" rel=\"noreferrer\">Treatment Optimization in MS: Canadian MS Working Group Updated Recommendations</a>}</p>\n\n<p>_{<a href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa0902533\" rel=\"noreferrer\">A Placebo-Controlled Trial of Oral Cladribine for Relapsing Multiple Sclerosis</a>}</p>\n\n<p>_{<a href=\"http://www.merckgroup.com/en/media/extNewsDetail.html?newsId=DAA395BF12E226E6C12578B6007430DB&amp;newsType=1\" rel=\"noreferrer\">Merck: Regulatory Update on Cladribine Tablets</a>}</p>\n\n<p>_{<a href=\"https://www.nice.org.uk/donotdo/interventions-affecting-disease-progression-cyclophosphamide-should-not-be-used-in-patients-with-multiple-sclerosis-because-research-evidence-does-not-show-beneficial-effects-on-the-course-of-the\" rel=\"noreferrer\">Interventions affecting disease progression: cyclophosphamide should not be used in patients with multiple sclerosis (because research evidence does not show beneficial effects on the course of the condition).</a>}</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214348/\" rel=\"noreferrer\">Effects of low dose methotrexate on relapsing-remitting multiple sclerosis in comparison to Interferon β-1α: A randomized controlled trial</a>}</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15106195\" rel=\"noreferrer\">Methotrexate for multiple sclerosis</a>}</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23192675\" rel=\"noreferrer\">Hematopoietic stem cell therapy for multiple sclerosis: top 10 lessons learned.</a>}</p>\n", "score": 7 } ]

[ "treatment", "autoimmune-disease", "clinical-study", "multiple-sclerosis", "chemotherapy" ]

[ { "answer_id": 18582, "body": "<p>Noroviruses (NoVs) and Rotaviruses (RVs) recognize histo-blood group antigens (HBGA) (<a href=\"https://doi.org/10.1017/erm.2014.2\" rel=\"nofollow noreferrer\">Tan &amp; Jiang, 2014</a>). HBGA are found on most epithelial cells, which line the gut. It would make sense then, that certain strains of NoV or RV may have a higher affinity for certain HBGAs; or even not be able to bind to a certain HBGA. This is not a novel idea and is found throughout virology. Here is a paper that discusses NoVs and RVs in the context of HBGAs.</p>\n\n<p><strong>References</strong></p>\n\n<p>Tan, M., &amp; Jiang, X. (2014). Histo-blood group antigens: A common niche for norovirus and rotavirus. <em>Expert Reviews in Molecular Medicine, 16</em>, E5. doi: <a href=\"https://doi.org/10.1017/erm.2014.2\" rel=\"nofollow noreferrer\">10.1017/erm.2014.2</a></p>\n", "score": 4 } ]

[ "blood", "infection", "antigen" ]

[ { "answer_id": 5221, "body": "<p>What you are asking about is called <em><a href=\"https://en.wikipedia.org/wiki/Bioavailability\" rel=\"noreferrer\">bioavailability</a></em>, which is the term for how much of a consumed substance is actually taken up by the body, and <a href=\"https://en.wikipedia.org/wiki/Bioequivalence\" rel=\"noreferrer\">bioequivalence</a>, which is about whether two products are used the same way in the body.</p>\n\n<p><strong><em>Protein</em></strong></p>\n\n<p>For protein, bioavailability is also called <a href=\"http://www.food-info.net/uk/protein/bv.htm\" rel=\"noreferrer\">Biological Value (BV)</a>. The BV of an egg, for example is <a href=\"http://www.fao.org/docrep/005/AC854T/AC854T74.htm#chII.I.7\" rel=\"noreferrer\">somewhere around 93</a> (see column 5). For cooked chicken, <a href=\"http://www.fao.org/docrep/005/AC854T/AC854T74.htm#chII.I.6\" rel=\"noreferrer\">a bit over 70</a>. </p>\n\n<p>It's hard to find sources for protein powder/shakes that don't seem biased (being from the manufactors of the protein, or bodybuilding sites), but here's a study from the Journal of Sports Science and Medicine: <a href=\"http://www.jssm.org/vol3/n3/2/v3n3-2pdf.pdf\" rel=\"noreferrer\">Protein - Which is best?</a>. It uses an adjusted scale, where a whole egg has a biological value of 100. In that scale, since whey protein has a higher BV than whole egg, it comes out as 104. Soy protein and casein have BVs in the mid-70s, a bit lower than beef.</p>\n\n<p>As for whether they have the same effect, well, what's different betrween different sources of protein is <em>composition</em>. Proteins are made from building blocks called amino acids, of which there are 20 in food. Many of those can be converted from one to the other or made from other things we eat, but <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/002222.htm\" rel=\"noreferrer\">9 amino acids are called 'essential'</a> and have to be eaten. Different foods, including protein powders differ in what amino acids they have. Usually, protein powders will contain these. How much they contain will depend on the product. </p>\n\n<p>Keep in mind that no source of is 'perfect' in that regard, either. A bean does not have the same amino acid composition in its proteins as a human body does. Neither does whey protein. Deficiency in essential amino acids isn't pleasant, <a href=\"http://www.ncbi.nlm.nih.gov/books/NBK234922/\" rel=\"noreferrer\">but it is rare in people who aren't generally malnutritient and consume enough protein overall, from more than one source</a>.</p>\n\n<p><strong><em>Vitamins</em></strong></p>\n\n<p>Basically, a lot of the same applies for vitamins. They aren't perfectly bioavailable when digested from food <em>or</em> from a multivitamin, sometimes one is better, sometimes the other. Answering this for all vitamins is way too broad, and it probably also depends on the product. The paper <a href=\"http://ajcn.nutrition.org/content/85/1/269S.full\" rel=\"noreferrer\">Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions</a> goes into a few of the problems and general concepts. </p>\n\n<p>For example, it looks like the bioavailibility of folic acid taken up from dietery supplements <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17284745\" rel=\"noreferrer\">is higher than that from food</a>, and especially outperforms <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15447898\" rel=\"noreferrer\">spinach and yeast</a> (warning: low number of subjects in study...). For vitamin C, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847730/\" rel=\"noreferrer\">Synthetic or Food-Derived Vitamin C—Are They Equally Bioavailable?</a> summarizes:</p>\n\n<blockquote>\n <p>In contrast, all steady state comparative bioavailability studies in humans have shown no differences between synthetic and natural vitamin C, regardless of the subject population, study design or intervention used. Some pharmacokinetic studies in humans have shown transient and small comparative differences between synthetic and natural vitamin C, although these differences are likely to have minimal physiological impact</p>\n</blockquote>\n\n<p>And goes on to say:</p>\n\n<blockquote>\n <p>Although synthetic and food-derived vitamin C appear to be equally bioavailable in humans, ingesting vitamin C as part of a whole food is considered preferable because of the concomitant consumption of numerous other macro- and micronutrients and phytochemicals, which will confer additional health benefits. </p>\n</blockquote>\n\n<p>So whole foods are preferable, but the vitamin C that you get from the supplements itself isn't any better or worse than the vitamin C an apple contains, and certainly isn't unhealthy. </p>\n\n<p>For some people, getting all vitamins they need from their diet is either impossible or very hard (vitamin D and iron deficiencies are rather common) and that's where supplements like the protein bars you use come in. As pointed out by Atl LED in the comments, though, for vitamin supplements to work it's important to take care of how the multivitamins need to be taken. If they need to be taken with food for maximum absorption, that's important or else you won't get the full benefits. </p>\n\n<p>If protein bars are judged as 'unhealthy' it should be because of things like their sugar content, but it's certainly not true that the proteins or vitamins in them are unhealthy or that we can't use them at all.</p>\n", "score": 8 } ]

