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[ { "answer_id": 5024, "body": "<p>There is a myth that drinking Diet Coke while chewing Mentos causes your stomach to explode, though this has been disproved by <a href=\"http://www.discovery.com/tv-shows/mythbusters/mythbusters-database/diet-coke-and-mentos-make-stomach-explode/\" rel=\"noreferrer\">MythBusters</a> and <a href=\"http://www.snopes.com/horrors/freakish/mentos.asp\" rel=\"noreferrer\">Snopes</a>. Both sources say that the reason for the explosion between Diet Coke and Mentos is because of the outside of the Mentos reacting with the Diet Coke. If the Mentos are still in your mouth, the Diet Coke will most likely explode, but if they are in your stomach, they won't cause an explosion, but they still may cause <a href=\"http://www.youtube.com/watch?v=K6xXngYnVK8&amp;t=1m58s\" rel=\"noreferrer\">a lot of burping</a>. Still, none of those sources are very reliable, so I'm going to have to prove how it works chemically.</p>\n\n<p>This <a href=\"https://www.auburn.edu/academic/cosam/departments/chemistry/outreach/MSP_AU_web/documents/AJP_2008_diet_coke_mentos_Coffey.pdf\" rel=\"noreferrer\">study</a> testing the reaction states that</p>\n\n<blockquote>\n <p>\"It is clear...that the roughness\n of the sample is a major contributor to the explosiveness of\n the reaction.\"</p>\n</blockquote>\n\n<p>This <a href=\"http://www.stevespanglerscience.com/lab/experiments/original-mentos-diet-coke-geyser/\" rel=\"noreferrer\">Steve Spangler Science experiment page</a> also agrees that the surface of the candy is an incredibly important factor in the Diet Coke/Mentos reaction.</p>\n\n<blockquote>\n <p>When you drop the Mentos into the soda, the gelatin and gum arabic from the dissolving candy break the surface tension.</p>\n</blockquote>\n\n<p>It is clear that is indeed the surface of the Mentos that causes such a reaction. So, it can be seen that if you eat the Mentos and they are in your stomach, the surface of the Mentos begins to break down, so it makes sense why there would be just burping, rather than an explosion (like in the YouTube video above). If the Mentos are still in your mouth, the surface has probably been already slightly broken down, but there would still be an explosion, just to a slightly smaller extent.</p>\n", "score": 6 } ]

[ "food-safety", "drug-interactions", "drinks", "chew-chewing", "breath-freshners" ]

[ { "answer_id": 5557, "body": "<ul>\n<li>Nettle-Peppermint Tea: Based on the mechanism of action, it should be noted that plain peppermint or used other ways should help. </li>\n</ul>\n\n<p><a href=\"http://everydayroots.com/allergy-remedies\" rel=\"nofollow\">everyday-roots.com</a></p>\n\n<blockquote>\n <p>peppermint contains a type of flavonoid called luteolin-7-O-rutinoside\n which can help inhibit the activity and secretion of anti-inflammatory\n enzymes, such as histamines, and greatly reduce the dreadful\n discomfort that comes along them.</p>\n</blockquote>\n\n<ul>\n<li>Bee Pollen. This is said to work if local honey doesn't. Basically you take the allergens before the season to help build a immunity. The honey must be clean and free from insecticides. </li>\n</ul>\n\n<p>This study from 2013 showed a improving in allergy symptoms after honey in high doses over 8 weeks: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24188941\" rel=\"nofollow\">Ingestion of honey improves the symptoms of allergic rhinitis: evidence from a randomized placebo-controlled trial in the East coast of Peninsular Malaysia.</a></p>\n\n<p><a href=\"http://everydayroots.com/allergy-remedies\" rel=\"nofollow\">everyday-roots.com</a></p>\n\n<blockquote>\n <p>make sure you are not anaphylactic or severely allergic to bees, or so\n allergic to pollen that you experience anaphylaxis.</p>\n</blockquote>\n\n<p>2011 study about Birch Pollen Honey between November and March helped reduce 60% of allergy symptoms. </p>\n\n<ul>\n<li><p>Citrus is suppose to help due to the fact that it nourished your immune system. But due to this <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/1578094\" rel=\"nofollow\">ncbi article</a>, it does not appear to be that effective.</p></li>\n<li><p><a href=\"http://Lavender%20essential%20oil%20inhalation%20suppresses%20allergic%20airway%20inflammation%20and%20mucous%20cell%20hyperplasia%20in%20a%20murine%20model%20of%20asthma.\" rel=\"nofollow\">Lavender oil inhalation</a>: </p></li>\n</ul>\n\n<blockquote>\n <p>Lvn inhibits allergic inflammation and mucous cell hyperplasia with\n suppression of T-helper-2 cell cytokines and Muc5b expression in a\n murine model of asthma. Consequently, Lvn may be useful as an\n alternative medicine for bronchial asthma.</p>\n</blockquote>\n\n<p><a href=\"https://healthyfocus.org/essential-oils-for-allergies/\" rel=\"nofollow\">healthyfocus.org</a> also lists some other oils that may help, such as eucalyptus, lemon and peppermint.</p>\n\n<ul>\n<li>Onions are supposed to contain <a href=\"http://www.webmd.com/vitamins-supplements/ingredientmono-294-quercetin.aspx?activeingredientid=294&amp;activeingredientname=quercetin\" rel=\"nofollow\">Quercetin</a> which is supposed to work similarly to anti-histamines to inhibit inflammation and secondarily bronchodilate. </li>\n</ul>\n\n<p><a href=\"http://www.healthline.com/health/allergies/best-natural-antihistamines\" rel=\"nofollow\">healthline.com</a> supports research for onions helping relieve some allergy symptoms. </p>\n", "score": 3 }, { "answer_id": 5443, "body": "<p>Local honey.</p>\n\n<p>There's no science to support it as far as I can find, but there are many people who swear by it. (I know several personally.) Considering that's its harmless, cheap and tasty, it's probably worth a try. </p>\n", "score": 0 } ]

[ "allergy", "allergen", "pollen", "seasonal-allergies" ]

[ { "answer_id": 5426, "body": "<p>To answer your question with the best quality evidence would require a double blinded prospective controlled study. Clearly that's not going to happen. But we do have a case control study looking at the bra wearing habits of those with breast cancer, and those without, to see if there is a dose response relationship. And there was none in this group.</p>\n\n<blockquote>\n <p>We conducted a population-based case–control study of breast cancer in the Seattle–Puget Sound metropolitan area that compared 454 invasive ductal carcinoma (IDC) cases and 590 invasive lobular carcinoma (ILC) cases diagnosed between 2000 and 2004 with 469 control women between 55 to 74 years of age. Information on bra-wearing habits and other breast cancer risk factors was collected from study participants through in-person interviews. Multivariate adjusted odds ratios (OR) and their associated 95% confidence intervals (CI) were estimated using polytomous logistic regression. No aspect of bra wearing, including bra cup size, recency, average number of hours/day worn, wearing a bra with an underwire, or age first began regularly wearing a bra, was associated with risks of either IDC or ILC. Our results did not support an association between bra wearing and increased breast cancer risk among postmenopausal women.</p>\n</blockquote>\n\n<p><a href=\"http://m.cebp.aacrjournals.org/content/early/2014/08/27/1055-9965.EPI-14-0414.abstract\" rel=\"nofollow\">http://m.cebp.aacrjournals.org/content/early/2014/08/27/1055-9965.EPI-14-0414.abstract</a></p>\n\n<p>Other studies have suggested a link, but this can be explained by the fact that those more likely to wear a bra are more likely to be overweight leading to a larger breast size, and obesity is a well known risk factor for cancer. Larger breasts also imply more breast tissue, and therefore more risk for breast cancer.</p>\n", "score": 3 } ]

[ "sleep", "clothes", "breast", "hyperpigmentation" ]

[ { "answer_id": 24072, "body": "<p>During dialysis only about 10 percent of the blood is outside your body at any given time, while the rest continues to circulate. If the blood flows at 600mL/min, then it doesn't take very long to clean 5 liters (say 8 min). So why aren't you done that quickly?</p>\n<p>There are three reasons:</p>\n<ol>\n<li>Each time cleaned blood is returned, it mixes with the waste-filled blood</li>\n<li>The proportion of wastes extracted isn't high to start out, and</li>\n<li>How much is extracted each time depends on how &quot;dirty&quot; the blood is</li>\n</ol>\n<p>So imagine that initially 10% of the waste is removed from blood that goes through the dialyzer. That means that if you stopped after that pint is returned to you, your blood would be 1% cleaner (10% of 10% = 1%). Not much difference. The next cycle would clean another pint (1% cleaner than the first one) and so on and so on.</p>\n<p>Thus each time a pint of blood flows past the filters in the dialyzer, there's a smaller gradient of wastes between it and the clean fluids on the other side, so less of the waste gets extracted from that pint. That's a good thing, but it's frustrating, because each hour is important, but gets less and less wastes out.</p>\n<p>If that's hard to imagine, imagine this:</p>\n<p>Say you're trying to clean red paint out of water in a glass, but all you can do is to dipping in a wet sponge-brush, then rinsing the sponge-water by pushing it against the side of a gallon-size tub full of water. Some of the water will be squeezed into the tub, and the pressure is released, part of the sponge is filled with clean water, so the next time you dip and squeeze the sponge inside the glass, you squeeze out a <strong>partially-cleaned</strong> sponge. That's the equivalent of partly-cleaned blood returning from the dialyzer. The first many cycles will look like they squeeze out lots of paint, yet the water in the glass will still be dark red.</p>\n<p>After many, many cycles, the water in the glass will finally look translucent red. Now, whenever you push the sponge against the side of the tub, the squeezed out water will look less reddish, so it's not as satisfying, but it's still helpful; the water you squeeze back into the glass to start each new cycle is still cleaner.</p>\n<hr />\n<p>Caveat: in dialysis the blood stays on your side of the filters in the dialyzer; only the wastes are pulled across, so the analogy isn't quite right.</p>\n", "score": 1 } ]

[ "blood", "medical-device", "electrolytes" ]

[ { "answer_id": 16666, "body": "<h3><strong>PT-141 (bremelanotide)</strong></h3>\n\n<blockquote>\n <p>To my knowledge, PT-141 is the only substance that has shown any promise in increasing libido, and that's only in the case of women with depressed sexual response. </p>\n</blockquote>\n\n<p>I think this is only partially correct. One question is how to you would go about operationalising libido in males? For example, one could argue that an intervention that gives a male an erection in the absence of any visual sexual stimuli is for all intents and purposes, an aphrodisiac. </p>\n\n<p>PT-141 (bremelanotide) does seem to have these properties:</p>\n\n<blockquote>\n <p><strong><a href=\"https://www.nature.com/articles/3901200\" rel=\"nofollow noreferrer\">Evaluation of the safety, pharmacokinetics and pharmacodynamic effects of subcutaneously administered PT-141, a melanocortin receptor agonist, in healthy male subjects and in patients with an inadequate response to Viagra®</a></strong></p>\n \n <p>PT-141, a cyclic heptapeptide melanocortin analog, was evaluated following subcutaneous administration to healthy male subjects and to patients with erectile dysfunction (ED) who report an inadequate response to Viagra®. An inadequate response was defined for this study by patient report indicating that achievement of an erection suitable for vaginal penetration occurred ≤50% of the time while taking 100 mg Viagra®. <strong>Erectile responses were assessed by RigiScan™ in healthy subjects in the absence of visual sexual stimulation (VSS) and in ED patients in the presence of VSS. Doses ranging from 0.3 to 10 mg were administered to healthy male subjects, resulting in a statistically significant erectile response at doses greater than 1.0 mg.</strong> ED patients were treated with placebo, 4 or 6 mg PT-141 in a crossover design in the presence of VSS. The erectile response induced by PT-141 was statistically significant at both doses. PT-141 was safe and well tolerated in both studies. The erectogenic potential of PT-141, its tolerability profile and its ability to cause significant erections in patients who do not have an adequate response to a PDE5 inhibitor suggest that PT-141 may provide an alternative treatment for ED with a potentially broad patient base.</p>\n \n <p>If some pheromone were effective in increasing libido in men then I would've expected to see a huge market for it and perhaps big pharma creating products that combine PDE5 inhibitors like \"Viagra\" with pheromones. </p>\n</blockquote>\n\n<p>You're correct here. In fact, perhaps the closest currently available to this is concomitant administration of PT-141 with PDE-5 inhibitors:</p>\n\n<blockquote>\n <p><strong><a href=\"https://doi.org/10.1016/j.urology.2004.10.060\" rel=\"nofollow noreferrer\">Co-administration of low doses of intranasal PT-141, a melanocortin receptor agonist, and sildenafil to men with erectile dysfunction results in an enhanced erectile response</a></strong></p>\n \n <p><em>Objectives</em> To evaluate the safety and pharmacodynamic effect of co-administration of subtherapeutic doses of PT-141, a cyclic heptapeptide melanocortin analogue, and sildenafil to patients with erectile dysfunction.</p>\n \n <p><em>Methods</em> Nineteen patients with erectile dysfunction who were responders to either Viagra or Levitra by self-report were given 25 mg sildenafil and 7.5 mg intranasal PT-141, 25 mg sildenafil and an intranasal placebo spray, and a placebo tablet and an intranasal placebo spray in a randomized cross-over design. Erectile activity in response to two 30-minute episodes of visual sexual stimulation was assessed by RigiScan during a 6-hour postdose period.</p>\n \n <p><em>Results</em> <strong>The erectile response induced by co-administration of PT-141 and sildenafil was significantly greater than the response elicited by administration of sildenafil alone. Co-administration of PT-141 and sildenafil was safe and well-tolerated and did not result in new adverse events or adverse events that were increased in frequency or severity compared with monotherapy</strong>.</p>\n \n <p><em>Conclusions</em> <strong>Co-administration of intranasal PT-141 and a phosphodiesterase type 5 inhibitor may constitute a treatment alternative for patients in whom higher doses of a single therapy are not effective or well tolerated.</strong></p>\n</blockquote>\n\n<p><strong>EDIT:</strong></p>\n\n<p>As correctly pointed out to me, in the above, I have mischaracterised the presence of an erection with male libido. One should not confuse raging passions for getting a <a href=\"https://youtu.be/lcHy8xEt2QI\" rel=\"nofollow noreferrer\">raging clue</a>. This is not a trivial point:</p>\n\n<blockquote>\n <p><strong><a href=\"https://doi.org/10.1111/j.1743-6109.2011.02319.x\" rel=\"nofollow noreferrer\">The Subjective Sexual Arousal Scale for Men (SSASM): Preliminary Development and Psychometric Validation of a Multidimensional Measure of Subjective Male Sexual Arousal</a></strong> </p>\n \n <p><strong>Male sexual arousal has been historically\n described as a central physiological state, with\n penile erection in a sexual context as its most valid\n objective measure [21]</strong>. Bancroft defines sexual\n arousal as a state that is motivated toward experi-\n encing sexual pleasure and possibly orgasm, which\n involves the processing of relevant stimuli, general\n arousal, incentive motivation, and genital response\n [22]. A multifaceted process of male sexual arousal\n is supported by functional magnetic resonance\n imaging data indicating different patterns of brain\n stimulation during sexual arousal, penile tumes-\n cence, and penile erection in healthy male volun-\n teers [23]. <strong>Furthermore, studies in men without\n sexual dysfunction have demonstrated that penile\n erection is not always highly associated with sub-\n jective mental aspects of sexual arousal [24,25].\n Based on these findings, a lack of subjective sexual\n arousal may explain why some men with ED fail to\n respond to treatment with PDE5 inhibitors\n despite having the physiological ability to achieve\n and maintain an erection.</strong></p>\n</blockquote>\n\n<p>However, my reference to the role of exogenous testosterone may more accurately reflect what is meant by \"libido\" or sexual desire.</p>\n\n<h3><strong>Exogenous testosterone</strong></h3>\n\n<p>Alternatively, you might have some measure of sexual interest in males, in which case administration of exogenous testosterone displays efficacy in this regard:</p>\n\n<blockquote>\n <p><strong><a href=\"https://doi.org/10.1210/jcem.75.6.1464655\" rel=\"nofollow noreferrer\">The effects of exogenous testosterone on sexuality and mood of normal men</a></strong> </p>\n \n <p>The effects of supraphysiological levels of testosterone, used for male contraception, on sexual behavior and mood were studied in a single-blind, placebo-controlled manner in a group of 31 normal men. After 4 weeks of baseline observations, the men were randomized into two groups: one group received 200 mg testosterone enanthate (TE) weekly by im injection for 8 weeks (Testosterone Only group), the other received placebo injections once weekly for the first 4 weeks followed by TE 200 mg weekly for the following 4 weeks (Placebo/Testosterone group). The testosterone administration increased trough plasma testosterone levels by 80%, compatible with peak testosterone levels 400-500% above baseline. Various aspects of sexuality were assessed using sexuality experience scales (SES) questionnaires at the end of each 4-week period while sexual activity and mood states were recorded by daily dairies and self-rating scales. <strong>In both groups there was a significant increase in scores in the Psychosexual Stimulation Scale of the SES (i.e. SES 2) following testosterone administration, but not with placebo.</strong> There were no changes in SES 3, which measures aspects of sexual interaction with the partner. In both groups there were no changes in frequency of sexual intercourse, masturbation, or penile erection on waking nor in any of the moods reported. <strong>The Placebo/Testosterone group showed an increase in self-reported interest in sex during testosterone treatment but not with placebo. The SES 2 results suggest that sexual awareness and arousability can be increased by supraphysiological levels of testosterone.</strong> However, these changes are not reflected in modifications of overt sexual behavior, which in eugonadal men may be more determined by sexual relationship factors. This contrasts with hypogonadal men, in whom testosterone replacement clearly stimulates sexual behavior. There was no evidence to suggest an alteration in any of the mood states studied, in particular those associated with increased aggression. We conclude that supraphysiological levels of testosterone maintained for up to 2 months can promote some aspects of sexual arousability without stimulating sexual activity in eugonadal men within stable heterosexual relationships. Raising testosterone does not increase self-reported ratings of aggressive feelings.</p>\n</blockquote>\n\n<p>If we consider both testosterone and PT-141 in tandem, <em>sexual awareness</em> and <em>sexual arousal</em> can be dissociated from one another.</p>\n\n<h3><strong>Dopaminergic stimulants e.g. meth/amphetamine</strong></h3>\n\n<p>There is some evidence from animal studies to suggest that amphetamine increases libido, as operationalised by frequency of sex. Again, I could suffer from the same folly as above where I confuse libido for some other construct, but this is also supported by subjective reports among meth users who like to have sex with other dudes. However, I will need to dig up some references.</p>\n\n<blockquote>\n <p>Former Nobel laureates and other researchers at Harvard awarded the 2007 Ig Nobel Peace Prize to the creators of the \"gay bomb\" -- a non-lethal military weapon under development intended to induce demoralizing homosexual behavior with aphrodisiacs. </p>\n</blockquote>\n\n<p>If the above regarding amphetamines is correct, it would be hilarious to see what effect acute administration of methamphetamine among a male prison population would be. </p>\n\n<h3><strong>Marketability of aphrodisiacs in general</strong></h3>\n\n<p>One problem is that the current milieu within which drugs are evaluated by the FDA is that a drug will only be approved for sale if it can treat a disease. Any use of the term \"aphrodisiac\" is effectively a no-no. What I imagine would happen is that eventually the diagnostic criteria for erectile dysfunction would be relaxed considerably, or some equivalent of <em>sexual arousal disorder</em> for males would enter into the vernacular.</p>\n\n<p>I'm a little surprised that recreational use of some combination of testosterone/methamphetamine/PT-141/PDE-5 inhibitors as some sort of sex aid isn't \"a thing\". Well, I'm sure it is somewhere in the world.</p>\n", "score": 1 } ]

[ "medications", "sex", "pheromones", "libido", "stimulants" ]

[ { "answer_id": 5792, "body": "<p>I'm an Electrical Engineer not a doctor but I've some knowledge about IR. Although you can not see it, IR is electromagnetic waves and it carry heat to your eyes. So, The eyes is negatively affected without your knowledge (If there is too much Infra red).\nIt is similar to ultraviolet that damage the skin although it is invisible rays.</p>\n\n<p>I don't know the cause of your headache because I'm not a doctor. But high power IR is dangerous for the eye. Don't look at it for long time.</p>\n\n<p>This question is similar to yours: <a href=\"https://biology.stackexchange.com/questions/13691/is-it-safe-to-look-at-infrared-leds\">https://biology.stackexchange.com/questions/13691/is-it-safe-to-look-at-infrared-leds</a></p>\n", "score": 3 }, { "answer_id": 5796, "body": "<p>Normally IR should not cause any troubles. However its all power-dependent. What is the overall power output of the LED you are using? I suggest you to compare it with the power output in similar existing eye-tracking devices on the market (you can contact the manufacturers, tell them you use their device and ask for specs due to safety concerns). I guess it wouldn't be nice to blast your eyes with even 5 mW.</p>\n", "score": 1 } ]

[ "eye", "headache" ]

[ { "answer_id": 5883, "body": "<p>Your technical understanding is correct and television is fiction. In fact, watching shows involving CPR and defibrillation is a source of both amusement and frustration for most medical professionals because it is almost always portrayed wildly inaccurately.</p>\n\n<p>Defibrillation is effective against only ventricular fibrillation (VF or V-Fib, which is when the heart is beating too irregularly for effective blood circulation to occur) and <em>pulseless</em> ventricular tachycardia (VT or V-Tach, which is when the heart is beating too fast for effective circulation). Automated defibrillators simply will not shock other rhythms, including asystole (\"flat line\"). No one trained to use a manual defibrillator would do so either.</p>\n\n<p>Yes, a defibrillator can definitely stop a beating heart. However, if that heart started out healthy and hasn't been injured, then it's quite likely it will restart on its own due to the <a href=\"https://en.wikipedia.org/wiki/Cardiac_action_potential#Autorhythmicity\" rel=\"nofollow noreferrer\">autorhythmicity</a> of cardiac cells. This is why <a href=\"https://en.wikipedia.org/wiki/Cardioversion\" rel=\"nofollow noreferrer\">cardioversion</a> can be used to treat arrhythmias with relative safety. A cardioversion is simply a defibrillation of the heart timed to coincide precisely with a safe point in the heart rhythm. </p>\n\n<p>Interestingly, there was even one case of an <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/2819293\" rel=\"nofollow noreferrer\">unsuccessful suicide attempt using a defibrillator</a>. Had the nurse followed his training and applied the paddles to his chest instead of his head, he might have succeeded.</p>\n\n<p>Although the \"it can't hurt\" logic is tempting, the fact is that inappropriate defibrillation <em>can</em> hurt. Defibrillation <a href=\"http://www.aed.com/blog/brief-explanation-defibrillator-really/\" rel=\"nofollow noreferrer\">works</a> by depolarizing the entire heart, which interrupts the arrhythmia and provides an opportunity for autorhythmicity to restart a normal rhythm. If the patient is in asystole the heart is already depolarized, so defibrillation will accomplish nothing except perhaps depolarizing cells that were in the process of repolarizing, thereby eliminating the already very small chance of restoring a heartbeat. </p>\n\n<p>Defibrillation is also ineffective against pulseless electrical activity (<a href=\"https://acls.com/free-resources/knowledge-base/pea-asystole/what-is-pulseless-electrical-activity-pea\" rel=\"nofollow noreferrer\">PEA</a>). In PEA, the heart's conduction system is functioning normally but some other cause is preventing it from pumping blood. Hypovolemia and hypoxemia are the most common causes of PEA. The only effective treatment for PEA is to find and correct the cause.</p>\n\n<p>If the patient is in some rhythm other than VF or VT, defibrillation may stop their heart, or put them into VF or VT. It simply isn't done no matter what you might see on television.</p>\n", "score": 7 } ]

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

[ { "answer_id": 7440, "body": "<p>\"Giving\" electrical current to the heart does not necessarily translate to mechanical contractions.\nThe excitation-contraction coupling (as the sequence of electrical activation an muscle contraction is officially called), is not always a guarantee.</p>\n\n<p>A cardiac arrest in many cases mirrors severe malfunction on the level of the micro-structures of the heart and a biochemical disarray in general. If you don't restore the pumping of the heart in seconds to minutes (even if this is crude and primitive-looking), the patient may not only die, but even worse they may \"live\" with severely depressed or completely absent brain function.</p>\n\n<p>The only way, a \"modern\" way would help a \"stopped\" heart is if some futuristic nano-device could be employed rapidly to either correct micro anatomy and microphysiology in minutes, or replace and collaborate with the patient's native structures.</p>\n\n<p>However, primitive it may seem to you, external manual compressions, if properly performed can make the difference (at a great percentage) between life and death.</p>\n\n<p>The \"electrical current- modern\" approach works for patients with severe arrhythmias or conduction problems. In these cases the \"mechanical part\" of the heart is intact and you only replace the electrical function of a problematic conduction system or problematic natural pacemakers.</p>\n\n<p>Even in this case, a properly performed placement of a temporary pacemaker is an awkward process that can take several minutes until successful (transcutaneous or transvenous) placement is established. If the patient is asystolic or almost asystolic (no-pulse), \"primitive\" compressions should be done until the pacemaker safely paces.</p>\n\n<p>Unless a super enhanced swarm of nano-machines, that can navigate safely through the human body and correct problems rapidly and at will, emerges, no \"sophisticated machines\" will replace manual compressions. In fact, during resuscitation they have been proven much more valuable than artificial breathing, which is reflected in the change in the guidelines during the past 15 years.</p>\n\n<hr>\n\n<p><a href=\"https://www.acls.net/aclsalg.htm\" rel=\"nofollow noreferrer\">Algorithms for Advanced Cardiac Life Support 2015</a></p>\n\n<p><a href=\"http://m.eurheartj.oxfordjournals.org/content/36/41/2793.full#sec-37\" rel=\"nofollow noreferrer\">Acute treatment of sustained ventricular arrhythmias</a></p>\n", "score": 5 } ]

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

[ { "answer_id": 5979, "body": "<h2>Remedies to control snoring:</h2>\n\n<ul>\n<li>Pillows. There is a pillow called the <a href=\"http://www.snore.net/review-sona-pillow/\" rel=\"noreferrer\">SONA pillow</a> its FDA approved and is <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15611895\" rel=\"noreferrer\">proven to work.</a> \n\n<blockquote>\n <p>The study was performed to determine the ability of a new inclined\n pillow to treat snoring and obstructive sleep apnea syndrome. The SONA\n Pillow is a triangular pillow with space to place your arm under the\n head while sleeping on the side.</p>\n</blockquote></li>\n</ul>\n\n<p>From the <a href=\"http://www.webmd.com/sleep-disorders/features/easy-snoring-remedies\" rel=\"noreferrer\">WebMD article \"7 Easy Fixes for Snoring\"</a>:</p>\n\n<ul>\n<li><p>Beware sprays and pills. They can not be all they said they would be or not be properly researched to be safe or work. </p>\n\n<blockquote>\n <p>Use caution before you self-treat with over-the-counter sprays and\n pills until you've checked with your doctor, says Sudhansu\n Chokroverty, MD, FRCP, FACP, program director for Clinical\n Neurophysiology and Sleep Medicine at JFK Medical Center in Edison,\n N.J. \"Many stop-snoring aids are marketed without scientific studies\n to support their claims,\" says Chokroverty, who is also a neuroscience\n professor at Seton Hall University's School of Health and Medical\n Sciences.</p>\n</blockquote></li>\n<li><p>More on pillows. Utilizing full body pillows can help. Also, don't sleep on back and elevating the head of the bed can help, but may cause neck pain. Taping tennis balls to the back of your pajamas to stop yourself from lyin on your back is said to work, as well. Another warning:</p>\n\n<blockquote>\n <p>This may cause neck pain, however.\" If snoring continues regardless of\n the sleep position, obstructive sleep apnea may be a cause. \"See a\n doctor in this case,\" Chokroverty says.</p>\n</blockquote></li>\n<li><p>Keeping your nasal passage ways open and eliminating allergens. Change and clean bedding and remove dust and other allergy triggers. As for nasal passage ways:</p></li>\n</ul>\n\n<blockquote>\n <p>If snoring starts in your nose, keeping nasal passages open may help.\n It allows air to move through slower, Slaughter says. \"Imagine a\n narrow garden hose with water running through. The narrower the hose,\n the faster the water rushes through.\"</p>\n \n <p>Your nasal passages work similarly. If your nose is clogged or\n narrowed due to a cold or other blockage, the fast-moving air is more\n likely to produce snoring.</p>\n</blockquote>\n\n<p>Things to do to fix this are:</p>\n\n<ul>\n<li><p>Hot showers before bed time</p></li>\n<li><p>Netti pots</p></li>\n<li><p>Nasal strips</p></li>\n</ul>\n\n<p><a href=\"https://www.nlm.nih.gov/medlineplus/snoring.html\" rel=\"noreferrer\">NLM.NIH.GOV</a> states simply. </p>\n\n<blockquote>\n <p>Lose weight if you are overweight. It may help, but thin people can\n snore, too. Cut down or avoid alcohol and other sedatives at bedtime\n Don't sleep flat on your back</p>\n</blockquote>\n\n<p>Those can be included with some lifestyles changes mentioned by <a href=\"http://www.mayoclinic.org/diseases-conditions/snoring/basics/lifestyle-home-remedies/con-20031874\" rel=\"noreferrer\">Mayo Clinic:</a></p>\n\n<ul>\n<li><p>Quit smoking</p></li>\n<li><p>Get enough sleep</p></li>\n<li><p>Raise head of bed about 4 inches</p></li>\n</ul>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/snoring/basics/alternative-medicine/con-20031874\" rel=\"noreferrer\">Alternative treatments</a> mentioned are playing certain musical instruments and singing which can improve muscle control and train muscles of the upper airway. </p>\n\n<p>Seeking a doctors care is very important as snoring can be a sign of <a href=\"https://www.nlm.nih.gov/medlineplus/sleepapnea.html\" rel=\"noreferrer\">sleep apnea</a> which can be life threatening. The <a href=\"http://www.britishsnoring.co.uk/why_do_i_snore/introduction_to_causes_snoring.php\" rel=\"noreferrer\">cause of snoring</a> is important and can change treatment. Also, of note is that <a href=\"http://www.britishsnoring.co.uk/cure_for_snoring.php\" rel=\"noreferrer\">snoring can not be cured, only controlled.</a> </p>\n\n<p>By remedies I assumed you meant things other than <a href=\"http://www.mayoclinic.org/diseases-conditions/snoring/basics/treatment/con-20031874\" rel=\"noreferrer\">surgery, implants, CPAP and Radiofrequency tissue ablation.</a> </p>\n", "score": 6 } ]

[ "sleep" ]

[ { "answer_id": 7022, "body": "<p>The general recommendation against vegetable oil has nothing to do with the oil source. The usual complain is that vegetable oils are perceived as \"highly processed\" and thus \"not natural\". Which of course is not true. You can't treat extra virgin olive oil same as margarine (aka \"hardened vegetable oil\"). There are many crappy products made from unspecified \"vegetable oil\", but it doesn't mean that all oils coming from plants are bad.</p>\n\n<p>Just make sure the oil is a high quality, cold pressed one.</p>\n\n<p>Sorry I can't cite any sources, but when something is a made up misconception, there are no sources to prove it's not real : /</p>\n", "score": 5 }, { "answer_id": 5984, "body": "<p>What is bad is not vegetable oil but making decisions based on pseudoscience. There is no evidence that low carb diets will do you any good except if you are (pre)diabetic. It's not good science to do studies on prediabetic obese people, put them on a low carb ketogenic diet, measure the improvement in insulin sensitivity and then conclude that carbs are bad. That's as stupid as saying that strenuous exercise is bad for the heart because the condition of heart failure patients worsens when put on a strenuous exercise routine.</p>\n\n<p>The real evidence on carbs and fats points to the complete opposite direction. A high carb, low fat diet actually improves insulin sensitivity and has many other health benefits, particularly for the cardiovascular system. <a href=\"http://nutritionfacts.org/2014/11/11/we-can-end-the-heart-disease-epidemic/\" rel=\"nofollow\">We can read here</a>:</p>\n\n<blockquote>\n <p>Maybe the Africans were just dying early of other diseases and so never lived long enough to get heart disease? No. In the video One in a Thousand: Ending the Heart Disease Epidemic, you can see the age-matched heart attack rates in Uganda versus St. Louis. Out of 632 autopsies in Uganda, only one myocardial infarction. Out of 632 Missourians—with the same age and gender distribution—there were 136 myocardial infarctions. More than 100 times the rate of our number one killer. In fact, researchers were so blown away that they decided to do another 800 autopsies in Uganda. Still, just that one small healed infarct (meaning it wasn’t even the cause of death) out of 1,427 patients. Less than one in a thousand, whereas in the U.S., it’s an epidemic.</p>\n</blockquote>\n\n<p>These Ugandans only got about 20% of less of their energy from fats, they were eating mostly a plant based diet. Human physiology is adapted to get most of the energy from carbs. Our ancestors living in Africa had to do without butter and oil, they would be filling their stomachs with energy from starches and fruits. You only need a small amount of the essential fatty acids Omega-6 and Omega-3, of the order of a few grams per day.</p>\n\n<p>There is plenty of other evidence for this. E.g. Evidence from autopsies on US soldiers killed in action in Vietnam shows that 80% had the early signs of atherosclerosis, while only about 3% of the North Vietnamese killed in action showed such signs. The main difference is the diet, the North Vietnamese were eating a plant based diet where most of their energy came from carbs. An intervention study by Dr. Esselstyn done on heart patients who could not be operated and were deemed to be terminally ill, resulted in most of these patients reversing their symptoms and living for many more years without symptoms, <a href=\"https://www.youtube.com/watch?v=J6pLRdawBw0\" rel=\"nofollow\">see here for details</a>.</p>\n\n<p>The opposite claim that a low carb high fat diet is good for health has arguably been falsified in a huge trial. The North American population has put itself on this diet, decreasing the amount of carbs relative to the amount of fats ever more. The result? <a href=\"http://www.mywebtimes.com/news/illinois_ap/extreme-obesity-is-ballooning-in-u-s-adults/article_a3085ab8-4b99-5285-a338-e566948ef2fc.html\" rel=\"nofollow\">Americans are not just getting fatter, they are ballooning to extremely obese proportions at an alarming rate.</a> People in their 40s are dying from heart disease, teenagers are getting type 2 diabetes.</p>\n\n<p>So, to conclude, what's bad for you is the ketogenic diet itself, not so much the oil you want to use for this diet.</p>\n", "score": 1 } ]

[ "diet", "oil" ]

[ { "answer_id": 19728, "body": "<p><strong>1) Human growth hormone (HGH) shots, meals and glucose and insulin spikes.</strong></p>\n\n<p>HGH shots increase blood glucose and therefore insulin, both of which can be further increased by having meals shortly before or after the shots.</p>\n\n<p>There is some evidence that glucose spikes (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12166607\" rel=\"nofollow noreferrer\">International Journal of Clinical Practice, 2002</a> ; <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16519037\" rel=\"nofollow noreferrer\">Clinical Therapeutics, 2005</a>) and insulin spikes (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3884502\" rel=\"nofollow noreferrer\">Hypertension, 1985</a>) after meals may be a risk factor for atherosclerosis. Theoretically, this could mean that having meals close to HGH shots could increase the risk of atherosclerosis, but there seems to be no direct evidence from the studies.</p>\n\n<p>To prevent high blood glucose spikes after meals one can try to avoid foods with quickly absorbable carbohydrates, such as sugar (sweets and sweetened beverages) and plain starch (white bread, pasta and rice, potatoes, cornflakes, instant oats) (<a href=\"https://www.health.harvard.edu/diseases-and-conditions/glycemic-index-and-glycemic-load-for-100-foods\" rel=\"nofollow noreferrer\">Harvard.edu</a>).</p>\n\n<p>It may also be a good idea to get tested for Hb1ac - increased values are a sign of chronically elevated blood glucose.</p>\n\n<p><strong>2) Human Growth Hormone and Diabetes</strong></p>\n\n<p>Treatment with human growth hormone can increase insulin resistance, but can increase the risk for diabetes type 2 <em>mainly in individuals with other predisposing factors,</em> such as obesity and family history of diabetes.</p>\n\n<p>Study 1) Human growth hormone (HGH) replacement therapy at a low-dose (9.6 μg/kg body weight/day) can increase insulin resistance after 1 week and 6 months of therapy (<a href=\"https://academic.oup.com/jcem/article/88/4/1455/2845123\" rel=\"nofollow noreferrer\">JCEM, 2003</a>).</p>\n\n<p>Study 2) <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7962308\" rel=\"nofollow noreferrer\">The effect of 3 months of recombinant human growth hormone (GH) therapy on insulin and glucose-mediated glucose disposal and insulin secretion in GH-deficient adults (JCEM, 1994)</a>:</p>\n\n<blockquote>\n <p>We conclude that short term low dose rhGH treatment of GH-deficient\n adults induces a temporary state of mild glucose intolerance,\n hyperinsulinemia, insulin resistance, and raised NEFA levels at 1\n week. By 3 months, these metabolic disturbances had returned to\n baseline for a persisting modest hyperinsulinemia.</p>\n</blockquote>\n\n<p>Study 3) <a href=\"https://care.diabetesjournals.org/content/35/1/57\" rel=\"nofollow noreferrer\">Incidence of Diabetes Mellitus and Evolution of Glucose Parameters in Growth Hormone–Deficient Subjects During Growth Hormone Replacement Therapy (Diabetes Care, 2012)</a>:</p>\n\n<blockquote>\n <p>Diabetes incidence appears to be increased in GH-deficient patients\n receiving GHRT [growth hormone replacement therapy] <em>and exhibiting an adverse risk profile at baseline.</em></p>\n</blockquote>\n\n<p>Study 4) <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10696981\" rel=\"nofollow noreferrer\">Incidence of diabetes mellitus and impaired glucose tolerance in children and adolescents receiving growth-hormone treatment (Lancet, 2000)</a>:</p>\n\n<blockquote>\n <p>We postulate that the higher than expected incidence of type 2\n diabetes mellitus with GH treatment may be an acceleration of the\n disorder <em>in predisposed individuals.</em></p>\n</blockquote>\n\n<p><strong>Conclusion:</strong> Even if meals near HGH shots increase blood glucose and insulin levels, there is no direct evidence from studies that they actually increase the incidence of diabetes or atherosclerosis. </p>\n", "score": 2 } ]

[ "endocrinology", "diabetes", "time-of-day", "meal", "growth-hormones" ]

[ { "answer_id": 17743, "body": "<p>Gauge sizes do affect the red blood cells (RBCs). However, this mostly applies in the high range with 23 gauge needles (and higher) predisposing the sample to hemolysis (the destruction of RBCs) which causes problems for some blood tests (namely the CBC). Large needles come with problems of their own like an increased risk of creating a tear in the blood vessel with associated pain etc. and failure to acquire the blood sample. These large needles are currently only recommended for blood donation, both to prevent hemolysis but also to speed up the donation process since they allow more blood flow than smaller needles.</p>\n\n<p>So in short, large needles are not without their own problems so needles that are smaller should be used for most blood sampling. However, this may create problems if the needle is very small.</p>\n\n<p>Source: <a href=\"http://apps.who.int/iris/bitstream/handle/10665/44294/9789241599221_eng.pdf;jsessionid=2CACD0158916EFB2547F59A71224EC01?sequence=1\" rel=\"noreferrer\" title=\"WHO phlebotomy guidelines\">WHO Guidelines on Drawing Blood: Best Practices is Phlebotomy, 2010.</a></p>\n", "score": 5 } ]

[ "blood-tests", "blood-donation" ]

[ { "answer_id": 7241, "body": "<p>The <a href=\"https://en.wikipedia.org/wiki/Bristol_stool_scale\" rel=\"nofollow noreferrer\">bristol chart</a> is commonly used for describing the texture and consistency of stools. See chart and details below.</p>\n\n<p><a href=\"https://i.stack.imgur.com/NUOTV.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/NUOTV.png\" alt=\"enter image description here\"></a>\n<em>By Cabot Health, Bristol Stool Chart (<a href=\"http://cdn.intechopen.com/pdfs-wm/46082.pdf\" rel=\"nofollow noreferrer\">http://cdn.intechopen.com/pdfs-wm/46082.pdf</a>)<a href=\"http://creativecommons.org/licenses/by-sa/3.0\" rel=\"nofollow noreferrer\"> [CC BY-SA 3.0]</a>, via Wikimedia Commons</em></p>\n\n<p>Quoting the wikipedia article linked above</p>\n\n<blockquote>\n <p>The seven types of stool are:</p>\n \n <ol>\n <li>Separate hard lumps, like nuts (hard to pass)</li>\n <li>Sausage-shaped, but lumpy</li>\n <li>Like a sausage but with cracks on its surface</li>\n <li>Like a sausage or snake, smooth and soft</li>\n <li>Soft blobs with clear cut edges (passed easily)</li>\n <li>Fluffy pieces with ragged edges, a mushy stool</li>\n <li>Watery, no solid pieces, entirely liquid</li>\n </ol>\n \n <p>Types 1 and 2 indicate constipation, with 3 and 4 being the ideal stools\n (especially the latter), as they are easy to defecate while not\n containing excess liquid, and 5, 6 and 7 tending towards diarrhoea.</p>\n</blockquote>\n", "score": 8 } ]

[ "quantified-self" ]

[ { "answer_id": 7342, "body": "<p>To get the most of your vitamins/minerals is quite simple, really.</p>\n\n<p>There are two types of soluble vitamins/minerals:</p>\n\n<ol>\n<li>Water-soluble</li>\n<li>Fat-soluble</li>\n</ol>\n\n<p>Absorption of water-soluble vitamins is quite easy, considering almost everything you eat/drink contains water. </p>\n\n<p>However, if you want maximum absorption rate for fat-soluble vitamins/minerals, you'll want to have some fat along with the supplement(s) you consume. </p>\n\n<p>This is why most multivitamin boxes will instruct you to consume the pill with dinner (because it's presumed that fat will be present with your dinner).</p>\n\n<hr>\n\n<p>Abstract - <a href=\"http://ajcn.nutrition.org/content/12/3/162.abstract\" rel=\"nofollow\">http://ajcn.nutrition.org/content/12/3/162.abstract</a></p>\n\n<p>'fact sheet' - <a href=\"http://extension.colostate.edu/topic-areas/nutrition-food-safety-health/fat-soluble-vitamins-a-d-e-and-k-9-315/\" rel=\"nofollow\">http://extension.colostate.edu/topic-areas/nutrition-food-safety-health/fat-soluble-vitamins-a-d-e-and-k-9-315/</a></p>\n", "score": 4 } ]

[ "digestion", "micronutrients", "supplement", "metabolism", "vegetarianism" ]

[ { "answer_id": 7655, "body": "<p><strong>Acute disseminated encephalomyelitis (ADEM)</strong> is an inflammatory disorder, which often follows an infection or a vaccination. It is the <strong>most frequent demyelinating disorder of the CNS in children</strong>. </p>\n\n<p>In case of an infectious aetiology, some epidemiological studies suggest that ADEM is more frequently associated with upper respiratory tract infections in countries with significant advances in infectious disease control, whereas in poor or developed countries, ADEM often occurs after childhood infections such as measles. Below a table with a list of the possible aetiologies for ADEM (from Garg et al).</p>\n\n<p><a href=\"https://i.stack.imgur.com/pYmiF.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/pYmiF.png\" alt=\"enter image description here\"></a></p>\n\n<p>Current evidence suggest that ADEM results from a transient autoimmune reaction against myelin or other autoantigens which occur through a phenomenon of molecular mimicry or activation of autoreactive T cells.</p>\n\n<p>Your question</p>\n\n<blockquote>\n <p>Does myelin fully regenerate after a demyelization disease such as\n ADEM (Acute Disseminated Encephalomyelitis)? Does myelin always get\n damaged after an ADEM?</p>\n</blockquote>\n\n<p><em>I have found two studies focusing on clinical outcome in children with ADEM:</em></p>\n\n<p><strong>1. According to this study <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12973660\" rel=\"nofollow noreferrer\">1</a> conducted among 39 patients with median age at onset of 8 years:</strong></p>\n\n<blockquote>\n <p>Of 39 children with 12 months' follow-up, 71 % recovered completely.\n Thirteen (33 %) children had relapses. Patients who had more than one\n relapse (n = 4) presented with new symptoms at each attack. Treatment\n with high-dose methylprednisolone was associated with complete\n recovery, and tapering over more than 3 weeks, with a lower rate of\n relapses. MRI lesions could persist even in asymptomatic patients; in\n particular, periventricular lesions tended to disappear later than\n others.</p>\n</blockquote>\n\n<p><strong>2. According to this study <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087985/\" rel=\"nofollow noreferrer\">2</a> including 14 children with a follow up of one and a half year:</strong></p>\n\n<blockquote>\n <p>10(71%) children had total remission of symptoms within one week of\n starting steroids. 4(29%) children had residual symptoms at the end of\n steroid therapy. The children were followed up for a variable period\n from two months to three and a half years. Most of the cases made\n uneventful recovery.</p>\n</blockquote>\n\n<p>You can find additional information in the complete report for each of the study.</p>\n\n<p><em>Sources:</em></p>\n\n<ul>\n<li>Garg RK et al. Acute disseminated encephalomyelitis. Postgrad Med J\n2003;79:11-17 doi:10.1136/pmj.79.927.11</li>\n<li>Jayakrishnan MP, Krishnakumar P. Clinical profile of acute\ndisseminated encephalomyelitis in children. Journal of Pediatric\nNeurosciences. 2010;5(2):111-114.</li>\n<li>Anlar B et al. Acute disseminated encephalomyelitis in children:\noutcome and prognosis. Neuropediatrics. 2003 Aug;34(4):194-9.</li>\n</ul>\n\n<p><strong><em>Edit (after additional information was submitted by the OP)</em></strong></p>\n\n<p>Probably yes, or at least that full remyelination has not completely finished. Concerning your question about the potential of remyelination: There isn't much information available on ADEM and remyelination, but at it shares some common features in terms of pathogenesis with multiple sclerosis (MS), let's take some evidence concerning remyelination in MS:</p>\n\n<p>We know that the treatment of MS aims at two things (1,2):</p>\n\n<ul>\n<li>Prevent further damages by modulating the inflammatory processes. This is normally achieved with immunomodulatory therapies.</li>\n<li>Repair the demyelination which resulted from the pathological inflammatory process by stimulation remyelination, ie the regeneration of new myelin sheats.</li>\n</ul>\n\n<p>While the first has showed some interesting results thanks to growing number of immunomodulatory therapies on the market (among which glucocorticoids, which are also used in ADEM treatment), the second has still to be proven. </p>\n\n<p>Although some immunomodulatory therapies might indirectly stimulate remyelination, current therapies directly targeting regeneration of myelin sheats have yet to be proven. Furthermore, the presence of axon degeneration despite immunomodulatory therapies, suggest that axon integrity and protection may occur through mechanisms independent of inflammation (3,4).</p>\n\n<p>Huang et al provide a good summary of <strong>current approach for remyelination</strong> (5):</p>\n\n<blockquote>\n <p>The principal source of new remyelinating cells is an abundant and\n widely distributed population of cells in the adult CNS traditionally\n called oligodendrocyte precursor cells (OPCs). In the adult CNS, these\n cells are both self-renewing and multipotent, having been observed to\n give rise to certain neurons, astrocytes (albeit rarely), and Schwann\n cells, as well as oligodendrocytes in vivo, and so can reasonably be\n regarded as a type of adult neural stem cell. The response to\n demyelination causes OPCs to become activated, a morphological change\n accompanied by upregulation of genes not normally expressed in the\n resting state. Activated OPCs proliferate, migrate and rapidly fill up\n the demyelinated lesions at a density that far exceeds that in normal\n tissue. To complete the remyelination process, the cells exit the cell\n cycle and differentiate into myelin sheath-forming oligodendrocytes,\n which is a complex process involving axon engagement, ensheathment and\n formation of compacted myelin.</p>\n</blockquote>\n\n<p>The article by Huang et al also provides a good review (it is open access) on the current pharmacological targets for remyelination as well as the barriers of remyelination (among which age, probably explaining while cases of ADEM in the adults show a worse outcome that cases in children).</p>\n\n<p>Hope this brings some clarification!</p>\n\n<p>Sources:</p>\n\n<ol>\n<li>Martino G, Franklin RJM, Baron van Evercooren A, Kerr D, Group SC.<br>\nStem cell transplantation in multiple sclerosis: current status and \nfuture prospects. Nat Rev Neurol. 2010;6:247–255.doi:10.1038/nrneurol.2010.35.</li>\n<li>Franklin RJM, ffrench-Constant C. Stem cell treatments and multiple\nsclerosis. BMJ. 2010;340:986–985. doi: 10.1136/bmj.c1387</li>\n<li>Coles AJ, Wing MG, Molyneux P, et al. Monoclonal antibody treatment\nexposes three mechanisms underlying the clinical course of multiple\nsclerosis. Ann Neurol. 1999;46:296–304. doi:\n10.1002/1531-8249(199909)46:3&lt;296::AID-ANA4>3.0.CO;2-#.</li>\n<li>Dutta R, Trapp BD. Pathogenesis of axonal and neuronal damage in\nmultiple sclerosis. Neurology.2007;68(22 suppl 3):S22–S31. doi:\n10.1212/01.wnl.0000275229.13012.32.</li>\n<li>Huang JK, Fancy SPJ, Zhao C, Rowitch DH, ffrench-Constant C,\nFranklin RJM. Myelin Regeneration in Multiple Sclerosis: Targeting\nEndogenous Stem Cells. Neurotherapeutics. 2011;8(4):650-658.\ndoi:10.1007/s13311-011-0065-x.</li>\n</ol>\n", "score": 6 } ]

[ "neurology", "myelin-sheath" ]

[ { "answer_id": 8749, "body": "<p><em>As an addendum (with some contrasts) to the previous answer (To be honest, I had the same feeling that women have definitely a different pain threshold compared to men.)</em></p>\n\n<p>According to WebMD (<a href=\"http://www.webmd.com/pain-management/chronic-pain-conditions\" rel=\"nofollow\">http://www.webmd.com/pain-management/chronic-pain-conditions</a>),</p>\n\n<blockquote>\n <p>It is now widely believed that pain affects men and women differently.\n While the sex hormones estrogen and testosterone certainly play a role\n in this phenomenon, psychology and culture, too, may account at least\n in part for differences in how men and women receive pain signals.</p>\n</blockquote>\n\n<p>But interestingly, studies showed that men have a higher pain threshold than women:</p>\n\n<blockquote>\n <p>male experimental animals injected with estrogen, a female sex\n hormone, appear to have a lower tolerance for pain-that is, the\n addition of estrogen appears to lower the pain threshold. Similarly,\n the presence of testosterone, a male hormone, appears to elevate\n tolerance for pain in female mice.</p>\n</blockquote>\n\n<p>It seems that the pain killing system in women and men work differently, as suggested by some studies showing that some painkiller (such as kappa-opioids, which are used in labour) work better in women than in men <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8898754\" rel=\"nofollow\">1</a>.</p>\n\n<p>The exact reasons for this difference in pain perception is, however still unknown.</p>\n\n<p>Here extracts from the abstract of a study, which browsed the literature concerning pain perception in men and women:</p>\n\n<blockquote>\n <p>In addition, sex hormones influence pain sensitivity; <strong>pain threshold\n and pain tolerance in women vary with the stage of the menstrual\n cycle</strong>. Imaging studies of the brain have shown differences between men\n and women in the spatial pattern and intensity of response to acute\n pain. <strong>Among rodents, females are more sensitive than males to noxious\n stimuli and have lower levels of stress-induced analgesia.</strong> (...) <strong>Research on transgenic mice suggests\n that normal males have a higher level of activity in the endogenous\n analgesic system compared with normal females</strong>.</p>\n</blockquote>\n\n<p>Wiesenfeld-Hallin Z. Sex differences in pain perception. Gend Med. 2005 Sep;2(3):137-45. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16290886\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/16290886</a></p>\n\n<p><strong>So probably, differences in pain perception between women and men is multifactorial: psychological, cultural and biological.</strong></p>\n", "score": 4 }, { "answer_id": 8692, "body": "<p>While not the best evidence, with a reasonably small control group and arguably a sub-optimal method for administering pain, the Mythbusters did conduct \"scientific\" investigation into who can tolerate the most pain:</p>\n\n<blockquote>\n <p>Women have a higher pain tolerance than men.</p>\n \n <p><strong>confirmed</strong></p>\n \n <p>[For the following myths involving pain tolerance, all of the test\n subjects sat in a chair and submersed one hand in an ice bath at 1°C\n for as long as they could endure.] Twenty-five members of each gender\n took part. The women lasted an average of 100.4 seconds in the ice,\n while the average for the men was 84.3 seconds.</p>\n</blockquote>\n\n<p><a href=\"http://mythresults.com/no-pain-no-gain\" rel=\"nofollow\">http://mythresults.com/no-pain-no-gain</a></p>\n\n<p>So while not a quantifiable difference, evidence suggested that the answer to your question is <strong>YES</strong>.</p>\n", "score": 0 } ]

[ "pain" ]

[ { "answer_id": 8906, "body": "<p><em>This is an interesting question, which comes frequently on Health SE.</em></p>\n\n<p>First, here a small background on <strong>vaginal secretions</strong>:</p>\n\n<p>More than 30 compounds have been described in the vaginal secretions. Several \"sources\" for those secretions have been indentified: vulvar secretions from sebaceous, sweat, Bartholin and Skene glands, secretions from the endometrium, transudate from the vaginal walls and exfoliated cells from the vaginal mucosa. </p>\n\n<p>Compounds of vaginal fluid are <strong>proteins, carbohydrates, fatty acids</strong>. <strong><em>There is also a vaginal bacterial flora (such as vaginal lactobacilla) which produces organic acids as metabolic byproducts which can contribute to the vaginal odor.</em></strong></p>\n\n<p><strong>So what influences those odors?</strong></p>\n\n<p>Certainly the menstrual cycle. Here an interesting study published some decades ago (more than > 30 years) in Science: </p>\n\n<p>A research group sampled vaginal secretions in women and asked participants to \"sniff\" the bottle containing the secretions. They were then asked to evaluate the intensity and pleasantness of the odor's secretion. Here a graph of the variation in vaginal odor during a menstrual cycle:</p>\n\n<p><a href=\"https://i.stack.imgur.com/b4wit.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/b4wit.png\" alt=\"enter image description here\"></a></p>\n\n<p>As you can see there is high variability, although slightly less unpleasant odor were noted in the preovulatory and ovulatory phase. So there is probably the <strong>role of sex hormones</strong> and an inter-individual variability</p>\n\n<p>Infections or medications (in particular antibiotics) which alters the vaginal ecoflora, leading some bacteries to outpower other bacterias, which in turn leads to the production of other organic compounds, associated with different odors.</p>\n\n<p>In women with bacterial vaginosis (= altered vaginal flora), one recent study has reported that </p>\n\n<blockquote>\n <p>increased dietary fat intake is associated with increased risk of BV\n and severe BV, whereas increased intake of folate, vitamin A, and\n calcium may decrease the risk of severe BV.</p>\n</blockquote>\n\n<p>so maybe diet can influence this vaginal odor.</p>\n\n<p>Finally, <strong>hygiene habits and sexual activity</strong> have also been linked to a change in vaginal flora, and might therefore lead to a change in vaginal odor.</p>\n\n<p>As <strong>odor perception can be \"subjective\"</strong> an inter-individual variability of its pleasantness should also be taken into account.</p>\n\n<p><strong>Sources:</strong></p>\n\n<p>Doty et al. Changes in the intensity and pleasantness of human vaginal odors during the menstrual cycle. Science  26 Dec 1975: Vol. 190, Issue 4221, pp. 1316-1318. DOI: 10.1126/science.1239080</p>\n\n<p>Fashemi B, Delaney ML, Onderdonk AB, Fichorova RN. Effects of feminine hygiene products on the vaginal mucosal biome. Microbial Ecology in Health and Disease. 2013;24:10.3402/mehd.v24i0.19703. doi:10.3402/mehd.v24i0.19703.</p>\n\n<p>Neggers YH, Nansel TR, Andrews WW, et al. Dietary Intake of Selected Nutrients Affects Bacterial Vaginosis in Women. The Journal of nutrition. 2007;137(9):2128-2133.</p>\n\n<p>Paavonen J et al. Physiology and ecology of the vagina. Scand J Infect Dis Suppl. 1983;40:31-5.</p>\n\n<p>Priestley CJ, Jones BM, Dhar J, Goodwin L. What is normal vaginal flora?Genitourinary Medicine. 1997;73(1):23-28.</p>\n", "score": 9 } ]

[ "sex", "reproduction" ]

[ { "answer_id": 8914, "body": "<p>Pediatric heart transplantation represents approximatively 15% of the total heart transplantations <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387410/\">1</a>.</p>\n\n<p>Several studies have provided some insights on the cardiac growth after heart transplantation. <strong>Most of them have shown that the transplanted heart in children follows similar growth as non-transplanted paediatric hearts.</strong></p>\n\n<p>Here some extracts of the major studies in that field:</p>\n\n<ul>\n<li>In a study including 13 infants with a duration of follow-up was\n3.1±0.4 years</li>\n</ul>\n\n<blockquote>\n <p><strong>Both right ventricular (RV) and left ventricular (LV)</strong> chamber\n dimensions <strong>were within the normal range</strong> at both early and late time\n points and grew normally</p>\n</blockquote>\n\n<p><em>D. Bernstein, S. Kolla, M. Miner, P. Pitlick, M. Griffin, V. Starnes, et al. Cardiac growth after pediatric heart transplantation. Circulation, 85 (1992), pp. 1433–1439</em></p>\n\n<ul>\n<li><strong>Another study reported normal cardiac growth after transplantation\nalthough these patients showed somatic growth deficits due to the\nimmunosuppresive therapy.</strong></li>\n</ul>\n\n<p><em>V.R. Zales, K.L. Wright, A.J. Muster, C.L. Backer, D.W. Benson, C. Mavroudis. Ventricular volume growth after cardiac transplantation in infants and children. Circulation, 86 (5 Suppl) (1992), pp. II272–II275</em></p>\n\n<ul>\n<li><strong>Finally, one large study which included 147 patients and followed them up during several years (up to 10 years) reported similar\nresults</strong></li>\n</ul>\n\n<blockquote>\n <p>The ventricular end-diastolic diameters, the ventricular end-diastolic\n volumes and ventricular mass increased proportionally 6 to 10 years\n after heart transplantation in all patients regardless of the BSA\n ratio.</p>\n</blockquote>\n\n<p><em>Delmo et al. Influence of size disparity of transplanted hearts on cardiac growth in infants and children. The Journal of Thoracic and Cardiovascular Surgery. Volume 143, Issue 1, January 2012, Pages 168–177</em></p>\n", "score": 7 } ]

[ "heart-transplant" ]

[ { "answer_id": 8989, "body": "<p><a href=\"http://insulinnation.com/treatment/medicine-drugs/beyond-bmi-and-a1c-measuring-insulin-resistance/\" rel=\"noreferrer\">InsulinNation</a> gives a good overview:</p>\n<blockquote>\n<p>Pre-diabetes can exist for a long time in your body without triggering the most common outward signs of diabetes (continual thirst, frequent urination, blurred vision, etc). And standard methods of detecting insulin resistance or pre-diabetes using glucose tolerance tests or an A1C percentage often show false negatives; that’s because the pancreas is still able to produce enough insulin to overcome insulin resistance. Type 2 diabetes is also good at hiding itself; it is common that someone diagnosed as a Type 2 has already had the disease for five years, which makes the battle for control an uphill climb even before it begins.</p>\n<p>Fortunately, there are other ways to identify insulin resistance using biomarkers in blood drawn from patients as a normal part of an annual or semi-annual general checkup. These biomarker data can be plotted against what is considered normal, and as a result, place the person at a specific point along the path to pre-diabetes or to Type 2 diabetes itself.</p>\n<p>Tools to detect insulin resistance include</p>\n</blockquote>\n<ul>\n<li><p>Tests showing the degree of pancreatic output and what could be defined as “pancreatic stress”. These include both fasting insulin and fasting glucose, a Homeostasis Model Assessment (HOMA) that measures beta cell function and insulin sensitivity, a C-Peptide test and a pro-insulin test;</p>\n</li>\n<li><p>Measurements of lipid hormones such as leptin and adiponectin. These biomarkers can give insight into a person’s unique communication between fat metabolism and insulin.</p>\n</li>\n<li><p>Tests that evaluate a person’s degree of inflammation.These biomarkers include a cardiac-specific C-reactive protein measurement (CRP) and a sedimentation rate.</p>\n</li>\n<li><p>Measurements that quantify fatty acid metabolism and the fatty acids released by the patient. These can also give particle size and number as well as an average inflammatory number.</p>\n</li>\n</ul>\n", "score": 9 }, { "answer_id": 9172, "body": "<p>There is a surrogate marker of insulin resistance, called IGFBP-1. It's a simple blood test, and easy to interpret. This test is done at a specialty lab and takes several weeks for the results to come back. You get your blood draw in the usual place (e.g. your local hospital), but then the sample is sent out to a specialty lab. This is a relatively non-invasive test. You can put EMLA cream on the inside of a child's elbow and there will be no pain for the blood draw.</p>\n<p>An individual with insulin resistance can do this test between once and four times a year, to track progress (or lack thereof). The lower the result, the more insulin resistant you are. For example, my son, who has been diagnosed with insulin resistance, has varied between 4 and 20 (I forget what the units are). When he was at 4, we were seeing more symptoms and higher BMI for age. When he was at 16 things were better. At 20, better still. I'm afraid I'm not certain what range is considered normal -- but I vaguely remember 20 and above was good.</p>\n<p>There are a number of articles out there about this. Here's one:\nMaclaren NK, Gujral S, Ten S &amp; Motagheti R. Childhood obesity and insulin resistance. Cell Biochemistry and Biophysics 2007 ;48:73–78.</p>\n<p>Apparently this only works as a surrogate for children.</p>\n", "score": 1 } ]

[ "nutrition", "diabetes" ]

[ { "answer_id": 9253, "body": "<p><em>Actually, I am a frequent flyer (I think I spend at least 10% of my year in an airplane or an airport) and I discussed the problem of sunlight with my treating physician.</em></p>\n\n<p>First, sunlight has an impact on the circadian rythm (which involves the secretion of melatonin, cortisol, control of body temperature) which <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717723/\">regulates your wake/sleep cycle.</a> </p>\n\n<p>The effect of evening light was examined in a study where a subject was exposed to several hours of light every evening for a week, and the timing of the rhythms of core body temperature and plasma cortisol were measured. </p>\n\n<p>The authors reported that</p>\n\n<blockquote>\n <p>Both rhythms were shifted by approximately 6 hours, and examination of\n temperature data collected throughout the experiment suggested that\n the shift had already occurred after only 2 days.</p>\n</blockquote>\n\n<p><strong>Dysregulated circadian rythms (due to impaired melatonin, cortisol and body temperature levels) is associated with many diseases among which <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018537/\">psychiatric diseases</a> and <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837358/\">metabolic syndrome</a>.</strong></p>\n\n<p>So, this possibly explains the results found in the study you linked on the telegraph.co.uk suggesting that <strong>early sunlight</strong> might reduce the risk of developing metabolic syndrome, probably because this is associated with a physiological (ie normal) circadian rythm.</p>\n\n<p>Finally, you linked one study regarding \"sunbathing is good for you\". I think, this should be taken with caution, particularly because <a href=\"https://www.melanoma.org/understand-melanoma/preventing-melanoma/why-is-tanning-dangerous\">increased sunbathing is linked to skin cancer</a>.</p>\n\n<p>We also discussed the effect of different timing of the day to produce the maximum of Vitamin D (I am already deficient...). He mailed me following extracts from <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717723/\">this review</a></p>\n\n<blockquote>\n <p>Factors that affect cutaneous production of vitamin D3 include\n latitude, season, time of day, air pollution, cloud cover, melanin\n content of the skin, use of sunblock, age and the extent of clothing\n covering the body. <strong>When the sun is low on the horizon, the\n atmospheric ozone, clouds and particulate air pollution absorb UVB\n radiation, limiting the amount that reach the surface of the Earth.\n The zenith angle of the sun plays a critical role in vitamin D3\n production. When the zenith angle is more oblique, the path length\n through the stratospheric ozone layer is increased and hence, fewer\n UVB photons are able to reach the earth’s surface</strong>.</p>\n</blockquote>\n\n<p>So overall, current research evidence speaks in favor of morning sunlight. Evening sunlight might on the contrary be associated with negative effects.</p>\n\n<p>Hope this helps!</p>\n", "score": 8 } ]

[ "dermatology", "sun-exposure" ]

[ { "answer_id": 10246, "body": "<p><a href=\"http://www.chicagotribune.com/lifestyles/food/sns-201608221300--tms--foodstylts--v-f20160822-20160822-story.html\" rel=\"nofollow noreferrer\"><strong>Some IBS patients benefit from probiotic supplements. Those with the best efficacy include Align, Culturelle and VSL#3.</strong></a></p>\n", "score": 1 }, { "answer_id": 11680, "body": "<p>I have it on good authority that bacillus coagulans and saccharomyces boulardii are effective at combating C. difficile, which is largely responsible for IBS. Here are a couple of citations from respectable sources: <a href=\"https://medlineplus.gov/druginfo/natural/1185.html\" rel=\"nofollow noreferrer\">bacillus coagulans</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296087/\" rel=\"nofollow noreferrer\">saccharomyces boulardii</a>.</p>\n", "score": 1 } ]

[ "probiotics", "irritable-bowel-syndrome", "diarrhea", "gut-microbiota-flora", "ulcerative-colitis" ]

[ { "answer_id": 9412, "body": "<p>You have to be sensible, losing weight is simple thermodynamics. If you consume less calories than you need, you will lose weight. Examine.com says it best:</p>\n<blockquote>\n<h2>What should I eat for weight loss?</h2>\n<p><strong>Eat less.</strong> Different diets can make this easier, so pick whichever one\nbest fits your lifestyle. Ultimately, you need to reduce your caloric\nintake.</p>\n<p><a href=\"http://examine.com/nutrition/what-should-i-eat-for-weight-loss/\" rel=\"nofollow noreferrer\"><em>Examine.com</em></a></p>\n</blockquote>\n<p>Since prolonged fasting <em>might</em> increase heat expenditure, diets that manipulate fasting (Intermittent Fasting, Alternate Day Fasting) <em>may</em> have some benefits on the “calories out” side of things. Yet, even here, weight lost is mostly due to the fact that you control eating: It is much harder to overeat in 8 hours than in 16.</p>\n<p>A good way to check that you aren't underfeeding yourself is to count calories and sum up per-week what you have eaten vs what your TDEE says you need. Pair that with your personal data for weight delta over the week and you can adjust your calorie intake appropriately.</p>\n<p>Provided you are meeting your calorie intake sufficiently prior to the fast there is no reason why you would run into any issues during because you body has the energy it needs to get through.</p>\n<p>The main benefit of your diet choice is most likely psychological, as you have picked those times because you believe/understand its easiest to fast then for you.</p>\n<p>In summary,</p>\n<h1>Answers:</h1>\n<ol>\n<li>Provided you have a good grasp of your personal macro-nutritional and calorie needs, yes.</li>\n<li>The “paleo diet” (hunter-gatherer diet) is high in fats, high in proteins, and low in carbohydrates, its a means to assist weight loss through low carbohydrate intake, see answer to question 1.</li>\n</ol>\n", "score": 3 }, { "answer_id": 9485, "body": "<p>Here's one long review article with lots of references that mentions eventual health benefits of fasting:</p>\n\n<p><em>Longo VD et al, 2014 Fasting: Molecular Mechanisms and Clinical Applications\n(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946160/\" rel=\"nofollow\">PubMed Central</a>)</em> </p>\n\n<p>I personally do not see fasting as a method to improve health, detoxify or lose weight but rather as something that can help spiritually. So, I do not want to comment those eventual health benefits - to me it's all vague and with insufficient evidence.</p>\n\n<p>In a short article about fasting on <a href=\"http://www.webmd.com/diet/fasting\" rel=\"nofollow\">WebMD</a>, there is a statement that:</p>\n\n<blockquote>\n <p>Fasting for a few days probably won't hurt most people who are\n healthy, provided they don't get dehydrated.</p>\n</blockquote>\n\n<p>and</p>\n\n<blockquote>\n <p>If you're fasting to lose weight, you may want to reconsider. The\n weight loss may not last after you finish fasting.</p>\n</blockquote>\n\n<p>...both of which I agree with.</p>\n\n<p>A good start to a weight loss diet is to adopt eating habits you actually intend to maintain life-long, so something what will become your new normal. If you think it has to be intermittent fasting, it is then your choice. From a limited evidence provided above, I do not think it is especially good or bad for physical health. </p>\n", "score": 2 } ]

[ "diet", "water", "research", "fasting" ]

[ { "answer_id": 19820, "body": "<p>In whole fruits, sugar is \"embedded\" in the fruit, not necessary chemically, but physically. It takes some time for the digestive system to extract sugar from the fruit, which slows down its absorption.</p>\n\n<p>If you eat a whole mango, all the sugar from it will be absorbed, let's say in 2 hours. If you make a thick juice from mango, both fiber and sugar will be present in it, but will be separated, so your digestive system will be able to extract free sugar from it faster than from a whole fruit, let's say in an hour and half. The presence of fiber will still slow down the absorption of sugar a bit, but not as effectively as in whole fruit. This also applies for the cola + fiber example. This means that blood glucose spikes will be likely higher after drinking fruit juice than after eating whole fruits.</p>\n\n<p>They are 2 main reasons why free sugar can be more harmful for health than the sugar from whole fruits:</p>\n\n<ul>\n<li>It is <strong>less filling</strong>, so it's easier to consume it too much, which can result in an unwanted weight gain</li>\n<li>It more likely results in <strong>higher blood glucose spikes</strong> (higher glycemic index) than the sugar from whole foods, which may be a risk factor for diabetes type 2.</li>\n</ul>\n\n<p>Sources:</p>\n\n<ul>\n<li><a href=\"https://defeatdiabetes.org/resources/healthful-eating/healthy-beverages/fruit-juice/\" rel=\"nofollow noreferrer\">Fruit juice (Defeatdiabetes.org)</a>: a simple explanation with references to studies</li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978819/\" rel=\"nofollow noreferrer\">Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies (BMJ, 2013)</a></li>\n</ul>\n", "score": 4 } ]

[ "nutrition", "sugar", "fruits" ]

[ { "answer_id": 14615, "body": "<p>This sounds like dream come true for 'alternative medicine':\n<a href=\"http://www.the-cma.org.uk/Articles/WaterOnly-Fasting-Can-Help-The-Body-To-Fight-Off-Disease-And-Can-Have-The-Most-Profound-Health-Benefits-Too-6098/\" rel=\"nofollow noreferrer\">Water-Only Fasting Can Help The Body To Fight Off Disease – And Can Have The Most Profound Health Benefits Too:</a></p>\n\n<blockquote>\n <p>_{A recent news item caught my attention – it concerns the therapeutic value of fasting. Researchers at the University of Southern California presented a study that explained that refraining from food for as little as two days can regenerate the immune system, and in addition, fasting for two to four days helps the body to fight infection and “flips a regenerative switch” that triggers stem cell-based regeneration of new white blood cells, thereby renewing the body’s defense system. During the fast, the body gets rid of the parts of the system that might be damaged or old, the inefficient parts. The scientists believe that even if you start with a system heavily damaged by chemotherapy or aging, fasting cycles can generate an entirely new immune system. In a small pilot clinical trial researchers found that fasting for a 72-hour period prior to chemotherapy protected patients against toxicity. Fasting also affects the levels of a substance in our bodies called IGF -1 and in reducing this it diminishes tumour growth and the risk of developing cancers.}<br><br>\n So, how does water-only fasting actually work? What is going on in the body?</p>\n \n <p>_{Water-only fasting – as the name suggests is where you only drink water and take no food whatsoever and, most importantly, you must take complete bed rest. The truly therapeutic part of the fast does not actually begin until the second or third day: the reason for this is that during the first 24 - 48 hours after starting a water fast, the body is still burning off circulating blood sugar and also sugar stored in the muscles and liver in the form of glycogen. Once the first two to three days of the fast are over, your body then begins to burn fat tissue for fuel. Next, molecules named ketones begin circulating in the blood. Ketones suppress hunger and this is why fasting is not a difficult process – once you are over the first few days.</p>\n \n <p>_{Many people don’t understand the process of ketosis correctly and fear that this could damage the kidney and brain, possibly leading to loss of consciousness and even more dire consequences. However, a group of ‘hygienic physicians’ as doctors working in this field are known (and which includes Dr Sabatino as one of the leaders in the field), have supervised many thousands of fasts over the past 50 years, and have shown these concerns to be unfounded. In fact, when fasting is undertaken in a supportive environment, with the supervising practitioner ensuring proper hydration, and total resting conditions, kidney and heart function often dramatically improve as weight and blood pressure drop. There is often a dramatic improvement in the acuity of special senses, vision, hearing etc. People wearing glasses will sometimes remark how they experience moments of absolutely perfect eyesight without their glasses.}\n}</p>\n</blockquote>\n\n<p>\"Researchers found out\": without a link to the original study, not even a date on the article cited above, that is very poor reporting and avoids being checked for accuracy. A very poor practice. Apart from some valid information, and relying on unsourced and probably preliminary scientific evidence, and using impressive sounding abbreviations, there is also the corresponding bull**** mixed under (e.g. \"fasting cycles can generate an entirely new immune system\").</p>\n\n<p>But are there studies that might confirm these alleged findings? A more reliable source for this claim is presented in a very accessible article here:</p>\n\n<blockquote>\n <p><a href=\"https://www.popsci.com/feed-or-starve-sickness-it-depends-on-infection\" rel=\"nofollow noreferrer\"><strong>Feed Or Starve A Sickness? It Depends On The Infection:</strong></a>\n To investigate how loss of appetite might affect the immune system in sick animals, researchers infected some mice with the bacteria Listeria (a common cause of food poisoning), and some with the influenza virus.<br>\n When the mice were force fed, those with bacterial infections died—but those with viral infections were more likely to survive. The researchers determined that glucose in food was responsible for these divergent fates (rather than proteins or fats). When the team used drugs to block the mice from using glucose, the mice infected with bacteria survived, while their virus-ridden peers died.<br>\n Viral and bacterial infections induce different types of immune responses. So our metabolism might require different fuels to prevent inflammation from damaging the body. During a viral infection, glucose seems to be key. But during a bacterial infection, fasting benefited the mice by allowing them to use ketones, a different fuel that is produced when fat is broken down.</p>\n</blockquote>\n\n<p>That indicates an important finding that <em>might</em> have very profound effects in the future. But the cited article is sensible enough to also state clearly:</p>\n\n<blockquote>\n <p>But it’s definitely too soon for these findings to translate into advice about how sick people should eat. This study focused on one strain of mice in a lab setting and only a couple of forms of infection. “It remains to be seen how these results apply to critical illness in humans,” Medzhitov and his coauthors wrote.</p>\n</blockquote>\n\n<p>The original research article is published here: \n<a href=\"http://www.cell.com/cell/fulltext/S0092-8674(16)30972-2\" rel=\"nofollow noreferrer\"><strong>Opposing Effects of Fasting Metabolism on Tissue Tolerance in Bacterial and Viral Inflammation (2016)</a>.</strong></p>\n\n<p>To repeat, in there is the important caveat to note:</p>\n\n<blockquote>\n <p>One limitation of this study (common to most animal studies) is that it was performed on a single mouse strain (C57BL/6J) in one mouse facility. Thus, the roles of genetic background and facility-specific environment remain unknown. In addition, there are many caveats with extrapolating data on organismal biology from studies in unnatural settings of animal facilities. […] Finally, it remains to be seen how these results apply to critical illness in humans.</p>\n</blockquote>\n\n<p>Further studies at least confirm that there are some interesting changes related to the modulation of immune system responses while fasting:<br> </p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28742108\" rel=\"nofollow noreferrer\"><strong>Fasting metabolism modulates the interleukin-12/interleukin-10 cytokine axis (2017):</strong></a>\n […] Growing evidence indicates that metabolic processes impact both, innate and adaptive immunity. […] In conclusion, we showed that fasting metabolism modulates the IL-12/IL-10 cytokine balance, establishing novel targets for metabolism-based immune-modulation.</p>\n</blockquote>\n\n<p>So, sadly, we still do not know for sure. </p>\n\n<p>General problems to simply saying \"it works\" are summarised here:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28610949\" rel=\"nofollow noreferrer\"><strong>Calorie restriction in rodents: Caveats to consider (2017):</strong></a>\n The calorie restriction paradigm has provided one of the most widely used and most useful tools for investigating mechanisms of aging and longevity. By far, rodent models have been employed most often in these endeavors. Over decades of investigation, claims have been made that the paradigm produces the most robust demonstration that aging is malleable. In the current review of the rodent literature, we present arguments that question the robustness of the paradigm to increase lifespan and healthspan. Specifically, there are several questions to consider as follows:<br> </p>\n \n <ol>\n <li>At what age does CR no longer produce benefits?</li>\n <li><p>Does CR attenuate cognitive decline? </p></li>\n <li><p><strong>Are there negative effects of CR, including effects on bone health, wound healing, and response to infection?</strong> </p></li>\n <li><p>How important is schedule of feeding? </p></li>\n <li>How long does CR need to be imposed to be effective? </li>\n <li>How do genotype and gender influence CR? </li>\n <li>What role does dietary composition play?</li>\n </ol>\n \n <p>Consideration of these questions produce many caveats that should guide future investigations to move the field forward.</p>\n</blockquote>\n\n<p>To compare these findings in animals with how humans will react to fasting while infected, a general overview of fasting across different species might be useful and is documented here:<br>\n<a href=\"http://www.springer.com/de/book/9783642290558\" rel=\"nofollow noreferrer\">Marshall D. McCue: \"Comparative Physiology of Fasting, Starvation, and Food Limitation\", Springer: Heidelberg, New York, 2012.</a> </p>\n", "score": 5 } ]

[ "virus", "immune-system", "bacteria", "fasting", "autophagy" ]

[ { "answer_id": 15585, "body": "<blockquote>\n<p>Approximately 100,000 patients annually receive ECT in the United States.</p>\n</blockquote>\n<p>and</p>\n<blockquote>\n<p>In the United States, ECT is most commonly performed 3 times per week regardless of electrode placement. [1] More frequent regimens are not justified. [1] Treatments 2 times per week may result in less memory impairment than treatments 3 times per week. [1, 9] Compared with treatments administered 3 times per week, twice-weekly treatments result in the same degree of final clinical improvement, although possibly at a slower rate of response. [1]</p>\n</blockquote>\n<p><a href=\"https://emedicine.medscape.com/article/1525957-overview\" rel=\"nofollow noreferrer\">https://emedicine.medscape.com/article/1525957-overview</a></p>\n<p>Electrocution requires a voltage of over <a href=\"https://www.emedicinehealth.com/electric_shock/article_em.htm#what_causes_electric_shock\" rel=\"nofollow noreferrer\">500 V</a>, and ECT is kept below this.</p>\n<p>ECT used to defined by the voltage used but now</p>\n<blockquote>\n<p>The dose is measured in millicoulombs of charge delivered</p>\n</blockquote>\n<p><strong>Mechanism of action</strong></p>\n<blockquote>\n<p>The mechanism of action of ECT is not fully known. ECT affects multiple central nervous system components, including hormones, neuropeptides, neurotrophic factors, and neurotransmitters. [13]</p>\n<p>The induction of a bilateral generalized seizure is required for both the beneficial and adverse effects of ECT. [9] An increase in gamma-aminobutyric acid (GABA) transmission and receptor antagonism has been observed, which raises the seizure threshold during ECT. [14] ECT may also lead to an increase of endogenous opioids, which may also have anticonvulsant properties. [12]</p>\n</blockquote>\n", "score": 2 }, { "answer_id": 15599, "body": "<p>Also provided at <a href=\"https://emedicine.medscape.com/article/1525957-overview\" rel=\"nofollow noreferrer\">the Medscape webpage linked by @GrahamChiu</a>,</p>\n\n<blockquote>\n <p>Electroconvulsive therapy (ECT) has been demonstrated by the American Psychiatric Association to be an effective and safe treatment for many psychiatric disorders. (<a href=\"https://doi.org/10.1176/appi.ajp.159.2.331\" rel=\"nofollow noreferrer\">Jaffe, 2001</a>) The use of ECT still generates significant controversy, however. One review concluded that ECT is only marginally more effective than placebo (ie, sham ECT). (<a href=\"http://reference.medscape.com/medline/abstract/16856307\" rel=\"nofollow noreferrer\">Ross, 2006</a>) ECT has been viewed as harmful by the general public, (<a href=\"https://doi.org/10.1016/j.psychres.2004.07.010\" rel=\"nofollow noreferrer\">Lauber, et al., 2005a</a>) psychiatric patients, (<a href=\"https://doi.org/10.1186/1471-244X-7-27\" rel=\"nofollow noreferrer\">Arshad, et al., 2007</a>) and mental health professionals. (<a href=\"https://doi.org/10.1007/s00127-005-0953-7\" rel=\"nofollow noreferrer\">Lauber, et al., 2005b</a>)</p>\n \n <p>ECT has also been perceived as a form of violence against women. (<a href=\"https://doi.org/10.1177/1077801206286404\" rel=\"nofollow noreferrer\">Burstow, 2006</a>) It has been negatively portrayed in movies such as One Flew Over the Cuckoo's Nest, House on Haunted Hill, and Requiem for a Dream. (<a href=\"https://journals.lww.com/ectjournal/Fulltext/2001/12000/The_Portrayal_of_ECT_in_American_Movies.6.aspx\" rel=\"nofollow noreferrer\">McDonald &amp; Walter, 2001</a>)</p>\n \n <p>Despite such debate, ECT is used in the United States and endorsed by the American Psychiatric Association. (<a href=\"https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2015-Electroconvulsive-Therapy.pdf\" rel=\"nofollow noreferrer\">APA, 2015</a>)</p>\n</blockquote>\n\n<h2>References</h2>\n\n<p>APA (2015). Electroconvulsive Therapy (ECT) Position Statement.<br>Available at: <a href=\"https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2015-Electroconvulsive-Therapy.pdf\" rel=\"nofollow noreferrer\">https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2015-Electroconvulsive-Therapy.pdf</a></p>\n\n<p>Arshad, M., Arham, A. Z., Arif, M., Bano, M., Bashir, A., Bokutz, M., ... &amp; Khan, M. M. (2007). Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan. BMC psychiatry, 7(1), 27.<br>DOI: <a href=\"https://doi.org/10.1186/1471-244X-7-27\" rel=\"nofollow noreferrer\">10.1186/1471-244X-7-27</a></p>\n\n<p>Burstow, B. (2006). Electroshock as a form of violence against women. Violence against women, 12(4), 372-392.<br>DOI: <a href=\"https://doi.org/10.1177/1077801206286404\" rel=\"nofollow noreferrer\">10.1177/1077801206286404</a></p>\n\n<p>Jaffe, R. (2001). The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. A Task Force Report of the American Psychiatric Association. 2nd ed. Washington, D.C.: American Journal of Psychiatry.<br>DOI: <a href=\"https://doi.org/10.1176/appi.ajp.159.2.331\" rel=\"nofollow noreferrer\">10.1176/appi.ajp.159.2.331</a></p>\n\n<p>Lauber, C., Nordt, C., Falcato, L., &amp; Rössler, W. (2005a). Can a seizure help? The public's attitude toward electroconvulsive therapy. Psychiatry research, 134(2), 205-209.<br>DOI: <a href=\"https://doi.org/10.1016/j.psychres.2004.07.010\" rel=\"nofollow noreferrer\">10.1016/j.psychres.2004.07.010</a></p>\n\n<p>Lauber, C., Nordt, C., &amp; Rössler, W. (2005b). Recommendations of mental health professionals and the general population on how to treat mental disorders. Social psychiatry and psychiatric epidemiology, 40(10), 835-843.<br>DOI: <a href=\"https://doi.org/10.1007/s00127-005-0953-7\" rel=\"nofollow noreferrer\">10.1007/s00127-005-0953-7</a></p>\n\n<p>McDonald, A., &amp; Walter, G. (2001). The portrayal of ECT in American movies. The journal of ECT, 17(4), 264-274.<br>\nAvailable from:\n [<a href=\"https://journals.lww.com/ectjournal/Fulltext/2001/12000/The_Portrayal_of_ECT_in_American_Movies.6.aspx\" rel=\"nofollow noreferrer\">https://journals.lww.com/ectjournal/Fulltext/2001/12000/The_Portrayal_of_ECT_in_American_Movies.6.aspx</a>]</p>\n\n<p>Ross, C. A. (2006). The sham ECT literature: implications for consent to ECT. Ethical Human Psychology and Psychiatry, 8(1), 17.<br>[<a href=\"http://reference.medscape.com/medline/abstract/16856307\" rel=\"nofollow noreferrer\">Medline</a>]</p>\n", "score": 2 } ]