[ "nutrition", "micronutrients", "digestion", "supplement", "proteins" ]

[ { "answer_id": 12955, "body": "<p>Although this question is hard to research - you're dependent on self-reported data on sleeping hours, and there are many confounders that influence this relation (why do people sleep longer? maybe people who sleep longer are more likely to be without a job, and being without a job is also associated with higher risk of heart disease etc.).</p>\n\n<p>However, the consensus seems to be that: Yes, it has been found that longer sleep (which is usually defined as >8 hours or 9 hours or longer) is associated with a higher risk of heart disease and also of diabetes. I'm not sure about damage to the brain functions, though I'm sure you could find this out easily too.\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845795/\" rel=\"nofollow noreferrer\">This review</a> gives an overview of studies that have investigated the association between sleep duration and cardiovascular disease.</p>\n", "score": 3 } ]

[ "sleep", "neurology", "cardiology", "organ-damage" ]

[ { "answer_id": 5447, "body": "<p>There's a review article on the effect of Papaya extracts in the treatment of Dengue fever, the main issue being thrombocytopaenia. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071726/\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071726/</a></p>\n\n<p>The best data quoted from that paper says:</p>\n\n<blockquote>\n <p>A study conducted in Malaysia had a more systematic approach in evaluating the use of papaya leaf juice in the treatment of dengue. The juice was obtained from the papaya leaves under hygienic conditions from trees that were grown without insecticides or pesticides. An open-labeled randomized controlled trial was conducted on 290 patients between the ages of 18 and 60 years with platelet counts ≤100,000/μL. The patients were confirmed to be suffering from dengue using a rapid dengue bedside test. Patients in the intervention group were administered fresh juice from 50 g of C. papaya leaves once a day 15 min after breakfast for 3 consecutive days. In addition, they received the standard treatment for dengue. The controls only received the standard treatment. The final analysis was conducted on 111 patients from the intervention group and 117 controls. The study found that there was a significant increase in the platelet counts in the intervention group at the end of 40 h when compared to the counts 8 h after the intervention began. This significant increase was not observed in the control group. An increase in arachidonate 12-lipoxygenase and the platelet-activating factor receptor gene expression was also observed in the intervention group. These genes are associated with increased platelet production.[7]</p>\n</blockquote>\n\n<p>The study itself <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638585/\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638585/</a> concludes</p>\n\n<blockquote>\n <p>the administration of CPLJ in DF and DHF is safe and does induce the rapid increase in platelet count. It may play a valuable role in the management of DF in the near future.</p>\n</blockquote>\n\n<p>Carica papaya leaves juice (CPLJ). \nPatients with dengue fever (DF). \nDengue haemorrhagic fever (DHF).</p>\n", "score": 6 } ]

[ "natural-remedy", "mosquito", "zika-virus", "malaria" ]

[ { "answer_id": 5538, "body": "<p>Yes. It is possible to remineralize teeth without cavitation. I am unsure what you mean by corroding, but cavities cannot be fixed by remineralization. Products can inhibit damage and harden intact and decalcified enamel.</p>\n<ul>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10686854\" rel=\"nofollow noreferrer\">Remineralizing tooth paste.</a></p>\n</li>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/14700079\" rel=\"nofollow noreferrer\">Xylitol</a></p>\n</li>\n</ul>\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18517060\" rel=\"nofollow noreferrer\">Low Cariogenic diet</a></p>\n<blockquote>\n<p>Initial caries lesions without cavitation of the surface can\nremineralise (heal) under conditions of low cariogenic diet and good\noral hygiene. However, once the surface has broken and cavitation\noccurred, there is no alternative to restorative dental therapy\nbecause remineralisation is no more possible.</p>\n</blockquote>\n<p>Avoiding things like some beverages that break down teeth is a good thing to remember when prevention teeth problems.</p>\n", "score": 3 }, { "answer_id": 5546, "body": "<p>This is only my personal experience, not solid evidence.</p>\n\n<p>I have had holes in my teeth for 10 years without any worsening. I try to eat a balanced diet low in modern refined processed foods, with natural meats like wild game. </p>\n\n<p>Also I listen to my body, if I get pain in my teeth, it is a reminder to clean better and stop eating sugar, the pain goes away if I do this.</p>\n", "score": 0 } ]