[ "depression", "psychologist-psychology", "psychiatrist-psychiatry", "electroconvulsive-therapy" ]

[ { "answer_id": 24697, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Proton_pump\" rel=\"nofollow noreferrer\">&quot;Proton pump&quot;</a> is a broad category of proteins rather than a specific pump.</p>\n<p>The drugs called &quot;proton pump inhibitors (PPIs)&quot; to reduce stomach acid target a specific proton pump, the <a href=\"https://en.wikipedia.org/wiki/Hydrogen_potassium_ATPase\" rel=\"nofollow noreferrer\">hydrogen/potassium ATPase</a>.</p>\n<p>Of course, it is possible for drugs to have off-target effects at other proteins, especially similar ones. It is also possible for side-effects of PPIs that are secondary to the reduction in gastric acid, which can affect digestion and absorption of certain nutrients.</p>\n<p>Lysosomes and other organelles use a different proton pump, the <a href=\"https://en.wikipedia.org/wiki/V-ATPase\" rel=\"nofollow noreferrer\">V-ATPase</a>. If you search for papers involving <a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=omeprazole+%22V-ATPase%22&amp;btnG=\" rel=\"nofollow noreferrer\">specific PPIs and the V-ATPase</a> it does appear that V-ATPase can potentially be affected by PPIs, and this has been considered as an anti-tumor strategy by some:</p>\n<p><em>Fais, S., De Milito, A., You, H., &amp; Qin, W. (2007). Targeting vacuolar H+-ATPases as a new strategy against cancer. Cancer research, 67(22), 10627-10630.</em></p>\n<p>I'm guessing the article you linked to is referring to this paper:</p>\n<p><em>Yepuri, G., Sukhovershin, R., Nazari-Shafti, T. Z., Petrascheck, M., Ghebre, Y. T., &amp; Cooke, J. P. (2016). Proton pump inhibitors accelerate endothelial senescence. Circulation research, 118(12), e36-e42.</em></p>\n<p>In this paper, cultured endothelial cells are incubated with the PPI esomeprazole at 5 or 10 μmol/L. They found increased pH (reduced acidity) in intracellular comparments imaged with a pH-sensitive dye, and various symptoms of endothelial dysfunction after esomeprazole treatment.</p>\n", "score": 4 }, { "answer_id": 24700, "body": "<p>First of all, if you found papers that suggest certain unexplored side effects, it means the research is underway and it can very well be that in the next years we get new information about how drugs work.</p>\n<p>Now to the actual question. From the pharmacokinetic point of view, <strong>PPIs only affect proton pumps of the stomach</strong>. The solution behind this is very simple: PPIs are <em>pro-drugs</em>, that only get <em>activated</em> when surrounding <em>pH is less than 1</em>. Since the only place in the body where this is the case are canaliculi of the gastric glands, only here PPIs bind to their target proteins.</p>\n<blockquote>\n<p>This compound [omeprazole] is a weak base ~pK_a 4. The H⁺, K⁺-ATPase in the parietal cell secretes acid into the secretory canaliculus generating a pH of &lt; 1.0 in the lumen of this structure. The acidity of this space allows accumulation of weak bases of this pK_a. Weak bases of a pK_a less than 4.0 can be accumulated only in this acidic space and no other acidic space in the body. Then, this compound is rapidly activated by the high acidity and inhibits acid secretion by binding to the cysteines accessible to the activated form.</p>\n</blockquote>\n<p>Source: Jai Moo Shin and Nayoung Kim. &quot;Pharmacokinetics and Pharmacodynamics of the Proton Pump Inhibitors&quot;. <em>J Neurogastroenterol Motil.</em> 2013 Jan; 19(1): 25–35. doi:10.5056/jnm.2013.19.1.25</p>\n", "score": 4 } ]

[ "medications", "digestion", "gastroenterology", "stomach", "proton-pump-inhibitors" ]

[ { "answer_id": 17942, "body": "<p>Long-term ketogenic diet can have various side effects.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28702868\" rel=\"nofollow noreferrer\">Safety and tolerability of the ketogenic diet used for the treatment of refractory childhood epilepsy: a systematic review of published prospective studies (PubMed, 2017):</a></p>\n\n<blockquote>\n <p>The most common adverse effects included <strong>gastrointestinal disturbances</strong>\n (40.6%), <strong>hyperlipidemia</strong> (12.8%), <strong>hyperuricemia</strong> (4.4%), <strong>lethargy</strong>\n (4.1%), <strong>infectious diseases</strong> (3.8%) and <strong>hypoproteinemia</strong> (3.8%).</p>\n</blockquote>\n\n<p><a href=\"http://biomedj.cgu.edu.tw/pdfs/2013/36/1/images/BiomedJ_2013_36_1_2_107152.pdf\" rel=\"nofollow noreferrer\">Dietary Therapies For Epilepsy (BioMed Journal, 2013)</a>:</p>\n\n<blockquote>\n <p>Side effects include <strong>constipation, dyslipidemia, growth slowing,\n acidosis,</strong> and <strong>kidney stones.</strong></p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15507148/\" rel=\"nofollow noreferrer\">Ketogenic diets and physical performance (PubMed, 2004)</a>:</p>\n\n<blockquote>\n <p><strong>Impaired physical performance</strong> is a common but not obligate result of a\n low carbohydrate diet.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664869/\" rel=\"nofollow noreferrer\">Ketogenic diet in endocrine disorders: Current perspectives (PubMed, 2017)</a>:</p>\n\n<blockquote>\n <p>The moderate adverse effects comprised of...<strong>mineral\n deficiencies</strong>...</p>\n</blockquote>\n\n<p><a href=\"https://www.ketovale.com/side-effects-of-keto-diet/\" rel=\"nofollow noreferrer\">Ketovale</a> mentions many side effects from a mixture of anecdotal and study reports: the side effects mentioned above plus <strong>keto flu (headache, weakness, brain fog, increased hunger and fatigue), acetone-like breath, muscle cramps, insomnia, reduced bone mineral density, keto rash</strong>...</p>\n\n<p>According to <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989112/\" rel=\"nofollow noreferrer\">2 cohort studies following 3,966 adults for 20-26 years: (PubMed, 2010)</a></p>\n\n<blockquote>\n <p>A low-carbohydrate diet based on animal sources was associated with\n higher all-cause mortality in both men and women, whereas a\n vegetable-based low-carbohydrate diet was associated with lower\n all-cause and cardiovascular disease mortality rates.</p>\n</blockquote>\n", "score": 6 }, { "answer_id": 17980, "body": "<p>You might be interested in this study: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/\" rel=\"noreferrer\">Long-term effects of a ketogenic diet in obese patients</a>.</p>\n\n<p>Specifically, for 83 obese study participants on a ketogenic (&lt;30g carb/day) diet for 24 weeks:</p>\n\n<blockquote>\n <p>The weight and body mass index of the patients decreased significantly (P&lt;0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant.</p>\n</blockquote>\n\n<p>All of these changes (weight and BMI decreased, total cholesterol decreased, LDL decreased, triglycerides decreased, HDL increased, blood glucose decreased) are normally considered to be indications of improved health.</p>\n", "score": 5 }, { "answer_id": 10657, "body": "<p><a href=\"https://www.youtube.com/watch?v=X9BvqlTvVao\" rel=\"nofollow noreferrer\">Ketosis is not a healthy state for your body</a>, a low carb diet by itself isn't healthy either as <a href=\"https://youtu.be/kQpr5Vz_B4M?t=2634\" rel=\"nofollow noreferrer\">Dr. Klaper explains here</a>. While you may not notice serious health problems after a year in ketosis, a great deal of damage will be done to your body. </p>\n", "score": 2 } ]

[ "nutrition", "diet", "ketosis" ]

[ { "answer_id": 11007, "body": "<p>Not allowed to comment, so just a partial answer from my part:\nSalmonella bacteria are commonly found in the excrements of birds and egg shells are usually contaminated with them, and even let them through to some extent. Therefore it is very important to boil the shell in advance. This should kill more than 99% of the Samonella bacteria found on the shell: <a href=\"http://www.foodsafetywatch.org/factsheets/salmonella/\" rel=\"nofollow noreferrer\">source link</a>.</p>\n\n<p>Not sure about the cancer risk or the likelihood of small cuts. However, Paparazzi is wrong that egg shell contains a lot of fiber. <a href=\"http://antoine.frostburg.edu/chem/senese/101/consumer/faq/eggshell-composition.shtml\" rel=\"nofollow noreferrer\">The main components of egg shell are chalk, with some traces of magnesium and protein</a>, so no fibers in there. Please don't downvote this answer, it's only meant as a comment. </p>\n", "score": 4 } ]

[ "nutrition", "digestion", "cancer", "gastroenterology", "kidney" ]

[ { "answer_id": 13024, "body": "<p>One reason the mouth heals quickly because it's very well vascularized (meaning it has a lot of blood vessels). Yes, the mouth does have a lot of bacteria, but so does the rest of you: humans contain 10x more bacterial cells than human cells, and a lot of those bacteria are extremely helpful to have around. Natural bacteria alone will not reduce healing. Infection with \"bad bacteria\" can reduce healing, but unless a person has poor oral hygiene, there is no reason to suspect they will have \"worse bacteria\" in their mouth compared to anywhere else on their body. Also, the tissues in the mouth have simple structure, meaning it is easy to rebuild them. For more information you can visit <a href=\"http://www.joseylanedentistry.com/3-reasons-why-your-mouth-heals-faster-than-other-parts-of-your-body/\" rel=\"nofollow noreferrer\">http://www.joseylanedentistry.com/3-reasons-why-your-mouth-heals-faster-than-other-parts-of-your-body/</a></p>\n", "score": 3 } ]

[ "oral-health", "self-healing-repairing", "cheeks", "mouth" ]

[ { "answer_id": 10924, "body": "<p>You lose weight when you consume less calories than you burn. You burn calories even when you do not exercise, because your body needs calories to maintain vital functions of the heart, kidneys, brain, to digest food, produce heat, etc.</p>\n\n<p>So, even if you lie in bed all day and consume less calories than you burn, you will lose weight.</p>\n\n<p>If you, as a sedentary adult, burn, for example, about 2,000 Calories per day, you need to consume less than this, let's say 1,500 Cal per day and you will lose weight, exercising or not.</p>\n\n<p>How do you know how many calories do you burn? If you consume a certain amount of calories and your body weight remains stable for several weeks, you know that you consume about as much calories as you burn. So, you can count how many you consume and you will know.</p>\n\n<p>To lose weight, it seems reasonable to consume about 500 Calories less per day than you consume. This is a deficit of 3,500 Calories per week, which equals about 1 pound of body fat. </p>\n\n<p>Exercise is associated with several health benefits (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885312/\" rel=\"nofollow noreferrer\">systematic review, PubMed Central</a>). You do not need to \"work out\" to call it exercise. Even walking is exercise.</p>\n", "score": 3 }, { "answer_id": 14336, "body": "<p>I agree with Jan, but I believe in 80% diet and 20% exercise since dieting is hard and you'd want to build up a habit of exercise so that your body is used to burning calories.\nAnyone who wants to lose weight should start cutting down on meal portion size.</p>\n", "score": 1 } ]

[ "diet", "weight" ]

[ { "answer_id": 11185, "body": "<p>Plastic bottles work just fine. When buying sparkling water (I'm German), they come in plastic bottles and never get this <em>taste of old shoe soles</em>, and I haven't had any problems with bacteria either. </p>\n\n<p>In your case, the cork could be a problem, as was pointed out before. I personally have made the experience that water in steel bottles always tastes a bit different to me than \"plain water\". If it is just the cork, I recommend using a different lid like <a href=\"http://g03.a.alicdn.com/kf/HTB1bRlQIXXXXXb7XXXXq6xXFXXX4/1000ML-Sports-Bottle-Bicycle-Cycling-Stainless-Steel-Travel-Sports-Bottle-Outdoor-Water-Bottle-Student-Metal-Drinking.jpg\" rel=\"nofollow noreferrer\" title=\"this\">this</a></p>\n\n<p>As you were asking for the \"healthiest way of having water in a bottle\": Just don't. Exchange the content of the bottle everyday, but rinse the bottle with very hot water before refilling. This is the safest way I know of.</p>\n\n<p>Again, this is largely based on experience and I don't have scientific studies I could quote.</p>\n", "score": 1 }, { "answer_id": 12949, "body": "<p>I agree with the answers on cleaning and the type of bottle/cork/lid.</p>\n\n<p>Another thing you should consider is that residue from your saliva may be what <a href=\"https://www.breathmd.com/how-to-smell-your-own-breath.php\" rel=\"nofollow noreferrer\">smells bad</a>. Try leaving the freshly-cleaned bottle filled with your usual water out for a day without drinking from it and see if there is any odor, in which case it might be your water source. Then try changing your oral hygiene habits - brushing after meals, brushing your TONGUE, gargling with mouthwash - and see if that improves anything.</p>\n", "score": 1 }, { "answer_id": 11183, "body": "<p>I don't have a citation on this </p>\n\n<p>Also use a brush and clean the outside of the mouth also </p>\n\n<p>Let it sit and dry completely. </p>\n\n<p>I rotate with two bottles.</p>\n\n<p>Does the cork smell? The cork is porous and may be holding some bacteria.</p>\n", "score": 0 }, { "answer_id": 16741, "body": "<p>Compare the symptoms of <a href=\"https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/cork-taint\" rel=\"nofollow noreferrer\">Cork Taint</a> with your observations. If they match then it would be sensible to remove the cork from practice. Cork is porous material and can harbor bacteria / mold etc. In contrast, glass / plastic does not provide a foot hold for bacteria (though water does). </p>\n\n<p>Emptying the vessel every morning, rinsing and allowing it to dry should flush bacteria away and prevent odors. If there is an existing odor, it may require several cycles in the dishwasher </p>\n", "score": 0 } ]

[ "plastic", "sanitation", "smell", "mold", "food-water-storage" ]

[ { "answer_id": 15301, "body": "<p>The following is from the <a href=\"http://www.who.int/medicinedocs/index/assoc/s14236e/s14236e.pdf\" rel=\"nofollow noreferrer\">2007 WHO Expert Committee</a> meeting regarding the addition of sumitriptan:</p>\n\n<blockquote>\n <p><strong>The Committee noted that the application was generally of poor quality and \n provided only a limited review of the evidence.</strong> Although medicines for man-\n aging migraine are on the Model List, the information provided did not estab-\n lish the public health need for an additional medicine. As noted by the expert reviewers, there is high-quality clinical evidence from a Cochrane review \n (57) that supports the superiority of sumatriptan for the acute management of \n migraine, compared with placebo. However, there have been few trials com-\n paring sumatriptan with standard management (aspirin and metoclopramide, \n or caffeine and ergotamine). In these studies, sumatriptan was found to be \n superior in effectiveness to caffeine and ergotamine although it caused more \n adverse events. When compared with aspirin and metoclopramide, sumat-\n riptan was superior for only one outcome (pain relief at 2 hours) and also \n caused more adverse events. The Committee noted that it would be helpful to \n have updated Cochrane reviews to confirm these findings. Some studies have \n found that the 50 mg dose of sumatriptan is as effective as the 100 mg dose.</p>\n \n <p><strong>Despite the availability of some generic preparations, the current cost of \n sumatriptan is substantially higher than that of aspirin and metoclopramide. \n No valid cost-effectiveness evidence was provided.</strong></p>\n \n <p>Overall the evidence provided in the application did not support the public \n health need or comparative effectiveness, safety and cost-effectiveness of \n sumatriptan. The Committee therefore recommended that sumatriptan not \n be added to the Model List and will seek high-quality national treatment \n guidelines to guide a full review of Section 7, Antimigraine Medicines.</p>\n</blockquote>\n\n<p>It would seem nobody bothered to take the time to write a good application.</p>\n", "score": 3 } ]

[ "migraine", "who-world-health-org", "beta-blockers", "cluster-headache" ]

[ { "answer_id": 11264, "body": "<p>First you have to consider how diseases are transmitted. STDs are usually skin to skin or warm body fluid to an open sore. Diseases like influenza, ebola, etc can't go through your skin. They require you to touch your eyes, mouth, or an open sore. Even getting a few drops of urine on your legs probably won't get you sick unless you move some of it to a wound, eyes, or mouth. This is why washing your hands is extremely important when using the restroom. </p>\n\n<p>Assuming that the bathroom has regular maintenance and cleaning, the top of the toilet seat is likely one of the cleanest surfaces in the restroom most of the time. The cold hard surface of the toilet seat isn't ideal for any type of disease. Viral and bacterial levels decline very quickly on such surfaces. As long as it is visibly clean there is little to no chance of catching a disease from it. And a disinfecting wipe would reduce the dangers from mild to zero. I'm actually surprised wipes aren't offered in public restrooms. Stores often offer wipes for the shopping cart, but not in the bathrooms for the toilet.</p>\n\n<p>Here is the fun part:\nIn studies it is actually the handles of the bathroom stall door and sink that are the dirtiest because they are touched after you use the toilet and before you wash your hands.</p>\n\n<p>Secondly many toilets have a violent enough flush to launch a spray of fine mist into the air that no one notices. There is a small chance that could give the flu to people in neighboring stalls. But the person whom uses the toilet five minutes later probably won't have any problems as long as they wash their hands. </p>\n\n<p>Don't worry about STDs. They usually aren't infectious enough or won't survive on cold hard surfaces. Many require skin to skin contact that a toilet doesn't provide. It is usually the more mundane diseases such as influenza or the common cold that are transmitted everywhere that are caught in the restroom. </p>\n\n<p>Truthfully you are more likely to catch something from the shopping cart that you didn't wipe down, than you are the restroom in the same store. That surface is less likely to be clean than the sink in the restroom. </p>\n\n<p>Some reading for the people whom want articles:</p>\n\n<p><a href=\"http://www.webmd.com/balance/features/what-can-you-catch-in-restrooms#3\" rel=\"nofollow noreferrer\">http://www.webmd.com/balance/features/what-can-you-catch-in-restrooms#3</a> \n<a href=\"http://www.goodhousekeeping.com/health/a22542/germs-on-public-toilet-seats/\" rel=\"nofollow noreferrer\">http://www.goodhousekeeping.com/health/a22542/germs-on-public-toilet-seats/</a></p>\n", "score": 3 } ]

[ "infection", "prevention", "disease-transmission" ]

[ { "answer_id": 11374, "body": "<p>There are four cognitive symptom categories for Alzheimer's disease: aphasia, amnesia, apraxia, agnosia. These are broad categories that our brains handle somewhat separately. People frequently do sustain a brain injury to the left side of the head that damages his or her ability to process language and speech without affecting any other cognitive abilities. Our ability to utilize language is somewhat separate in the brain from areas responsible for the ability to reason, remember or use muscles. </p>\n\n<p>So transient forgetting of spellings of common words would be processed in the language areas of the brain, and deficits of that ability are called Aphasia. </p>\n\n<p>Forgetting daily chores falls into the category of Amnesia and is handled by a different area of the brain.</p>\n\n<p>But your examples are about as non serious as they can get. Everyone has minor lapses in cognitive ability. So I'm hesitant to suggest seeing a doctor as I don't want to be blamed for a bunch of people getting laughed at when they go see their doctor for symptoms that lack of sleep may cause. Pose some more serious examples or extensive repeated lapses of forgetfulness or difficulty with words, or motor control, and I would have no problem suggesting you speak with a doctor. </p>\n\n<p>Yes, Alzheimer's disease can happen to people in their late teens. But it is very rare. Most commonly onset of this condition is 40 or above. \n<a href=\"https://www.gstatic.com/healthricherkp/pdf/alzheimer_s_disease.pdf\" rel=\"nofollow noreferrer\">https://www.gstatic.com/healthricherkp/pdf/alzheimer_s_disease.pdf</a></p>\n\n<p>And I simply don't know enough about aphasia research to answer your third question. I suspect the answer may be out of scope for this forum, but I don't know. Perhaps someone else will. However I must also caution you that dementia is one of the most serious, but isn't the only cause of cognitive lapses. </p>\n\n<p><a href=\"http://www.alzfdn.org/AboutAlzheimers/symptoms.html\" rel=\"nofollow noreferrer\">http://www.alzfdn.org/AboutAlzheimers/symptoms.html</a></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Aphasia\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Aphasia</a> </p>\n", "score": 4 } ]

[ "brain", "symptoms", "alzheimers", "dreams" ]

[ { "answer_id": 11598, "body": "<h2>Introduction</h2>\n\n<p>First of all, the study should not be trusted too much. Thirty six test subjects does not seem very much to me in order to make such a claim. However, &amp;AtlLED's opinion in the comment differs from this.</p>\n\n<p>From the abstract (emphasis mine):</p>\n\n<blockquote>\n <p><strong>Thirty-six</strong> infants were studied during diving exercises in infant swimming. [...] Although the bradycardic response gradually decreases, the study shows that a clear-cut response exists in children older than has previously been reported.</p>\n</blockquote>\n\n<p>However, I think it is clear that the heart-rate does seem to slow down. There is nothing to very little studies available so the rest of my answer is somewhat <strong>educated speculation</strong>.</p>\n\n<hr>\n\n<h2>Frontal Lobe</h2>\n\n<blockquote>\n <p>The frontal lobe is also the most common place for brain injury to occur. Damage to the frontal lobe can create changes in personality, limited facial expressions, and difficulty in interpreting one’s environment, such as not <strong>being able to adequately assess risk and danger</strong>. (<a href=\"http://www.healthline.com/human-body-maps/frontal-lobe/male\" rel=\"nofollow noreferrer\">healthline.com</a>)</p>\n</blockquote>\n\n<p>Therefore, an infants frontal lobe is not well developed at the age of 3 months or less. </p>\n\n<blockquote>\n <p>The volume of the hippocampal formations increased sharply until the age of 2 years, and continued to increase slowly thereafter. (<a href=\"http://www.ajnr.org/content/20/4/717.full\" rel=\"nofollow noreferrer\">Study</a>)</p>\n</blockquote>\n\n<p>Take a look at this <a href=\"https://i.stack.imgur.com/Buu74.gif\" rel=\"nofollow noreferrer\">neat graph</a> and notice the huge jump from 0 years to 2 years. The steepest growth is presumably around 0,5 years (just guessing from approximation the tangent).<a href=\"https://i.stack.imgur.com/OvKcN.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/OvKcN.gif\" alt=\"&lt;code&gt;[Source][3]&lt;/code&gt;\"></a></p>\n\n<h2>Conclusion</h2>\n\n<p>It seems therefore fairly reasonable to me to conclude that around the age of 6 months, the frontal lobe is well developed so that the infant is able to correctly address the risk of drowning. And as any normal human, they would start to <strong>panic</strong> when they <em>realise that they are drowning</em>.<br>\nThis panicking will cause an increase of heart rate and is the opposite of a bradycardia response. </p>\n\n<h2>A bit on evolution</h2>\n\n<p>Evolutionary speaking, it makes sense to have a survive-by-all-means mechanism that will be triggered as soon as one is in serious danger. Such a mechanism can be counterproductive in a very few examples, like here when the bradycardia response is reversed. Nevertheless, it is very useful in most cases and therefore, we have this mode. </p>\n\n<p>I would therefore conclude (again, educated guessing) that the bradycardia response of babies was never \"intended\" (1) and is just a side product of them not being able to judge a situation correctly.</p>\n\n<hr>\n\n<h2>Appendix</h2>\n\n<p>A \"standard\" newborn male infant weighs around 3kg, is about 48cm tall and its head circumference is roughly 34cm, so the radius is 10 cm. Assuming the body is cylindric, this would give us a density of 5.8g/cm^3 (V = π r^2 h, density = V / mass) (<a href=\"https://intergrowth21.tghn.org/site_media/media/articles/newbornsize.pdf\" rel=\"nofollow noreferrer\">Values taken from the Intergrowth.21 study</a>).</p>\n\n<p><a href=\"https://i.stack.imgur.com/qkk93.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/qkk93.png\" alt=\"enter image description here\"></a></p>\n\n<p>I weigh roughly 70kg, am about 180cm tall and my head radius is maybe 30cm, which means my density is about 103.8g/cm^3.<br>\n Concluding, an infants buoyancy is significantly larger than mine. As the infant grows and gains weight, the buoyancy will decrease until the density reaches the density of a full grown human during adolescents. </p>\n\n<p>This does not explain why the heart rate is so low, but it is another factor as to why infants are quite good at swimming.</p>\n\n<hr>\n\n<h2>Note</h2>\n\n<p>(1): Intended is a pretty bad word here. I mean, the argument was about evolution and not creation. I meant by this that the bradycardia response is just a side-product of multiple factors: The survive-by-all-means mechanism in adults and the baby's inability to correctly asses danger.</p>\n", "score": 5 } ]

[ "infant", "swimming", "reflex-impulse", "instinct", "apnea-holding-breath" ]

[ { "answer_id": 17368, "body": "<p>I will discuss azathioprine here, as there are many different immunosuppressant drugs that work in different ways. The immune system is a complex thing and most will inhibit only one particular aspect of it.</p>\n\n<p><strong>Azathioprine</strong></p>\n\n<p>Azathioprine is an immunosuppressant drug. It has been around for a long time but is still widely used. Unlike certain modern drugs that inhibit various <a href=\"https://medical-dictionary.thefreedictionary.com/Inflammation+mediators\" rel=\"nofollow noreferrer\">inflammatory mediators</a> (like the <a href=\"https://en.wikipedia.org/wiki/TNF_inhibitor\" rel=\"nofollow noreferrer\">TNF inhibitors</a>), azathioprine works at the level of DNA to prevent DNA replication (by blocking the construction of DNA from purine building blocks and purine creation) and thus inhibit the proliferation and function of white blood cells (lymphocytes in particular).</p>\n\n<p>Adapted from <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC152947/\" rel=\"nofollow noreferrer\">this paper</a>:</p>\n\n<blockquote>\n <p>Azathioprine is among the oldest pharmacologic immunosuppressive\n agents in use today. Over the past 50 years, azathioprine has been\n used in the treatment of hematologic malignancies, rheumatologic\n diseases, solid organ transplantation, and inflammatory bowel disease.</p>\n \n <p>The drug is a purine analog, and the accepted mechanism of action is\n at the level of DNA. Ultimately, azathioprine can then become\n incorporated into replicating DNA and can also block the pathway of\n purine synthesis. It is this action that is thought to contribute to\n its relative specificity to lymphocytes due to their lack of a salvage\n pathway. However, the effects on the blockade of DNA replication have\n never fully explained all of the laboratory and clinical findings of\n azathioprine-induced immunosuppression.</p>\n</blockquote>\n\n<p>This effect on DNA replication also accounts for some of the potential side effects, such as increased risk of certain cancers, as well as the increased susceptibility to infection shared by all immunosuppressants. That is why infections must be identified and treated quickly in people on drugs like this. Vaccinations for influenza and pneumococcus are also recommended (<a href=\"https://patient.info/doctor/influenza-vaccination#nav-6\" rel=\"nofollow noreferrer\">in the UK</a>).</p>\n\n<p><strong>Other sources</strong>:</p>\n\n<ul>\n<li><a href=\"https://bnf.nice.org.uk/drug/azathioprine.html#drugAction\" rel=\"nofollow noreferrer\">Azathioprine in the British National Formulary</a></li>\n<li><a href=\"https://en.wikipedia.org/wiki/Azathioprine\" rel=\"nofollow noreferrer\">Azathioprine on Wikipedia</a></li>\n</ul>\n\n<hr>\n\n<p>For anyone who is interested, here are two images showing the chemical structure of azathioprine on the left and purine (which it inhibits through <a href=\"https://adc.bmj.com/content/79/5/448\" rel=\"nofollow noreferrer\">molecular mimicry</a>) on the right. The similarity is evident, though azathioprine is metabolised to 6-mercaptopurine before it has effect.</p>\n\n<p><a href=\"https://i.stack.imgur.com/Oj8Up.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Oj8Up.png\" alt=\"Azathioprine molecule\"></a> <a href=\"https://i.stack.imgur.com/XmCoF.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/XmCoF.png\" alt=\"Purine chemical structure\"></a></p>\n\n<p>Interestingly, <a href=\"https://adc.bmj.com/content/79/5/448\" rel=\"nofollow noreferrer\">molecular mimicry</a> is often a factor in development of autoimmune disease (for which azathioprine is generally used) and also a way of treating them, as is the case with azathioprine.</p>\n\n<p>I have posted another <a href=\"https://health.stackexchange.com/a/17185/14056\">answer</a> on autoimmune disease which may be of interest.</p>\n", "score": 4 } ]

[ "medications", "immune-system", "autoimmune-disease", "immunosuppressant" ]

[ { "answer_id": 12056, "body": "<p>In short, to improve your ability to remember what you did yesterday or today just start by making a conscious effort to recall it on a daily basis. A simple example would to take some notes about what you did that day each day. e.g. after work keep a log of what happened during they day, lunch meetings, etc, what you did, who said what. \nPeople who seem Naturally good at remembering what they did during they day probably rethink their day over and over without conscious effort. </p>\n\n<p><strong>Reason why</strong></p>\n\n<p>The reason for this is that your brain will capture / allocate resources to what you focus your attention on and over time it gets better at it. Being a software developer your brain probably spends its building the concepts around structures around the existing code and the problem you are trying to solve, not so much the day by day events. </p>\n\n<p><strong>Puzzles</strong></p>\n\n<p>You are absolutely right thinking that the brain training puzzles wont help with your <a href=\"https://en.wikipedia.org/wiki/Episodic_memory\" rel=\"nofollow noreferrer\">episodic memory</a> because they wont. Those puzzles will improve on specific abilities such as the ability to track multiple objects what ever specific function they are training, but getting that to improve your memory in the day to day is like exercising your arm to improve the strength in your leg. </p>\n\n<p><strong>Exercise</strong></p>\n\n<p>As for physical exercise, it's very important for brain health as highlighted in the below quote from the book <a href=\"http://www.npr.org/books/titles/152336508/the-first-20-minutes-surprising-science-reveals-how-we-can-exercise-better-train\" rel=\"nofollow noreferrer\">The fist 20 minutes</a></p>\n\n<blockquote>\n <p>There is no medicine or other intervention that appears to be nearly\n as effective as exercise in maintaining or even bumping up a person's\n cognitive abilities.</p>\n</blockquote>\n\n<p>It will improve your overall cognitive ability but may not improve your ability to remember what you did yesterday. For a bit more look here <a href=\"https://health.stackexchange.com/questions/10754/does-exercise-increase-memory\">Does exercise increase memory?</a> </p>\n\n<p><strong>Final Note</strong></p>\n\n<ul>\n<li>What you are talking about is <a href=\"https://en.wikipedia.org/wiki/Episodic_memory\" rel=\"nofollow noreferrer\">episodic memory</a> (Day to day) not <a href=\"https://en.wikipedia.org/wiki/Short-term_memory\" rel=\"nofollow noreferrer\">short term memory</a> (Last 10 minutes)</li>\n<li>Practice using it, possibly a daily journal that includes what you ate for lunch, who said what, but not as something introspective</li>\n<li>If anything has changes recently get advice from an expert because there can be many causes to memory issues. </li>\n</ul>\n", "score": 2 } ]

[ "mental-health", "memory", "b-12-supplements", "short-term-memory-loss", "brain-exercises" ]

[ { "answer_id": 24426, "body": "<p>Hypothyroidism - low levels of thryroid hormones are produced. There are many diseases where hypothyroidism arises. E.g. Graves Disease, Hashimotos disease.</p>\n<p><a href=\"https://www.hindawi.com/journals/jtr/2011/809341/\" rel=\"nofollow noreferrer\">Early observations</a> of Hypothyroidism showed two girls that were born without thyroid glands.</p>\n<blockquote>\n<p>&quot;growth was severely stunted... very little power of locomotion; but could manage to walk from chair to chair with a little assistance. She had no power of speech... no goiter [was present]. The other girl was 6 months of age... was plump but had a marked idiotic expression, a large face with a small head, and very receding forehead. The tongue was large and protruding from the mouth&quot;</p>\n</blockquote>\n<p>One of the girls was 10 years old, which is proof could be a decade or longer.</p>\n<p>If you are interested in further reading I would recommend: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319261/\" rel=\"nofollow noreferrer\">Congenital hypothyroidism</a>.</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517413/\" rel=\"nofollow noreferrer\">New evidence</a> suggests Myxedema coma does not result from hypothyroidism.</p>\n<p>Fortunately for 21st century medicine - if hypothyroidism is well-controlled, it will not shorten the suffers lifespan.</p>\n", "score": 1 } ]

[ "endocrinology", "hypothyroid", "tsh-levels" ]

[ { "answer_id": 12642, "body": "<h2>With a very small budget</h2>\n\n<p>If you do not want to spend any (or very little) money on it, I recommend filling a small garbage bag with wet sand and then placing a cushion or pillow over it. I'm guessing if you want to add a realistic touch, you could place some small sticks of wood in the garbage bag to act as ribs. </p>\n\n<p>Unfortunately, the above answer is all based on my guessing; but seems like it would be fun to experiment with. However, the below answer and link will give you instructions to make a DIY manikin that a CPR instructor has made and uses. </p>\n\n<h2>Slightly bigger budget</h2>\n\n<p>With some patience, time and approximately $14 USD, you can make a manikin out of a plunger, lid, foam, plaster of Paris and a few other common items. I will not go into detail about it, but <a href=\"http://cyylau.blogspot.com/2013/02/diy-cpr-manikin.html\" rel=\"noreferrer\">here</a> is a link to the blog where you can find detailed instructions, pictures and a list of materials. </p>\n\n<p>You mention having the children practice some skills on a human. As long as they are old enough to understand the concept of not actually doing these skills on a person who doesn't need them, I encourage you to teach them on a human. Teach them the anatomical landmarks, how to check for breathing and a pulse and how to open an airway(1) on a real person. </p>\n\n<p>Hope this is helpful to you. If you have any additional questions, please let me know! </p>\n\n<hr>\n\n<p>(1) <strong>Note:</strong> If you plan to teach them how to open an airway, be sure to only do the head-tilt chin-lift. If you wish to teach the jaw thrust, that is best done on a doll. </p>\n", "score": 7 } ]

[ "first-aid", "cpr" ]

[ { "answer_id": 17692, "body": "<p>Testicular torsion occurs when the spermatic cord to a testicle twists, cutting off the blood supply (a condition called ischemia). The most common symptom is the rapid onset of acute testicular pain and prolonged testicular torsion will result in the death of the testicle and surrounding tissues (<a href=\"https://emedicine.medscape.com/article/2036003-overview#showall\" rel=\"nofollow noreferrer\">Ogunyemi, et al. 2018</a>).</p>\n\n<p>Generally, testicular torsion requires emergency surgery. If treated within a few hours, the testicle can usually be saved. However, waiting longer for treatment can cause permanent damage and may affect the ability to father children. When blood flow has been cut off for too long, a testicle may become so badly damaged it has to be removed.</p>\n\n<p>Wearing underpants will not necessarily prevent testicular torsion. Males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles (<a href=\"https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270\" rel=\"nofollow noreferrer\">Mayo Clinic, 2018</a>).</p>\n\n<p>In men and boys who are at risk of testicular torsion, the condition often occurs with no apparent trigger. Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.</p>\n\n<p>The risk factors are:</p>\n\n<ul>\n<li><strong>Age</strong><br>\nTesticular torsion is most common in males between 10 and 25 years old. </li>\n<li><strong>Previous testicular torsion</strong><br>\nA person that had testicular torsion that went away without treatment is likely to have it again in either testicle unless surgery is performed to correct the underlying problem. </li>\n<li><strong>Climate</strong><br>\nTorsions are sometimes called \"winter syndrome\". This is because they often happen in winter, when it is cold outside. The scrotum of a man who has been lying in a warm bed is relaxed. When he arises, his scrotum is exposed to the colder room air. If the spermatic cord is twisted while the scrotum is loose, the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion. </li>\n<li><p><strong>Bell clapper deformity</strong><br>\nIn this deformity the testicle is only attached to the spermatic cord, like a bell clapper. A bell clapper deformity is a predisposing factor for testicular torsion in non-neonates. Currently there is no recommended clinical examination for a bell clapper deformity.</p>\n\n<p>Having testicles that can rotate or move back and forth freely in the scrotum is an inherited trait. Some males have this attribute and others do not. The only way to prevent testicular torsion for a man with this trait is through surgery to attach both testicles to the inside of the scrotum so that they cannot rotate freely. (<a href=\"http://www.medicalnewstoday.com/articles/190514.php\" rel=\"nofollow noreferrer\">Brunner, 2010</a>)</p></li>\n</ul>\n\n<p>With these facts in mind, with exception of a slight plausability created through the climate issue, neither being clothed or practicing nudism/naturism (<a href=\"https://en.wikipedia.org/wiki/Naturism\" rel=\"nofollow noreferrer\">whichever you wish to call it</a>) can prevent testicular torsion.</p>\n\n<h2>Other aspects aside from testicular torsion</h2>\n\n<p>With regards to protection from urine, semen and faeces, with good personal hygiene, these won’t pose a problem.\nThe combination of heat, sweat, and friction in your nether regions is not only uncomfortable, it can be unhealthy. Tight and non-breathable clothing traps heat and moisture, which can encourage the growth of candida, and lead to an unbearable yeast infection. That's not the only thing you have to worry about. When bacteria travel from back to front, it increases your risk for contracting an uncomfortable urinary tract infection (UTI) as well.</p>\n\n<p>For men, the temperature of the testes is at issue: In order for testes to produce sufficient quality and quantity of sperm, the temperature of testes must be lower than the core body temperature.</p>\n\n<blockquote>\n <p>\"That is why [testes] are located outside of the body,\" explains Celia E. Dominguez, reproductive endocrinologist, Centre for Reproductive Medicine at the Emory University School of Medicine. \"Testes were made to be out in the breeze.\" (<a href=\"http://www.webmd.com/infertility-and-reproduction/features/boxers-vs-briefs-increasing-sperm-count\" rel=\"nofollow noreferrer\">Davis, 2004</a>)</p>\n</blockquote>\n\n<p>Testes can overheat when a man wears brief underwear. If the testes are too hot — several degrees above where they should be — they are not able to produce sufficient sperm, resulting in low sperm count.</p>\n\n<h2>References</h2>\n\n<p>Brunner, S. (2010). What Is Testicular Torsion? What Causes Testicular Torsion? <em>Medical News Today</em> [Online]<br>\nRetrieved from: <a href=\"http://www.medicalnewstoday.com/articles/190514.php\" rel=\"nofollow noreferrer\">http://www.medicalnewstoday.com/articles/190514.php</a></p>\n\n<p>Davis, J. L. (2004). Boxers vs. Briefs: Increasing Sperm Count. <em>WebMD</em> [Online]<br>\nRetrieved from: <a href=\"http://www.webmd.com/infertility-and-reproduction/features/boxers-vs-briefs-increasing-sperm-count\" rel=\"nofollow noreferrer\">http://www.webmd.com/infertility-and-reproduction/features/boxers-vs-briefs-increasing-sperm-count</a></p>\n\n<p>Mayo Clinic. (2018). Testicular Torsion, <em>Mayo Clinic</em> [Online]<br>Retrieved from: <a href=\"https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270\" rel=\"nofollow noreferrer\">https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270</a></p>\n\n<p>Ogunyemi, O. I., Weiker, M., &amp; Abel, E. J. (2018). Testicular Torsion, <em>Medscape</em> [Online]<br>Retrieved from: <a href=\"https://emedicine.medscape.com/article/2036003-overview#showall\" rel=\"nofollow noreferrer\">https://emedicine.medscape.com/article/2036003-overview#showall</a></p>\n", "score": 2 }, { "answer_id": 17686, "body": "<p>From the (almost nonexistent) research I could find related to the presence of underwear and concomitant testicular torsion, I think that loose underwear or complete nudity would actually <strong>increase</strong> your risk of testicular torsion, as the testicles are more mobile without restriction by a form-fitting garment. The only resource I can find supporting your original claim is an answer on <a href=\"https://www.quora.com/Can-tight-underwear-cause-testicular-pain\" rel=\"nofollow noreferrer\">Quora</a>, which I would not necessarily trust.</p>\n<blockquote>\n<p><strong><a href=\"https://www.sciencedirect.com/science/article/pii/S1522840109000135\" rel=\"nofollow noreferrer\">&quot;Diagnosis and Management of Testicular Torsion, Torsion of the Appendix Testis, and Epididymitis.&quot; Shan Yin, Jennifer L. Trainor. <em>Clinical Pediatric Emergency Medicine.</em> 2009.</a></strong></p>\n<p>In addition, scrotal support with a pediatric athletic supporter or tight-fitting brief-style underwear can minimize mobility of the testicle and hence pain.</p>\n</blockquote>\n<p>Although this doesn't specifically mention loose-fitting underwear as a potential risk factor for testicular torsion, I don't think it's an unreasonable inference to draw, especially given corroborating research in adolescent athletes:</p>\n<blockquote>\n<p><strong><a href=\"https://www.sciencedirect.com/science/article/pii/S0022534705672655\" rel=\"nofollow noreferrer\">&quot;Testicular Health Awareness in Pubertal Males.&quot; Phillip Nasrallah, Giju Nair, Joseph Congeni, Cynthia L. Bennett, Daniel McMahon. <em>The Journal of Urology.</em> 2000.</a></strong></p>\n<p>...5% of athletes reported tight underwear or compression\nshorts as their only type of protection [against testicular torsion].</p>\n</blockquote>\n", "score": 0 } ]