[ "dentistry", "minerals" ]

[ { "answer_id": 12952, "body": "<p>Cooling burn-injured skin has a benificial effect on the extent or depth of the wound. This cannot fully be explained by only \"taking away the heat\". We know this, because delayed cooling still has a beneficial effect, even if the intradermal temperature has already fully normalized.<br> \nCooling a burn wound influences important cellular and humoral mediators involved in the inflammatory respons that develops in the burning skin. However, the mechanisms are still not fully understood. </p>\n\n<p><a href=\"http://www.sciencedirect.com/science/article/pii/S0305417915000054?via%3Dihub\" rel=\"nofollow noreferrer\">This review</a> gives some interesting background information.</p>\n", "score": 3 }, { "answer_id": 5839, "body": "<p>Cooling a burn will reduce swelling and help with pain.</p>\n\n<p>(I am first aid / CPR / AED certified. I am also certified to teach first aid / CPR.)</p>\n", "score": 0 } ]

[ "dermatology", "burns" ]

[ { "answer_id": 10413, "body": "<p>I also tried to search for any formal information about the product's contents and composition, but couldn't find anything, probably because it is a generic product sold at a supermarket.\nAt any rate, this kind of composition (capsule, pellets and tablet) seems to form the mechanism for the 'delayed release' of Omeprazole, as written on the package.\n<a href=\"https://i.stack.imgur.com/lPM2B.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/lPM2B.jpg\" alt=\"Omeprazole Magnesium package\"></a></p>\n\n<p>Omeprazole is a drug with a rather short half-life (0.5-1 hour according to <a href=\"https://www.drugbank.ca/drugs/DB00338\" rel=\"noreferrer\">Drug Bank</a>). This means that without any intervention in its pharmacokinetics (absorption, elimination time), it will start working in reducing stomach acid rather quickly - Immediate-release Omeprazole should be taken shortly (about 30 minutes) before eating, in order to reduce stomach acid prior to or during eating.</p>\n\n<p>Now, although Omeprazole's effect is in the stomach, it needs to be protected from the acidic content of the stomach, where it passes before it is absorbed into the blood. After passing the stomach, it is absorbed into the blood and then reaches the parietal cells of the stomach lining and exerts its effect.</p>\n\n<p>In order to make Omeprazole more friendly to the patient, and remove the need to take it only half an hour before eating (thus imposing limitations on the patient and increasing the risk of improper use that might lead to heartburn), delayed-release formulations have been developed. Their main difference and advantage is that the patient does not have to take the capsule only before eating - once he takes the capsule, its contents are <strong>slowly</strong> released in the body (more slowly than the immediate release formulation), thus providing a delayed effect throughout the day. That is why delayed-release Omeprazole should only be taken once a day (usually in the morning).</p>\n\n<p>The delayed release mechanism is comprised of the pellets and the tablet. The pellets, being smaller, start to disintegrate and release the active ingredient Omeprazole before the tablet (but only after passing through the stomach, since they are enteric-coated as mentioned before). Meanwhile the tablet starts to dissolve, disintegrate and release the active ingredient, but this happens more slowly. After many calculations, it was possible to formulate the capsule and its contents in such a way that one capsule covers an entire day (24 hours). This enables the patient to take one capsule in the morning and act as usual, without worrying about getting heartburn after eating.</p>\n\n<p>As I said in the beginning, I was unable to find formal documentation for this mechanism of delayed release, but the <a href=\"https://www.walmart.com/ip/Equate-Omeprazole-Magnesium-Capsules-20.6mg-42ct/14706053\" rel=\"noreferrer\">consumers' questions</a> in Walmart's website seem to point in that direction (see page 7; please note that these answers are most probably not provided by professionals, but by customers and others). See also definition no. 2 <a href=\"http://accesspharmacy.mhmedical.com/content.aspx?bookid=513&amp;sectionid=41488035\" rel=\"noreferrer\">here</a>, which also seems to apply for this capsule's composition.\n <a href=\"https://i.stack.imgur.com/AmaMr.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/AmaMr.png\" alt=\"Q&amp;A from Walmart&#39;s website\"></a></p>\n", "score": 5 }, { "answer_id": 8947, "body": "<p>Couldn't find anything definitive about what it is, but the monograph approved by the FDA only allows Omeprazole as the active ingredient. So it can't be anything that is designed to have an active effect on the body. Also magnesium is not listed as an inactive ingredient anywhere, so we can count that out. If I were to bet I'd say it's just lactose and filler (which is listed under the inactive ingredients and there's basically no volume for it to be in the granules) to give the capsule weight and aid in swallowing/handling. With just the granules the capsule might not have much weight and make consumers think it's empty or not filled correctly or get stuck in the throat more easily.</p>\n\n<p>The enteric coated granules definitely contain the active drug according to every source I could find. </p>\n", "score": 0 } ]

[ "medications" ]

[ { "answer_id": 5898, "body": "<p>Apparently <a href=\"http://www.entnet.org/content/stuffy-nose\" rel=\"nofollow\">exercise causes your nasal membranes</a> to constrict helping you breathe easier. After you exercise the effects wear off and the symptoms return.</p>\n\n<blockquote>\n <p>Membranes in the nose have an abundant supply of arteries, veins, and\n capillaries, which have the ability to expand and constrict. Normally\n these blood vessels are in a half-constricted or half-open state. But\n when a person exercises vigorously, hormone (adrenaline) levels\n increase. Adrenaline causes constriction of the nasal membranes so\n that the air passages open up and the person breathes freely.</p>\n \n <p>The opposite takes place when an allergic attack or a cold develops.\n During a cold, blood vessels expand, membranes become congested, and\n the nose becomes stuffy, or blocked.</p>\n \n <p>In addition to allergies and infections, certain circumstances can\n cause nasal blood vessels to expand, leading to vasomotor rhinitis.</p>\n</blockquote>\n\n<p><a href=\"http://fitnessandwellnessnews.com/work-out-sinus-pressure/\" rel=\"nofollow\">fitnessandwellnessnews.com</a>, also make a valid argument. However, there's pertains less to the situation.</p>\n\n<blockquote>\n <p>Exercise can temporarily relieve nasal congestion. The increase in\n circulation clears sinus pressure and allows for easier breathing. An\n aerobic workout is especially successful in clearing congestion with\n its cardio focus. Although you may want to blend in with the bedding,\n movement provides the best relief. A stuffed nose is worse when lying\n down. Sinuses don’t have gravity working with them to drain cavities\n blocked by mucus. Sinus congestion is also loosened by increased\n temperature in the body’s core. A runny nose may ensue, which,\n although annoying, relieves sinus pressure and stuffiness.</p>\n</blockquote>\n", "score": 2 } ]

[ "exercise", "allergy", "nose" ]

[ { "answer_id": 17505, "body": "<p><a href=\"https://medicalsciences.stackexchange.com/users/3414/graham-chiu\">Graham Chiu</a> put it very well: <code>\"Where would you get a ligament from that isn't going to make you worse off?\"</code></p>\n\n<p>We rely on our ligaments for the structural stability of our skeleton. This supersedes the integrity of our muscular attachments, although there are a few exceptions. Since they're attached to muscles, tendons are going to be more superficial (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124375/\" rel=\"nofollow noreferrer\">easier to access</a>) and <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666537/\" rel=\"nofollow noreferrer\">more abundant</a>.</p>\n\n<p>Some circumstances can necessitate the transfer (not a complete removal as in tendon harvest, but the redirection of one end) of a ligament. This happens when one skeletal structure's stability is secondary to the stability of a neighboring bony union, so a ligament is appropriately reprioritized:</p>\n\n<blockquote>\n <p><strong><a href=\"https://drmillett.com/wp-content/uploads/2017/01/acromioclavicular-joint-reconstruction-coracoacromial-ligament-transfer-docking-technique.pdf\" rel=\"nofollow noreferrer\">\"Acromioclavicular joint reconstruction with coracoacromial \n ligament transfer using the docking technique.\" Millett <em>et al.</em> <em>BMC Musculoskeletal Disorders.</em> 2009.</a></strong> </p>\n \n <p>Symptomatic Acromioclavicular (AC) dislocations have historically been surgically\n treated with Coracoclavicular (CC) ligament reconstruction with transfer of the Coracoacromial (CA) ligament. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved,\n decreasing the risk of recurrent distal clavicle instability.</p>\n \n <p><a href=\"https://i.stack.imgur.com/tUXfE.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/tUXfE.jpg\" alt=\"CClig-CAlig\"></a></p>\n</blockquote>\n", "score": 3 } ]

[ "surgery", "tendons", "knee", "ligament", "laparoscopy-keyhole" ]

[ { "answer_id": 7193, "body": "<p>Persons who do regular physical exercise have a lower heart rate while they are resting (or not exercising): </p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/22081187\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/22081187</a></p>\n\n<p>Hence, their hearts will be beating same number of beats over a longer period of time.</p>\n\n<p>In addition, a number of trials have shown that regular physical exercise is associated with significant health benefits and lower incidence of serious health problems, e.g.: </p>\n\n<p><a href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17018-9/abstract\" rel=\"nofollow\">http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17018-9/abstract</a></p>\n", "score": 3 } ]

[ "exercise", "muscle", "life-expectancy", "metabolism", "physiology" ]

[ { "answer_id": 15621, "body": "<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502130/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502130/</a></p>\n<blockquote>\n<p><strong>Conclusion</strong></p>\n<p>The findings from this study support the view that the mechanism for the JM is a reduction in presynaptic inhibition of alpha motoneurons as it is influenced by physical and not mental activity.</p>\n</blockquote>\n", "score": 2 } ]

[ "physiology", "reflex-impulse" ]