[ "benefits", "physical-health", "clothes", "nudity-nude-naked" ]

[ { "answer_id": 12760, "body": "<p>Caffeine is readily absorbed, with up to 99% absorbed within 45 minutes of ingestion.<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK223808/\" rel=\"nofollow noreferrer\">[1]</a></p>\n\n<p>The mean half-life in healthy individuals is 5 hours, although this varies widely between individuals, ranging from 1.5 to 9.5 hours. For our purposes, we'll use the mean of 5 hours.<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK223808/\" rel=\"nofollow noreferrer\">[1]</a></p>\n\n<p>Knowing the above plus how much caffeine you've ingested will allow you to plot caffeine levels over time. Given the wide variation in half-life, I'm going to ignore the 99% absorption and treat it as 100%. Using your example we get:</p>\n\n<ul>\n<li>The 180 mg you ingested 5 hours ago is now down to 90 mg.</li>\n<li>The 180 mg you ingested 2 hours ago is now down to 136 mg. </li>\n<li>Therefore, there are now 90 + 136 = 226 mg in your system. </li>\n</ul>\n\n<p>Clearly that's only a ballpark figure given the wide variance of half-life times, but it's probably as close as you can get without more rigorous measuring techniques.</p>\n", "score": 5 }, { "answer_id": 17000, "body": "<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC370671/\" rel=\"nofollow noreferrer\">This study</a> correlated blood pressure and caffeine, and it showed that the body regulated after 4 days of consumption, therefore if you goal is to measure blood pressure, keep in mind <a href=\"https://health.stackexchange.com/a/16996/809\">tolerance</a> </p>\n\n<blockquote>\n <p>Acute caffeine in subjects who do not normally ingest methylxanthines\n leads to increases in blood pressure, heart rate, plasma epinephrine,\n plasma norepinephrine, plasma renin activity, and urinary\n catecholamines. Using a double-blind design, the effects of chronic\n caffeine administration on these same variables were assessed. Near\n complete tolerance, in terms of both humoral and hemodynamic\n variables, developed over the first 1-4 d of caffeine. No long-term\n effects of caffeine on blood pressure, heart rate, plasma renin\n activity, plasma catecholamines, or urinary catecholamines could be\n demonstrated. Discontinuation of caffeine ingestion after 7 d of\n administration did not result in a detectable withdrawal phenomenon\n relating to any of the variables assessed.</p>\n</blockquote>\n", "score": 2 } ]

[ "medications", "caffeine" ]

[ { "answer_id": 13787, "body": "<p>Try this: poke your tongue out of your mouth and, holding your hand in front of your mouth, jab your hand (finger, palm, whatever) a little with your tongue. Push at your hand. I predict your hand will interpret this as a very soft contact and nothing the slightest bit painful. Go ahead and push as hard as you can.</p>\n\n<p>Next, push your tongue against your cheek so that your cheek bulges out a little and stretches. Push harder. Keep going. It hurts, right? In fact, you probably have to stop before you push as hard as you did against your hand. Your tongue isn't sharp, but the pain probably feels sharp. </p>\n\n<p>Stretching is a different form of pain than other pressure sensations. I don't know why, but it is. The gas bubble distending the intestine locally is like your tongue distending your cheek. Someone even did a study (<a href=\"https://link.springer.com/referenceworkentry/10.1007%2F978-3-540-29805-2_4797\" rel=\"nofollow noreferrer\">excerpt</a>) putting balloons into people to prove that it is the distension in the intestine that is causing the reported pain.</p>\n", "score": 4 } ]

[ "pain", "gastroenterology", "flatulence-gas-fart" ]

[ { "answer_id": 12989, "body": "<p>This is a very good and important question, not only for you but for other people as well.</p>\n\n<p>As people have said in the comments, YES it can be potentially dangerous to have unprotected sexual encounters with her without having tested for STDs first. Even if she's had unprotected sex with only ONE person, she would've been at risk for an STD.</p>\n\n<p>As long as she hasn't been tested, please have protected sex only. <a href=\"https://academic.oup.com/cid/article/53/suppl_3/S64/311640/Interventions-to-Prevent-Sexually-Transmitted\" rel=\"noreferrer\">This study</a> talks about (among other things) the effectiveness of condoms in reduving the risk for STDs.</p>\n\n<p>You should be honest with her and say \"I'm not comfortable having unprotected sex if you do not test for STDs first.\" STDs can be asymptomatic, so she might have one and not know about it. So it's not a question of trust. If it makes it easier for you, you might even say \"It's not that I do not trust you, but I do not know the people you've had sex with before and it's them I don't trust.\" </p>\n\n<p>Generally, I tell people: If a person refuses to check for STDs/does not want to have protected sex, they do not truly care about you. If that's the case, walk away.</p>\n", "score": 6 } ]

[ "sex", "disease-transmission", "sti", "condom" ]

[ { "answer_id": 13034, "body": "<p>There are voluntary and involuntary muscles on urination. The default circuit is to close the involuntary during and before bowel. It is a way of the body forcing you to clear the bowel.</p>\n\n<p><a href=\"https://www.britannica.com/science/urination\" rel=\"nofollow noreferrer\">urination</a></p>\n", "score": 1 }, { "answer_id": 13066, "body": "<p>They certainly can occur at the same moment, but there are also situations where they might not. Similar to your hypothesis, if someone is for example severely constipated they may not be able to urinate until they have had a bowel movement due to the urethra (the tube that allows urine to leave your bladder) being pinched off from the pressure of the stool. </p>\n", "score": 0 } ]

[ "urinary-system", "stools", "urination", "urethra", "defecation" ]

[ { "answer_id": 13372, "body": "<p>First of all, thyroid hormones are actively taken up into cells and accumulate there. Therefore, the apparent volume of distribution for T4 is 10 liters rather than 5 liters (<a href=\"http://dx.doi.org/10.1080/01969720490443354\" rel=\"noreferrer\">1</a>). Secondly, I would assume a slightly lower proportion of free T4 (0.02%) (<a href=\"http://dx.doi.org/10.1080/01969720490443354\" rel=\"noreferrer\">1</a>). That results in 90 pmol/L.</p>\n\n<p>This is still above the reference range for FT4. However, T4 is rapidly converted to T3, rT3, 3,5-T2, thyronamines and iodothyroacetates (<a href=\"http://dx.doi.org/10.3389/fendo.2015.00177\" rel=\"noreferrer\">2</a>). In combination, these mechanisms end up in plausible concentrations.</p>\n\n<p>This scenario also explains, why even slight variations of parameters can end up in dramatic changes of hormone concentrations, e.g. in allostatic load (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/28775711\" rel=\"noreferrer\">3</a>).</p>\n\n<ol>\n<li><p>J. W. Dietrich, A. Tesche, C. R. Pickardt &amp; U. Mitzdorf. Thyrotropic Feedback Control: Evidence For An Additional Ultrashort Feedback Loop From Fractal Analysis. Cybernetics and Systems Vol. 35 , Iss. 4, 2004. doi <a href=\"http://dx.doi.org/10.1080/01969720490443354\" rel=\"noreferrer\">10.1080/01969720490443354</a></p></li>\n<li><p>Hoermann R, Midgley JE, Larisch R, Dietrich JW. Homeostatic Control of the\nThyroid-Pituitary Axis: Perspectives for Diagnosis and Treatment. Front\nEndocrinol (Lausanne). 2015 Nov 20;6:177. doi <a href=\"http://dx.doi.org/10.3389/fendo.2015.00177\" rel=\"noreferrer\">10.3389/fendo.2015.00177</a>.\nPMID <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/26635726\" rel=\"noreferrer\">26635726</a></p></li>\n<li><p>Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood \nA, Klein HH, Dietrich JW. Thyroid Allostasis-Adaptive Responses of Thyrotropic\nFeedback Control to Conditions of Strain, Stress, and Developmental Programming. \nFront Endocrinol (Lausanne). 2017 Jul 20;8:163. doi <a href=\"http://dx.doi.org/10.3389/fendo.2017.00163\" rel=\"noreferrer\">10.3389/fendo.2017.00163</a>. PMID <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/28775711\" rel=\"noreferrer\">28775711</a></p></li>\n</ol>\n", "score": 6 } ]

[ "medications", "thyroid" ]

[ { "answer_id": 20173, "body": "<p><strong>What is hyperfocus?</strong></p>\n\n<blockquote>\n <p>Adults with ADHD often report episodes of long-lasting, highly focused\n attention, a surprising report given their tendency to be distracted\n by irrelevant information. This has been colloquially termed\n “hyperfocus.” (<a href=\"https://link.springer.com/article/10.1007%2Fs12402-018-0272-y\" rel=\"nofollow noreferrer\">ADHD, 2019</a>)</p>\n</blockquote>\n\n<p><strong>Do medications used to treat ADHD decrease hyperfocus?</strong></p>\n\n<p>1) <a href=\"https://www.sciencedirect.com/science/article/pii/S089142221630213X?via%3Dihub\" rel=\"nofollow noreferrer\">Ozel-Kizil et al, 2016, Hyperfocusing as a dimension of adult attention deficit hyperactivity disorder (Research in Developmental Disabilities)\n</a>:</p>\n\n<p>In the study, they compared individuals >18 years of age diagnozed with ADHD; one group of 53 individuals without medication and another group of 79 individuals treated with stimulants (methylphenidate or SSRIs):</p>\n\n<blockquote>\n <p>There was no difference between total Hyperfocusing Scale and Adult\n ADHD Self- Report Scale scores of two patient groups.</p>\n</blockquote>\n\n<p>2) <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22372513/\" rel=\"nofollow noreferrer\">Wigal et al, 2012, Adverse events in medication treatment-naïve children with attention-deficit/hyperactivity disorder (Journal of Child and Adolescent Psychopharmacology)</a></p>\n\n<p>In this study, they were observing side effects of lisdexamfetamine dimesylate for several weeks in 6-12 years old children; in one group they were \"stimulant-naive\" (not previously treated with stimulants) and in another \"previous-exposure subjects\".</p>\n\n<blockquote>\n <p>The stimulant-naïve group reported more trouble sleeping, stomach\n pain, and hyperfocus...</p>\n</blockquote>\n\n<p>The hyperfocus was considered a side effect.</p>\n\n<p><a href=\"https://www.rxlist.com/adderall-side-effects-drug-center.htm\" rel=\"nofollow noreferrer\">RxList</a> and <a href=\"https://www.drugs.com/sfx/adderall-side-effects.html\" rel=\"nofollow noreferrer\">Drugs.com</a> have lists of side effects of ADHD medications (amphetamine and dextroamphetamine), which could interfere with the ability to focus: restlessness, dizziness, fear, anxiety, sleeplessness, impotence, confusion, nausea, headache, etc.</p>\n", "score": 1 } ]

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

[ { "answer_id": 13466, "body": "<p>Human head lice <em>generally</em> do not survive very long when they are out of their preferred habitat.\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687769/\" rel=\"nofollow noreferrer\">But they <em>can</em> adapt:</a> \"Head and body lice used to be designated Pediculus capitis and P. corporis but they are now known to belong to the same species, P. humanus x[16,17]. Fifty years ago Levene and Dobzhansky [18] showed that head lice could be trained or adapted to become the rather larger body lice by attaching them to the body in small pill boxes.\"</p>\n\n<p>That should read as: an infestation should be looked at as a locally serious problem. Although any spread from there is not that likely, looking for them elsewhere is prudent advice. Treatment should be guided by actual symptoms. They are quite hungry. If a certain amount of time has passed after \"the war is over\" and no symptoms appeared elsewhere in the meantime, then a scalp repopulated from other sources on that body is very unlikely. Eggs surviving in the hair itself are much more likely.</p>\n", "score": 4 } ]

[ "parasites" ]

[ { "answer_id": 13494, "body": "<p>I'm a physical therapist (PT) - considering we specialize in the application of movement and exercise.</p>\n\n<p>Consistency NOT time of day is the key to any exercise regimen.</p>\n\n<p>A walk in the park at 6AM or 2PM would have the same effects on \"health\".</p>\n\n<p>Ask him explain to explain the reasoning behind this - and - if he'd send or write down the the name of the research article(s). </p>\n\n<p>I'd gladly review it for you.</p>\n\n<hr>\n\n<p><strong>UPDATE</strong></p>\n\n<p>Sorry just saw you said he has no research backing this claim. </p>\n\n<blockquote>\n <p>I can tell you if you prefer to walk in the evening this is just as\n beneficial as walking in the morning. You will see the same health\n benefits.</p>\n</blockquote>\n\n<p>Walking is a fantastic exercise, so do it <strong><em>whenever</em></strong> it works best for you!</p>\n", "score": 4 } ]

[ "exercise", "walking" ]

[ { "answer_id": 13510, "body": "<blockquote>\n <p><strong>Please Note: This is not a diagnosis, it is being provided to help you and a health care professional understand possible causes of your\n condition. You must see a local professional for an evaluation and\n orthopedic testing.</strong></p>\n</blockquote>\n\n<hr>\n\n<p>Runners Knee is also known as \"Patellofemoral Pain Syndrome (PFPS)\" which essential describes the symptoms not the cause of the problem.</p>\n\n<p>So you basically were given a term to describe what you already knew (not exactly useful). I’m surprised further testing was not done.</p>\n\n<hr>\n\n<h2>Chondromalacia Patella</h2>\n\n<p>From the limited information I have it sounds like <strong>Chondromalacia Patella</strong>.<br>\nWhich is the combination of patellar tracking issues and deterioration of articular cartilage on the posterior surface of the patella.</p>\n\n<p>I would have to perform special orthopedic tests to narrow down the cause.</p>\n\n<hr>\n\n<blockquote>\n <p>Essentially the information below is what your PT should be looking for to rule in / out this diagnosis <em>(normally the information below isn’t given to\n patients but it sounds like you’ve been getting nowhere with this --\n hopefully this gives your PT a direction to figure out what is going\n on)</em>.</p>\n</blockquote>\n\n<hr>\n\n<h2>Clinical Picture</h2>\n\n<ul>\n<li>Generally there is a gradual onset of diffuse aching pain over the\nanterior or anteromedial aspect of the knee.</li>\n<li><p>There may or may not be inflammatory signs.</p></li>\n<li><p>There is often crepitus (cracking) as the knee moves thru its ROM</p></li>\n<li><p>There is an exacerbation of pain with activities such as squatting,\nkneeling, and ascending stairs.</p></li>\n<li><p>There is what is referred to as a positive movie sign – that means\nthat refers to seating in a movie – fair amount of flexion – will get\nachy in the ant/medial knee to the extent where you have to change\nposition or shake out the knee – patient may also have a feeling of the\nknee catching or giving way.</p></li>\n<li>Typically see mechanical causes of this pathology – will affect not\nonly tracking but also the contact surface areas of the PF jt</li>\n</ul>\n\n<hr>\n\n<h2>Etiology – Mechanical Causes</h2>\n\n<ol>\n<li>Genu Valgum (means knee) – where we are going to see an increase in the valgus vector at the knee- which is going to affect tracking.</li>\n<li>Femoral Anteversion</li>\n<li>Excessive Internal Femoral Rotation- alters the Q angle which\nincreases the lateral stresses.</li>\n<li>Patella Alta – if the length of the patellar tendon exceeds the top\nto bottom displacement of the patella by 15% or 1 cm</li>\n<li>Laxity of medial capsular retinaculum</li>\n<li>Tightness of the lateral retinaculum</li>\n<li>Acute or chronic patellar subluxations</li>\n<li>Pronation of the foot</li>\n<li>External Tibial Torsion</li>\n<li>Weakness of the VMO</li>\n</ol>\n\n<p>This pathology – referred from the floor up – or from the hip down </p>\n\n<blockquote>\n <p>Usually there is something going on above or below the joint – results\n in this pathology – must find what is causing this to be successful</p>\n</blockquote>\n\n<hr>\n\n<h2>Treatment</h2>\n\n<ul>\n<li><p>If you understand the cause you will be able to effectively plan the\nintervention</p></li>\n<li><p>There are things you can’t fix- structural deformities – if it\ninvolves structures that displace the patella laterally</p></li>\n<li><p>The follow will also alter patellar tracking. Excessive pronation of the foot, weakness of VMO, tightness of lateral retinaculum or ITB (ober , patellar tilt test) , weakness of frontal plane hip muscles</p></li>\n</ul>\n\n<hr>\n\n<h2>Misc Notes</h2>\n\n<ul>\n<li>Terminal Extension Exercises - Don’t strengthen the VMO</li>\n<li>Open Kinetic Chain (OKC) – the literature says the OKC ex from a position of 90-45 degrees of flexion is the safe arc in terms of joint reaction forces to do open chain work</li>\n<li>Close Kinetic Chain (CKC) - that arc of safe movement – is from 0-60 degrees of knee flexion </li>\n</ul>\n\n<hr>\n\n<h2>What Professional(s) to See</h2>\n\n<p>An outpatient physical therapist should be able to narrow this down. As far as Musculoskeletal related issues the leading experts in this field are orthopedic surgeons <em>(with physical therapists being #2).</em> </p>\n\n<p><strong><em>Professional Bias</em></strong><br>\nHowever be aware just like a PT will advocate therapeutic exercise - a surgeon will tend to lean toward surgery.</p>\n\n<p>Also see DoctorWhom's post below as he has provided some great insight that should help guide you what to do next.</p>\n\n<hr>\n\n<p><strong>Sources</strong>\n<br><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095938/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095938/</a>\n<a href=\"http://www.jospt.org/doi/pdf/10.2519/jospt.2010.0302?code=jospt-site\" rel=\"nofollow noreferrer\">http://www.jospt.org/doi/pdf/10.2519/jospt.2010.0302?code=jospt-site</a></p>\n", "score": 8 }, { "answer_id": 13511, "body": "<p>In addition to the above answer that provides guidance on some things to take into consideration when discussing this with your doctor/therapist, I will recommend how to approach seeking the right provider.</p>\n\n<p>First, you've seen \"GPs, Physiotherapists and Physical therapists\" - but <strong>have you seen an orthopedic surgeon or non-surgical orthopedic physician?</strong> This is a situation where a specialist examination and imaging (perhaps even an MRI but at least Xrays) probably should be done. It is not always clear when to send a patient straight to PT for eval/treatment versus sending them to an orthopedic surgeon/nonsurgical specialist first, but in this case since the previous did not yield sufficient results, I'd recommend going that route.</p>\n\n<p>Seeing an ortho surgeon doesn't mean you're saying you want surgery. They are the best experts for evaluating what is wrong and determining what options for treatment you have. They often work with Physical Therapist experts to determine course of therapy in non-surgical management.</p>\n\n<p>When you go:</p>\n\n<p><strong>Write down and bring with you</strong> a <strong>concise, clear timeline of events</strong> - onset, past injuries, symptoms - and a list of what makes it worse/better. Bring any imaging or results you've had done before, then they can decide if they want to start from scratch or build on the tests/evaluations done before.</p>\n", "score": 2 } ]

[ "injury", "knee" ]

[ { "answer_id": 13608, "body": "<h2>Two Types of Leg Length Discrepancies (LLD)</h2>\n\n<p>Just a heads up it's pretty tough to give a general answer to such an involved area (I tried lol). I’m forced to leave quite a bit out as there are so many causes, tests, treatments etc.</p>\n\n<hr>\n\n<h2>True LLD</h2>\n\n<ul>\n<li>Simply put there is an anatomical or structural difference (L) vs (R)</li>\n<li>Typically these are congenital <em>(i.e malformations such as adolescence\ncoxa vara)</em> or trauma <em>(such as a fracture can also cause this)</em></li>\n<li>Exactly you’ve already outlined above. as this is an actually\ndifference in length some type of external intervention is required.</li>\n<li>Unfortunately when dealing with a True LLD anytime the brace,\northotic etc. is removed the underlying kinematic imbalance will\nreappear.</li>\n<li>Not surprisingly you’ll see frontal plane devations toward the\naffected (shorter) side - such as a lateral pelvic tilt, scoliosis etc..</li>\n</ul>\n\n<h2>Functional LLD</h2>\n\n<ul>\n<li>An apparent or functional LLD generally results from a compensation\ndue to improper positioning -- they are never structural.</li>\n<li>There’s a whole battery of orthopedic tests used to narrow down the\ncause and type of LLD, I will not be going into this in any depth. \nAlso there are TONS of conditions that can lead to this, for\nsimplicity I’m going to focus primarily on Sacroiliac (SI) Joint and\nthe related musculature.</li>\n</ul>\n\n<hr>\n\n<h1>SacroIliac Joint Dysfunction</h1>\n\n<p>Pain in or around region of joint that is presumed to be due to malalignment or abnormal movement of SI joints</p>\n\n<hr>\n\n<h1>Common Pelvic Girdle (SI) Dysfunctions</h1>\n\n<ul>\n<li>Posterior torsion of innominate</li>\n<li>Anterior torsion of innominate</li>\n<li>Superior Pubis</li>\n<li>Innominate Upslip</li>\n<li>Innominate Outflares</li>\n</ul>\n\n<hr>\n\n<h2>Sacroiliac Joint - 3 Kinetic Chains</h2>\n\n<ul>\n<li>LE kinetic chain\n\n<ul>\n<li>Sacrum-innominate-LE</li>\n</ul></li>\n<li>Spine kinematic chain\n\n<ul>\n<li>L4-5-sacrum</li>\n</ul></li>\n<li>Closed kinetic chain\n\n<ul>\n<li>Innominate-sacrum-innominate</li>\n</ul></li>\n</ul>\n\n<hr>\n\n<h1>Symmetrical Motion</h1>\n\n<ul>\n<li>Movement of both in nominates relative to sacrum \n\n<ul>\n<li>See this primarily with ant and post pelvic tilts</li>\n</ul></li>\n<li><p>Asymmetrical motion</p>\n\n<ul>\n<li>Antagonistic motions of each innominate relative to sacrum</li>\n</ul></li>\n<li><p>Lumbopelvic motion </p>\n\n<ul>\n<li>Rotation of Spine &amp; both innominates around femoral heads</li>\n</ul></li>\n<li>Posterior torsion\n\n<ul>\n<li>Ipsilateral ASIS higher</li>\n<li>Ipsilateral PSIS lower</li>\n</ul></li>\n</ul>\n\n<hr>\n\n<h2>SI Joint: Supportive Network of Musculature</h2>\n\n<ul>\n<li>Iliopaoas</li>\n<li>Rectus Femoris</li>\n<li>Hip abductors/adductors</li>\n<li>Piriformis</li>\n<li>Gluteus maximus</li>\n<li>Sartorius</li>\n<li>Hamstrings</li>\n<li>Abdominals </li>\n<li>Quadratus Femoris</li>\n<li>Multifidus</li>\n</ul>\n\n<hr>\n\n<p><strong><em>Joint Characteristics</em></strong></p>\n\n<ul>\n<li><p>Primary support to SI jt - self locking mechanism, shape of the\narticular surfaces, and the ligaments</p></li>\n<li><p>SI Joint – Normally in a position of stable equilibrium and b/c of\nthat there tends to be the need for significant force to disrupt it</p></li>\n<li><p>some of the strongest muscles in the body surround the SI but none\nhave the primary function of moving it</p></li>\n<li><p>no voluntary SI movements and the movements that we do see is influenced by other body regions thru weight changes and positional changes \n-these surrounding muscles are going to facilitate the stability of the joint </p></li>\n</ul>\n\n<hr>\n\n<h2>Musculature Details</h2>\n\n<p><strong>Iliopsoas</strong>\n - Unilateral - when the pelvis and femur are fixed the iliopsoas will\nproduce ipsilateral FB of the lumbar spine with contralateral RO.\nThe FB of the spine relative to the pelvis will decrease lumbar lordosis\nBilateral contraction of iliopsoas produces ant pelvic rotation and takes the sacrum along </p>\n\n<p><strong>Rectus Femoris</strong>\n - when pelvis is fixed, flexes the thigh on the pelvis\n - thigh and lumbar spine are fixed – and pelvis is free to move – it can cause ant innominate torsion ipsilaterally </p>\n\n<p><strong>Hip Abductors / Adductors</strong>\n - Directly influence SI jt thru the pubic symphysis - since the gluteus medius tends to pull the ilium away from the sacrum- almost a distraction effect\n - Create stress through public symphyisis \n - Adductors- create stress thru pubic symphysis\n - Abductors sartorius may have an anterior torsion effect on the innominate when the hip is extended and the knee is slightly flexed abductor </p>\n\n<p><strong>Piriformis:</strong> \n-Bilateral contraction of the piriformis produces a nutation effect on the sacrum \n– Unilaterally get a rotational effect toward contralateral side</p>\n\n<p><strong>Gluteus Maximus:</strong> Bilateral contraction of the maximus- post pelvic rotation – unilateral contraction – causes ipsilateral post torsion </p>\n\n<p><strong>Hamstrings:</strong> Tightness can cause post innominate torsion</p>\n\n<p><strong>Transversus Abdominis:</strong> Contributes to the stiffness of the SI jt</p>\n\n<p><strong>Quadratus Femoris</strong> - bilaterally contraction-stabilizes the lumbar spine and can result in sacral nutation</p>\n\n<p><strong>Multifidus</strong> – it is considered an anticipatory stabilizer of the LS spine \nthe multifidi are recruited as a stabilizer before the Lower and Upper limbs move \nCo contraction of multifidus and the TrA – further increase stiffness of the SI jt. Ipsilateral side bending will increase the shearing stress to the ipsilateral SI jt </p>\n\n<hr>\n\n<h2>Specific Treatments</h2>\n\n<p>As treatments are very evaluation dependent I’d really need results of an evaluation and orthopedic testing otherwise I’d just be throwing out random exercises.</p>\n\n<hr>\n\n<p><strong>Sources</strong></p>\n\n<ol>\n<li><p><a href=\"https://books.google.com/books?id=6_c0vgAACAAJ&amp;dq=inauthor:%22Ludwig%20Ombregt%22&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwjO6t21r5_WAhVn2oMKHV40CZIQ6AEILjAB\" rel=\"nofollow noreferrer\">Orthopedic Clinical Examination: An Evidence Based Approach for Physical Therapists.</a> </p></li>\n<li><p><a href=\"https://books.google.com/books/about/A_System_of_Orthopaedic_Medicine_E_Book.html?id=YaFsAAAAQBAJ\" rel=\"nofollow noreferrer\">A System of Orthopaedic Medicine, 3rd Edition.</a></p></li>\n</ol>\n", "score": 3 } ]

[ "orthopedics", "musculoskeletal-system", "bone-fractures", "gait-walk-abnormalities" ]

[ { "answer_id": 16084, "body": "<p>The question is a quite broad since you don't state whether you mean a ketogenic diet, levels of protein and fats, or what you mean by \"athletic and mental performance\" so I will answer quite generally.</p>\n\n<p>There is some anecdotal limited evidence that shows unhindered athletic performance on a Low Carb diet, such as observations made on Innuit people prior to dramatic changes in their diets. However the bulk of the literature shows impaired athletic performance, particularly in anaerobic events (eg sprints, lifting, field athletics), and no change in endurance events. Most studies also reported a 1-2 week diet adaptation time, during which most performance indicators suffered: </p>\n\n<p>Burke, Louise M. \"Re-examining high-fat diets for sports performance: did we call the ‘nail in the coffin’too soon?.\" Sports Medicine 45.1 (2015): 33-49.</p>\n\n<p>Hawley, John A., and Jill J. Leckey. \"Carbohydrate dependence during prolonged, intense endurance exercise.\" Sports Medicine 45.1 (2015): 5-12.</p>\n\n<p>As for brain function, a recent review article by Koppel (2017) looked at over 50 studies and found that people suffering from neurological conditions such as epilepsy, and more recently, Alzheimer’s benefited from Low Carb, high fat diets (in particular improved cognition). Care should be taken if extrapolating these results to otherwise healthy individuals and/or athletes. </p>\n\n<p>Koppel, Scott J., and Russell H. Swerdlow. \"Neuroketotherapeutics: A modern review of a century-old therapy.\" Neurochemistry international (2017).</p>\n", "score": 2 } ]

[ "nutrition", "brain", "carbohydrates", "fad-diet", "macronutrient" ]

[ { "answer_id": 13652, "body": "<p>Hand sanitizers have bactericidal and virucidal properties that <em><a href=\"https://youtu.be/0at_jtzJCDM?t=50\" rel=\"noreferrer\">when used properly</a> in sufficient quantity for at least 20 seconds</em> kill the vast majority of pathogenic organisms/viruses. Alcohol-based sanitizers are superior in spectrum of what it kills.</p>\n\n<p>However, you are correct that it doesn't kill everything, and some of what it doesn't kill is pretty nasty stuff.</p>\n\n<p>For example, spores are formed by some bacteria, including Clostridium difficile, (aka C diff) which is a hard-to-kill bacteria that can cause severe diarrhea (usually in people whose immune system or gut flora are disrupted). It takes substances like bleach to kill the spores, so you have to wash them off instead.</p>\n\n<p>Similarly, fungus isn't always killed by sanitizers. </p>\n\n<p>From the CDC's \"<a href=\"https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html\" rel=\"noreferrer\">Show Me the Science - When &amp; How to Use Hand Sanitizer</a>\"- </p>\n\n<blockquote>\n <p>Washing hands with soap and water is the best way to\n reduce the number of microbes on them in most situations. If soap and\n water are not available, use an alcohol-based hand sanitizer that\n contains at least 60% alcohol.</p>\n \n <p>Alcohol-based hand sanitizers can quickly reduce the number of\n microbes on hands in some situations, but sanitizers do not eliminate\n all types of germs. Why? Although alcohol-based hand\n sanitizers can inactivate many types of microbes very effectively when\n used correctly, people may not use a large enough volume of the\n sanitizers or may wipe it off before it has dried. Furthermore,\n soap and water are more effective than hand sanitizers at removing or\n inactivating certain kinds of germs, like Cryptosporidium, norovirus,\n and Clostridium difficile.</p>\n</blockquote>\n\n<p>There's also a <a href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm\" rel=\"noreferrer\">short novel on this topic.</a></p>\n", "score": 6 }, { "answer_id": 13659, "body": "<p>This question seems to ask in which situations hand sanitizers can be a suitable substitute for water and soap.</p>\n\n<blockquote>\n <h1><a href=\"http://news.rutgers.edu/research-news/handwashing-cool-water-effective-hot-removing-germs/20170529\" rel=\"nofollow noreferrer\">Techniques for hand hygiene</a></h1>\n \n <p><strong>Soap and water is still considered the gold standard for hand hygiene.</strong></p>\n \n <p>When using soap and water, it is important to wet the hands first.\n Then apply 3 to 5 mL of soap to the hands, avoiding bar soap. Next rub\n the hands together for a minimum of 15 seconds covering all surfaces\n of the hands and fingers. Finally rinse the hands off with water, dry\n thoroughly with a paper towel and use the paper towel to turn off the\n faucet. </p>\n \n <p><strong>When soap and water is not available, alcohol-based hand rubs (wipes, gels, or foams) should be applied.</strong> When using an\n alcohol-based product, healthcare workers must completely follow the\n manufacturer's label to ensure that the desired efficacy is reached.</p>\n</blockquote>\n\n<p>To answer the initial question properly we have to differentiate the situations:</p>\n\n<ul>\n<li>daily setting, \"normal world\": almost never; only when detergents and water are unavailable and an actual incidence would advise disinfection</li>\n<li><a href=\"http://bigthink.com/amped/humans-10-human-and-90-bacterial\" rel=\"nofollow noreferrer\">health care setting, medical world</a>: still almost never, as a substitute, <strong>but</strong> as an important addition to water and detergent</li>\n</ul>\n\n<h1>For a General Question of daily Hygiene:</h1>\n\n<p>The main effect of a handwash is that it <em>washes</em> <em>away</em> the bacteria/germs. Water, especially warm and hot water does its own thing to remove them, a soap-like substance adds to this effect and so is a towel. Any added ingredients that qualify for actually killing germs are just <a href=\"http://news.rutgers.edu/research-news/handwashing-cool-water-effective-hot-removing-germs/20170529\" rel=\"nofollow noreferrer\">icing on the cake</a>.\nNone of the above methods I listed will so much kill but <em>remove</em> bacteria or dilute them in the sense of reducing their numbers. \nNothing that is not also harmful to you will kill <em>all</em> of the bacteria. As long as you are not ill <em>and required</em> to be or live as sterile as possible that is a good thing.</p>\n\n<p>You are yourself a living being. Sounds like a fun fact but is meant to convey that \"a human\" might have <a href=\"http://bigthink.com/amped/humans-10-human-and-90-bacterial\" rel=\"nofollow noreferrer\">different definitions now</a> than a few decades ago. Not all bacteria are harmful. Most of them are not. Many of them are actually beneficial or even needed, like those in your gut. While gut bacteria might have quite a good reputation by now, those on your skin, that those handwashes would like to kill are only slowly getting a <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535073/\" rel=\"nofollow noreferrer\">better stand.</a> Everyone lives in a symbiosis with their individual microbiome. Overzealous sanitation at least disrupts this balance. Costs and benefit should be carefully calculated. </p>\n\n<p>Normal handwash is usually (more than) enough. It is not possible to really sterilise everything completely, nor would that be desirable. </p>\n\n<p>Add to that the effects of evolution:\n What does that mean in the slightly longer term?\nIn using sanitizers regularly you create an environment on your skin where the pressure to adapt is directed towards resisting the chemicals used in that agent. Some bacteria survive this attack. Compare that to their phenomenal ability to multiply and <a href=\"https://www.youtube.com/watch?v=yybsSqcB7mE\" rel=\"nofollow noreferrer\">overcome chemical onslaughts with for example antibiotics.</a> This leads to the situation that you un-train your own immune system to deal with any bacteria and disrupt the workings of the good bacteria your microbiome needs or can tolerate. Indiscriminate killing also tends to have the very unwelcome side effect of <a href=\"https://www.nature.com/articles/s41598-017-06055-9\" rel=\"nofollow noreferrer\">giving just the most harmful bacteria an edge</a> in the fight for survival.</p>\n", "score": 2 } ]

[ "hand-sanitizers" ]

[ { "answer_id": 14471, "body": "<p>There are many benefits associated with Himalayan rock salt.</p>\n\n<p>Looking into the first hit from the still favourite search engine one lands on a journal from an otherwise respectable publisher in the medical sciences and finds:</p>\n\n<blockquote>\n <p><a href=\"https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0030-1249902\" rel=\"nofollow noreferrer\">The Global Proving of Himalayan Crystal Salt</a>:</p>\n \n <p>Themes for Himalayan Rock Salt:\n <strong>Major themes</strong>\n – Suicide/Homicide/Accident/Death/Rape\n – Comfortable with oneself/Confidence/ buoyancy\n – Emotions: Grief/Sadness/Pain\n – Moods: Irritable/Negative\n – Mother-child theme\n – Masculine/Feminine energy\n – Homosexuality\n – Lonely\n – Old things/Memory\n – Heart/Love Minor themes\n – Past life\n – Postponing\n – Watched, being\n – Cobweb sensation Co-incidences\n – Work in bathroom/Sink/Tap\n – Cosmic events The Higher Self\n – Spiritual side – Meditation Food\n – Food theme\n – Food affinities The cosmic projection\n – Animals/Birds\n – Ocean\n – Flowers\n <strong>Physical representation</strong>\n – Physical: Eye\n – Physical: Head\n – Physical: Hips\n – Physical: Lips: Herpetic eruptions\n – Dental issues</p>\n</blockquote>\n\n<p>And this sums up quite nicely what a big cure-it-all this is. It's a miracle food and priced accordingly!</p>\n\n<p>But how can it be so effective? – Simple answer: <a href=\"http://www.collective-evolution.com/2016/02/01/this-is-what-happens-to-your-body-when-you-eat-pink-himalayan-salt/\" rel=\"nofollow noreferrer\">it's old, it's pure, it's from an obscure Eastern region associated with mysticism; and it is even said to contain \"all 84 trace elements\" the human body needs in the perfect ration!</a> –– Wait a minute. Pure and 84 elements? That are in a human body and needed? How exotic!</p>\n\n<h1>OK, really? Health Benefits?</h1>\n\n<blockquote>\n <p><a href=\"https://www.medicalnewstoday.com/articles/315081.php\" rel=\"nofollow noreferrer\">What is pink Himalayan salt?</a></p>\n \n <p>Pink Himalayan salt is mined in Pakistan and may be up to 98 percent sodium chloride.</p>\n</blockquote>\n\n<p>Translation: It's not from the mountains of the Himalaya but one of the largest salt mines in the vicinity of <a href=\"https://en.wikipedia.org/wiki/Lahore\" rel=\"nofollow noreferrer\">Lahore</a>. Looking at a map locating <a href=\"https://en.wikipedia.org/wiki/Khewra_Salt_Mine\" rel=\"nofollow noreferrer\">Khewra Salt Mine</a> one is hard press to identify the surroundings with the claimed origin of these salts. It's in Punjab and not in the Karakorum mountains. Exposing the first lie about it right in its name.</p>\n\n<blockquote>\n <p>Pink Himalayan salt is chemically similar to table salt. It contains up to 98 percent sodium chloride. The remainder of the salt is made up of trace minerals, such as potassium, magnesium, and calcium, which give the salt its light pink tint.</p>\n</blockquote>\n\n<p>Translation: Mostly table salt, with some dirt left in.</p>\n\n<blockquote>\n <p>The presence of these minerals also explains why Himalayan salt tastes different to regular table salt.</p>\n</blockquote>\n\n<p>That might settle this issue. But even the yellow press can make this clearer:</p>\n\n<blockquote>\n <p><a href=\"http://time.com/4834865/himalayan-pink-salt-benefits/\" rel=\"nofollow noreferrer\">Pink Himalayan salt is nutritionally very similar to regular salt. It’s just prettier and more expensive.</a></p>\n</blockquote>\n\n<p>If we inquire about this opinion on a site dedicated to evidence based medicine and promoting science in general the picture gets bleak:</p>\n\n<blockquote>\n <h2><a href=\"https://sciencebasedmedicine.org/pass-the-salt-but-not-that-pink-himalayan-stuff/\" rel=\"nofollow noreferrer\"><strong>What kind of salt should we use?</strong></a><br></h2>\n \n <p><strong>Even if this analysis is accurate, it is meaningless for health and if anything is worrisome. The amount of minerals in it is too minuscule to make any difference, and we already get plenty of the same trace minerals from other foods. They claim that two double-blind studies were done, but no such studies are listed in PubMed. There is no evidence published in peer-reviewed journals that replacing white salt with pink salt makes a shred of difference or leads to any improvement in health.</strong></p>\n \n <p>If you read down the list of minerals, you will notice that it includes a number of radioactive substances like radium, uranium, and polonium. It also includes substances that act as poisons, like thallium. I wouldn’t be worried, since the amounts are so small; but if anyone believes the trace amounts of “good” minerals in Himalayan sea salt are good for you, why not believe the trace amounts of poisons and radioactive elements are bad for you?</p>\n \n <p>The claim that pink Himalayan salt contains 84 trace minerals may be true, but the claim that it “promotes health and wellness” is false until proven otherwise by legitimate clinical studies. While waiting for evidence, I’d just as soon my salt didn’t contain uranium.</p>\n</blockquote>\n\n<h1>Is this a Scam?</h1>\n\n<p>There were several chemicals analysis undertaken to verify at least the claims about mineral contents of this salt:<br>\nAccording to an analysis by the <a href=\"https://de.wikipedia.org/wiki/Technische_Universit%C3%A4t_Clausthal\" rel=\"nofollow noreferrer\">University of Technology Clausthal</a> the <a href=\"https://web.archive.org/web/20061024061013/http://www.zdf.de/ZDFde/inhalt/19/0,1872,2275027,00.html\" rel=\"nofollow noreferrer\">salt as sold contains just 10 different minerals</a>:</p>\n\n<blockquote>\n <p>Außerdem entspricht der Anteil an Natriumchlorid nicht dem internationalen Standard für Speisesalz: Der müsste bei mindestens 97 Prozent liegen. Die untersuchten Proben enthalten etwa 94 bis 95 Prozent Natriumchlorid und etwa drei Prozent Polyhalit. <br>\n Translation: international trade regulations proscribe a content of 97% sodium chloride for regular table salt whereas Himalayan Salt only contains 94–95% and in addition 3% <a href=\"https://en.wikipedia.org/wiki/Polyhalite\" rel=\"nofollow noreferrer\">polyhalite</a></p>\n</blockquote>\n\n<h3>Consumer Rights</h3>\n\n<p>Various consumer rights organisations have been alerted to this expensive salt and the outrageous claims made about it:<br>\n<a href=\"https://web.archive.org/web/20071009153653/http://www.vnoe.at/presse/Der_Nepp_mit_dem_Himalayasalz.pdf\" rel=\"nofollow noreferrer\">They</a> <a href=\"http://www.oekotest.de/cgi/index.cgi?artnr=28360;bernr=04;co=;suche=himalaya%20salz\" rel=\"nofollow noreferrer\">all</a> <a href=\"http://www.ugb.de/dmlc/n/6/140889/\" rel=\"nofollow noreferrer\">concluded</a> <a href=\"http://www.test.de/Himalaya-Salz-Glaubensfrage-1058556-0/\" rel=\"nofollow noreferrer\">that</a> the <a href=\"http://www.markenmagazin.de/olg-koeln-himalaya-salz-irrefuehrung-ueber-die-geografische-herkunft-eines-produktes-urteil-vom-01-10-2010-6-u-7110/\" rel=\"nofollow noreferrer\">place of origin is bogus</a>, the claims about the <a href=\"http://kirste.userpage.fu-berlin.de/medi/suppl/mensch.html\" rel=\"nofollow noreferrer\">mineral content and mineral needs of a human body</a> are bogus, physiological benefit claims are bogus.</p>\n\n<h2>If there are no benefits, are there dangers?</h2>\n\n<p>Looking for the health status of the people in the region where this salt is mined and consumed is very instructive: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/14315706\" rel=\"nofollow noreferrer\">the people there</a> live in the so called <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28348999\" rel=\"nofollow noreferrer\">Himalayan goitre belt</a>! While regular table salt <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/4546523\" rel=\"nofollow noreferrer\">should be iodised</a> now that Khewra salt is not. And <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24820989\" rel=\"nofollow noreferrer\">lack of</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20509329\" rel=\"nofollow noreferrer\">iodine leads</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18599931\" rel=\"nofollow noreferrer\">some problems</a> in the region where those lucky people always eating Khewra salt for cheap should be much healthier than we who have to pay so much for it.</p>\n\n<h2>Even if this is a Scam, I like how Looks and Tastes</h2>\n\n<p>Complete bogus it may be, but it is pretty, I get my iodine from elsewhere and <a href=\"https://academic.oup.com/ps/article/90/12/2869/1602392\" rel=\"nofollow noreferrer\">pricey stuff</a> tends to <a href=\"https://www.cambridge.org/core/journals/journal-of-wine-economics/article/do-more-expensive-wines-taste-better-evidence-from-a-large-sample-of-blind-tastings/D58EA9E4DA934A7ED0F8CEE33F780DDC\" rel=\"nofollow noreferrer\">taste better?</a> Well, only if you know that it is prices!</p>\n\n<blockquote>\n <p><a href=\"https://academic.oup.com/ps/article/90/12/2869/1602392\" rel=\"nofollow noreferrer\">In the current study, there were no significant differences among TS and other gourmet-style salts with respect to meat quality and sensory characteristics of fresh poultry breast meat products. Objective tenderness, flavor, and overall cook loss yields were not altered due to the replacement of TS with other gourmet salts. Subjective tenderness, juiciness, and flavor notes were also not significantly different among salt treatments. The use of alternative salts with lower sodium content in chicken marination may be a healthy alternative to TS, with respect to potential sodium reduction (especially SGDG) and mineral enhancement, without sacrificing meat quality or sensory attributes. Sonoma gourmet salt may also potentially increase marination yields.</a></p>\n</blockquote>\n\n<h2>Summary</h2>\n\n<p>Usually, the claimed benefits are a reason for scorn. If in this case there are not even taste benefits then we have to conclude that there is only a single one health benefit associated with pink Himalayan salt: it's so expensive that the gullible buyers will have less money to waste on other detrimental supplements or health foods.</p>\n", "score": 6 } ]

[ "salt", "minerals" ]

[ { "answer_id": 13881, "body": "<p>In the US this should be a very rare event. Every state (or region) has hospitals designated as level 1 trauma centers. Being certified as a level 1 trauma center means they have all the personnel and facilities necessary to handle any type of trauma at any time. That means surgical teams and all the support staff and facilities such as radiology, blood bank, pharmacy and all the necessary personnel are on site and available 24/7. Surgeons being \"on call\" isn't good enough.</p>\n\n<p>Along with trauma centers, there is a system of regulations governing which patients qualify as trauma patients and how EMS must handle them. When EMS responds to a 911 call and they determine that the patient meets trauma criteria, they <strong><em>must</em></strong> transport that patient to the nearest trauma center. (This is one of the few times that EMS can overrule a conscious, sober, adult patient's choice of hospitals.)</p>\n\n<p>However, exceptions can and do happen. For example, a patient has suffered massive blood loss. The trauma center is 45 minutes away and the patient is deteriorating rapidly and unlikely to survive the trip, but another hospital is 5 minutes away that has a blood bank and surgical capabilities. In that case the medics would contact their own medical control (usually an ED doctor where they're based) and request a diversion. If approved, they would then contact the new destination hospital to give them a heads up on what's headed their way. You don't take a critical patient somewhere without knowing for sure they can accept them. The idea here is the patient will be stabilized at the smaller hospital and then transferred to the trauma center ASAP. </p>\n\n<p>So the scenario you ask about should almost never happen. There's no benefit to taking a trauma patient somewhere where there are no surgeons since there's little a hospital can do that the medics can't. It's better to fly the patient if possible or simply keep moving. Time is everything in trauma and diverting to a hospital without the necessary resources would be a waste of precious time. </p>\n\n<p>In comments Narusan raises a good question: What if the patient travels to the smaller hospital himself? In that case the same thing would happen. They would stabilize the patient to the best of their abilities and then transfer them to a trauma center as soon as possible. </p>\n\n<p><a href=\"https://www.ems.gov/pdf/advancing-ems-systems/Provider-Resources/EMS_Trauma_Agenda.pdf\" rel=\"nofollow noreferrer\">https://www.ems.gov/pdf/advancing-ems-systems/Provider-Resources/EMS_Trauma_Agenda.pdf</a></p>\n", "score": 5 }, { "answer_id": 13879, "body": "<p>Short answer is the ED will try and stabilize the patient as best as they can with fluids and pressors if needed. But patient will need surgery to figure out where the bleed is coming from. </p>\n", "score": 0 } ]

[ "emergency-room" ]

[ { "answer_id": 13980, "body": "<h2>Yes</h2>\n\n<p>A decent share of radiation will do the trick for you, as both Hiroshima and Nagasaki, but also <a href=\"https://en.wikipedia.org/wiki/Marie_Curie\" rel=\"nofollow noreferrer\">physicists</a> experimenting with the newly found radiation have shown.</p>\n\n<p>There even is a unit (<a href=\"https://en.wikipedia.org/wiki/Sievert\" rel=\"nofollow noreferrer\">sievert</a>) which measures how cancerous a dose of radiation is. One sievert is equivalent to a 5,5% chance of cancer.</p>\n\n<p><a href=\"https://xkcd.com/radiation/\" rel=\"nofollow noreferrer\">Relevant XKCD for how what radiation has how much sievert</a>:</p>\n\n<p><a href=\"https://i.stack.imgur.com/9Dcv9.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/9Dcv9.png\" alt=\"XKCD\"></a></p>\n\n<p>Furthermore, <a href=\"http://www.washingtoncitypaper.com/columns/straight-dope/article/13045187/can-cancer-be-transplanted-what-happens-if-organs-carry-tumors\" rel=\"nofollow noreferrer\">cancer can be transplanted</a>. This is an issue that <a href=\"https://rd.springer.com/book/10.1007/978-94-009-0175-9\" rel=\"nofollow noreferrer\">has been subject to quite a few conferences</a>.</p>\n\n<p><a href=\"https://worldbuilding.stackexchange.com/q/68530\">Related Worldbuilding.SE question.</a></p>\n", "score": 3 } ]

[ "cancer" ]

[ { "answer_id": 15456, "body": "<p>Take a look at the IHE Radiology Scheduled Workflow integration profile in <a href=\"http://ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol1.pdf\" rel=\"nofollow noreferrer\">IHE Radiology (RAD) Technical Framework</a>. This explains a common workflow model.</p>\n", "score": 3 } ]

[ "medical-imaging", "x-rays", "ct-scans", "healthcare-data", "bone-scan" ]

[ { "answer_id": 14118, "body": "<p>Currently, there are three options to deal with white spots in frontal teeth after orthodontic treatment: </p>\n\n<ol>\n<li>remineralization,</li>\n<li>micro-abrasion, and </li>\n<li>resin infiltration.</li>\n</ol>\n\n<p>There are several case report about micro-abrasion and resin infiltration, and some clinical trials about all, but a recent <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27030284\" rel=\"nofollow noreferrer\">systematic review</a> found the evidence of effectiveness was rated as low, that means that the results are inconsistent or there is a high risk of bias, i.e. the manufacturers of the products published the results. </p>\n\n<p>The three options are different: \n<strong>Remineralization</strong> uses fluoride aiming to add something to the surfaces layer of the tooth. There are some clinical trials showing positive results (ncbi.nlm.nih.gov/pubmed/19887683) and others showing no effect (ncbi.nlm.nih.gov/pubmed/27480987). But the advantge of a non invasive therapy is that there is no loss of enamel surface, hence there is no irreversible alteration to the tooth surface. </p>\n\n<p><strong>Microabrasion</strong> on the other hand smooth irreversibly the surface of the eroded enamel with an acid. </p>\n\n<p>Finally, <strong>infiltration</strong>, also irreversibly treatment, use an acid to remove a small layer of the eroded enamel and then add a resin layer. From the esthetic point of view this solve the issue immediately, but the lack of prospective studies add an interrogation mark to the long term results. </p>\n\n<p>Hence, from all the three options, currently the <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27907894\" rel=\"nofollow noreferrer\">remineralization</a> is the only that is non-invasive. </p>\n", "score": 5 } ]

[ "dentistry", "home-remedies", "stain-removal-teeth", "white-strips-teeth" ]

[ { "answer_id": 17723, "body": "<p>It will most likely depend on the location of the injury if there's tension (joint areas) and not the depth, size or type of injury.</p>\n\n<p>\"There is evidence suggesting that increased mechanical tension can initiate hypertrophic scars formation.Based on this hypothesis, it makes sense to minimize mechanical forces after surgery. Surgical excision scars should be positioned along, rather than across, relaxed skin tension lines whenever possible\"</p>\n\n<p>And also \"Inflammation is also known to contribute to hypertrophic scarring, and every attempt to minimize the inflammatory response should be made by ascertaining clean surgery and good wound care to prevent infection thereafter. Using inert suture materials is also important in this context\"</p>\n\n<p>Source:(lifted from)</p>\n\n<p>Update on hypertrophic scar treatment\nFelipe Bettini Rabello, Cleyton Dias Souza, and Jayme Adriano Farina Júnior.</p>\n\n<p>Source link: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129552/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129552/</a></p>\n", "score": 1 }, { "answer_id": 17734, "body": "<p>Another factor that comes into play is related to the individual, and not just the location, type, and severity of the injury. For example, some connective tissue disorders, such as Ehlers Danlos Syndrome (particularly classical type), can make you higher risk for hypertrophic, atrophic, and keloid scarring. Depending on the severity of skin involvement, even relatively minor injuries can result in such types of scarring. </p>\n", "score": 0 } ]

[ "dermatology", "scar-tissue-scars" ]

[ { "answer_id": 14321, "body": "<p>Hunger is far more complicated than \"my weight is below normal for my height, I should eat now.\" It's not some sort of correction mechanism that turns on and off to make your weight go up and down.</p>\n\n<p>On a first approximation, you feel hungry because your stomach is empty and/or your blood sugar is low. People can drink water or eat lettuce to fill up their stomachs, and that works a little. Often, if you eat something very high in sugar, not mediated by anything slower to digest, you will be even hungrier afterwards because of your body's insulin response. The web is full of \"foods that make you hungry\", \"what to do instead of eating when you're hungry\" and such like, some of which have a grain of truth in them, and that certainly demonstrate how complicated hunger is in humans.</p>\n\n<p>Studies have been done showing that people can get hungry for a variety of reasons that have nothing to do with their current weight. Here's <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3894001/\" rel=\"nofollow noreferrer\">a review</a> of various papers relating to insulin levels and cognitive factors such as looking at or thinking about food.</p>\n", "score": 2 }, { "answer_id": 14310, "body": "<p>So think about fat stored in your body as being like money in a 401K.</p>\n\n<p>You decide you need groceries, so you go to the store, but you can't use the money in the 401K to buy them, you need cash or a credit card.</p>\n\n<p>Your body is the same; it needs immediate cash (carbohydrates/sugars...) for the day to day needs, and it tells you it needs them through hunger. Just like the 401K won't help you buy groceries, fat won't stop day to day hunger, so you have to eat.</p>\n", "score": 0 } ]

[ "weight", "overweight", "obesity" ]

[ { "answer_id": 15978, "body": "<blockquote>\n <p>[I]s weight gain a one variable function of calorie intake minus calorie consumption?</p>\n</blockquote>\n\n<p>Yes. It stands to reason because why else is the <a href=\"https://www.nhs.uk/chq/pages/1126.aspx?categoryid=51\" rel=\"nofollow noreferrer\">recommended daily calorie intake</a> always talked about in nutritional information labels? Note, however, that as stipulated in the NHS link,</p>\n\n<blockquote>\n <p>These values can vary depending on age, metabolism and levels of physical activity, among other things.</p>\n</blockquote>\n\n<p>Calories not 'burnt' by the body's metabolism is stored as fat.</p>\n\n<blockquote>\n <p>[H]ow many grams one would gain for excessive 1000 calories?</p>\n</blockquote>\n\n<p>There are no definitive answers to this question as again, it seems to work out differently from person to person due to the components of <a href=\"https://academic.oup.com/ajcn/article/95/4/989/4576902\" rel=\"nofollow noreferrer\">intake and expenditure</a>.</p>\n\n<p><a href=\"https://www.healthline.com/nutrition/calories-in-a-pound-of-fat\" rel=\"nofollow noreferrer\">A link provided by @paparazzo</a> states that with fat working out to be about 3500 calories per pound,</p>\n\n<blockquote>\n <p>Some of the studies state that body fat tissue contains only 72% fat. Different types of body fat may also contain varying amounts of fat.</p>\n \n <p>BOTTOM LINE:A pound of body fat may contain anywhere between 3,436 and 3,752 calories, roughly estimated.</p>\n</blockquote>\n\n<h2>The bottom line on this question</h2>\n\n<p>Calories not 'burnt' by the body's metabolism is stored as fat. If you are overweight you need to reduce your calorie intake <strong>and/or</strong> increase your exercise levels.</p>\n\n<p>If you are underweight it is not straight forward as you need to have your weight gain managed.</p>\n\n<p><a href=\"https://www.nhs.uk/chq/Pages/2302.aspx\" rel=\"nofollow noreferrer\">There are many possible medical reasons for being underweight</a>. Speak to your doctor because before trying to put on weight, you need to know that it is safe to do so. </p>\n", "score": 1 } ]

[ "weight", "calories" ]

[ { "answer_id": 14545, "body": "<p>Having kidney stones alone entails <a href=\"https://www.health.harvard.edu/blog/5-steps-for-preventing-kidney-stones-201310046721\" rel=\"nofollow noreferrer\">a recommendation for low-sodium diet</a>:</p>\n\n<blockquote>\n <p>Reduce sodium: A high-sodium diet can trigger kidney stones because it increases the amount of calcium in your urine. So a low-sodium diet is recommended for the stone prone. Current guidelines suggest limiting total daily sodium intake to 2,300 mg. If sodium has contributed to kidney stones in the past, try to reduce your daily intake to 1,500 mg. This will also be good for your blood pressure and heart.</p>\n</blockquote>\n", "score": 2 } ]

[ "salt", "kidney", "kidney-stones" ]

[ { "answer_id": 24534, "body": "<p>Aadrenaline will generally quickly worsen heart failure because</p>\n<ol>\n<li>it massively increases peripheral vascular resistance and thus after-load on the heart.</li>\n<li>It significantly increases myocardial oxygen demand and in heart failure due to ischaemic heart disease this can quickly lead to myocardial infarction.</li>\n</ol>\n<blockquote>\n<p>Do the effects of epinephrine not last long enough</p>\n</blockquote>\n<p>The effects of epinephrine are indeed short but so are most ionotropic drugs - this is irrelevant however since if it were to be used in surgery it would be given via continuous infusion or repeated iv bolus doses.</p>\n<blockquote>\n<p>... or have potentially harmful effects in larger quantities?</p>\n</blockquote>\n<p>It has potentially harmful effects even in small quantities in heart failure.</p>\n<blockquote>\n<p>Is it that the patient's blood flow is also increased when using epinephrine, making blood loss more significant?</p>\n</blockquote>\n<p>No.</p>\n<p>The exact opposite. A major function of epinephrine in the body is to minimize blood loss in the case of trauma by inducing profound peripheral vasoconstriction. This is why for example it is often used topically to treat acute epistaxis (nose bleeds). So while it does under normal circumstances increase cardiac output it would be incorrect to say it &quot;increases blood flow&quot;.</p>\n<p>Although epinephrine does have important uses in surgery (to treat for example low blood pressure in the setting of bradycardia) there are generally more effective alternative drugs when it comes to heart failure (dobutamine for example).</p>\n<p>The blocking of adrenaline is in fact a cornerstone in the treatment of heart failure which is why beta-blockers (i.e beta-adrenergic receptor blockers) are usually prescribed to patients with heart failure.</p>\n", "score": 2 }, { "answer_id": 24281, "body": "<p>Generally, in intensive care medicine there are variants of catecholamines (the general class epinephrine belongs to) that can be applied to increase heart output. However, there are various drawbacks to this therapy, including putting increased strain on an already strained muscle and the effect of e. g. epinephrine on all the other organs of the body.</p>\n<p>For side effects of epinephrine and catecholamines in general see e. g. here: <a href=\"https://www.researchgate.net/figure/Adverse-and-beneficial-effects-of-catecholamines_tbl1_316052992\" rel=\"nofollow noreferrer\">https://www.researchgate.net/figure/Adverse-and-beneficial-effects-of-catecholamines_tbl1_316052992</a></p>\n<blockquote>Is it that the patient's blood flow is also increased when using epinephrine, making blood loss more significant?</blockquote>\nMore blood volume output per time can increase bleeding (if it the heart is sufficiently able to increase volume output from increased activation). That said, flow and pressure are two different things to consider - peripherally epinephrine casues vasoconstriction and may decrease blood flow. Still, that very same vasoconstriction may in turn increase blood pressure and wash away previously formed blood clots, which is why epinephrine (or increasing blood pressure) may result in increased bleeding.\n<p>Generally speaking treatment of heart failure (the insufficiency of the heart to pump blood) has a variety of approaches depending on the cause and stage of heart failure.</p>\n<p>For maintenance, generally the heart's work is reduced by trying to decrease peripheral resistance to pumping and/or decreasing volume to be pumped e. g. by increasing extraction of water in the kidney.</p>\n", "score": 0 } ]

[ "surgery", "lasting-effects-duration", "adrenaline", "procedural-behavior", "epi-pen-epinephrine" ]

[ { "answer_id": 22819, "body": "<p>As per the US CDC non-detectable viral load means effectively no transmission possible (there are not many absolutes in medical sciences).</p>\n\n<p>See also: <a href=\"https://www.cdc.gov/hiv/risk/art/index.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/hiv/risk/art/index.html</a></p>\n\n<p>Numerous campaigns have been created on these findings:</p>\n\n<ul>\n<li><a href=\"http://www.aidsmap.com/about-hiv/undetectable-viral-load-and-transmission-information-people-hiv\" rel=\"nofollow noreferrer\">http://www.aidsmap.com/about-hiv/undetectable-viral-load-and-transmission-information-people-hiv</a></li>\n<li><a href=\"https://www.preventionaccess.org/undetectable\" rel=\"nofollow noreferrer\">https://www.preventionaccess.org/undetectable</a></li>\n</ul>\n", "score": 1 } ]

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

[ { "answer_id": 15960, "body": "<p>Have someone take photos of the back of your head periodically. Date the photos.</p>\n\n<p><em>(Carey's <a href=\"https://health.stackexchange.com/questions/14891/how-to-accurately-monitor-hair-loss#comment23007_14891\">comment</a> seemed good enough to make it an answer.)</em></p>\n", "score": 2 } ]

[ "hairloss" ]

[ { "answer_id": 15146, "body": "<p><a href=\"https://www.health.ny.gov/professionals/ems/policy/10-05.htm\" rel=\"noreferrer\">The MOLST (Medical Orders for Life-Sustaining Treatment) form</a> is an update to the non-hospital DNR, which as you saw in a previous answer has very stringent (and frankly unrealistic) requirements.</p>\n\n<p>The MOLST is printed on bright pink paper, and EMS providers are trained to look for it upon entering a house. In addition, patients are able to wear a metal bracelet stating \"DNR\" if they have a valid MOLST or non-hospital DNR form that states the patient is DNR, and EMS services are trained to treat this bracelet the same as the form itself.</p>\n\n<p>The MOLST does need to be signed by a physician, but any signed MOLST is considered valid unless there is a more recent form or there is other evidence to suggest that the wishes of the patient have changed. This eliminates the 90-day renewal requirement of the non-hospital DNR.</p>\n\n<p>The one limitation I could find is that a MOLST is not valid for psychiatric patients or patients with developmental disabilities.</p>\n\n<p>Many healthy people have DNR forms. In fact, whether or not you want a DNR is a part of an advance directive <a href=\"http://www.caringinfo.org/files/public/ad/New_York.pdf\" rel=\"noreferrer\">(here's the form for New York)</a>, which every person is encouraged to have, regardless of health status. <a href=\"http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/\" rel=\"noreferrer\">Here is an interesting essay</a> that provides anecdotal evidence about doctors with no health problems of their own choosing to have a DNR order in place. A doctor is likely to ask you questions about your advance directive in order to make sure that you are not depressed or suicidal (which would invalidate the MOLST), but there are many good reasons for not wanting aggressive care. A good doctor will respect your decisions about the medical care you want to receive.</p>\n", "score": 7 }, { "answer_id": 15247, "body": "<blockquote>\n <p>If an otherwise healthy person has a do not resuscitate order and has a heart attack and the ambulance comes, will they just let him die like that? Or is do not resuscitate only applicable to terminally ill people?</p>\n</blockquote>\n\n<p>This is a very interesting question. And as a non-American, I am quite shocked by the answer.</p>\n\n<p>To begin with, what you are essentially asking is does an express refusal override implied consent? Morally, yes: the whole point about autonomy is that people have the right to make bad decisions about their life.</p>\n\n<p>The matter is complicated because such a directive has to be explicitly known by the person. So let's simplify things: suppose you have a \"Do Not Resuscitate\" tattoo on your chest. This is unambiguously stating your express refusal to be resuscitated, like so:</p>\n\n<p><a href=\"https://i.stack.imgur.com/cp9VS.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/cp9VS.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>The following case study from Miami, FL was reported in NEJM just a few months ago:</p>\n\n<p><a href=\"http://www.nejm.org/doi/full/10.1056/NEJMc1713344\" rel=\"nofollow noreferrer\">http://www.nejm.org/doi/full/10.1056/NEJMc1713344</a></p>\n\n<blockquote>\n <p><strong>An Unconscious Patient with a DNR Tattoo</strong></p>\n \n <p><strong>We present the case of a person whose presumed code-status preference\n led him to tattoo “Do Not Resuscitate” on his chest. Paramedics\n brought an unconscious 70-year-old man with a history of chronic\n obstructive pulmonary disease, diabetes mellitus, and atrial\n fibrillation to the emergency department</strong>, where he was found to have\n an elevated blood alcohol level. The staff of the medical intensive\n care unit evaluated him several hours later when hypotension and an\n anion-gap metabolic acidosis with a pH of 6.81 developed. His anterior\n chest had a tattoo that read “Do Not Resuscitate,” accompanied by his\n presumed signature (Figure 1).</p>\n</blockquote>\n\n<p>A good case how to make your express refusal known, right? Nope, not quite:</p>\n\n<blockquote>\n <p><strong>We initially decided not to honor the tattoo, invoking the principle\n of not choosing an irreversible path when faced with uncertainty.</strong> This\n decision left us conflicted owing to the patient’s extraordinary\n effort to make his presumed advance directive known; therefore, an\n ethics consultation was requested.</p>\n</blockquote>\n\n<p>Regarding your question about New York state, can such a directive still be ignored? Yes, it would seem so. Though granted, there is a recent update to the matter:</p>\n\n<blockquote>\n <p>Cuomo on Nov. 29 signed the legislation that will add “attending nurse\n practitioner” to the list of health care providers that patients and\n families can tap to create various directives related to end-of-life\n decisions.</p>\n</blockquote>\n\n<p><a href=\"https://libn.com/2017/11/30/state-lets-nps-sign-off-on-do-not-resuscitate/\" rel=\"nofollow noreferrer\">https://libn.com/2017/11/30/state-lets-nps-sign-off-on-do-not-resuscitate/</a></p>\n", "score": 2 }, { "answer_id": 15144, "body": "<p>If the person has a valid out of hospital DNR order, then that person should not be resuscitated if they experience a cardio respiratory arrest. In that case the person clearly is not healthy.</p>\n\n<p>The DNR order has to be reviewed every 90 days by the person's doctor. And in the event of an arrest can be overridden by a relative or physician where the person is unable to object.</p>\n\n<p><a href=\"https://www.health.ny.gov/professionals/ems/policy/99-10.htm\" rel=\"nofollow noreferrer\">https://www.health.ny.gov/professionals/ems/policy/99-10.htm</a></p>\n", "score": 1 } ]

[ "first-aid", "emergency", "cpr" ]

[ { "answer_id": 15967, "body": "<p>A <strong>regular caffeine consumer</strong> will likely develop a partial or complete <strong>tolerance</strong> to many caffeine effects and side effects, including increased heart rate. Tolerance develops within few days of regular caffeine consumption and disappears within few days of caffeine discontinuation.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC370671/pdf/jcinvest00468-0195.pdf\" rel=\"nofollow noreferrer\">Tolerance to the Humoral and Hemodynamic Effects of Caffeine in Man (PubMed Central, 1981)</a></p>\n\n<blockquote>\n <p>Acute caffeine in subjects who do not normally ingest methylxanthines\n leads to increases in blood pressure, heart rate, plasma epinephrine,\n plasma norepinephrine, plasma renin activity, and urinary\n catecholamines. Using a double-blind design, the effects of chronic\n caffeine administration on these same variables were assessed. <strong>Near\n complete tolerance,</strong> in terms of both humoral and hemodynamic\n variables, <strong>developed over the first 1-4 days of caffeine. No\n longterm effects of caffeine on blood pressure, heart rate, plasma\n renin activity, plasma catecholamines, or urinary catecholamines could\n be demonstrated.</strong></p>\n</blockquote>\n\n<p>A <strong>single caffeine dose</strong> may increase blood pressure but not necessary heart rate in individuals with supraventricular tachicardia.</p>\n\n<p><a href=\"https://onlinelibrary.wiley.com/doi/pdf/10.1111/jce.12504\" rel=\"nofollow noreferrer\">A prospective placebo controlled randomized study of caffeine in patients with supraventricular tachycardia undergoing electrophysiologic testing (Wiley Online Library, 2015)</a></p>\n\n<blockquote>\n <p>Caffeine, at moderate intake (5 mg/kg), was associated with\n significant increases in systolic and diastolic blood pressures, but\n had no evidence of a significant effect on cardiac conduction and\n refractoriness. Furthermore, no effect of caffeine on SVT induction or\n more rapid rates of induced tachycardias was found.</p>\n \n <p><strong>the resting heart rate was not significantly different between both\n groups</strong> [caffeine vs placebo].</p>\n</blockquote>\n\n<p><a href=\"http://cafeesaude.com/wp-content/uploads/2012/01/Arritmias-D-J-Pelchovitz-et-al-Am-J-Med-Vol-124-2011.pdf\" rel=\"nofollow noreferrer\">Caffeine and Cardiac Arrhythmias: A Review of the Evidence (The American Journal of Medicine, 2011)</a></p>\n\n<blockquote>\n <p>Overall, the data suggest that in most patients, even those with known\n or suspected arrhythmia, <strong>caffeine in moderate doses is well\n tolerated and there is therefore no reason to restrict ingestion of\n caffeine.</strong> Care should be taken to avoid caffeine in situations in\n which catecholamines are thought to drive the arrhythmia, as well as\n in patients who note sensitivity to caffeine.</p>\n</blockquote>\n\n<p><hr/>\nNow, I personally cannot claim if caffeine consumption is or is not dangerous for individuals with tachycardia, but most doctors, for example, from <a href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Tachycardia-Fast-Heart-Rate_UCM_302018_Article.jsp#.WtSAgy5uZpg\" rel=\"nofollow noreferrer\">American Heart Association</a>) still advise them to cut it down.</p>\n", "score": 4 } ]

[ "caffeine", "heart" ]

[ { "answer_id": 15536, "body": "<p>Given the breadth of knowledge and clinical experience required to answer this question in full (and given that it is not typically something I deal with in my specialty), I will rely heavily on <a href=\"https://www.uptodate.com/contents/treatment-and-prevention-of-pneumocystis-pneumonia-in-hiv-uninfected-patients\" rel=\"nofollow noreferrer\">this UpToDate article</a>. To summarize:</p>\n\n<ul>\n<li>Research involving <em>non-HIV</em> immunosuppressed patients mostly involve <strong>patients with cancer</strong> (especially receiving hematopoietic stem cell transplants [HCT] ) and <strong>solid organ transplant recipients</strong>.</li>\n<li>There are <strong>no published guidelines</strong> for PCP prophylaxis among patients with rheumatologic diseases receiving immunosuppressive drugs.</li>\n<li>A <a href=\"https://www.ncbi.nlm.nih.gov/pubmed?term=25269391\" rel=\"nofollow noreferrer\">meta-analysis</a> performed in 2014 including 13 trials and involving 1,412 patients suggests that <strong>PCP prophylaxis using trimethoprim-sulfamethoxazole (TMP/SMX), commonly referred to as Bactrim, is recommended in <em>non-HIV</em> immunosuppressed patients when the risk of PCP exceeds approximately 6%</strong>. The number-needed-to-treat (NNT) to prevent PCP was reported as 19 patients (95% CI 17 to 42).</li>\n<li>Patient populations considered at great enough risk to necessitate PCP prophylaxis include patients:\n\n<ul>\n<li>receiving a glucocorticoid dose equivalent greater than or equal to 20mg daily for one month or longer <em>with</em> another concomitant cause of immunocompromise;</li>\n<li>receiving temozolomide and radiotherapy, until recovery of lymphopenia;</li>\n<li>with acute lymphoblastic leukemia (ALL);</li>\n<li>receiving allogeneic HCT for as long as immunosuppressive therapy is given;</li>\n<li>certain autologous HCT recipients;</li>\n<li>solid organ transplant recipients, usually for 6-12 months following transplantation;</li>\n<li>with certain primary immunodeficiencies (severe combined immunodeficiency [SCID], CD4 T-lymphocytopenia, hyper-IgM syndrome, etc.)</li>\n<li>those receiving a purine analog in combination with cyclophosphamide.</li>\n</ul></li>\n</ul>\n\n<p>The above bullet points are sourced from multiple studies; I have obviously not taken the time to perform a full literature review and suggest you dig further into those resources if you need more information.</p>\n\n<p>In regards to the safety of using methotrexate with cotrimoxazole; this appears to be a very real but rare risk. I am not aware of any studies that bear out the extent of this risk or the incidence of co-toxicity, but the authors of the UpToDate article do suggest that <strong>low prophylactic doses of TMP-SMX should be safe in patients receiving MTX.</strong> Some published authors would disagree. I have personally discussed this risk with a rheumatologist in my hospital who agrees with the above statement. Obviously, this is only one doctor's experience and opinion.</p>\n\n<p>If a patient can not take TMP-SMX or you would prefer to use a different agent due to the risk of myelosuppression, alternatives include <em>dapsone</em> or <em>atovaquone</em> </p>\n\n<p>The typical PCP prophylactic dose is usually <strong>1 Bactrim double-strength tablet daily</strong> <em>or</em> <strong>three times per week</strong>.</p>\n", "score": 7 } ]

[ "immunosuppressant", "pcp" ]

[ { "answer_id": 15530, "body": "<p><a href=\"https://doi.org/10.1007/s00223-015-0022-5\" rel=\"nofollow noreferrer\">Morley (2016)</a> states <strong>(with more references than I am copying across here)</strong>,</p>\n\n<blockquote>\n <p>At a basic level, protein synthesis and/or degradation are controlled by activation of the insulin or IGF-₁ receptor.</p>\n \n <p><a href=\"https://i.stack.imgur.com/HT7g7.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/HT7g7.gif\" alt=\"enter image description here\"></a></p>\n \n <p>...</p>\n \n <p>The primary treatment of sarcopenia is resistance exercise. As was shown by the LIFE study (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266388/\" rel=\"nofollow noreferrer\">Pahor,&nbsp;et&nbsp;al.&nbsp;2014</a>), aerobic exercise can also decrease functional decline in lower limb muscles. Exercise has also been shown to be an important therapeutic approach to reversing frailty. There is evidence to support that excess protein [1–1.2 g (kj day)] may also enhance muscle mass and, to a lesser extent, function (<a href=\"https://doi.org/10.1016/j.jamda.2013.05.021\" rel=\"nofollow noreferrer\">Bauer,&nbsp;et&nbsp;al.&nbsp;2013</a>). This is particularly true for leucine enriched essential amino acids (whey protein). Essential amino acid supplementation prevents muscle mass loss due to bed rest. A recent multicenter study has shown that whey protein together with vitamin D increased both muscle mass and stair climb. There is some evidence for synergistic effects of exercise and protein to enhance muscle function. Vitamin D supplementation increases muscle strength without increasing muscle mass or power. Vitamin D is more effective in older persons and those with low vitamin D levels. It also decreases falls in persons who are vitamin D deficient. At present, no drugs have been shown to be clinically more therapeutically effective.</p>\n</blockquote>\n\n<p>For exercise and diet there is the following from <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938033/\" rel=\"nofollow noreferrer\">Waters,&nbsp;et&nbsp;al.&nbsp;(2010)</a></p>\n\n<blockquote>\n <p>With exception of ACEI as a pharmaceutical intervention, the most compelling evidence to combat sarcopenia is resistance training either alone or in combination with nutritional supplements.</p>\n</blockquote>\n\n<p>For anabolic steroids/SARMs, <a href=\"https://doi.org/10.1007/s00223-015-0022-5\" rel=\"nofollow noreferrer\">Morley (2016)</a>, states that with:</p>\n\n<ul>\n<li><strong>Nandrolone</strong><br>there is no evidence that it increased strength</li>\n<li><strong>MK₀₇₇₃ (TFM-₄AS-₁)</strong><br>a ₄-aza steroidal drug that has androgen gene selectivity. In females, it increased IGF-₁ as well as stair climbing power and gait speed (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23732550\" rel=\"nofollow noreferrer\">Papanicolaou,&nbsp;et&nbsp;al.&nbsp;2013</a>). This study was terminated because of an increased signal for cardiac failure. In women with sarcopenia, it increased muscle mass, bilateral leg press, and stair climbing power but not gait speed (<a href=\"http://www.clinicaltrials.gov\" rel=\"nofollow noreferrer\">www.clinicaltrials.gov</a>). The study in males was reported at the <a href=\"https://www.medscape.com/viewcollection/14753\" rel=\"nofollow noreferrer\">90th Endocrine Society in 2008</a>. It showed anabolic effects of MK₀₇₇₃.</li>\n<li><strong>Enobosarm</strong><br>In a 12-week study, increased total lean mass and stair climb (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177038/\" rel=\"nofollow noreferrer\">Dalton,&nbsp;et&nbsp;al.&nbsp;2011</a>). In female patients with cancer, enobosarm increased lean mass compared to baseline, but not significantly compared to placebo<br><br><strong>Overall, these studies of SARMs have shown no advantage over testosterone.</strong><br><br></li>\n<li><strong>Growth Hormone/Insulin Growth Factor-₁</strong><br>Increased nitrogen retention and increased muscle mass</li>\n<li><strong>Ghrelin antagonists</strong><br>Overall, while ghrelin agonists will increase food intake and muscle mass, it is unlikely that they will produce a significant effect on function in persons with sarcopenia.</li>\n<li><strong>Myostatin antibodies</strong><br>Increased lean body mass and handgrip</li>\n<li><strong>Activin ₁₁R antagonists</strong><br>Increased thigh muscle volume, muscle mass, and 6-min walk distance</li>\n<li><strong>Angiotensin converting enzyme inhibitor (perindopril)</strong><br>Increased distance walked and decreased hip fracture</li>\n<li><strong>Espindolol (B₁/B₂/B₃ adrenergic receptor antagonist)</strong><br>Maintains muscle mass and increased hand grip strength</li>\n<li><strong>Fast skeletal muscle troponin activators (Tirasemtiv)</strong><br>Improves muscle function</li>\n</ul>\n\n<p><strong>References</strong></p>\n\n<p>Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., ... &amp; Visvanathan, R. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the american Medical Directors association, 14(8), 542-559.<br>PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23867520\" rel=\"nofollow noreferrer\">23867520</a> DOI: <a href=\"https://doi.org/10.1016/j.jamda.2013.05.021\" rel=\"nofollow noreferrer\">10.1016/j.jamda.2013.05.021</a></p>\n\n<p>Dalton, J. T., Barnette, K. G., Bohl, C. E., Hancock, M. L., Rodriguez, D., Dodson, S. T., ... &amp; Steiner, M. S. (2011). The selective androgen receptor modulator GTx‐024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women: results of a double‐blind, placebo‐controlled phase II trial. Journal of cachexia, sarcopenia and muscle, 2(3), 153-161.<br>PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22031847\" rel=\"nofollow noreferrer\">22031847</a> PMCID: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177038/\" rel=\"nofollow noreferrer\">PMC3177038</a> DOI: <a href=\"https://doi.org/10.1007/s13539-011-0034-6\" rel=\"nofollow noreferrer\">10.1007/s13539-011-0034-6</a></p>\n\n<p>Morley, J. E. (2016). Pharmacologic options for the treatment of sarcopenia. Calcified tissue international, 98(4), 319-333.<br>DOI: <a href=\"https://doi.org/10.1007/s00223-015-0022-5\" rel=\"nofollow noreferrer\">10.1007/s00223-015-0022-5</a></p>\n\n<p>Pahor, M., Guralnik, J. M., Ambrosius, W. T., Blair, S., Bonds, D. E., Church, T. S., ... &amp; King, A. C. (2014). Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. Jama, 311(23), 2387-2396.<br>PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24866862\" rel=\"nofollow noreferrer\">24866862</a> PMCID: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266388/\" rel=\"nofollow noreferrer\">PMC4266388</a> DOI: <a href=\"https://doi.org/10.1001/jama.2014.5616\" rel=\"nofollow noreferrer\">10.1001/jama.2014.5616</a></p>\n\n<p>Papanicolaou, D. A., Ather, S. N., Zhu, H., Zhou, Y., Lutkiewicz, J., Scott, B. B., &amp; Chandler, J. (2013). A phase IIA randomized, placebo-controlled clinical trial to study the efficacy and safety of the selective androgen receptor modulator (SARM), MK-0773 in female participants with sarcopenia. The journal of nutrition, health &amp; aging, 17(6), 533-543.<br>\nPMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23732550\" rel=\"nofollow noreferrer\">23732550</a> DOI: <a href=\"https://doi.org/10.1007/s12603-013-0335-x\" rel=\"nofollow noreferrer\">10.1007/s12603-013-0335-x</a></p>\n\n<p>Waters, D. L., Baumgartner, R. N., Garry, P. J., &amp; Vellas, B. (2010). Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. <em>Clinical Interventions in aging</em>, 5(1), 259—270.<br>PMCID: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938033/\" rel=\"nofollow noreferrer\">PMC2938033</a></p>\n", "score": 5 } ]