[ { "answer_id": 7415, "body": "<p><em>First, here is a small background on lactose intolerance:</em></p>\n\n<p>Lactose is a disaccharide present in high quantity in mammalian milk. Once in the intestine, it is hydrolysed into glucose and galactose, which are then absorbed. Lactase hydrolisation is dependent on an intestinal brush border enzyme called lactase.</p>\n\n<p><strong>Intestinal lactase activity is highest during the perinatal period</strong> (where milk is essential for the nourishment of newborn). After this period (in general after the weaning period) <strong>lactase activity decreases at variable rates following a normal maturational down-regulation</strong>. As such, two groups of individuals emerge: </p>\n\n<ul>\n<li>the <strong>lactase non-persistence group</strong> with low lactase activity\n(hypolactasia)</li>\n<li>the <strong>lactase persistence group</strong> where the level of lactase activity in\nthe adulthood in similar or slightly less (moderate to high lactase activity) to the one found in the\nneonatal period.</li>\n</ul>\n\n<p>Some studies have suggested a geographic pattern for the distribution of genes associated with the two conditions (the review by <em>Misselwitz et al</em> provides a good overview).</p>\n\n<p>Interestingly, reduction in lactase activity does not always lead to symptoms. However, <strong>when symptoms occur, lactose intolerance is diagnosed</strong>.</p>\n\n<p>The most <strong>frequent cause of lactose malabsorption</strong> is the so-called <strong>“lactase non-persistence” (primary lactase deficiency)</strong>, which is characterised by a decrease in lactase expression during infancy. Note, <strong>in some rare cases</strong>, lactase can be complete lacking causing severe symptoms in the newborns <strong>(congenital lactase deficiency)</strong>. </p>\n\n<p>There are other <strong>secondary causes of lactase malabsorption (secondary or acquired lactase deficiency)</strong>: small bowel bacterial overgrowth, giardiasis (a type of infectious enteritis), coeliac disease, inflammatory bowel disease. In these cases, gastrointestinal disorders damage the brush border of the small intestine and leads to a decrease in lactase activity.</p>\n\n<p>Your question</p>\n\n<blockquote>\n <p>I was told that I am lactose intolerant. How did that happen after so\n many years?</p>\n</blockquote>\n\n<p>There are several possible explanations. First, some studies have shown an increased incidence of lactose intolerance in the elderly, suggesting that lactase activity might decline further with age. In particular, individuals with already intermediate to low lactase activity might be at higher risk of developing lactase intolerance decades after the infancy period. Second a secondary cause for lactase deficiency cannot be excluded. Finally, a study conducted in 1998 showed that there is sometimes a confusion between lactose maldigestion and lactose intolerance. <strong>My two later points are of course only hypothesis</strong>, as you don't provide enough information in your question (in particular how the diagnosis of lactose intolerance was made)</p>\n\n<p>Your question</p>\n\n<blockquote>\n <p>Is it possible to regain/rebuild lactose tolerance?</p>\n</blockquote>\n\n<p>I have found no studies conducted in humans showing that lactase activity could be regained.</p>\n\n<p>Current treatment of lactose intolerance aims at improving symptoms while maintaining sufficient calcium intake, which can be affected by mil restricted diet. According to a concensus of experts, initial management of lactose intolerance is to aim for remission of symptoms by avoiding milk and dairy products. Here an interesting extract of the recommendations:</p>\n\n<blockquote>\n <p>most individuals with lactose malabsorption can tolerate up to 12 g of\n lactose without significant symptoms. After the initially restricted\n diet, lactose should be gradually reintroduced until the patient’s\n threshold for symptoms is reached. At this point, several behavioral\n measures can be adopted to overcome possible symptoms, including\n having fermented and matured milk products in the diet, consuming\n lactose together with other foods, and distributing lactose intake\n over the day.</p>\n</blockquote>\n\n<p>If the above mentioned measures don’t provide any relief, pharmacological strategies can be considered such as lactase supplements, lactose-hydrolyzed or lactose-reduced milk, probiotics, colonic adaptation, and rifaximin. However, some of these intervetions lack evidence based data and show large inter-individual variability.</p>\n\n<p>Sources:</p>\n\n<ul>\n<li>Misselwitz B, Pohl D, Frühauf H, Fried M, Vavricka SR, Fox M. Lactose\nmalabsorption and intolerance: pathogenesis, diagnosis and treatment.\nUnited European Gastroenterology Journal. 2013;1(3):151-159.</li>\n<li>Mattar R, de Campos Mazo DF, Carrilho FJ. Lactose intolerance:\ndiagnosis, genetic, and clinical factors. Clinical and Experimental\nGastroenterology. 2012;5:113-121.</li>\n<li>Lomer M et al. Review article: lactose intolerance in clinical\npractice – myths and realities. Alimentary Pharmacology &amp;\nTherapeutics. 2008:27: 93–103.</li>\n<li>Carroccio et al. Lactose intolerance and self-reported milk\nintolerance: relationship with lactose maldigestion and nutrient\nintake. Lactase Deficiency Study Group.J Am Coll Nutr. 1998\nDec;17(6):631-6.</li>\n</ul>\n", "score": 6 } ]

[ "nutrition", "gastroenterology", "lactose-intolerant" ]