[ "treatment" ]

[ { "answer_id": 15739, "body": "<p>There are several &quot;pill identifiers&quot; available online:</p>\n<ul>\n<li><a href=\"https://www.rxlist.com/pill-identification-tool/article.htm\" rel=\"nofollow noreferrer\">RxList</a></li>\n<li><a href=\"https://www.webmd.com/pill-identification/default.htm\" rel=\"nofollow noreferrer\">WebMD</a></li>\n<li><a href=\"https://www.drugs.com/pill_identification.html\" rel=\"nofollow noreferrer\">Drugs.com</a> (international database from 185 countries)</li>\n</ul>\n<p>You enter the shape and color of a pill and any imprints and you get the pictures with drug names.</p>\n<p>There are apps for mobile phones:</p>\n<ul>\n<li><p><a href=\"http://www.idmypill.com/\" rel=\"nofollow noreferrer\">ID My Pill</a></p>\n<p>You take a photo of a pill and you get the info.</p>\n</li>\n</ul>\n<p>Or you go to a search engine and type &quot;recognize my pill&quot; in or so.</p>\n<p><a href=\"http://www.resourcepharm.com/pharmacist/identification-of-foreign-medicines.html\" rel=\"nofollow noreferrer\">ResourcePharm.com</a> has a page: &quot;Identify Foreign Medicines&quot; with links to lists of drugs in various countries.</p>\n", "score": 5 } ]

[ "medications", "pill" ]

[ { "answer_id": 15949, "body": "<p>Altogether, digital thermometers are known to be very inaccurate.². If you want the most accurate reading, a fever should be measured rectally, not axillary (in the armpit)¹.</p>\n<p>So therefore, different limits apply to axillary temperature measurements:</p>\n<blockquote>\n<p>In patients older than 1 month, the mean difference (SD) between the\nrectal and axillary temperatures was 1.04°C (0.45°C); thus, <strong>the\naxillary temperature was adjusted by adding 1°C, and no adjusted\naxillary temperature differed from the rectal temperature by more than\n1°C.</strong></p>\n<p>^{<strong><a href=\"https://jamanetwork.com/journals/jamapediatrics/article-abstract/517797?redirect=true\" rel=\"nofollow noreferrer\">Comparison of Rectal, Axillary, and Forehead Temperatures</a></strong>, Arch Pediatr Adolesc Med}</p>\n</blockquote>\n<p>The basal body temperature varies from 36.5 up to 37.5 degrees celsius according to <em>Elsevier, 2017</em>³. Studies from 2008 allow values of &lt;= 38.3 degrees.⁴.In your case, your first reading was 37.7 basal temperature (not really sick), and the second 38.0 (maybe slightly sick).</p>\n<p>Both values aren't accurate for medical differential diagnosis (axillary measurements, and varying quite a lot), but body temperature really doesn't tell you a lot anyway. If you feel sick, consider yourself sick. I personally probably have above 37 degrees axillary in the morning after a cozy sleep, and unless I feel sick, I wouldn't consider myself sick if my temperature is 0.3 above guidelines and I lack other symptoms of any sickness.</p>\n<hr />\n<p>^{1: S. T. ZengeyaI. Blumenthal, <strong><a href=\"https://link.springer.com/article/10.1007%2FBF02532519\" rel=\"nofollow noreferrer\">Modern electronic and chemical thermometers used in the axilla are inaccurate</a></strong>, European Journal of Pediatrics}</p>\n<p>^{2: <strong><a href=\"https://www.nursingtimes.net/an-investigation-into-the-accuracy-of-different-types-of-thermometers/197691.article\" rel=\"nofollow noreferrer\">An investigation into the accuracy of different types of thermometers</a></strong>, Nursing Times}</p>\n<p>^{3: Luxem, Jürgen; Runggaldier, Klaus: <strong><a href=\"https://shop.elsevier.de/rettungsdienst-rsrh-9783437480430.html#panel1\" rel=\"nofollow noreferrer\">Rettungsdienst RS/RH</a></strong>, Elsevier. 2017. <em>German book for the paramedic education</em>}</p>\n<p>^{4: Laupland, B. <strong><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19535958\" rel=\"nofollow noreferrer\">Fever in the critically ill medical patient.</a></strong>, 2008.}</p>\n<p>See also:</p>\n<p>^{<strong><a href=\"https://www.uspharmacist.com/article/temperature-measurement-for-patients-with-fever\" rel=\"nofollow noreferrer\">Temperature Measurement for Patients with Fever</a></strong>, US Pharmacists, 2008.}</p>\n", "score": 3 } ]

[ "fever", "thermometer" ]

[ { "answer_id": 16456, "body": "<p>The bulk of the evidence says dextromethorphan (DM) is no better than placebo.</p>\n\n<p><a href=\"https://www.medscape.com/viewarticle/803288\" rel=\"nofollow noreferrer\">(2013) Do Cough Remedies Work?</a></p>\n\n<blockquote>\n <p>Studies involving use of dextromethorphan in children have reported no\n clinically significant difference in symptoms of cough compared with\n placebo.[1] This lack of effect is not affected by dose, because\n studies of higher doses of dextromethorphan have also reported no\n difference in symptoms.[2] In adult patients with upper respiratory\n infection, there is no added benefit of using dextromethorphan or\n codeine.[3,4]</p>\n</blockquote>\n\n<p>_{\n1. (2006) Child assessment of dextromethorphan, diphenhydramine, and placebo for nocturnal cough due to upper respiratory infection. <a href=\"https://www.medscape.com/medline/abstract/16928841\" rel=\"nofollow noreferrer\">https://www.medscape.com/medline/abstract/16928841</a><br>\n2. (2004) Dose-response relationship with increasing doses of dextromethorphan for children with cough. <a href=\"https://www.medscape.com/medline/abstract/15531013\" rel=\"nofollow noreferrer\">https://www.medscape.com/medline/abstract/15531013</a><br>\n3. (2000) Antitussive efficacy of dextromethorphan in cough associated with acute upper respiratory tract infection. <a href=\"https://www.medscape.com/medline/abstract/11045895\" rel=\"nofollow noreferrer\">https://www.medscape.com/medline/abstract/11045895</a><br>\n}</p>\n\n<p>There is <a href=\"https://www.medscape.com/medline/abstract/6852361\" rel=\"nofollow noreferrer\">one study</a> that found DM to be more effective than codeine, but it was very small (16 patients) and quite old (1983). It is not compelling.</p>\n", "score": 6 }, { "answer_id": 16461, "body": "<p>What you've read seems to be the case, as this systematic review shows <a href=\"http://www.cochrane.org/CD001831/ARI_over-the-counter-otc-medications-for-acute-cough-in-children-and-adults-in-community-settings\" rel=\"nofollow noreferrer\" title=\"Cochrane review\">Cochrane review</a>; there is no evidence for its use.\nThere isn't evidence against its use either (I guess it hasn't shown security problems) but it doesn't seem sensible to spend your money or the health system's on medication with no evidence of efficacy.</p>\n", "score": 2 } ]

[ "medications", "cough" ]

[ { "answer_id": 16580, "body": "<h3>As <a href=\"https://health.stackexchange.com/questions/16576/is-it-advisable-to-wear-uv-protected-swimsuit-that-covers-arms-and-legs-for-skin/16580#comment26950_16580\">critiqued in comments</a>, this answer possibly misrepresents the vitamin D situation, which is better described <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288313/\" rel=\"nofollow noreferrer\">here</a>. Proceed with suspicion!</h3>\n<hr />\n<hr />\n<hr />\n<h1>Summary</h1>\n<p>Because of the associated cancer risk, protecting your skin from sunlight is a good idea, also when swimming, and especially by wearing <a href=\"https://en.wikipedia.org/wiki/Sun_protective_clothing\" rel=\"nofollow noreferrer\">UV-absorptive clothing</a>. Sunscreen makes a huge difference too.</p>\n<p>You can get enough vitamin D from even a few minutes of sunlight, and also otherwise from cheap nutritional supplements. Exposing your skin to solar UV is pretty much only a negative.</p>\n<p>Whether something is &quot;too paranoid&quot; is for each to judge for themselves, based on the facts.</p>\n<h1>The facts</h1>\n<p>The <a href=\"http://www.who.int/uv/faq/uvhealtfac/en/index1.html\" rel=\"nofollow noreferrer\">WHO page <em>Are there beneficial effects of UV radiation?</em></a> advises this as to benefits of UV radiation:</p>\n<blockquote>\n<p>There is no doubt that a little sunlight is good for you! But <strong>5 to 15 minutes of casual sun exposure of hands, face and arms two to three times a week during the summer months is sufficient to keep your vitamin D levels high</strong>. Closer to the equator, where UV levels are higher, even shorter periods of exposure suffice.</p>\n<p>Hence, for most people, vitamin D deficiency is unlikely. Possible exceptions are those who have very limited sun exposure such as the housebound elderly, or those with heavily pigmented skin who live in high-latitude countries where UV levels are relatively low.</p>\n</blockquote>\n<p>They also advise on the negatives on the page <a href=\"http://www.who.int/uv/faq/uvhealtfac/en/index2.html\" rel=\"nofollow noreferrer\"><em>What are the effects of UV on the skin?</em></a>:</p>\n<blockquote>\n<p><strong>There is no such thing as a healthy tan!</strong> The skin produces a dark-coloured pigment, melanin, as a shield against further damage from UV radiation. The darkening provides some protection against sunburn: a dark tan on a white skin offers a sun protection factor of between 2 and 4. However, it is no defence against long-term UV damage such as skin cancer. A suntan may be cosmetically desirable, but in fact it is nothing but a sign that your skin has been damaged and has attempted to protect itself.</p>\n</blockquote>\n<p>According to <a href=\"http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/skin-cancer#heading-Zero\" rel=\"nofollow noreferrer\">Cancer Research UK's facts page on skin cancer</a>,</p>\n<blockquote>\n<p>1 in 54 people will be diagnosed with malignant melanoma during their lifetime.</p>\n</blockquote>\n<p>According to the same page, your chances of surviving after diagnosis for 1 year are 97%, for 5 years 90%, and for 10 years 90%.</p>\n<p>According to <a href=\"https://www.skincancer.org/skin-cancer-information/skin-cancer-facts#nonmelanoma\" rel=\"nofollow noreferrer\">Skin Cancer Foundation's facts page</a>,</p>\n<blockquote>\n<p><strong>The vast majority of melanomas are caused by the sun.</strong> In fact, one UK study found that about 86 percent of melanomas can be attributed to exposure to ultraviolet (UV) radiation from the sun.</p>\n</blockquote>\n<h1>In conclusion</h1>\n<p>Swimwear is healthier the more it protects your skin from sunlight.</p>\n<p>There are always some obstacles to always doing the healthiest thing though. For instance—</p>\n<ul>\n<li>More clothing means more weight and heat, which may make going swimming less convenient for you, especially if you like to swim competitively and in warm water. Since exercise is itself healthy, it would be unwise to discourage it by making it feel like a chore!</li>\n<li>Cultural resistance: pool maintainers in some places (<a href=\"https://www.quora.com/Why-do-some-swimming-pools-eg-in-France-insist-on-everyone-wearing-tight-Lycra-swimming-suits\" rel=\"nofollow noreferrer\">e.g. France</a>) have been known to refuse guests with swimwear that doesn't look like swimwear, out of hygiene concerns. It might be wise to get staff permission or bring an alternative set to avoid disappointment.</li>\n</ul>\n<p>I hope this helps you to decide!</p>\n", "score": 3 } ]

[ "dermatology", "sun-exposure", "uv-rays", "sunlight", "swimming" ]

[ { "answer_id": 16589, "body": "<p><strong>In short: According to several recent systematic reviews of studies, milk consumption is not associated with significant side effects, increased mortality, cancer, osteoporosis, heart disease or stroke.</strong></p>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122229/\" rel=\"nofollow noreferrer\">Milk and dairy products: <strong>good or bad for human health?</strong> An assessment of the totality of scientific evidence (PubMed, 2016)</a></p>\n\n<blockquote>\n <p>very few adverse effects have been reported.</p>\n \n <p>milk and dairy intake was inversely associated with colorectal cancer,\n bladder cancer, gastric cancer, and breast cancer, and not associated\n with risk of pancreatic cancer, ovarian cancer, or lung cancer, while\n the evidence for prostate cancer risk was inconsistent.</p>\n \n <p>There was no consistent association between milk or dairy intake and\n cardiovascular disease, coronary heart disease or stroke</p>\n</blockquote>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966685/\" rel=\"nofollow noreferrer\">Food Sources of <strong>Saturated Fat</strong> and the Association With Mortality: A Meta-Analysis (PubMed, 2013)</a></p>\n\n<blockquote>\n <p>...high intakes of milk, cheese, yogurt, and butter were not associated with a\n significantly increased risk of mortality compared with low intakes.</p>\n</blockquote>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22081694\" rel=\"nofollow noreferrer\">Milk and <strong>acid-base balance:</strong> proposed hypothesis versus scientific evidence (PubMed, 2011)</a></p>\n\n<blockquote>\n <p>Recently the lay press has claimed a hypothetical association among\n dairy product consumption, generation of dietary acid, and harm to\n human health. This theoretical association is based on the idea that\n the protein and phosphate in milk and dairy products make them\n acid-producing foods, which cause our bodies to become acidified,\n promoting diseases of modern civilization. Some authors have suggested\n that dairy products are not helpful and perhaps detrimental to bone\n health because higher osteoporotic fracture incidence is observed in\n countries with higher dairy product consumption. However, scientific\n evidence does not support any of these claims.</p>\n</blockquote>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778815/\" rel=\"nofollow noreferrer\">Dairy product consumption and risk of <strong>hip fracture:</strong> a systematic review and meta-analysis (PubMed, 2018)</a></p>\n\n<blockquote>\n <p>Consumption of total dairy products and cream was not significantly\n associated with the risk of hip fracture. There was insufficient\n evidence to deduce the association between milk consumption and risk\n of hip fracture. A lower threshold of 200 g/day milk intake may have\n beneficial effects, whereas the effects of a higher threshold of milk\n intake are unclear.</p>\n</blockquote>\n\n<hr>\n\n<p>Disclaimer: My conclusion is not that milk is healthy and I am not trying to encourage anyone to drink it. I just haven't found convincing evidence that it is unhealthy. </p>\n", "score": 9 }, { "answer_id": 16585, "body": "<p>There are several issues regarding dairy that have to be taken into consideration.</p>\n\n<p>One is the link between casein and cancers. I have heard a presentation from the author of some of the prominent studies on the subject, and have reduced my own family's intake of dairy based on findings. An example of another author's findings is <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166373/\" rel=\"noreferrer\">this paper</a>, which concludes</p>\n\n<blockquote>\n <p>The milk protein, casein, promotes the proliferation of prostate\n cancer cells such as PC3 and LNCaP.</p>\n</blockquote>\n\n<p>Secondly is the fact that many adults lose the ability to digest lactose, which happens by slow loss of the enzyme on the intestinal brush border. Many don't realize it because of the slow onset. Symptoms of gas and diarrhea/constipation and abdominal pain are common, because the bacteria in the late gut DO digest it and produce quite a bit of gas, and it serves as an osmotic laxative.</p>\n\n<p>Third, there are conflicting studies on the health impact of fat in milk. Generally, saturated fats from animal sources are advised to be avoided due to increasing cardiovascular risk via cholesterol levels. However, some studies have suggested full fat milk is actually better than skim in terms of health impact. Verdict is still out on that.</p>\n", "score": 5 } ]

[ "cancer", "milk", "bones" ]

[ { "answer_id": 16787, "body": "<p>Exercise does seem to have beneficial effects in treating and preventing many chronic diseases. As far as mechanism is concerned, we should probably narrow the scope:</p>\n\n<p>Question:</p>\n\n<blockquote>\n <p>What is the mechanism for the beneficial effects of exercise in people who have high blood pressure?</p>\n</blockquote>\n\n<p>It seems to be multifactorial, and independent of any impact on weight loss. Regular exercises (with or without associated weight loss) causes a number of physiologic adaptations in metabolic, vascular, and cardiac health, all of which seem to contribute to the beneficial effects for people with high blood pressure (lower blood pressure, better long term disease outcomes). There are, of course, many types of exercise and many causes of high blood pressure, but these seem to apply generally.</p>\n\n<ol>\n<li><p>Changes in sympathetic/parasympathetic tone: regular exercise causes decreased catecholamine production and (associated) decreased sympathetic mediated vasoconstriction. This leads directly to lower blood pressure because of the decrease in systemic vascular resistance</p></li>\n<li><p>Increased perfusion and development of muscular capillary beds. Increased perfusion of muscular beds may be the primary mechanism for the acute decrease in blood pressure. With regular exercise, angiogenesis causes further development of muscular capillary beds as well. The opening of arterioles to perfuse these (now more developed) capillary beds also decreases systemic vascular resistance (and along with it, blood pressure). </p></li>\n<li><p>Improved insulin sensitivity: insulin sensitivity is compromised in many people with high blood pressure, whether or not they have frank diabetes. The reduction in circulating insulin improves clearance of lipids and glucose from the blood, and theoretically reduces the downstream negative effects of high circulating lipids and glucose, including atherosclerosis. This has a direct effect on hypertension as well as the downstream negative effects of hypertension.</p></li>\n<li><p>Decreased inflammation: regular exercise reduces circulating levels of inflammatory mediators, improving endothelial function (and decreasing atherosclerosis). This also has a direct effect on hypertension as well as its sequelae. </p></li>\n<li><p>Improved cardiac function: regular exercise improves diastolic filling (directly, through beneficial adaptations in cardiac muscle, and, probably, indirectly, through the above effects on systemic vascular resistance, atherosclerosis, and endothelial function). </p></li>\n</ol>\n\n<p>An excellent broad ranging review of the health benefits of physical activity discusses these benefits. You can find it for free <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/\" rel=\"noreferrer\">here</a></p>\n\n<p>A more recent review by the same first author is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28708630\" rel=\"noreferrer\">here</a>, but it is behind a paywall.</p>\n", "score": 8 } ]

[ "exercise", "biochemistry" ]

[ { "answer_id": 16714, "body": "<p>This has been on peoples' minds for decades and the answer is still not clear.</p>\n\n<p>TL;DR at the bottom.</p>\n\n<p>Research done in the past has not always been of the best quality and so conclusions that might have been made which suggest harm, are probably wrong. For example: a UK study in 2005 suggested increased rates of cancer in association with distance from power-lines (closer = worse) BUT the association continued even further than the distance the power lines could have any effect. That means that the suspicion that it could be the electromagnetics of the power line can't be related, because even after it dropped off there was still something apparently going on.</p>\n\n<blockquote>\n <p>Title: Do power line - generated electromagnetic fields have any\n association with certain disorders? Source: JAMA: Journal of the\n American Medical Association [0098-7484] Ross, Randy yr:1988 vol:259\n iss:8 pg:1131 SINCE THE MID-1960s, scientists have debated whether\n low-level electromagnetic fields generated by power lines represent a\n health hazard. Recent studies suggesting possible links between\n electromagnetic exposure and cancer have drawn renewed attention to\n this controversy.</p>\n \n <p>For years, researchers have hypothesized links between electromagnetic\n fields and a variety of disorders ranging from malignant melanoma to\n mental illness. British investigators have suggested a link between\n electromagnetic exposure and suicide, while a Russian study indicated\n cardiovascular changes in electrical workers.</p>\n \n <p>At least one literature review, by a London utility company scientist,\n discounted these and other associations (JR Soc Med 1982;75:933-941).\n But epidemiologic and other studies have continued.</p>\n</blockquote>\n\n<p>A study looking at some particularly rapidly developing cells taken from mice in China in 2015 suggested that the cells might not live as long, but no signs of cancer. This was in MICE, not humans, and in cells taken from the body and therefore not around their normal external defence and healing mechanisms. What that means is that this study is of uncertain value.</p>\n\n<blockquote>\n <p>Title: Effects of Long-Term 50Hz Power-Line Frequency Electromagnetic\n Field on Cell Behavior in Balb/c 3T3 Cells Source: PLoS ONE\n [1932-6203] An, Guang-Zhou yr:2015 vol:10 iss:2 pg:e0117672 -e0117672\n Abstract Power-line frequency electromagnetic field (PF-EMF) was\n reported as a human carcinogen by some epidemiological research, but\n the conclusion is lack of robust experiment evidence. To identify the\n effects of long-term PF-EMF exposure on cell behavior, Balb/c 3T3\n cells in exponential growth phase were exposed or sham-exposed to 50\n Hertz (Hz) PF-EMF at 2.3 mT for 2 hours (h) one day, 5 days every\n week. After 11 weeks exposure, cells were collected instantly. Cell\n morphology was observed under invert microscope and Giemsa staining,\n cell viability was detected by 3-(4, 5-dimethylthiazol-2-yl)-2,\n 5-diphenyltetrazolium bromide (MTT) assay, cell cycle and apoptosis\n was examined by flow cytometry, the protein level of Proliferating\n Cell Nuclear Antigen (PCNA) and CyclinD1 was detected by western blot,\n cell transformation was examined by soft agar clone assay and plate\n clone forming test, and cell migration ability was observed by scratch\n adhesion test. It was found that after PF-EMF exposure, cell\n morphology, apoptosis, cell migration ability and cell transformation\n didn’t change. However, compared with sham group, cell viability\n obviously decreased and cell cycle distribution also changed after 11\n weeks PF-EMF exposure. Meanwhile, the protein level of PCNA and\n CyclinD1 significantly decreased after PF-EMF exposure. These data\n suggested that although long-term 50Hz PF-EMF exposure under this\n experimental condition had no effects on apoptosis, cell migration\n ability and cell transformation, it could affect cell proliferation\n and cell cycle by down-regulation the expression of PCNA and CyclinD1\n protein.</p>\n</blockquote>\n\n<p>A recent study (2014) in Denmark looking at actual humans (specifically whether kids developed leukaemia closer to power lines) found no association between distance from power lines and rates of developing cancer - and this was from much stronger power lines than the street-based ones you're talking about.\nThis one is a significant paper for 3 reasons: 1) it looked at actual people. 2) children are in theory MORE susceptible to radiation-based tumours (ie EM radiation) and 3) leukaemia is a typical type of cancer seen in response to radiation.</p>\n\n<blockquote>\n <p>Title: Distance from residence to power line and risk of childhood\n leukemia: a population-based case–control study in Denmark Source:\n Cancer causes and control : An International Journal of Studies of\n Cancer in Human Populations [0957-5243] Pedersen yr:2014 vol:25 iss:2\n pg:171 -177 \n Abstract \n Purpose Epidemiological studies have found an\n association between exposure to extremely low-frequency magnetic\n fields (ELF-MF) and childhood leukemia. In 2005, a large British study\n showed an association between proximity of residence to high-voltage\n power lines and the risk of childhood leukemia. The association\n extended beyond distances at which the ‘power line’-induced magnetic\n fields exceed background levels, suggesting that the association was\n not explained by the magnetic field, but might be due to chance, bias,\n or other risk factors associated with proximity to power lines. Our\n aim was to conduct a comparable study in an independent setting\n (Denmark).</p>\n \n <p>Methods We included 1,698 cases aged &lt;15, diagnosed with leukemia\n during 1968–2006, from the Danish Cancer Registry and 3,396 controls\n randomly selected from the Danish childhood population and\n individually matched by gender and year of birth. We used geographical\n information systems to determine the distance between residence at\n birth and the nearest 132–400 kV overhead power line.</p>\n \n <p>Results Odds ratios (ORs) were 0.76 [95 % confidence interval (CI)\n 0.40–1.45] for children who lived 0–199 m from the nearest power line and 0.92 (95 % CI 0.67–1.25) for those who lived 200–599 m away when\n compared with children who lived ≥600 m away. When restricting the\n analysis to 220 and 400 kV overhead power lines, the OR for children\n who lived 200–599 m from a power line was 1.76 (95 % CI 0.82–3.77)\n compared to children who lived ≥600 m away. However, chance is a\n likely explanation for this finding as the result was not significant,\n numbers were small, and there were no indications of an higher risk\n closer to the lines since no cases were observed within 200 m of\n these.</p>\n \n <p>Conclusions We found no higher risk of leukemia for children living\n 0–199 m or for children living 200–599 m of a 132–400 kV overhead\n power line. A slightly elevated OR for children living between 200 and\n 599 m of a 220–400 kV overhead power line is likely to be a chance\n finding.</p>\n</blockquote>\n\n<p>So... what does that mean when it comes to living close to power lines?</p>\n\n<ol>\n<li>prior thought has been that it's bad, but this has been with shonky research.</li>\n<li>Chinese mice cells taken from the body don't show signs of cancer, but maybe don't last as long</li>\n<li>actual humans (children in Denmark) don't seem to show any signs of developing leukaemia</li>\n<li>public opinion is still divided, even though the research seems to be pretty sound.</li>\n</ol>\n\n<p>TL;DR\nMy suggestion?\nGetting the apartment isn't any risk (cancer-wise) to yourself. You might find it harder to get rid of if anyone else feels the same trepidation you do!</p>\n", "score": 4 } ]

[ "cancer", "risks", "radiation" ]

[ { "answer_id": 16799, "body": "<blockquote>\n<p>The American Heart Association no longer condemns eggs in its guidelines. But it does recommend that people limit themselves to 300 milligrams of cholesterol daily (a single egg has about 200 milligrams of cholesterol, as well as a mix of saturated and unsaturated fats, including the monounsaturated kind found in olive oil). The federal government, in its Dietary Guidelines for Americans, notes that eating an egg yolk per day “does not result in increased blood cholesterol levels, nor does it increase the risk of cardiovascular disease in healthy people.”</p>\n<p>^{Source: <a href=\"https://well.blogs.nytimes.com/2014/11/14/ask-well-how-many-eggs-can-i-eat/\" rel=\"noreferrer\">New York Times</a>}</p>\n</blockquote>\n<p>But – if your friends eat sugary cereal, bagels etc., their diet is worse than a bit too much cholesterol. Furthermore, if you eat scrambled eggs with bacon, it is probably wiser to cut down the bacon than the eggs…</p>\n<blockquote>\n<p>Dr. Hu said that eggs are a particularly good replacement for less healthful fare, like processed meats and refined carbohydrates. In fact, studies suggest that for most people, starting your day with a breakfast of scrambled eggs will have a better impact on your overall cholesterol profile than a bagel or a bowl of sugary cereal.</p>\n<p>^ibid.</p>\n</blockquote>\n<p>As <strong>@Jan</strong> pointed out in the comments: There are hyperresponders to cholesterol, <a href=\"https://academic.oup.com/jn/article/133/4/1036/4688287\" rel=\"noreferrer\">which report cholesterol spikes in the blood after consumption of cholesterol</a>. For most humans, <a href=\"https://www.webmd.com/cholesterol-management/ss/slideshow-cholesterol-overview\" rel=\"noreferrer\">fats play a bigger role in cholesterol levels than cholesterol consumption.</a></p>\n", "score": 9 } ]

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

[ { "answer_id": 16995, "body": "<p>So far, I could not find evidence that the Zimnitsky test is applied in exactly the same way in western countries.</p>\n\n<p>The <a href=\"https://en.wikipedia.org/wiki/Urine_specific_gravity\" rel=\"nofollow noreferrer\">urine specific gravity</a> \nis a parameter that is assessed during urine analysis.\nThis can be measured from a single urine sample as well as from a <a href=\"https://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/24-hour_urine_collection_92,P08955\" rel=\"nofollow noreferrer\">24-hour urine collection</a>.</p>\n\n<p>If I understood your sources regarding the Zimnitsky test correctly, it basically also tests urine for its specific gravity over a time period of 24 hours.\nHowever, the difference is that during Zimnitsky test eight (to twelve) individual samples are tested, not a collection. </p>\n", "score": 2 }, { "answer_id": 16927, "body": "<p>For diabetes, it is important to control glucose levels. This can easily be done (to a varying degree of accuracy) by checking the urine for glucose.</p>\n<blockquote>\n<p>Urine tests were once the main type of testing used to measure glucose levels in people who potentially had diabetes. However, they are less common now that blood tests have become more accurate and easier to use.</p>\n<p>^{<a href=\"https://www.healthline.com/health/glucose-test-urine#purpose\" rel=\"nofollow noreferrer\">Healthline.com</a>}</p>\n</blockquote>\n<p>Nowadays, blood sugar is simply determined by a blood test (and a lab isn't even needed, glucose meters can measure on the spot), and so the extensive urine test is no longer required. Speaking from my limited experience, blood tests were performed every 3 hours (which is incidentally the same period you described for the Zimnitsky Test).</p>\n<p>Now, urine tests are also performed if kidney failures/diseases are suspected, but I have to double-check how often. I doubt that it was on a daily basis, let alone a 3-hour basis.</p>\n", "score": 1 } ]

[ "diagnostics", "urine", "urine-test" ]

[ { "answer_id": 17164, "body": "<p>Similar situations are referred to by their common origin in the health sciences: <a href=\"https://en.wikipedia.org/wiki/Medical_students%27_disease\" rel=\"noreferrer\">medical students' disease, second year syndrome, etc.</a></p>\n\n<p>More generally, <a href=\"https://en.wikipedia.org/wiki/Hypochondriasis\" rel=\"noreferrer\">hypochondria</a> refers to excessively worrying about having a serious illness to the point of having a psychiatric problem.</p>\n\n<p>\"<a href=\"https://en.wikipedia.org/wiki/Cyberchondria\" rel=\"noreferrer\">Cyberchondria</a>\" has been coined to refer to the common modern situation where people may develop symptoms of hypochondria from reading medical advice on the internet, which is often skewed towards more serious illness in particular for symptoms that also have benign causes.</p>\n", "score": 5 } ]

[ "diagnosis" ]

[ { "answer_id": 24712, "body": "<p>As pointed out by the <a href=\"https://biology.stackexchange.com/a/7194/29337\">more reputable answer</a> at the <a href=\"https://biology.stackexchange.com/q/2250/29337\">similar question at Biology.SE</a> (backed with sources of information and hence more highly voted), what would happen if you drank only distilled water is nothing perceptible. The only place where concentrations of distilled water would ever be high enough to conceivably matter is in the tissues of the mouth and throat, and even there, the effect would be temporary.</p>\n<blockquote>\n<p>Compare drinking 8 glasses of either distilled or tap water every day. <a href=\"http://www.mgwater.com/mgrank.shtml\" rel=\"nofollow noreferrer\">With tap water</a>, you're looking at less than 200 ppm of Mg, Na, K, and Ca combined. That's less than 400mg of total mineral content per day. Given that the combined RDA of all of those minerals is on the order of <a href=\"http://www.iom.edu/Activities/Nutrition/SummaryDRIs/%7E/media/Files/Activity%20Files/Nutrition/DRIs/5_Summary%20Table%20Tables%201-4.pdf\" rel=\"nofollow noreferrer\">7g for an adult male</a>, this is not <em>nothing</em>, but it's certainly small. Your dietary intake of these minerals probably varies by more than this daily, and your intestines, kidneys, sweat glands and mineral storage organs (like your bones and muscles) are constantly maintaining the mineral blood levels within a <em>very</em> narrow range, despite handling a throughput of several pounds of water and food daily. They might have to work slightly harder to manage this range if you drank nothing but distilled water, but in a healthy adult, normal intakes already vary by more than this amount without major problems. For example, the average American <a href=\"http://www.cdc.gov/features/dssodium/\" rel=\"nofollow noreferrer\">consumes more than 3.4 grams of sodium daily</a>, while a <a href=\"http://www.ucsfhealth.org/education/guidelines_for_a_low_sodium_diet/index.html\" rel=\"nofollow noreferrer\">low-sodium diet is on the order of 2g</a>. Low-sodium diets have been widely studied in the medical literature, and are considered safe.</p>\n<p>As for pH, the lowered pH is caused by increased carbon-dioxide absorption to form carbonic acid. Just as carbon dioxide is more soluble in distilled water, it is less soluble in stomach acid, and may be burped out. Would you die of acidosis from drinking seltzer water all the time? If that were the case, I'm sure there would be big health warnings about drinking soda, <a href=\"http://www.popsci.com/scitech/article/2008-07/will-drinking-carbonated-beverages-weaken-my-bones\" rel=\"nofollow noreferrer\">while it seems relatively benign</a>. Furthermore, your body produces and excretes (through the lungs) <a href=\"http://en.wikipedia.org/wiki/Carbon_dioxide#Human_physiology\" rel=\"nofollow noreferrer\">around 1kg of CO2 daily</a>, dwarfing any extra CO2 you might get by drinking distilled water. If the small amounts of CO2 found in distilled water were dangerous, jogging would be invariably fatal.</p>\n<p>If you were to drink nothing but distilled water, and eat no food, you probably would die of hyponatremia within a few weeks. But you would also die of hyponatremia if you were to drink nothing but tap water, though perhaps slightly more slowly.</p>\n</blockquote>\n", "score": 1 }, { "answer_id": 17178, "body": "<p>The problem is the obvious electrolyte loss , especially if you mean distilled water.It may not be a problem with a diet containing enough electrolytes. </p>\n", "score": 0 } ]

[ "water" ]

[ { "answer_id": 17352, "body": "<p>Essentially this depends on which specific protein a person is allergic too. There will be a lot of crossover in plants so closely related as to be different subspecies of the same species, but some proteins may be unique.</p>\n\n<p>Following your example of corn, this is taken from an interesting 2012 paper on the <a href=\"https://www.researchgate.net/publication/228328388_Molecular_Features_of_Maize_Allergens_and_their_Implications_in_Human_Health\" rel=\"nofollow noreferrer\">Molecular Features of Maize Allergens and their Implications in Human Health</a>:</p>\n\n<blockquote>\n <p>Detailed biochemical knowledge of maize allergy is lacking. There are several unanswered questions including the symptoms and mechanisms involved in maize allergenic reactions, its prevalence in adults and children, the implicated allergen molecules and the clinical cross-sensitization. Therefore, diagnostic tests and maize allergy management constitute a field of great interest. Currently, maize allergen proteins are classified into 20 different families, displaying diverse structures and functions. They are responsible for many IgE cross-reactions between unrelated pollen and plant food allergen sources. The most relevant maize allergen molecules belong to the Expansin and the Ole e 1 superfamilies, the panallergen Profilin, and the Lipid Transfer Proteins (LTPs), i.e. Zea m 14, the major maize allergen.</p>\n</blockquote>\n\n<p>This is clearly a complex area, with ongoing research.</p>\n\n<p>You mention sweet corn vs popping corn, which are different subspecies of <em>Zea mays</em>. Interestingly, <a href=\"https://en.m.wikipedia.org/wiki/Sweet_corn\" rel=\"nofollow noreferrer\">sweet corn</a> is sweet because of a recessive mutation that reduces the conversion of sugar to starch.</p>\n\n<p>Heating a food can <a href=\"https://en.m.wikipedia.org/wiki/Denaturation_(biochemistry)\" rel=\"nofollow noreferrer\">denature</a> proteins, reducing their bio activity. It is possible that the act of popping corn might reduce allergenicity somewhat.</p>\n\n<p>In a <a href=\"https://www.sciencedirect.com/science/article/pii/S0278691515000848\" rel=\"nofollow noreferrer\">Review of Food Processing and Allergenicity</a>, peanuts, tree nuts, cows' milk, hens' eggs, soy, wheat and mustard were reviewed. It was found that:</p>\n\n<ul>\n<li>Processing may influence, but does not abolish, the allergenic potential of proteins.</li>\n<li>Reduction of allergenicity by fermentation and hydrolysis are the best characterised.</li>\n</ul>\n\n<p><a href=\"https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/cross-reactivity\" rel=\"nofollow noreferrer\"><strong>Cross-reactivity</strong></a></p>\n\n<p>There is also cross-reactivity, in which allergy to one protein results in an allergy to another similar protein in a completely different species (e.g. apples and birch pollen). This results in types of allergy like <a href=\"https://en.wikipedia.org/wiki/Oral_allergy_syndrome\" rel=\"nofollow noreferrer\">oral allergy syndrome</a>.</p>\n\n<p>All allergies are mediated by an immune system dysfunction known as <a href=\"https://en.wikipedia.org/wiki/Type_I_hypersensitivity\" rel=\"nofollow noreferrer\">type 1 hypersensitivity</a>. Other types of hypersensitivity are responsible for other reactions and autoimmune conditions.</p>\n", "score": 5 } ]

[ "immune-system", "allergy" ]

[ { "answer_id": 17377, "body": "<p>The first part of your question is very difficult to answer for the reasons mentioned in <a href=\"https://health.stackexchange.com/users/8212/narusan\">Narusan</a>'s comment: Specifically, comparing cancer incidence rates between many different groups of cancer survivors and people from matched demographics who have never had cancer is going to be very difficult, especially since these sets of data would be sourced from varied studies without the same controls. However, the second part of your question—whether the original type of treatment plays a role in new cancer formation (secondary malignancies)—has been investigated.</p>\n<blockquote>\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0360301605005882\" rel=\"nofollow noreferrer\"><strong>&quot;The calculated risk of fatal secondary malignancies from intensity-modulated radiation therapy.&quot; Kry <em>et al.</em> <em>International Journal of Radiation Oncology Biology Physics.</em> 2005.</strong></a></p>\n<p>Results: Depending on treatment energy, the IMRT treatments required 3.5–4.9 times as many monitor units to deliver as did the conventional treatment. The conservative maximum risk of fatal second malignancy was 1.7% for conventional radiation, 2.1% for IMRT using 10-MV X-rays, and 5.1% for IMRT using 18-MV X-rays.</p>\n<p>Conclusion: The risk of fatal secondary malignancy differed substantially between IMRT [intensity-modulated radiation therapy] and conventional radiation therapy for prostate cancer, as well as between different IMRT approaches. Perhaps this risk should be considered when choosing the optimal treatment technique and delivery system for patients who will undergo prostate radiation.</p>\n</blockquote>\n<p>Here, IMRT was shown to deliver a higher &quot;out-of-field&quot; dose (raditation to untargeted parts of the body) and had a greater associated risk of secondary malignancies than conventional radiation.</p>\n<blockquote>\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0360301608008158\" rel=\"nofollow noreferrer\"><strong>&quot;Risk of Developing Second Cancer From Neutron Dose in Proton Therapy as Function of Field Characteristics, Organ, and Patient Age.&quot; Jarlskog <em>et al.</em> <em>International Journal of Radiation Oncology Biology Physics. 2008.</em></strong></a></p>\n<p>Results: The main contributors (&gt;80%) to the neutron-induced risk are neutrons generated in the treatment head. Treatment volume can influence the risk by up to a factor of ∼2. Young patients are subject to significantly greater risks than are adult patients because of the geometric differences and age dependency of the risk models. Breast cancer should be the main concern for females. For males, the risks of lung cancer, leukemia, and thyroid cancer were significant for pediatric patients. In contrast, leukemia was the leading risk for an adult. Most lifetime risks were &lt;1% (70-Gy treatment). The only exceptions were breast, thyroid, and lung cancer for females. For female thyroid cancer, treatment risk can exceed baseline risk.</p>\n<p>Conclusion: The risk of developing a second malignancy from neutrons from proton beam therapy of a brain lesion is small (i.e., presumably outweighed by the therapeutic benefit) but not negligible (i.e., potentially greater than the baseline risk). The patient's age at treatment plays a major role.</p>\n</blockquote>\n<p>Like the IMRT, neutron bombardment from proton therapy was shown to have off-target effects and contribute to new cancers.</p>\n<p>Hopefully, these papers serve as decent representations of different secondary malignancy potentials with respect to primary cancer therapies. In the article <a href=\"https://www.nccn.org/patients/resources/life_after_cancer/understanding.aspx\" rel=\"nofollow noreferrer\">&quot;Understanding Your Risk of Developing Secondary Cancers,&quot;</a> the National Comprehensive Cancer Network reminds readers to prioritize their care without regard to comparatively low-probability secondary malignancies:</p>\n<blockquote>\n<p>...patients should not cause themselves undue worry about this possibility. &quot;The biggest risk to patients with cancer is the cancer that they are battling. They should follow the treatment plan designed by their oncologist and not worry about other factors. The vast majority of patients are not going to develop a secondary malignancy because of cancer treatment for the original cancer.&quot;</p>\n</blockquote>\n<p>Finally, some medical imaging techniques are similar to those cancer therapies that are more likely to cause secondary malignancies. The <a href=\"http://www.philrutherford.com/Radiation_Risk/BEIR/BEIR_VII.pdf\" rel=\"nofollow noreferrer\">BEIR VII report &quot;Health Risks from Exposure to Low Levels of Ionizing Radiation&quot;</a> includes risk estimates for different imaging and radiology techinques (although <a href=\"https://www.sciencedirect.com/science/article/pii/S1120179717302338\" rel=\"nofollow noreferrer\">some academic debate exists</a> on whether it's an appropriate estimation tool for this, the table below uses data from BEIR VII). Keep in mind that any amount of ionizing radiation is not good for your dividing cells!</p>\n<p><a href=\"https://i.stack.imgur.com/3MWRk.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/3MWRk.png\" alt=\"BEIR VII Estimated Doses\" /></a></p>\n<p>(XR: x-ray; NM: nuclear medicine; CT: computerized tomography; IR: interventional radiology)</p>\n", "score": 5 }, { "answer_id": 17379, "body": "<p>This is a big topic and there is a huge amount of medical literature and research on the effectiveness of treatments and survival rates, so I will try to give a general overview and take a different slant to the other answer.</p>\n\n<p>Many factors affect recurrence rates, including the type of cancer, treatment, family history and the passage of time. Cancer is not just one disease but a very wide range of conditions, so it is hard to generalise.</p>\n\n<p>This can be considered from two aspects:</p>\n\n<ol>\n<li><p>Cancer that returns after treatment</p></li>\n<li><p>New cancers that develop separately from a previous one</p></li>\n</ol>\n\n<hr>\n\n<p><strong>Cancer that returns after treatment</strong></p>\n\n<p>Having one type of cancer does make you more likely to have a second cancer of that type in future, as it may suggest an underlying genetic or environmental susceptibility. For example, some people carry mutations of the <a href=\"https://en.m.wikipedia.org/wiki/BRCA1\" rel=\"nofollow noreferrer\">BRCA</a> genes that are linked with breast, ovarian and prostate cancers. If these gene mutations are present, there is an increased risk of several types of cancer (and probably a significant family history). Fundamentally, all cancers arise from damage or mutations to DNA. BRCA is normally involved in repair of DNA damage, so mutations that prevent this increase the likelihood of DNA damage causing a cancer.</p>\n\n<p>However, most times that cancer “comes back” are because it never went away fully in the first place. Even a single malignant cell escaping treatment can cause a recurrence some time later. This varies greatly on the type of cancer, grade (how aggressive the cancer is, tested by histology and <a href=\"https://en.m.wikipedia.org/wiki/Immunohistochemistry\" rel=\"nofollow noreferrer\">immunohistochemisty</a> for example) and stage (how far the cancer has spread, measured by imaging such as MRI). Here is a link to further explanations of <a href=\"https://www.nhs.uk/common-health-questions/operations-tests-and-procedures/what-do-cancer-stages-and-grades-mean/\" rel=\"nofollow noreferrer\">grading and staging cancer</a>.</p>\n\n<p>Another source: <a href=\"https://www.cancerresearchuk.org/about-cancer/what-is-cancer/why-some-cancers-come-back\" rel=\"nofollow noreferrer\">Cancer Research UK - Why some cancers come back</a></p>\n\n<p>We do not have technology that can detect just a few malignant cells that might remain after treatment, which is why people are monitored for years post-treatment.</p>\n\n<p>This is where the term <em>cancer survivor</em> is a little misleading. There is actually an <a href=\"https://xkcd.com/931/\" rel=\"nofollow noreferrer\">XKCD cartoon</a> that has a good visual representation of this.</p>\n\n<hr>\n\n<p><strong>New cancers that develop separately</strong></p>\n\n<p>As mentioned above, certain genetic susceptibilities may mean someone with one type of cancer is more prone to another separate one at baseline. For example, someone who has breast cancer and a BRCA mutation is at increased risk of ovarian cancer as well.</p>\n\n<p>I was going to talk about the carcinogenic effects of treatments like radiotherapy and chemotherapy and the risk of cancer arising solely due to these treatments, but this has been covered excellently in the answer by Bruce. If that was the intended focus of the question you should definitely accept that answer :)</p>\n\n<p>Source: <a href=\"https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor/second-cancers-after-breast-cancer.html\" rel=\"nofollow noreferrer\">Second cancers after breast cancer</a></p>\n", "score": 2 } ]

[ "cancer", "risks" ]

[ { "answer_id": 17453, "body": "<p>I'm not clear why you're asking this as this information is readily available unless I missed something in your question.</p>\n<p>As for anticoagulant activity, my recollection is that if anything Ibuprofen is one of the worse NSAIDs in terms of <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422108/\" rel=\"nofollow noreferrer\">cardiovascular side effects</a> being prothrombotic, though not as bad as Diclofenac.</p>\n<p><a href=\"https://i.stack.imgur.com/7SDv0.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/7SDv0.png\" alt=\"ibuprofen mode of action\" /></a></p>\n<blockquote>\n<p>The main mechanism of action of ibuprofen is the non-selective, reversible inhibition of the cyclooxygenase enzymes COX-1 and COX-2 (coded for by PTGS1 and PTGS2, respectively).</p>\n</blockquote>\n<p>...</p>\n<blockquote>\n<p>Ibuprofen exerts its anti-inflammatory and analgesic effects through inhibition of both COX isoforms. In addition, ibuprofen scavenges HO . radical, . NO and ONOO - and can potentiate or inhibit nitric oxide formation through its effects on nitric oxide synthase (NOS) isoforms. Ibuprofen may activate anti-nociceptive axis through binding to the cannabinoid receptors and through inhibition of fatty acid amide hydrolase (FAAH) that metabolizes endocannabinoid anandamide.</p>\n</blockquote>\n<p>The supplementary question is, <strong>why is that NSAIDs also don't have anti-coagulant effect?</strong>. And the answer is that they do but it is short lived and reversible as the drug concentration falls, where aspirin's effect is irreversible.</p>\n<blockquote>\n<p>All conventional, non-COX selective NSAIDs, also block platelets by inhibiting thromboxane synthesis but in contrast to aspirin, this effect is reversible. This is why an NSAID is not a satisfactory substitute for low-dose aspirin as a prophylactic therapy for cardiovascular events. As the blood concentration of the NSAID declines, the effect on the platelets also declines and is lost. This loss of platelet inhibitory effect is more pronounced for NSAIDs with shorter half-lives in the body such as ibuprofen, where for significant parts of the 24 hour day, platelets will not be inhibited. This problem is compounded if compliance with the NSAID is not perfect.</p>\n<p>There is one other important complication. This effect of aspirin is blocked by concomitant therapy with all non-selective, conventional NSAIDs, except for diclofenac. (2) Also, we now know that the non-selective, conventional NSAIDs also increase the risk of cardiovascular events occurring. Diclofenac happens to be the most risky of the non-selective NSAIDs, and approximately equivalent to available COX-II selective NSAIDs such as celecoxib. (3)</p>\n</blockquote>\n<p><a href=\"https://www.pharmgkb.org/pathway/PA166121942\" rel=\"nofollow noreferrer\">https://www.pharmgkb.org/pathway/PA166121942</a>\n<a href=\"https://www.bmj.com/content/346/bmj.f3195/rr/656306\" rel=\"nofollow noreferrer\">https://www.bmj.com/content/346/bmj.f3195/rr/656306</a></p>\n<p>Coxib and traditional NSAID Trialists’ (CNT) Collaboration. Vascular and upper\ngastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; doi:10.1016/S0140-6736(13)60900</p>\n", "score": 7 } ]

[ "medications", "drug-metabolism", "mechanism-of-action" ]

[ { "answer_id": 30580, "body": "<p>For this answer, I'll assume that with <em>“anti-inflammatory pills”</em> we're exclusively talking about NSAIDs.</p>\n<p>In summary, I see multiple reasons why donors have to wait a few days after taking NSAIDs. In summary:</p>\n<ol>\n<li>To get fresh platelets into their blood</li>\n<li>To decrease the odds of inadvertently transmitting a masked infection</li>\n<li>To prevent directly transmitting NSAIDs to the patient.</li>\n</ol>\n<h5>1. Platelets</h5>\n<p>Aspirin inhibits platelet activation by <em>irreversibly</em> acetylating their COX enzymes[1]. The average lifespan of a platelet indeed is around 8-10 days[1]. However, let's say you take aspirin once on day 1, then you'll be inhibiting young and old platelets alike. On day 4-5, about half of those inhibited platelets will have been replaced by new and uninhibited platelets.</p>\n<h5>2. Infection Transmission</h5>\n<p>Infections often present with fever, pains/discomfort, and 'feeling sick'. NSAIDs are analgesic and antipyretic,\nso NSAIDs could theoretically 'mask' an infection. Given the myriads of possible incubation periods and contagion durations of infections, mandating a waiting period can be used as a general method to reduce the risk of transmitting a 'hidden' pathogen.</p>\n<h5>3. Plasma Contamination</h5>\n<p>NSAIDs are capable of providing some incredibly dangerous side effect.\nFor example, Stevens-Johnson syndrome, toxic epidermal necrolysis can be caused by NSAIDs[2]. These side effects are rare, but they can be deadly.<br />\nMoreover, birth defects can result from taking NSAIDs during the pregnancy[2].\nWaiting 8 days should be sufficient to 'wash out' NSAIDs from the donor's plasma in most cases, even for those with longer half lives (e.g. Etoricoxib has a half-life of about 22 hours[3])</p>\n<hr />\n<p>[1] Rang and Dale, ISBN-13: 978-1-4377-1933-8, Chapter 26: Anti-inflammatory and immunosuppressant drugs<br />\n[2] <a href=\"https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/i/ibuprofen__systemisch\" rel=\"nofollow noreferrer\">https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/i/ibuprofen__systemisch</a>_<br />\n[3] DOI: 10.1345/aph.1E543, PMID: 15827069</p>\n", "score": 4 }, { "answer_id": 24388, "body": "<blockquote>\n<p>Although ACCP recommends 7- to 10-day aspirin intake cessation before surgery in patients with low cardiovascular risk, the results of our study suggest that aspirin intake cessation not longer than 96 hours can be adequate.</p>\n</blockquote>\n<blockquote>\n<p>The recommendation to stop aspirin intake for 7 to 10 days is based only on the concern for the mature platelets during exposure to aspirin.</p>\n</blockquote>\n<p>Source: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008770/#!po=66.9355\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008770/#!po=66.9355</a>.</p>\n<p>There are some mechanisms that may modulate the antiplatelet effects in the presence of aspirin and after aspirin cessation:-</p>\n<ol>\n<li><p>Immature platelets, which are reticulated and larger, have less attenuated and more elevated platelet activity than mature platelets in the presence of aspirin. Moreover, the inhibition of human megakaryocyte cyclooxygenase with low doses of aspirin is incomplete, and megakaryocyte cyclooxygenase seems to recover within 12 hours after aspirin ingestion.</p>\n</li>\n<li><p>Interruption of the platelet function by aspirin results in the production of new platelets, presumably through the action of a feedback system controlling thrombocytopoiesis. These newly formed platelets may help in speedy recovery of the platelet activity.</p>\n</li>\n</ol>\n<p>These mechanisms above are responsible for speedy recovery of platelet activity before the average lifespan of platelets.</p>\n<p>The concern for mature platelets (as I have mentioned in the quotation box) can also be applied to individuals before platelet donation i.e to wait for average lifetime of platelets which is 7-10 days (the duration which you are backing up in your question, without any reference, at least for me) before donation. Otherwise, according to <a href=\"http://apps.who.int/iris/bitstream/10665/76724/1/9789241548519_eng.pdf?ua=1\" rel=\"nofollow noreferrer\">who</a> guidelines one must defer from donating blood 5 days after taking aspirin and 48 hrs after taking other NSAIDS (The blood bank nearby me defer from donating for 3 days).</p>\n", "score": 3 } ]

[ "blood", "blood-donation", "anti-inflammatory", "plasma" ]

[ { "answer_id": 17619, "body": "<p>The reasons can be found in the training of Hong Kong paramedics. Their training is roughly comparable to the EMT-Intermediate level in the US. According to the Hong Kong Fire Service, which provides emergency medical services (EMS) in the city, their capabilities are as follows:</p>\n\n<p><a href=\"https://www.hkfsd.gov.hk/eng/source/safety/paramedic_amb.html\" rel=\"nofollow noreferrer\">https://www.hkfsd.gov.hk/eng/source/safety/paramedic_amb.html</a></p>\n\n<blockquote>\n <ul>\n <li><p>Defibrillator \n To salvage patients in non-traumatic cardiac arrest.</p></li>\n <li><p>Nitroglycerin (NTG) \n To reduce angina pain. </p></li>\n <li><p>Ventolin &amp; Atrovent To ease shortness of breath in patients having asthma / emphysema / chronic bronchitis. </p></li>\n <li><p>Intravenous infusion of Dextrose 10% in Water (D10W) \n To correct the decreased level of consciousness in patients suffering\n from hypoglycemia. </p></li>\n <li><p>Glucagon \n To correct the decreased level of consciousness in patients suffering from hypoglycemia. </p></li>\n <li><p>Intravenous infusion of Normal Saline \n To replenish body fluid in patients suffering from severe blood loss in accidents or other medical emergencies. </p></li>\n <li><p>Entonox \n To reduce pain through patient-controlled inhalation. </p></li>\n <li><p>Naloxone \n To revive patients suffering from narcotic overdose. </p></li>\n </ul>\n \n <p>In addition, some ambulances are equipped with more\n sophisticated drugs and equipment:</p>\n \n <ul>\n <li><p>Adrenaline \n To treat anaphylaxis through correcting shock and breathing difficulty. </p></li>\n <li><p>Valium To treat convulsion in epileptic children.</p></li>\n <li><p><strong>Laryngeal-Mask Airway and Combitube To provide better airway management and artificial ventilation for patients in cardiac arrest.</strong></p></li>\n </ul>\n</blockquote>\n\n<p>You'll notice that what's missing from the list are intubation and cricothyroidotomy, so they're not well prepared to handle a trauma arrest. The logic behind diverting to the nearest hospital is that without definitive airway control the patient is unlikely to survive a trip any longer than absolutely necessary. </p>\n\n<p>There is an <a href=\"https://www.jems.com/articles/print/volume-42/issue-4/features/an-evidence-based-review-of-prehospital-traumatic-cardiac-arrest.html\" rel=\"nofollow noreferrer\">interesting review</a> of traumatic arrest literature that draws this conclusion:</p>\n\n<blockquote>\n <p>Should you transport the patient in cardiac arrest if the nearest\n trauma center is 5 minutes away? Yes. Transport in this case may\n provide benefit to the patient as they may be a candidate for\n thoracotomy or other advanced surgical procedures.</p>\n \n <p>What about 20 minutes away? Likely no. The patient is unlikely to be a\n candidate for thoractomy and aggressive resuscitation should be done\n on scene with transport only with ROSC due to the risk to providers\n and predicted worse outcome.</p>\n</blockquote>\n\n<p>It's worth noting that even though American paramedics are trained to perform endotracheal intubation and cricothyroidotomy, trauma arrests are often not transported at all. Where I live, an adult arrest due to blunt or penetrating injury will generally receive three rounds of ACLS on scene. If no pulse is restored, they are not transported.</p>\n", "score": 5 } ]

[ "hospital", "trauma" ]

[ { "answer_id": 17866, "body": "<p>Well, you can do do various surgical procedures on nerves. You can suture a macroscopic nerve (i.e. a nerve that you can see) that has been injured. However, there are various problems that come with suturing an injured nerve. </p>\n\n<p>One of the main problems is that nerves are pretty unique histologically. Nerves comprise of the longest cells in the body with many of them spanning the distance from the spinal cord out to the fingers or toes. Although these cells are long they are extremely thin. These thin and long cells come together to form a nerve. Each cell is connected to their respective muscle fibers and control their contraction. </p>\n\n<p>When a nerve is injured or ruptured these cells break, and these connections break too. You don't have a lot of time to connect them back together and if you do it is impossible to connect the nerves absolutely correctly together. So although some function of the nerve might be retained it might, at least at first, be severely impaired. This might be somewhat improved with rehabilitation.</p>\n\n<p>For an analogy you could imagine a doorbell with the wires joined into one big cable and then branching out to a bunch of different apartments. If you cut on the big common cable and join it randomly together most of the doorbells might work but would ring in the wrong apartment.</p>\n\n<p><strong>Reference</strong>: Trehan, S. K., Model, Z., &amp; Lee, S. K. (2016). Nerve repair and nerve grafting. <em>Hand clinics</em>, 32(2), 119-125. doi: <a href=\"https://doi.org/10.1016/j.hcl.2015.12.002\" rel=\"nofollow noreferrer\">10.1016/j.hcl.2015.12.002</a> PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27094885\" rel=\"nofollow noreferrer\">27094885</a></p>\n\n<p>PS: With regard to why surgeons try to avoid injuring nerves that also has to do with avoiding injury to important structures, not just nerves, but also blood vessels, ureters etc.</p>\n", "score": 9 } ]

[ "neurology" ]

[ { "answer_id": 17857, "body": "<p>Adrenaline = epinephrine. Different name, same chemical. </p>\n\n<p>\"<a href=\"https://www.sciencedirect.com/topics/neuroscience/epinephrine\" rel=\"noreferrer\">Adrenergic receptors</a>\" is perhaps where things get more confusing. That is a family of hormone receptors (α1 α2 β1 β2...) that respond to endogenous hormones including epinephrine and norepinephrine, and medications that are adrenergic agonists.</p>\n\n<p>Colloquially, people might say \"adrenaline\" to encompass all stress hormones, which is suggested by the phrase \"Do it NOW!!! hormones.\" Stress hormones are not limited to adrenaline (epinephrine) but include multiple families of hormones that are released in response to stress. I like the way this is phrased in a <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079864/\" rel=\"noreferrer\">journal of endocrinology</a>: </p>\n\n<blockquote>\n <p>In response to stress, the level of various hormones changes.\n Reactions to stress are associated with enhanced secretion of a number\n of hormones including glucocorticoids, catecholamines, growth hormone\n and prolactin, the effect of which is to increase mobilization of\n energy sources and adapt the individual to its new circumstance.</p>\n</blockquote>\n\n<p>Here's a simplified diagram of adrenergic receptors and activity. I say simplified because there are multiple other steps involved, and it includes many different actions of the chemicals. </p>\n\n<p>E= epinephrine, NE= norepinephrine, DA = dopamine, etc</p>\n\n<p><a href=\"https://i.stack.imgur.com/wbhVj.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/wbhVj.jpg\" alt=\"Adrenergic receptors\"></a></p>\n", "score": 9 } ]

[ "endocrinology", "terminology", "stress" ]

[ { "answer_id": 18502, "body": "<p>I will interpret your question in the more generalised form of \"why doesn't folic / folinic acid supplementation reduce the efficacy of methotrexate treatment?\" The question may be better in this more generalised form so a moderator may want to edit it more towards that.</p>\n\n<p>The review in [1] strongly suggests that folic acid supplementation does not reduce the efficacy of methotrexate treatment. </p>\n\n<p>As for why that's the case, I don't think it's completely understood. But there are some pointers which I'll outline below. </p>\n\n<p>In [2] the authors state that \"Both folic acid (FA) and folinic acid (FLN) supplements have been shown to reduce the toxicity of MTX [...] and may prevent the formation of the less effective metabolite 7-hydroxy-MTX\".</p>\n\n<p>In [3] the authors state that \"Methotrexate is a competitive antagonist of folic acid. It inhibits dihydrofolate reductase with resultant interference of DNA synthesis leading to apoptosis.\" They also state \"inhibition of dihydrofolate reductase is not presumed to be the primary mediator [of efficacy] as supplementation with folic acid does not reduce the clinical efficacy\"</p>\n\n<p>In summary, methotrexate inhibits cancer growth by other unknown mechanisms than just preventing DNA synthesis by competing for folic acid uptake. Folic acid supplementation only reduces the effect of the latter. In addition, the speed at which cancer cells divide when compared to normal cells may skew the folic acid vs methotrexate uptake antagonism in a way that makes folic acid supplementation more beneficial for healthy cells than cancer cells.</p>\n\n<p>As for your other question in the title \"why doesn't folic acid supplementation make cancer tumours grow\", I assume you mean why supplementation in it's own right doesn't make them grow. This is because the rate at which cancer grows is limited by a whole range of factors including many different nutrients like oxygen, water and many others. Increasing folic acid would be only one of the nutrients it needs.</p>\n\n<p>[1] : <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8608361\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/8608361</a></p>\n\n<p>[2] : <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21044441\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/21044441</a></p>\n\n<p>[3] : T. Bayless, S. Hanauer: Advanced therapy in inflammatory bowel disease, vol II: IBD and Crohn's disease. Page 667.</p>\n", "score": 3 } ]

[ "mechanism-of-action", "vitamin-b", "folate", "cerebral-folate-deficiency" ]

[ { "answer_id": 19016, "body": "<p>The bran (fiber) from whole-wheat flour slows down the movement of food from the stomach into the small intestine (gastric emptying), which results in slower glucose absorption. So, the glucose from whole-wheat flour (with fiber) is absorbed slower than the glucose from white flour (no fiber), which results in smaller blood glucose spikes after meals, which may be a preventative factor against diabetes type 2 (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163785/\" rel=\"nofollow noreferrer\">PubMed, 2018</a>).</p>\n\n<p>The fiber from whole-wheat bread can help maintain bowel regularity better than white bread. Whole-wheat bread also contains more minerals, such as potassium and magnesium (<a href=\"https://foodmetrics.org/compare-wheat-flour-white-bread-enriched-vs-bread-multi-grain-includes-whole-grain;f1=20083;f2=28397\" rel=\"nofollow noreferrer\">Foodmetrics.org</a>) </p>\n", "score": 3 } ]

[ "nutrition", "healthy-cooking", "fibre", "cooking" ]

[ { "answer_id": 18710, "body": "<p>Depending on viewing angle: We might observe nothing more than an artefact of measuring antibodies.</p>\n<p>If we assume that not all patients form antibodies at the same incidence rate but all patients with the same probability and one and same patient at a constant rate then a quite simple effect of immunogenicity might be observed:<br />\nin constant administration antibodies are just used up at a constant rate, being active and bound, but not free and measurable. In episodic treatment the rate of antibody production then leads to more free antibodies (not used up) to measure – and immediately available for action against the biologic, once that is re-introduced to the system.</p>\n<p>Thus a simple rephrasing of the introductory quote from the question might read</p>\n<blockquote>\n<p>Interruption of scheduled maintenance anti-TNF therapy or episodic therapy has consistently been associated with higher rates of antibody <del>formation</del> detection.</p>\n</blockquote>\n<p>A recent paper summarises the situation as:</p>\n<blockquote>\n<p>Treatment options include biologic therapies; however, a proportion of patients lose response to biologics, partly due to the formation of anti-drug antibodies (ADAbs). Concomitant immunosuppressive agents reduce the development of ADAbs.</p>\n<p>A comprehensive literature search was conducted for articles published January 2009 to August 2015 reporting immunogenicity to adalimumab (ADM), certolizumab pegol (CZP), golimumab, infliximab (IFX), ustekinumab, and vedolizumab in inflammatory bowel disease (IBD).</p>\n<p>In most of the included studies that evaluated efficacy, the presence of ADAbs was associated with a reduction in efficacy. Efficacy was assessed in a variety of ways, including Crohn’s Disease Activity Index (CDAI) response/remission, Mayo response, endoscopic improvement and treatment discontinuation. In studies of IFX, the proportion of patients achieving and maintaining a response was generally lower for patients with detected ADAbs than those without detected ADAbs ( Supplementary Table 7). ADAbs to ADM were also associated with reduced efficacy and a loss of response, together with a high rate of secondary treatment failure; these associ-ations were shown to be statistically significant in some studies ( Supplementary Table 8). In one study,26 discontinuation of ADM treatment was reported to be very high (83.3%) in patients with ADAbs ( Supplementary Table 8).</p>\n<p>The timing of sampling (prior to or just after the next administration) greatly influences the detection rate. <strong>Most assays do not detect ADAbs in the presence of drug; since drug concentration is the lowest just before the next infusion, this is the optimal time to sample. This might be one explanation for the formation of ADAbs being reported to be lower in RCTs than in observational studies.</strong> Often, a limited number of time points were studied, and insufficient time was allowed for drug levels to decrease prior to sampling. However, it is also likely that improved assay techniques used in observational studies, together with the selection of patients with loss of response, led to higher levels of detection of ADAbs than in RCTs.</p>\n<p>_{<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784568/\" rel=\"nofollow noreferrer\">Séverine Vermeire &amp; Ann Gils &amp; Paola Accossato &amp; Sadiq Lula &amp; Amy Marren: &quot;Immunogenicity of biologics in inflammatory bowel disease&quot;</a>, Therap Adv Gastroenterol. 2018; 11: 1756283X17750355. Published online 2018 Jan 21. doi: <a href=\"https://dx.doi.org/10.1177%2F1756283X17750355\" rel=\"nofollow noreferrer\">10.1177/1756283X17750355</a>, PMCID: PMC5784568, PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29383030\" rel=\"nofollow noreferrer\">29383030</a>.}</p>\n</blockquote>\n<p>The above is just hopefully informed speculation, though, based on the lack of information in the studied papers as to how antibodies were measured. That is whether all of these possible values were taken: antigen concentration, the antigen-antibody complex concentration, the free antibody and/or total antibody concentrations.</p>\n<blockquote>\n<p>The antigen-antibody reaction is widely used in laboratory diagnostics, including immunohaematology. It is a reversible chemical reaction:</p>\n<p>antigen + antibody ⇄ antigen - antibody complex</p>\n<p>The forces joining the antigen-antibody complex are not strong covalent bonds but weaker bonds, appropriately named “weak interactions”.<br />\n_{<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2581910/\" rel=\"nofollow noreferrer\">Roberto Reverberi &amp; Lorenzo Reverberi: &quot;Factors affecting the antigen-antibody reaction&quot;</a>, Blood Transfus. 2007 Oct; 5(4): 227–240. doi: <a href=\"https://dx.doi.org/10.2450%2F2007.0047-07\" rel=\"nofollow noreferrer\">10.2450/2007.0047-07</a> PMCID: PMC2581910, PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19204779\" rel=\"nofollow noreferrer\">19204779</a>}</p>\n</blockquote>\n<p>_{Chasing a wild goose: Even more speculative might be the thought that in these processes an effect of continuous reinforcement versus intermittent reinforcement occurs.}</p>\n<p>One point to observe: Infliximab is quite different to other anti-TNF agents, as they are quite different in their attributes:</p>\n<blockquote>\n<p><a href=\"https://i.stack.imgur.com/EiIY0m.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/EiIY0m.png\" alt=\"enter image description here\" /></a></p>\n<p>_{A pharmacokinetics simulation of serum concentrations of infliximab, etanercept, and adalimumab at steady state in patients with RA treated with each drug at doses and schedules shown.}</p>\n<p>Clinical consequences of immunogenicity of TNF antagonists include acquired drug resistance and infusion or injection site reactions. Anti-drug antibodies can form multivalent complexes with the target drug, leading to rapid clearance and inactivation of the drug. Strategies to deal with this include dose escalation or the addition of concomitant immunosuppressive therapy to reduce antibody formation. Studies of the immunogenicity of protein-based drugs have suggested that chimeric antibodies are generally more immunogenic than humanized or human antibodies. However, comparisons of the immunogenic potential of the anti-TNF agents are difficult, largely because of differences in the sensitivity of the assays designed to detect anti-drug antibodies, as well as the interference in the assays of the drug itself.<br />\n_{Jennifer L. Jones: &quot;Are all anti-TNF agents the same?&quot;, in: Peter M. Irving et al (Eds): &quot;Clinical Dilemmas in Inflammatory Bowel Disease&quot;, Wiley-Blackwell: Chichester, Hobokem ²2011.}</p>\n</blockquote>\n", "score": 2 } ]

[ "medications" ]

[ { "answer_id": 18762, "body": "<p>Hypovolemic shock may be a <strong>reversible cause of cardiac arrest</strong> <a href=\"https://en.m.wikipedia.org/wiki/Hs_and_Ts\" rel=\"noreferrer\">(5)</a></p>\n<p>Mechanisms:</p>\n<ul>\n<li><p>Acute cardiac ischemia and myocardial infarction: these are due to decreased oxygen supply to the heart itself (remember that shock itself represent global ischemia)(1)<a href=\"https://www.uptodate.com/contents/pathophysiology-and-etiology-of-sudden-cardiac-arrest#H1240264379\" rel=\"noreferrer\">(2)</a></p>\n</li>\n<li><p>pH changes, especially acidemia: when shock reaches to a irreversible state so much acidosis has developed(1) which itself can cause a cardiac arrest.<a href=\"https://www.uptodate.com/contents/pathophysiology-and-etiology-of-sudden-cardiac-arrest#H1240264379\" rel=\"noreferrer\">(2)</a></p>\n</li>\n<li><p>Electrolyte abnormalities, most notably hypokalemia, hyperkalemia, and hypomagnesemia: ischemia (untreated) leads infarction leads necrosis leads loss of cell membrane leads ions and enzymes to leak and and produce toxic effects.<a href=\"https://www.uptodate.com/contents/pathophysiology-and-etiology-of-sudden-cardiac-arrest#H1240264379\" rel=\"noreferrer\">(2)</a> (3)</p>\n</li>\n<li><p>Heart Failure:The incidence of sudden cardiac death appears to be increased during periods of worsening HF symptoms.<a href=\"https://www.uptodate.com/contents/pathophysiology-and-etiology-of-sudden-cardiac-arrest/abstract/28\" rel=\"noreferrer\">4</a>.</p>\n</li>\n</ul>\n<p><strong>While Hypovolemic Shock itself does not involve cardiac arrest,</strong></p>\n<ul>\n<li>if uncompensated will ultimately cause tissue damage, release of destructive enzymes, acidosis, depletion of cellular ATP. (1)</li>\n</ul>\n<p>Pathophysiology:</p>\n<blockquote>\n<p>As volume status continues to decrease, systolic blood pressure drops. As a result, oxygen delivery to vital organs is unable to meet oxygen demand. Cells switch from aerobic metabolism to anaerobic metabolism, resulting in lactic acidosis.</p>\n<p>As sympathetic drive increases, blood flow is diverted from other organs to preserve blood flow to the heart and brain.</p>\n<p>This propagates tissue ischemia and worsens lactic acidosis. If not corrected, there will be worsening hemodynamic compromise and, eventually, death.<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK513297/\" rel=\"noreferrer\">(4)</a></p>\n</blockquote>\n<p><strong>References:</strong></p>\n<ol>\n<li><p>Guyton and Hall Medical Physiology</p>\n</li>\n<li><p><a href=\"https://www.uptodate.com/contents/pathophysiology-and-etiology-of-sudden-cardiac-arrest#H1240264379\" rel=\"noreferrer\">https://www.uptodate.com/contents/pathophysiology-and-etiology-of-sudden-cardiac-arrest#H1240264379</a></p>\n</li>\n<li><p>Robbins and Cotran Pathologic Basis of Diseases</p>\n</li>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/books/NBK513297/\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/books/NBK513297/</a></p>\n</li>\n<li><p><a href=\"https://en.m.wikipedia.org/wiki/Hs_and_Ts\" rel=\"noreferrer\">https://en.m.wikipedia.org/wiki/Hs_and_Ts</a></p>\n</li>\n</ol>\n", "score": 7 } ]

[ "heart" ]

[ { "answer_id": 18951, "body": "<p>Your question about why any individual physician chooses to practice a specific way is not answerable, but the underlying question about how physicians use evidence to make decisions is what I will address. This is from a perspective in the USA, but I believe that much of this applies globally. (But please feel free to add answers from other countries, as I'd love to hear how things work elsewhere!)</p>\n\n<p>Guidelines (see also hierarchy of evidence <a href=\"https://en.wikipedia.org/wiki/Hierarchy_of_evidence\" rel=\"nofollow noreferrer\">here</a> or <a href=\"https://libguides.ohsu.edu/c.php?g=693307&amp;p=4912291\" rel=\"nofollow noreferrer\">here</a> or <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981887/\" rel=\"nofollow noreferrer\">here</a>) are generally not rigid rules, they are consensus best-practice recommendations from a professional organization, based on evidence as it emerges. Guidelines are excellent tools for decision-making because they provide a consensus of what many experts in the field have assessed that the current evidence from all available studies best supports. </p>\n\n<p>But Guidelines take a while to form and a while to revise or overturn, so they aren't necessarily reflecting cutting edge research. Additionally, there are sometimes even conflicting guidelines from different organizations on a topic - for example frequency of mammogram (yearly vs every 2 years) is currently a hot debate between the major organizations that address women's health, with valid viewpoints on all sides (balancing frequency of rapidly progressing cases vs the harms of false positive rates and complications of unnecessary biopsies etc etc, which is a huge discussion on its own).</p>\n\n<p>There is no single organization that issues guidelines for all physicians. There are professional organizations for each specialty and even subspecialty (like <a href=\"https://www.aafp.org/patient-care/browse/type.tag-clinical-practice-guidelines.html\" rel=\"nofollow noreferrer\">AAFP</a> <a href=\"https://www.acog.org/About-ACOG/ACOG-Departments/Deliveries-Before-39-Weeks/ACOG-Clinical-Guidelines?IsMobileSet=false\" rel=\"nofollow noreferrer\">ACOG</a> <a href=\"https://www.aap.org/en-us/professional-resources/quality-improvement/Pages/Guidelines-and-Policy-Development.aspx\" rel=\"nofollow noreferrer\">AAP</a> <a href=\"https://annals.org/aim/fullarticle/745942/development-clinical-practice-guidelines-guidance-statements-american-college-physicians-summary\" rel=\"nofollow noreferrer\">ACP</a> etc), professional organizations for major disease processes (like <a href=\"https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines.html\" rel=\"nofollow noreferrer\">American Cancer Society</a>), national organizations that look at how guidelines apply at a population level (<a href=\"https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations\" rel=\"nofollow noreferrer\">USPSTF</a>, NIH), and independent organizations that provide EBM (evidence based medicine) tools for a fee that try to unite all recommendations and provide a discussion of how to approach decision making (UpToDate, Dynamed, and to a degree Medscape or Epocrates, etc).</p>\n\n<p>When a new guideline comes out that creates a paradigm shift, how does a doctor decide whether to follow it for an individual patient in his/her practice? When guidelines contradict, which does he/she choose to use? When a new study comes out that challenges current guidelines, does he/she change his/her practice based on the study, or wait until the professional organizations have digested it and weighed it against the current evidence, and issued new guidelines?</p>\n\n<p>There is no single answer to those questions. Physicians are trained to interpret and evaluate the strength and applicability of evidence, from guidelines to individual journal articles. If there is a standard of practice, and the physician chooses to deviate, there very well may be good justification for that. </p>\n\n<p>For an over-simplified example, if a physician who has been practicing a long time has had success in treating patients with the old paradigm, and the new paradigm is controversial, or the new paradigm was only non-inferior without clear mortality or morbidity benefit, they might choose to stick with what they have seen work. Medicine is called an art for a reason.</p>\n\n<p>This is an interesting article that might help expand understanding of physician decision-making: <a href=\"https://www.elsevier.com/connect/why-arent-all-physicians-using-clinical-practice-guidelines\" rel=\"nofollow noreferrer\">https://www.elsevier.com/connect/why-arent-all-physicians-using-clinical-practice-guidelines</a>. </p>\n\n<p>This article shows how the AAFP processed and recommended approaching the new ACC/AHA guidelines, to give another view into the complexity: <a href=\"https://www.aafp.org/afp/2018/0315/p372.html\" rel=\"nofollow noreferrer\">https://www.aafp.org/afp/2018/0315/p372.html</a></p>\n\n<p>So, what about LDL guidelines? It's a little bit controversial. I would say most newer physicians are going by the new guidelines, as that is what they learned while training. But a discussion about how to decide whether or not to follow those new guideline is not a short, concise answer. If I find a good article on it I will add it here.</p>\n", "score": 4 } ]

[ "cholesterol", "guidelines" ]

[ { "answer_id": 19057, "body": "<p>Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT</p>\n\n<p>Published: September 6, 2018 DOI:<a href=\"https://doi.org/10.1016/j.cell.2018.08.047\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/j.cell.2018.08.047</a></p>\n\n<p>Abstract:\nProbiotics are widely prescribed for prevention of antibiotics-associated dysbiosis and related adverse effects. However, probiotic impact on post-antibiotic reconstitution of the gut mucosal host-microbiome niche remains elusive. We invasively examined the effects of multi-strain probiotics or autologous fecal microbiome transplantation (aFMT) on post-antibiotic reconstitution of the murine and human mucosal microbiome niche. Contrary to homeostasis, antibiotic perturbation enhanced probiotics colonization in the human mucosa but only mildly improved colonization in mice. Compared to spontaneous post-antibiotic recovery, probiotics induced a markedly delayed and persistently incomplete indigenous stool/mucosal microbiome reconstitution and host transcriptome recovery toward homeostatic configuration, while aFMT induced a rapid and near-complete recovery within days of administration. In vitro,Lactobacillus-secreted soluble factors contributed to probiotics-induced microbiome inhibition. Collectively, potential post-antibiotic probiotic benefits may be offset by a compromised gut mucosal recovery, highlighting a need of developing aFMT or personalized probiotic approaches achieving mucosal protection without compromising microbiome recolonization in the antibiotics-perturbed host.</p>\n\n<p>My conclusions from reading this abstract: it includes human study. It is not directed specifically to C. diff. It discusses recolonization of the gut microbiome and that recolonization might be necessary for probiotics to be effective for ulcerative colitis.</p>\n", "score": 2 }, { "answer_id": 19060, "body": "<p><strong><em>PRESCRIBED</em> PROBIOTICS AND ANTIBIOTIC-ASSOCIATED DIARRHEA</strong></p>\n\n<p><strong>There seems to be <em>moderate evidence</em> that probiotic <em>supplements</em> can reduce the risk of antibiotic-associated diarrhea.</strong></p>\n\n<p><a href=\"https://www.cochrane.org/CD006095/IBD_use-probiotics-prevent-clostridium-difficile-diarrhea-associated-antibiotic-use\" rel=\"nofollow noreferrer\">The use of probiotics to prevent Clostridium difficile diarrhea associated with antibiotic use (Cochrane.org, 2017)</a></p>\n\n<blockquote>\n <p>Based on this systematic review and meta-analysis of 31 randomized\n controlled trials including 8672 patients, <em>moderate certainty\n evidence</em> suggests that probiotics are effective for preventing CDAD\n [C. difficile-associated diarrhea after antibiotic use].</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29511547\" rel=\"nofollow noreferrer\">Comparative efficacy and tolerability of probiotics for antibiotic-associated diarrhea: Systematic review with network meta-analysis (PubMed, 2018)</a></p>\n\n<blockquote>\n <p>LGG [Lactobacillus rhamnosus GG ] is probably the best option to\n consider when AAD is indicated. L. casei appears to be the most\n efficacious choice when associated with severe C. difficile-related\n cases.</p>\n</blockquote>\n\n<p><a href=\"https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-018-0831-x\" rel=\"nofollow noreferrer\">A practical guide for probiotics applied to the case of antibiotic-associated diarrhea in The Netherlands (BMC Gastroenterology, 2018)</a></p>\n\n<p>After systematic review of available literature, they conclude that:</p>\n\n<blockquote>\n <p>...there is sufficient evidence to make a recommendation for the use\n of specific probiotic products for the prevention of antibiotic\n associated diarrhea. In particular, we provide a three-star\n recommendation for preparations with...the probiotic strain\n Lactobacillus rhamnosus GG.</p>\n</blockquote>\n\n<p><a href=\"https://www.mdpi.com/2079-6382/6/4/21\" rel=\"nofollow noreferrer\">Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis (MDPI, 2017)</a></p>\n\n<blockquote>\n <p>...the overall quality of the included studies was moderate...The\n results suggests that probiotic use may be beneficial in the\n prevention of AAD among <em>outpatients.</em></p>\n</blockquote>\n\n<p><a href=\"https://www.gastrojournal.org/article/S0016-5085(17)30136-1/pdf\" rel=\"nofollow noreferrer\">Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis (Gatroenterology, 2017)</a></p>\n\n<blockquote>\n <p>...we found evidence that administration of probiotics closer to the\n first dose of antibiotic reduces the risk of CDI by >50% in\n <em>hospitalized</em> adults.</p>\n</blockquote>\n\n<p><strong><em>COMMERCIAL</em> PROBIOTICS AND OVERALL HEALTH</strong></p>\n\n<p><strong>There seems to be <em>insufficient evidence</em> to claim that commercially available probiotic capsules or foods, such as yogurt, kefir, cheese, sauerkraut, kombucha and kimchi, help in overall health. Even if they \"help with the gut flora overall,\" this dos not already mean they are beneficial for health.</strong> </p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29267517\" rel=\"nofollow noreferrer\">What do Cochrane systematic reviews say about probiotics as preventive interventions? (PubMed, 2107)</a></p>\n\n<blockquote>\n <p>Despite the marketing and the benefits associated with probiotics,\n there is little scientific evidence supporting the use of probiotics.\n None of the reviews provided any high-quality evidence for prevention\n of illnesses through use of probiotics.</p>\n</blockquote>\n\n<p><a href=\"https://www.bmj.com/content/324/7350/1361.full\" rel=\"nofollow noreferrer\">Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis (theBMJ, 2002)</a></p>\n\n<blockquote>\n <p>Commercially available strains are being marketed in capsules and\n yoghurt based drinks, but their potential benefit needs further\n investigation. It would be wrong to credit the proved benefits of one\n strain to an untested but closely related strain.</p>\n</blockquote>\n", "score": 1 } ]

[ "antibiotics", "probiotics", "gut-microbiota-flora" ]