[ { "answer_id": 8926, "body": "<blockquote>\n<p>Is there an objective answer to whether or not taking a multi-vitamin dietary supplement is beneficial to health?</p>\n</blockquote>\n<p>No, there is not.</p>\n<p>If you dig into the existing research, unless you are looking to experience some confirmation bias one way or the other, you will only continue to find evidence that there is no conclusion.</p>\n<p>In this case <a href=\"https://en.wikipedia.org/wiki/Multivitamin#Research\" rel=\"noreferrer\">Wikipedia actually does sum it up nicely</a>, emphasis mine:</p>\n<blockquote>\n<p>Provided that precautions are taken (such as adjusting the vitamin amounts to what is believed to be appropriate for children, pregnant women or people with certain medical conditions), multivitamin intake is generally safe, but <strong>research is still ongoing with regard to what health effects multivitamins have</strong>.</p>\n<p>Evidence of health effects of multivitamins comes largely from prospective cohort studies which evaluate health differences between groups that take multivitamins and groups that do not. <strong>Correlations between multivitamin intake and health found by such studies may not result from multivitamins themselves, but may reflect underlying characteristics of multivitamin-takers.</strong> For example, it has been suggested that multivitamin-takers may, overall, have more underlying diseases (<strong>making multivitamins appear as less beneficial in prospective cohort studies</strong>). On the other hand, it has also been suggested that multivitamin users may, overall, be more health-conscious (<strong>making multivitamins appear as more beneficial in prospective cohort studies</strong>). Randomized controlled studies have been encouraged to address this uncertainty.</p>\n</blockquote>\n<p>I'd love to quote the whole &quot;Research&quot; section here, but if you read through it, and between the lines, you can start to get an inkling of just how all over the place and inconclusive research has been.</p>\n<p>For example, the citation for the &quot;randomized controlled studies have been encouraged&quot; bit is simply a paper from 2011 that concludes with &quot;these results highlight the need for more case-control studies or randomized controlled clinical trials to further examine this relationship.&quot; In other words, as recently as 5 years ago, at least one researcher was still in the state of realizing that randomized trials may be needed to clear things up.</p>\n<p>Every credible source, e.g. Johns Hopkins, periodically releases some article that says &quot;In a recent study, vitamins have shown to be beneficial / unhelpful&quot;. If you dig into the methods of these studies you will likely find (very reasonable) initial bias in both directions as well as the introduction of other variables due to the selected sample set.</p>\n<p>For example, the title of that that Johns Hopkins editorial linked to in the other answer is <a href=\"http://annals.org/article.aspx?articleid=1789253\" rel=\"noreferrer\">&quot;Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements&quot;</a>. With a title like that I'm sure that research wasn't neutral to begin with (not that it was bad, it's just this is a really inconclusive topic so it's easy to interpret study results according to initial views, hence the fact that this has been an ongoing conflict for decades).</p>\n<p>The abstract of that study concludes with the absurdly inconclusive, and probably biased, <em>&quot;Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.&quot;</em> -- A sentence which I can't help but laugh at because, you know, <a href=\"https://www.google.com/search?tbm=isch&amp;q=wtf+face\" rel=\"noreferrer\">what</a>? -- The issue really is so up in the air that anybody can pretty much find any data to support any viewpoint. You can pick anything you want from that abstract and use it as a basis to publish an article with a catchy headline like &quot;The Vitamin Verdict&quot; that supports your view either way, there is very little objectivity involved.</p>\n<p>However, there does at least seem to be a general consensus that, <em>massive overdose aside</em> they don't <em>hurt</em> (except for the couple of studies that said they do, which were countered by meta studies that said the studies said they didn't, and so on...).</p>\n<p>Note by the way this isn't really &quot;of late&quot;, well, at least not in the US where it's been a slowly but steadily increasing trend for <a href=\"http://www.cdc.gov/nchs/products/databriefs/db61.htm\" rel=\"noreferrer\">at least 30 years</a>. I distinctly remember having a heated conversation with somebody about this exact same topic 20 years ago.</p>\n<p>I think personal dietary and health trends are simply too varied to make any kind of general conclusion here. Perhaps they are good for some people in some situations and have no benefit for others, and every study from now until the end of time will continue to be inconclusive and unintentionally (or intentionally!) biased.</p>\n", "score": 6 }, { "answer_id": 8923, "body": "<p>In a perfect world, no, a multivitamin wouldn't be needed. However, even with high intake of fruits and vegetables, you have to consider micronutrient degradation in fresh fruits that you buy in the store. As soon as you pick a fruit/veggie, the micronutrients are starting to break down. The longer you wait to eat it, the less it will have.</p>\n\n<p>One way to get around this is to have your own garden and eat what you pick every day. The other way to ensure more micronutrient intake is to take a multivitamin. One thing to consider as well is that the RDA for each vitamin/mineral isn't the upper limit for positive benefits. There are more benefits to be reaped at higher intake with a lot of the vitamins/minerals.</p>\n\n<p>As for the links posted by Jan, the 1st one states that there is no definitive evidence either way, so nothing can be concluded. The 2nd link analyzed multivitamin users and only concluded results of the risk of heart attacks, mental decline, and cancer. That is not the main purpose of a multivitamin in the first place.</p>\n\n<p>If you look at the benefits of each vitamin/mineral(<a href=\"http://www.helpguide.org/harvard/vitamins-and-minerals.htm\" rel=\"nofollow\">http://www.helpguide.org/harvard/vitamins-and-minerals.htm</a>) you'll see nothing about heart attacks, cancer, or mental decline. Lets see a study on these proposed benefits of each vitamin/mineral with multivitamin users vs non-users. I'm sure that would lead to different results. </p>\n\n<p>Summary: Yes, they can be useful if you are not getting your daily intake of each of the vitamins/minerals. They can also provide benefits beyond the RDA for certain vitamins/minerals. Micronutrient degradation happens and can cause lower intake of micronutrients than you might expect, even with high amounts of fruits and vegetables in your diet. Take a multivitamin for the benefits of the vitamins/minerals, not to try and stop heart attacks, cancer, etc. </p>\n", "score": 4 }, { "answer_id": 8919, "body": "<p>Several reviews of studies about multivitamin supplements have been done lately, mostly in 2015:</p>\n<ol>\n<li><a href=\"http://www.aafp.org/afp/2015/0101/od1.html\" rel=\"nofollow noreferrer\">U.S. Preventive Services Task Force - Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: Recommendation Statement</a></li>\n</ol>\n<blockquote>\n<p><strong>Multivitamins: no recommendation; Single- or paired-nutrient supplements:\nno recommendation</strong></p>\n<p>Evidence on supplementation with multivitamins to reduce the risk of\ncardiovascular disease or cancer is inadequate, as is the evidence on\nsupplementation with individual vitamins, minerals, or functional\npairs. Supplementation with beta carotene or vitamin E does not reduce\nthe risk of cardiovascular disease or cancer.</p>\n</blockquote>\n<ol start=\"2\">\n<li><a href=\"http://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/is-there-really-any-benefit-to-multivitamins\" rel=\"nofollow noreferrer\">John Hopkins Medicine - Is There Really Any Benefit to Multivitamins?</a>:</li>\n</ol>\n<blockquote>\n<p>A recent look at multivitamins by Johns Hopkins researchers shows that\n<strong>there’s no proof of benefit,</strong> but there is evidence of possible harm\nfrom high doses of certain vitamin supplements.</p>\n</blockquote>\n<ol start=\"3\">\n<li><a href=\"https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf\" rel=\"nofollow noreferrer\">US Department of Agriculture - Dietary Guidelines for Americans 2015-2020</a>:</li>\n</ol>\n<blockquote>\n<p><em>In some cases,</em> fortified foods and dietary supplements may be useful\nin providing one or more nutrients that <em>otherwise may be consumed in\nless-than-recommended amounts.</em></p>\n</blockquote>\n<p>^^ This last claim is a direct quote from the Guidelines -- it is an unfortunate sentence structure, which can be misleading. What they are saying is that &quot;in some cases, &quot; which is for individuals with inadequate nutrient intake by regular diet (but not for those with adequate intake), supplements may be beneficial.</p>\n", "score": 1 }, { "answer_id": 8962, "body": "<p>One point that has not been explored is the quality of the supplement. It can vary widely regardless of the percentage of each vitamin. The NIH has done extensive testing on whether vitamins and other supplements are beneficial. In this link, it lists 3 independent organizations that test supplements of all kinds.\nAnother issue is whether or not the vitamins are prescribed by a dr. Mine does want me to take them as well as other supplements, so I do on his advice.\n<a href=\"https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx\" rel=\"nofollow\">NIH Dietary Supplements</a></p>\n", "score": 1 } ]

[ "micronutrients" ]

[ { "answer_id": 13023, "body": "<p>On a population level, women tend to have higher body fat percentage than men: 25% for normal women versus 15% for men. This means that for a man and women with equally-sized abs, the man's abs will look more prominent because they have less fat on top of them. </p>\n\n<p>Another contributing factor is that men put on muscle more easily than women do. This isn't sexism, it's biological fact due to the actions of testosterone to build muscle. If a man and a woman exercise for the same amount of time and the same intensity, the man will build more muscle because he has about 3x as much testosterone as the woman, and androgens (including testosterone) increase muscle growth. (This is why some body builders take \"steroids\": to boost their muscle growth.) </p>\n\n<p>So, in summary, the reason men develop \"more abs\" is because they have lower body fat and can build muscle more easily. This is of course ON AVERAGE...there are plenty of men who have no visible abs and plenty of women with impressive 6-packs. Any individual through proper diet and exercise can develop good-looking abs regardless of their gender.</p>\n", "score": 1 } ]

[ "endocrinology", "muscle", "abs" ]

[ { "answer_id": 9097, "body": "<p>A decade ago, a study (1) reviewed the evidence regarding the effect of cycling on impotence (due for example to pudendal nerve entrapment) and the effect of repeated scrotal temperature on spermatogenesis. While sparse evidence suggested a possible link, the author concluded that those results needed to be replicated in larger studies.</p>\n\n<p>Some years later, several studies have indirectly investigated this:</p>\n\n<ol>\n<li>A study examined sperm quality among male partners (2261) of couples\nattending IVF (2)</li>\n</ol>\n\n<p>Conclusion: in men who reported bicycling as their primary form of exercise, <strong>bicycling of ≥5 hours per week was associated with low sperm concentration and total motile sperm</strong></p>\n\n<ol start=\"2\">\n<li>A cross sectional study of 10 cyclist (compared to 10 sedentary\ncontrols) (3)</li>\n</ol>\n\n<p>Conclusion: compared to controls, <strong>cyclists had a lower proportion of spermatozoa with normal morphology</strong>. However, they did not report any significant difference in semen volume and sperm motility, viability and count.</p>\n\n<ol start=\"3\">\n<li>A study including 24 healthy non professional cyclists (4)</li>\n</ol>\n\n<p>Conclusion: a <strong>16-week low-to-intensive cycling training could possibly impact negatively on spermatozoa</strong></p>\n\n<p><strong>Finally a larger and recent study (5) conducted in the UK in 2014 among 5284 male cyclist reported no associations between cycling volume erectyl dysfunction and infertility.</strong></p>\n\n<p><strong>So to summarise, current evidence is controversial and larger studies are needed to investigate this potential association.</strong></p>\n\n<p><em>Sources:</em></p>\n\n<ol>\n<li><p>Southorn et al. Great balls of fire and the vicious cycle: A study of the effects of cycling on male fertility. The Journal of Family Planning and Reproductive Health Care. 2002: 28(4)</p></li>\n<li><p>Wise LA, Cramer DW, Hornstein MD, Ashby RK, Missmer SA. Physical activity and semen quality among men attending an infertility clinic. Fertility and sterility. 2011;95(3):1025-1030. doi:10.1016/j.fertnstert.2010.11.006.</p></li>\n<li><p>Gebreegziabher et al. Sperm Characteristics of Endurance Trained Cyclists. Int J Sports Med 2004; 25(4): 247-251</p></li>\n<li><p>Maleki B. et al. Long-term Low-to-Intensive Cycling Training: Impact on Semen Parameters and Seminal Cytokines. Clin J Sport Med. 2015 Nov;25(6):535-40.</p></li>\n<li><p>Hollingworth Milo et al. An Observational Study of Erectile Dysfunction, Infertility, and Prostate Cancer in Regular Cyclists: Cycling for Health UK Study.\nJournal of Men's Health. July 2014, 11(2): 75-79.</p></li>\n</ol>\n", "score": 8 } ]

[ "exercise", "sex", "reproduction", "fertility" ]

[ { "answer_id": 16656, "body": "<p>The key, I think, is the relationship between energy transferred and the ability of the receiving tissue to tolerate it. For example, although the overall kinetic energy of a knife is relatively low the tip/blade pressure is extremely high, more than high enough to part tissues and, critically, cut through arterial walls causing fatal bleeding.</p>\n\n<p>Drowning is more complex. The pathophysiology that leads to tissue damage and thus death is hypoxia so I would class this as a chemical injury. However, this is a bit of a cop-out. Arguably, what kills in the case of the knife wound is not the wound itself but the resulting tissue hypoxia from bleeding so should we not count that as \"chemical\" as well?</p>\n\n<p>Overall, this is probably best used as a guide to \"injury\" in the sense of \"external factor causing direct tissue damage\". It is definitely not all encompassing. Finally, I think there could be a good argument made for \"hypoxic\" as a 6th category of injury.</p>\n", "score": 3 } ]

[ "foreign-body-object", "knife-stab-wound" ]

[ { "answer_id": 13250, "body": "<p>Foods that cause bloating in general will also cause bloating on a flight. Foods that can cause bloating from gas production include anything with certain artificial sweeteners (like maltitol, which cannot be properly digested by gut bacteria), fruits (due to fructose), beans, etc. Other foods can cause bloating due to water retention - basically anything with a high salt content, like french fries. The main issue with flying is dehydration: the recirculated air is kept quite dry, which can lead to reduced body water unless you make sure to drink plenty of water throughout the flight. (The only downside to drinking plenty of water is that you'll likely have to use the tiny airplane bathrooms, but you'll still feel better overall if you stay hydrated.) You're also sitting down for a long time, which can reduce circulation, so it can be helpful to wear compression stockings and to stand up occasionally to stretch your legs. Finally, you should avoid alcohol, because alcohol is dehydrating (e.g. see <a href=\"https://gastrolyte.com.au/dehydration/dehydration-and-alcohol/\" rel=\"nofollow noreferrer\">https://gastrolyte.com.au/dehydration/dehydration-and-alcohol/</a>). </p>\n\n<p>Summary - Eat foods that are low in salt and do not contain artificial sweeteners; Drink plenty of water; Wear compression stockings and be sure to move your legs / stand up and walk as much as possible; Avoid alcohol during the flight.</p>\n", "score": 1 } ]

[ "digestion", "alcohol", "travel", "bloated-bloating", "intestine" ]

[ { "answer_id": 9270, "body": "<p><strong><em>This is an interesting question. You are certainly not an isolated case.</em></strong></p>\n\n<p><strong>The \"origin\" of foot odor has been examined in many studies.</strong></p>\n\n<ul>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3145263\" rel=\"noreferrer\">This study conducted by Marshall et al</a> focused on the microflora\nfound on normal feet (no foot odor) and compared it to feet with foot\nodor. They reported a <strong>higher population densities of staphylococci and\naerobic coryneform bacteria in the feet with foot odor</strong>. They also\nreported that these feets had higher exo-enzymes (lipase, protease,\nand callous degrading enzymes) than the other feet.</li>\n<li>During the same period, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/2232162\" rel=\"noreferrer\">Kobayashi et al</a> showed <strong>staphylococcus epidermidis</strong> was linked to the presence of foot odor or not</li>\n<li>Some years later, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/2369557\" rel=\"noreferrer\">a japanese group led by Kanda</a> analysed socks (!) and feet from two group of people (with/without odor) using a gas chromatography/mass spectrometry (GC/MS). They reported that <strong>short-chain fatty acids</strong> were the primary components of foot odor</li>\n</ul>\n\n<p><em>In 2006, a very interesting study was conducted by a group of canadian researchers: their aim was to identify microorganisms that are involved in producing unpleasant odors and examine plant extracts and fragrant agents which would inhibit the routes of production of these substances.</em></p>\n\n<p>Here first an overview of the <strong>fatty acid they have found ( acetic acid is responsible for the odor of sweat, isovaleric acid, propionic acid,\nisobutyric acid, and butyric acid are involved in foot odor)</strong></p>\n\n<p><a href=\"https://i.stack.imgur.com/Mn5U9.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/Mn5U9.png\" alt=\"enter image description here\"></a></p>\n\n<p>Then they looked at a difference in organisms distribution and found that <strong>bacilli were significantly different between the groups:</strong></p>\n\n<p><a href=\"https://i.stack.imgur.com/FR2c4.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/FR2c4.png\" alt=\"enter image description here\"></a></p>\n\n<p>They then examined the possible role of naturally occurring materials using leucine dehydrogenase activity as an index (which is involved in foot odor), and obtained <strong>citral, citronellal, and geraniol</strong> as good competitive inhibitors. <strong>So these fragments are likely to inhibit foot odor.</strong></p>\n\n<p>Why different bacteries are present in some individuals and not in another might be multifactorial and precipitated by diseases (fungus, endocrine disorders,...). I haven't found any study suggesting it might be genetic.</p>\n\n<p><strong>Now, there are indeed many websites suggesting many different possible ways of treating foot odor. The only <a href=\"http://www.tandfonline.com/doi/pdf/10.3810/psm.1996.08.1517?needAccess=true\" rel=\"noreferrer\">peer-reviewed paper</a> I could find is was on <em>The Physician and Sportsmedicine</em> . Here their advices:</strong></p>\n\n<p><a href=\"https://i.stack.imgur.com/eUZuO.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/eUZuO.png\" alt=\"enter image description here\"></a></p>\n\n<p>Hope this brought some clarifications.</p>\n\n<p><em>Sources: Ara et al. Foot odor due to microbial metabolism and its control.Can J Microbiol. 2006 Apr;52(4):357-64.</em></p>\n", "score": 7 } ]

[ "hygiene", "perspiration", "smell", "athletes-foot" ]