[ { "answer_id": 19149, "body": "<p>I also don't see any fracture in the scaphoid, but \"fractures of the scaphoid are not visible in about 16% of cases on initial radiographs\" (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293310/\" rel=\"noreferrer\">Clinical scaphoid fracture, PubMed, 2011</a>).</p>\n\n<p>When symptoms suggest scaphoid fracture, but no fracture is seen on a radiograph, the current approach is to consider it as a \"clinical scaphoid fracture,\" immobilize the wrist and take another radiograph after 14 days. The article linked above criticizes this approach and recommends performing an early CT, MRI or scintigraphy to rule out other causes, such as distal radius fracture and tendon strain (see also <a href=\"https://www.aafp.org/afp/2004/0901/p879.html\" rel=\"noreferrer\">aafp.org, Table 1</a>).</p>\n", "score": 7 } ]

[ "bone-fractures" ]

[ { "answer_id": 19510, "body": "<p><strong>How does one explain 'avoid purines in food' if purine-rich plant food isn't counting?</strong></p>\n\n<p>Sustained increase in blood uric acid levels (hyperuricemia) is a risk factor for acute gouty arthritis (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16375734/\" rel=\"nofollow noreferrer\">Current Pharmaceutical Design</a>).</p>\n\n<p>Purines can increase serum uric acid levels. Intake of <em>hypoxanthine,</em> the main purine in organ meats, red meat and seafood, strongly increases uric acid and increases the risk of gout, while <em>guanine,</em> the main purine in plant foods does not increase uric acid; this is why purine-rich plant foods are not associated with increased risk of gout (<a href=\"http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.576.7655&amp;rep=rep1&amp;type=pdf\" rel=\"nofollow noreferrer\">JN</a>, <a href=\"https://www.jstage.jst.go.jp/article/bpb/37/5/37_b13-00967/_html\" rel=\"nofollow noreferrer\">J-Stage</a>, <a href=\"https://scialert.net/fulltext/?doi=pjn.2019.260.263\" rel=\"nofollow noreferrer\">Science Alert</a>, <a href=\"https://www.nejm.org/doi/10.1056/NEJMoa035700?url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org&amp;rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov\" rel=\"nofollow noreferrer\">NEJM</a>).</p>\n\n<p>Studies in which the intake of high-purine plants was not associated with increased risk of gout: <a href=\"https://www.nejm.org/doi/10.1056/NEJMoa035700?url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org&amp;rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov\" rel=\"nofollow noreferrer\">NEJM</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104583/\" rel=\"nofollow noreferrer\">CO-Rheumatology</a></p>\n\n<p>Vegetarians are at lowest risk of gout, followed by fish eaters, meat eaters and vegans, who are at the highest risk, supposedly due to lack of preventative effect of proteins from milk (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572016/\" rel=\"nofollow noreferrer\">Plos One</a>). </p>\n\n<p><strong>How does one explain 'avoid alcohol' if alcoholic wine seems fine?</strong></p>\n\n<p><strong>Ethanol</strong> increases serum uric acid levels by stimulation of the production of uric acid from purines (<a href=\"https://onlinelibrary.wiley.com/doi/full/10.1002/art.20821\" rel=\"nofollow noreferrer\">Arthritis Care and Research</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15936302\" rel=\"nofollow noreferrer\">Clinica Chimica Acta</a>).</p>\n\n<p><strong>Beer</strong> is high in purines (225–1,145 μmol/L), especially in <em>guanosine</em> (<a href=\"https://books.google.com/books?id=hBO3N5qLTEIC&amp;pg=PA286&amp;lpg=PA286&amp;dq=beer%20guanosine%20hypoxanthine&amp;source=bl&amp;ots=L7bTns_SZy&amp;sig=ACfU3U0O764PCgfR9rHCUsORA9PQTcuj7Q&amp;hl=sl&amp;sa=X&amp;ved=2ahUKEwiv-8yd9OviAhVawsQBHWaOAVAQ6AEwAHoECAYQAQ#v=onepage&amp;q=beer%20guanosine%20hypoxanthine&amp;f=false\" rel=\"nofollow noreferrer\">Beer in Health and Disease Prevention</a>). Guanosine is the most readily absorbed dietary purine, which can explain why beer increases serum uric acid levels (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/6743968\" rel=\"nofollow noreferrer\">British Journal of Rheumatology</a>) and the risk of gout attacks (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104583/\" rel=\"nofollow noreferrer\">CO-Rheumatology</a>).</p>\n\n<p><strong>Wine</strong> is low in purines (28-108 μmol/L) (<a href=\"https://onlinelibrary.wiley.com/doi/pdf/10.1002/bmc.1197\" rel=\"nofollow noreferrer\">Biomedical Chromatography</a>). According to some studies, moderate wine intake does not increase uric acid levels (<a href=\"https://onlinelibrary.wiley.com/doi/full/10.1002/art.20821\" rel=\"nofollow noreferrer\">Arthritis Care and Research</a>). However, according to one study, even moderate wine intake increases the risk of gout attacks <em>in the individuals with gout</em> (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991555/\" rel=\"nofollow noreferrer\">American Journal of Medicine</a>), probably due to ethanol. </p>\n\n<p><strong>Spirits</strong> are low in purines (0.7–26 μmol/L) (<a href=\"https://onlinelibrary.wiley.com/doi/pdf/10.1002/bmc.1197\" rel=\"nofollow noreferrer\">Biomedical Chromatography</a>); they increase uric acid levels less than beer (<a href=\"https://onlinelibrary.wiley.com/doi/full/10.1002/art.20821\" rel=\"nofollow noreferrer\">Arthritis Care and Research</a>). Spirit consumption is associated with an increased risk of gout attacks (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104583/\" rel=\"nofollow noreferrer\">CO-Rheumatology</a>). Congeners (substances other than ethanol) in spirits can have different effects on uric acid (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24022993\" rel=\"nofollow noreferrer\">Phytotherapy Research</a>); in one study whisky stimulated uric acid excretion and thus lowered its serum levels (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12198370\" rel=\"nofollow noreferrer\">Alcoholism: Clinical and Experimental Research</a>).</p>\n\n<p><strong>Which dietary factors are associated with <em>decreased</em> uric acid levels and risk of gout?</strong></p>\n\n<ul>\n<li>Dairy intake, presumably due to protein-induced uric acid excretion (<a href=\"https://www.nejm.org/doi/10.1056/NEJMoa035700?url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org&amp;rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov\" rel=\"nofollow noreferrer\">NEJM</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21188562\" rel=\"nofollow noreferrer\">Current Rheumatology Reports</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/30485934\" rel=\"nofollow noreferrer\">APJCN</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251556/\" rel=\"nofollow noreferrer\">Rheumatic Disease Clinics of North America</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572016/\" rel=\"nofollow noreferrer\">Plos One</a>)</li>\n<li>Protein from dairy and vegetable sources, because protein stimulates uric acid excretion (<a href=\"https://www.nejm.org/doi/10.1056/NEJMoa035700?url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org&amp;rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov\" rel=\"nofollow noreferrer\">NEJM</a>)</li>\n<li>Vitamin C and folate intake (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104583/\" rel=\"nofollow noreferrer\">CO-Rheumatology</a>)</li>\n<li>Cherries, possibly by inhibiting uric acid production, anti-inflammatory effect and antioxidant effect of anthocyanins (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510330/\" rel=\"nofollow noreferrer\">Arthritis and Rheumatology</a>)</li>\n</ul>\n\n<p><strong>What can one do to prevent gout?</strong></p>\n\n<p>Diet low in purines alone may not be very effective in prevention of gout attacks. Lowering beer and meat intake may reduce the risk of gout attacks, but more likely if done in combination with reduction of body weight and blood pressure (if necessary); uric acid-lowering drugs can also help (<a href=\"https://annals.org/aim/fullarticle/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college\" rel=\"nofollow noreferrer\">Annals of Internal Medicine, 2017</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/30213692\" rel=\"nofollow noreferrer\">Autoimmunity Reviews, 2018</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512152/\" rel=\"nofollow noreferrer\">Journal of Advanced Research, 2017</a>).</p>\n", "score": 5 } ]

[ "diet", "alcohol", "epidemiology", "gout" ]

[ { "answer_id": 19628, "body": "<p>No, blood sugar control is not 100% of the battle for complications from diabetes, but it IS the majority of it. Although a lot of the sequelae are related to elevated glucose levels, diabetes is a complex metabolic dysregulation that has many other factors involved. The pathogenesis of diabetes differs between types, they are really quite different diseases, so I will focus primarily on type 2 diabetes (the most common and the most metabolically complex).</p>\n\n<p>Some things to consider that will help frame your understanding:</p>\n\n<ul>\n<li><p>Look at the association between dysfunction in insulin resistance, blood pressure, cholesterol and fat metabolism, protein metabolism, and inflammation in the spectrum of <a href=\"https://emedicine.medscape.com/article/165124-overview#a3\" rel=\"nofollow noreferrer\">endocrine dysfunction in <strong>metabolic syndrome.</strong></a> It is clear that it's not just sugar that's out of balance in the process of type 2 diabetes / insulin resistance.</p></li>\n<li><p>Look at the <a href=\"https://emedicine.medscape.com/article/238946-overview#a3\" rel=\"nofollow noreferrer\"><strong>complexity of the pathophysiology of renal dysfunction</strong></a> in diabetes, and how much is involved beyond just glycosylation from elevated glucose.</p></li>\n<li><p>Consider insulin: the pathophysiology of type 2 diabetes centers on insulin resistance, and often individuals have elevated fasting insulin and high spikes in insulin. The <strong>insulin molecule has <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK525983/\" rel=\"nofollow noreferrer\">fairly broad metabolic activities</a> on its own</strong> - from fat metabolism to inflammation to protein turnover to vasodilation... so persistently elevated or high spiking insulin levels have metabolic consequences that are independent from glucose levels. </p></li>\n</ul>\n\n<p>But from what we know in studies, a healthier a1c (the indicator of average blood sugar) <a href=\"https://www.sciencedirect.com/science/article/abs/pii/S1056872716303026\" rel=\"nofollow noreferrer\">correlates with better outcomes</a>. Maintaining normal levels of blood sugar (not just a1c which looks at the average BG but true normal including normal range postprandial levels etc) brings the risk of most macro and microvascular complications down to near what it would be if you didn't have diabetes. Again, it appears that although much of that is due to the blood glucose levels, a good part is that the other metabolic dysregulations improve along with improving blood glucose levels.</p>\n", "score": 3 } ]

[ "type-2-diabetes" ]

[ { "answer_id": 19866, "body": "<p><strong>If and why is McDonald's food considered extremely unhealthy?</strong></p>\n\n<p>\"Extremely unhealthy\" is what some people say for many foods, but to say that fast food is \"considered unhealthy,\" more evidence is needed. I have no evidence to say that McDonalds is better or worse than others in this regard.</p>\n\n<p>In the experiment about eating in McDonalds shown in the documentary Super Size Me and described in <a href=\"https://en.wikipedia.org/wiki/Super_Size_Me\" rel=\"nofollow noreferrer\">this Wikipedia article</a>, the guy claims he was consuming 5,000 Calories per day:</p>\n\n<blockquote>\n <p>Spurlock ate at McDonald's restaurants three times per day, eating\n every item on the chain's menu at least once. Spurlock consumed an\n average of 20.9 megajoules or <strong>5,000 kcal (the equivalent of 9.26 Big\n Macs) per day</strong> during the experiment. An intake of around 2,500 kcal\n within a healthy balanced diet is more generally recommended for a man\n to maintain his weight. As a result, the then-32-year-old Spurlock\n gained 11.1 kilograms (24 lb), a 13% body mass increase, increased his cholesterol to 230 mg/dL (6.0 mmol/L), and experienced mood\n swings, sexual dysfunction, and fat accumulation in his liver.</p>\n</blockquote>\n\n<p>So, if he had a severely <em>hypercaloric diet</em> for a month, this alone (and not where and which exact foods he was eating) could result in weight gain and consequently in increased cholesterol (<a href=\"https://www.cdc.gov/cholesterol/risk_factors.htm\" rel=\"nofollow noreferrer\">CDC</a>). Any double calorie diet at any other restaurant or at home could do the same. So, this experiment does not provide any convincing evidence to say that McD food is unhealthy. </p>\n\n<p>In <a href=\"https://www.al.com/entertainment/2015/08/meet_the_science_teacher_who_l.html\" rel=\"nofollow noreferrer\">another experiment</a>, another guy was on a <em>hypocaloric diet</em> by eating carefully at McDonalds for 180 days - he lost 13.6 kg (30 pounds) and his cholesterol levels dropped significantly.</p>\n\n<p><strong>Is there any other evidence to say that fast food is unhealthy?</strong></p>\n\n<p>A typical food pattern in fast food restaurants includes hamburgers and sandwiches (white bread, processed beef or bacon, cheese), chicken nuggets and French fries (with fried oils), salad with dressing (oils), apple pies, chocolate cookies, ice cream and sweetened beverages (sugar) (<a href=\"https://www.mcdonalds.com/us/en-us/full-menu.html\" rel=\"nofollow noreferrer\">McD menu</a>). Such food pattern <em>tends</em> to:</p>\n\n<ul>\n<li>have little fiber, so it can be <strong><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544045/\" rel=\"nofollow noreferrer\">constipating</a></strong></li>\n<li>be energy dense and can be, in association with lack of fiber, less satiating, which can make you eat more than you need and <strong><a href=\"https://care.diabetesjournals.org/content/30/4/974\" rel=\"nofollow noreferrer\">gain excessive weight</a></strong></li>\n<li>have a lot of quickly absorbed carbohydrates (plain starch in white bread and fries, sugar), which is, along with excessive weight, a risk factor for <strong><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836142/\" rel=\"nofollow noreferrer\">diabetes type 2</a></strong></li>\n<li>have an excessive amount of trans fats (in French fries, chicken nuggets, pies, biscuits - <a href=\"https://ndb.nal.usda.gov/ndb/nutrients/report/nutrientsfrm?max=25&amp;offset=0&amp;totCount=0&amp;nutrient1=605&amp;nutrient2=&amp;subset=1&amp;sort=c&amp;measureby=m\" rel=\"nofollow noreferrer\">USDA</a>, <a href=\"https://foodwatch.com.au/blog/fats-and-oils/item/13-trans-fat-foods-to-remove-from-your-diet.html\" rel=\"nofollow noreferrer\">Foodwatch</a>), which can increase LDL cholesterol, which can be a risk factor for <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26268692\" rel=\"nofollow noreferrer\"><strong>cardiovascular disease</strong></a></li>\n<li>contain a lot of preservatives and other food additives, which <strong>spoil the taste</strong></li>\n</ul>\n\n<p>To be fair, in many fast food restaurants, including McDs, you can also buy an apple, a salad without dressing, a veggie burger and mineral water.</p>\n\n<p><strong>Are sandwiches themselves considered the worst kinds of junk food and are the those from McD significantly worse than sandwiches in general?</strong></p>\n\n<p>Sandwiches typically contain processed meat. <em>High</em> consumption of processed meat is associated with increased risk of <strong><a href=\"https://www.ahajournals.org/doi/full/10.1161/circulationaha.109.924977\" rel=\"nofollow noreferrer\">cardiovascular disease and diabetes type 2</a></strong>. I don't have any evidence to say that sandwiches are the worst food and which brand is worse, though.</p>\n\n<p><strong>In conclusion,</strong> there is evidence that <em>food patterns</em> (not the food items themselves) promoted by fast food restaurants are associated with increased health risks. The risk increases with frequent eating energy dense, low-fiber foods.</p>\n", "score": 3 } ]

[ "diet" ]

[ { "answer_id": 19950, "body": "<p>Are PPIs effective in prevention of esophageal carcinoma in individuals with Barrett's esophagus? <strong>The evidence is conflicting</strong>; I listed it from yes to no.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24221456\" rel=\"nofollow noreferrer\">Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis (Gut, 2014)</a>:</p>\n\n<blockquote>\n <p>Based on meta-analysis of observational studies, the use of PPIs is\n associated with a decreased risk of OAC and/or BO-HGD in patients with\n BO. None of the studies showed an increased risk of OAC. PPI use\n should be considered in BO, and chemopreventive trials of PPIs in\n patients with BO are warranted.</p>\n</blockquote>\n\n<p><a href=\"https://www.ihs.gov/sites/nptc/themes/responsive2017/display_objects/documents/guidance/NPTC-Formulary-Brief-GERD-&amp;-PUD.pdf\" rel=\"nofollow noreferrer\">GERD and Peptic Ulcers (Indian Health Service, 2018)</a>:</p>\n\n<blockquote>\n <p>...observational data suggest that PPIs are most effective for\n preventing progression of Barrett’s to cancer</p>\n</blockquote>\n\n<p><a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31388-6/fulltext\" rel=\"nofollow noreferrer\">Esomeprazole and aspirin in Barrett's oesophagus (AspECT): a randomised factorial trial (The Lancet, 2018)</a>:</p>\n\n<blockquote>\n <p>Our data indicate that high-dose PPI (40 mg twice-daily) is better\n than low-dose (20 mg once-daily) for patients with Barrett's\n oesophagus in terms of delaying death, cancer, and dysplasia.</p>\n</blockquote>\n\n<p><a href=\"https://www.nature.com/articles/s41571-018-0096-x\" rel=\"nofollow noreferrer\">Chemoprevention of Barrett’s oesophagus: a step closer with PPIs and aspirin (Clinical Oncology, 2018)</a>:</p>\n\n<blockquote>\n <p>On the basis of the findings from AspECT and the evidence from\n observational studies, we believe that PPI use in clinical practice\n for chemoprevention in patients with Barrett’s oesophagus is\n justified...The finding that aspirin was beneficial moves us one step\n closer to broader recommendations for aspirin use in patient with\n Barrett’s oesophagus and for prevention of chronic diseases in\n general.</p>\n</blockquote>\n\n<p><a href=\"https://www.medscape.com/viewarticle/897636\" rel=\"nofollow noreferrer\">Aspirin Plus PPI Prevents Esophageal Cancer (Medscape, 2018)</a>:</p>\n\n<blockquote>\n <p>Combined use of aspirin and a high-dose proton pump inhibitor (PPI)\n protects against the development of esophageal cancer in people who\n are at elevated risk for the malignancy, according to the results of a\n major phase 3 chemoprevention trial from the United Kingdom, the\n Aspirin and Esomeprazole Chemoprevention in Barrett's Metaplasia\n (AspECT) trial.</p>\n</blockquote>\n\n<p><a href=\"https://www.gastrojournal.org/article/S0016-5085(19)32511-9/fulltext\" rel=\"nofollow noreferrer\">Will a Proton Pump Inhibitor and an Aspirin Keep the Doctor Away for Patients With Barrett’s Esophagus? (Gastroenterology, 2019)</a>:</p>\n\n<blockquote>\n <p>Most patients with known Barrett’s esophagus have symptomatic\n gastroesophageal reflux disease. The study would support using a PPI\n for acid suppression for such patients. Some patients lack\n gastroesophageal reflux disease by symptoms, endoscopic findings, or\n even pH testing; for these patients, the benefit is uncertain or\n unlikely.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28072858\" rel=\"nofollow noreferrer\">Proton Pump Inhibitors Do Not Reduce the Risk of Esophageal Adenocarcinoma in Patients with Barrett's Esophagus: A Systematic Review and Meta-Analysis (PLosOne, 2017)</a>:</p>\n\n<blockquote>\n <p>No dysplasia- or cancer-protective effects of PPIs usage in patients\n with BE were identified by our analysis.</p>\n</blockquote>\n\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S1877782118300687?via%3Dihub\" rel=\"nofollow noreferrer\">Maintenance proton pump inhibition therapy and risk of oesophageal cancer (Cancer Epidemiology, 2018)</a>:</p>\n\n<blockquote>\n <p>In conclusion, the long term use of PPIs is associated with increased\n risk of oesophageal adenocarcinoma in the absence of other risk\n factors. Long term use of PPIs should be addressed with caution.</p>\n</blockquote>\n", "score": 1 } ]

[ "medications", "cancer", "reference-request", "esophagus" ]

[ { "answer_id": 19966, "body": "<p>In short: In some studies, smoking was associated with reduced risk of retinopathy only in individuals with diabetes type 2, but with an increased risk in those with type 1. In diabetes type 2, nicotine may further increase insulin levels, which may be protective against retinopathy. </p>\n\n<p>In this study <a href=\"https://www.researchgate.net/profile/Irene_Stratton/publication/12061775_UKPDS_50_Risk_factors_for_incidence_and_progression_of_retinopathy_in_Type_II_diabetes_over_6_years_from_diagnosis/links/0deec529984412dd76000000/UKPDS-50-Risk-factors-for-incidence-and-progression-of-retinopathy-in-Type-II-diabetes-over-6-years-from-diagnosis.pdf\" rel=\"nofollow noreferrer\">UKPDS 50: Risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis\", Diabetologia, 2001)</a> they have found an association between diabetic retinopathy and:</p>\n\n<ul>\n<li>High blood glucose levels</li>\n<li>High blood pressure</li>\n<li>Not smoking</li>\n</ul>\n\n<p>The authors of the study concluded:</p>\n\n<blockquote>\n <p>Somewhat counter-intuitively, <strong><em>smoking status was inversely related to\n the development of new lesions and to the progression of established\n retinopathy.</em></strong> This finding is not likely to be chance alone because of\n the strength of the association. <strong><em>It, however, is at variance with\n much of the published epidemiology of diabetic retinopathy.</em></strong></p>\n</blockquote>\n\n<p><strong>Studies with <em>no or mild positive association</em> between smoking and diabetic retinopathy:</strong></p>\n\n<p><a href=\"https://diabetes.diabetesjournals.org/content/26/1/46\" rel=\"nofollow noreferrer\">Diabetes, 1977</a>: \"The numbers of patients with proliferative retinopathy rose with increasing tobacco consumption.\"</p>\n\n<p><a href=\"https://academic.oup.com/aje/article-abstract/118/2/228/48956?redirectedFrom=PDF\" rel=\"nofollow noreferrer\">American Journal of Epidemiology, 1983</a>: \"These data suggest that there is no excess risk of retinopathy in smokers or ex-smokers when contrasted with those who never smoked.\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/4085172\" rel=\"nofollow noreferrer\">Diabetes Research, 1985</a>: \"Cigarette smoking was related to retinopathy in men but not in women.\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3758532\" rel=\"nofollow noreferrer\">Diabetologia, 1986</a>: \"Proliferative retinopathy was present in 12.5% of the smoking and in 6.8% of the non-smoking patients [with diabetes type 1].\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2060413\" rel=\"nofollow noreferrer\">Diabetes Care, 1991</a>: \"Smoking is not likely to be an important risk factor for diabetic retinopathy.\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8841303\" rel=\"nofollow noreferrer\">Ophtalmology, 1996</a> \"Cigarette smoking is not a risk factor for the long-term incidence of retinopathy.\"</p>\n\n<p><a href=\"https://www.karger.com/Article/PDF/350813\" rel=\"nofollow noreferrer\">Karger, 2013</a>: \"We found neither a beneficial nor a harmful effect of smoking on long-term incidence\" [in diabetes type 1].</p>\n\n<p><a href=\"https://care.diabetesjournals.org/content/35/3/556\" rel=\"nofollow noreferrer\">Diabetes Care, 2012</a>, <a href=\"https://care.diabetesjournals.org/content/40/3/412\" rel=\"nofollow noreferrer\">Diabetes Care, 2017</a>, <a href=\"https://bmjopen.bmj.com/content/7/9/e016280\" rel=\"nofollow noreferrer\">BMJ, 2017</a>: They don't even mention smoking as a risk factor.</p>\n\n<p><strong>Studies with <em>negative association</em> between smoking and diabetic retinopathy:</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/6881128\" rel=\"nofollow noreferrer\">American Journal of Epidemiology, 1983</a>: \"In participants diagnosed before age 30, the relative risk for the presence of retinopathy in smokers compared with those who had never smoked was 1.06 (95% confidence limits (CL) 0.97-1.18); <em>in participants diagnosed at 30 years or older it was 0.89.</em>\" </p>\n\n<p><a href=\"https://link.springer.com/article/10.1007%2Fs12020-018-1697-y\" rel=\"nofollow noreferrer\">A meta analysis in Endocrine, 2018</a>: \"Compare with non-smokers, the risk of diabetic retinopathy significantly increased in smokers with type 1 diabetes while <em>significantly decreased in smokers with type 2 diabetes.</em>\"</p>\n\n<p><strong>Possible explanation:</strong> In the study mentioned in the question <a href=\"https://www.researchgate.net/profile/Irene_Stratton/publication/12061775_UKPDS_50_Risk_factors_for_incidence_and_progression_of_retinopathy_in_Type_II_diabetes_over_6_years_from_diagnosis/links/0deec529984412dd76000000/UKPDS-50-Risk-factors-for-incidence-and-progression-of-retinopathy-in-Type-II-diabetes-over-6-years-from-diagnosis.pdf\" rel=\"nofollow noreferrer\">UKPDS 50</a> and in the <a href=\"https://link.springer.com/article/10.1007%2Fs12020-018-1697-y\" rel=\"nofollow noreferrer\">2018 meta analysis</a>, <strong>smoking was negatively associated with retinopaty only in individuals with <em>diabetes type 2.</em></strong> In diabetes type 2 with elevated insulin levels, nicotine could further increases insulin levels (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8790020\" rel=\"nofollow noreferrer\">Circulation, 1996</a>), which could be protective against retinopathy (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546345/\" rel=\"nofollow noreferrer\">Cell Metabolism, 2014, Fig. 1</a>):</p>\n\n<p><a href=\"https://i.stack.imgur.com/u52oR.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/u52oR.jpg\" alt=\"enter image description here\"></a></p>\n\n<p><strong>PYRAZINES</strong></p>\n\n<p>A part of diabetic retinopathy pathophysiology is that excessive glucose is converted to sorbitol, which is trapped in the retinal cells and damages them (<a href=\"https://www.hindawi.com/journals/isrn/2013/343560/\" rel=\"nofollow noreferrer\">Hindawi</a>). <a href=\"https://tobaccocontrol.bmj.com/content/25/4/444\" rel=\"nofollow noreferrer\">Pyrazines</a>, which appear as additives in tobacco, can stimulate the clearance of sorbitol by converting it to fructose; they can also lower blood glucose and increase insulin levels (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1970847\" rel=\"nofollow noreferrer\">Metabolism</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252962/\" rel=\"nofollow noreferrer\">British Journal of Pharmacology</a>), all of which may help prevent retinopathy. Fenugreek is high in pyrazine (<a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/pyrazine\" rel=\"nofollow noreferrer\">PubChem</a>).</p>\n\n<p>In one systematic review of Chinese herbal medicines, including the ones with pyrazine, the authors were not able to make any conclusions about their effectiveness in diabetic retinopathy (<a href=\"http://www.ccmu.edu.cn/docs/20190221143615941927.pdf\" rel=\"nofollow noreferrer\">Cochrane, 2018</a>).</p>\n\n<p><strong>Tetramethylpyrazine (Ligustrazine)</strong></p>\n\n<p>Studies about potential beneits of tetramethylpyrazine on retina.</p>\n\n<ul>\n<li><a href=\"http://www.ccmu.edu.cn/docs/20190221143615941927.pdf\" rel=\"nofollow noreferrer\">Single herbal medicine for diabetic retinopathy (Cochrane, 2018)</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4613279/\" rel=\"nofollow noreferrer\">Tetramethylpyrazine Protects Retinal Capillary Endothelial Cells (TR-iBRB2) against IL-1β-Induced Nitrative/Oxidative Stress (International Journal of Molecular Science, 2015)</a></li>\n<li><a href=\"https://link.springer.com/article/10.1007/s12177-009-9024-8\" rel=\"nofollow noreferrer\">Neural protection by naturopathic compounds—an example of tetramethylpyrazine from retina to brain (Journal of Ocular Biology, Diseases, and Informatics, 2009)</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675694/\" rel=\"nofollow noreferrer\">Protective effects of tetramethylpyrazine on rat retinal cell cultures (Neurochemistry International, 2008)</a></li>\n<li><a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/jnc.13970\" rel=\"nofollow noreferrer\">Tetramethylpyrazine nitrone protects retinal ganglion cells against N‐methyl‐d‐aspartate‐induced excitotoxicity (Journal of Neurochemistry, 2017)</a></li>\n</ul>\n", "score": 4 }, { "answer_id": 19971, "body": "<p>I've previously researched the answer to this question. I've inserted my research on this answer below. I'm very interested to hear what you think.</p>\n\n<hr>\n\n<p>Nicotine is a component of cigarette smoke. Nicotine promotes angiogenesis in the laboratory (1), including in human retinal endothelial cells.(2) However, surprisingly “cigarette smoke” inhibits angiogenesis in the laboratory(3) and epidemiological studies suggest smoking is actually protective against developing proliferative diabetic retinopathy.(4) </p>\n\n<p>Pyrazine compounds have been shown to be highly potent inhibitors of angiogenesis and the growth of chorioallantoic membranes (CAM). CAM are vascular membrane found in eggs of birds and reptiles which is analogous to the mammalian placenta.(5, 6)</p>\n\n<p>Tobacco leaf contains very low levels of pyrazines and contains the precursors for pyrazine formation. After the tobacco leaf is roasted, the levels of pyrazines increases dramatically whilst the levels of amino acids in the leaf simultaneously decrease.(7) Pyrazines comprise a very small fraction of cigarette smoke condensate by weight (5-50µg/cig).(7) </p>\n\n<p>Internal documents obtained through litigation reveals cigarette manufacturers have added a range of non-nicotine compounds initially referred to as known as “Super-juice” to cigarettes since approximately 1976.(8) Manufacturers have disclosed that Pyrazine compounds are currently 10 of out of the 599 ingredients in cigarettes. These compounds provided users who smoke “light” cigarettes with the flavor profile of high-tar cigarettes. Pyrazines were may enhance the perceived smoothness of the cigarettes, increasing the tolerability of irritation to the respiratory tract during consumption. Furthermore, pyrazine compounds were may have complex chemosensory effects which appeared to influence the ‘learned behavior’ of consumers, promoting and enhancing consumer acceptance and ongoing usage.(8) </p>\n\n<p>To date, 106 pyrazines are found in either tobacco or tobacco smoke, with 40% of these pyrazine being found in both.(7) </p>\n\n<p>The effect of nicotine and pyrazine on endothelial growth and survival has been compared, confirming that nicotine acts as a growth factor for endothelial cells and pyrazine acts as a death factor for endothelial cells. The following compounds were found to inhibit the growth of endothelial cells: 2-ethylpyridine, 3-ethylpyridine, and pyrazine.(9) </p>\n\n<p>One component of cigarette smoke 2,3,5,6-tetramethylpyrazine (also known as ligustrazine, used in Chinese herbal medicine), has undergone a pharmacokinetic evaluation.(10) It found that tetramethylpyrazine is rapidly absorbed from the nasal mucosa into the systemic circulation, and then crosses the blood–brain barrier (BBB) to reach the cerebral cortex.</p>\n\n<p>In 2005, a group accidentally discovered that various compounds with a pyrazine-pyridine backbone are potent inhibitors of vascular endothelial growth factor receptor-2 (VEGFR2).(11)</p>\n\n<p>Thus, in isolation nicotine promotes angiogenesis of retinal endothelial cells partially via the VEGF pathway. However, cigarette smoke contains not only nicotine but also pyrazine compounds which antagonize VEGF receptors, potently inhibiting the angiogenic drive of nicotine.</p>\n\n<p><a href=\"https://i.stack.imgur.com/SfiOi.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/SfiOi.png\" alt=\"Graphic representatin of the Maillard Browning reaction in the formation of pyrazines\"></a></p>\n\n<p>References</p>\n\n<ol>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24793809\" rel=\"nofollow noreferrer\">Ma X, Jia Y, Zu S, et al. alpha5 Nicotinic acetylcholine receptor mediates nicotine-induced HIF-1alpha and VEGF expression in non-small cell lung cancer. Toxicology and applied pharmacology 2014;278:172-179.</a></li>\n<li><a href=\"https://iovs.arvojournals.org/article.aspx?articleid=2187889\" rel=\"nofollow noreferrer\">Dom AM, Buckley AW, Brown KC, et al. The α7-nicotinic Acetylcholine Receptor and MMP-2/-9 Pathway Mediate the Proangiogenic Effect of Nicotine in Human Retinal Endothelial Cells. Investigative Ophthalmology &amp; Visual Science 2011;52:4428-4438.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12709416\" rel=\"nofollow noreferrer\">Michaud SE, Menard C, Guy LG, Gennaro G, Rivard A. Inhibition of hypoxia-induced angiogenesis by cigarette smoke exposure: impairment of the HIF-1alpha/VEGF pathway. FASEB journal : official publication of the Federation of American Societies for Experimental Biology 2003;17:1150-1152.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11270671\" rel=\"nofollow noreferrer\">Stratton IM, Kohner EM, Aldington SJ, et al. UKPDS 50: Risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia 2001;44:156-163.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862761/\" rel=\"nofollow noreferrer\">Ivnitski-Steele I, Walker MK. Inhibition of neovascularization by environmental agents. Cardiovascular toxicology 2005;5:215-226.</a></li>\n<li><a href=\"https://academic.oup.com/toxsci/article/75/2/393/1655896\" rel=\"nofollow noreferrer\">Melkonian G, Eckelhoefer H, Wu M, et al. Growth and Angiogenesis Are Inhibited in Vivo in Developing Tissues by Pyrazine and Its Derivatives. Toxicological Sciences 2003;75:393-401.</a></li>\n<li><a href=\"https://www.researchgate.net/publication/294261056_The_Chemical_Components_of_Tobacco_and_Tobacco_Smoke_Second_Edition\" rel=\"nofollow noreferrer\">Rodgman A, Perfetti TA. The Chemical Components of Tobacco and Tobacco Smoke, Second Edition: CRC Press; 2016.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26063608\" rel=\"nofollow noreferrer\">Alpert HR, Agaku IT, Connolly GN. A study of pyrazines in cigarettes and how additives might be used to enhance tobacco addiction. Tobacco Control 2016;25:444.</a></li>\n<li><a href=\"https://academic.oup.com/toxsci/article/93/1/82/1651255\" rel=\"nofollow noreferrer\">Yu R, Wu M, Lin S, Talbot P. Cigarette Smoke Toxicants Alter Growth and Survival of Cultured Mammalian Cells. Toxicological Sciences 2006;93:82-95.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26579367\" rel=\"nofollow noreferrer\">Meng D, Lu H, Huang S, et al. Comparative pharmacokinetics of tetramethylpyrazine phosphate in rat plasma and extracellular fluid of brain after intranasal, intragastric and intravenous administration. Acta Pharmaceutica Sinica B 2014;4:74-78.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16033269\" rel=\"nofollow noreferrer\">Kuo G-H, Prouty C, Wang A, et al. Synthesis and Structure−Activity Relationships of Pyrazine-Pyridine Biheteroaryls as Novel, Potent, and Selective Vascular Endothelial Growth Factor Receptor-2 Inhibitors. Journal of Medicinal Chemistry 2005;48:4892-4909.</a></li>\n</ol>\n\n<hr>\n\n<p>Very interested to get your thoughts on this. Thank you</p>\n", "score": 3 } ]

[ "smoking", "medications", "type-2-diabetes", "tobacco" ]

[ { "answer_id": 20000, "body": "<p>The claim that &quot;water is not close to an optimal hydration solution because it goes right through you into the urine&quot; is grossly exaggerated. Water is just good for hydration; even if somewhat more effective beverages are available, they are not really necessary for everyday needs.</p>\n<p><strong>Sugars speed up water <em>absorption.</em></strong></p>\n<blockquote>\n<p>Fructose stimulated 66-100 per cent as much net sodium and water\nabsorption as glucose. <em>(<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1120780\" rel=\"nofollow noreferrer\">The Journal of Clinical Investigation, 1975</a>)</em></p>\n<p>In conclusion, solutions with multiple substrates <em>[glucose, fructose]</em> stimulate several\ndifferent solute absorption mechanisms yielding greater water\nabsorption than solutions with only one substrate. <em>(<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8614315\" rel=\"nofollow noreferrer\">Medicine and\nScience in Sport and Exercise, 1995</a>)</em></p>\n</blockquote>\n<p><strong>Sodium promotes water <em>retention.</em></strong></p>\n<p>Sodium does not stimulate water absorption but makes the water to stay longer in your body:</p>\n<blockquote>\n<p>...increasing the amount of sodium (0–60 mmol/L) in a 6% glucose\nbeverage did not lead to increases in fluid delivery...Sodium is also\nimportant for rehydration after a period of dehydration as sodium\nhelps with fluid retention. <em>(<a href=\"https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-6-9\" rel=\"nofollow noreferrer\">Nutrition &amp; Metabolism, 2009</a>)</em></p>\n<p>In indoor environments, performing routine activities and even without\nexcessive sweating, isotonic beverages <em>[containing sodium, chloride, potassium and sugars]</em> may be more effective at\nretaining fluids and maintaining hydration status by up to 10%\ncompared to distilled water <em>(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372905/\" rel=\"nofollow noreferrer\">Nutrients, 2017</a>)</em>.</p>\n</blockquote>\n<p>Drinking sports drinks with sugars and sodium can make sense in certain sports when quick and sustained hydration is needed. <a href=\"https://rehydrate.org/solutions/homemade.htm\" rel=\"nofollow noreferrer\">Oral rehydration solution</a>, which contain sugar and sodium are better than plain water for treatment of severe dehydration: <a href=\"https://pediatrics.aappublications.org/content/100/6/e4\" rel=\"nofollow noreferrer\">to prevent water intoxication (dilutional hyponatremia), especially in infants</a>.</p>\n<p>Plain water does not just go through you but stays in your body for a shorter time than water with added sugars and sodium. Still, for everyday use, plain water is good enough, because you can get sugar and sodium from food. Saying that, a little bit of sodium in some mineral waters can greatly improve their <em>taste.</em></p>\n<p><strong>How can you estimate hydration status on your own?</strong></p>\n<p>The signs of good hydration include normal moist in mouth, no thirst, colorless or straw yellow urine, no drop of body weight within few hours or days and normal <a href=\"https://www.medicinenet.com/script/main/art.asp?articlekey=90720\" rel=\"nofollow noreferrer\">skin turgor</a>, which means that the skin at the back of your hand flattens immediately after being pinched and released (<a href=\"https://www.encyclopedia.com/medicine/diseases-and-conditions/pathology/dehydration\" rel=\"nofollow noreferrer\">Encyclopedia.com</a>).</p>\n<p>Interestingly, <em>thirst</em> can be an unreliable sign of dehydration - some people can be severely dehydrated without being thirsty (<a href=\"https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086\" rel=\"nofollow noreferrer\">Mayo Clinic</a>). The most <em>measurable</em> sign of dehydration is a <em>sudden weight loss</em> (more than 1 kg within few hours to few days).</p>\n<p><strong>How can a doctor evaluate dehydration?</strong></p>\n<p>A doctor needs to evaluate the severity and type of dehydration. Severity can be quickly estimated by weight loss: 1-3% loss = mild, 4-6% = moderate, 7% or more = severe (<a href=\"https://emedicine.medscape.com/article/906999-clinical#showall\" rel=\"nofollow noreferrer\">Emedicine</a>).</p>\n<p>The severity and type of dehydration can be further estimated by a <strong>combination</strong> of blood and urine tests; results can be <em>completely different</em> in isotonic, hypertonic and hypotonic dehydration.</p>\n<p><strong><em>Isotonic</em> dehydration:</strong> (<a href=\"https://www.lecturio.com/magazine/dehydration/\" rel=\"nofollow noreferrer\">Lecturio</a>)</p>\n<ul>\n<li>Blood osmolality: 285-295 mOsm/kg (normal range)</li>\n<li>Blood sodium: 135-145 mmol/liter</li>\n<li>24-hour urine volume: &lt;800 mL/24 h (<a href=\"http://pennstatehershey.adam.com/content.aspx?productId=117&amp;pid=1&amp;gid=003425\" rel=\"nofollow noreferrer\">ADAM</a>)</li>\n<li>Urine specific gravity: increased</li>\n</ul>\n<p>Possible causes: excessive sweating, repeated vomiting, diarrhea, severe bleeding, burns (<a href=\"https://www.researchgate.net/figure/Common-causes-of-isotonic-hypotonic-and-hypertonic-dehydration_tbl1_281126067\" rel=\"nofollow noreferrer\">ResearchGate</a>)</p>\n<p><strong><em>Hypertonic</em> dehydration:</strong> (<a href=\"https://www.lecturio.com/magazine/dehydration/\" rel=\"nofollow noreferrer\">Lecturio</a>)</p>\n<ul>\n<li>Blood osmolality: &gt;300 mOsm/kg</li>\n<li>Blood sodium &gt;150 mmol/liter</li>\n<li>24-hour urine volume: decreased (in water deprivation) or increased (in diabetes mellitus or insipidus)</li>\n<li>Urine specific gravity: increased (in water deprivation, diabetes mellitus) or decreased (in diabetes insipidus) <em>(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831666/\" rel=\"nofollow noreferrer\">Journal of General Internal Medicine</a>)</em></li>\n</ul>\n<p>Possible causes: water deprivation, excessive sweating, drinking sea water, hyperventilation, diabetes mellitus or insipidus, ketoacidosis, end-stage renal failure, certain diuretics (<a href=\"https://www.lecturio.com/magazine/dehydration/\" rel=\"nofollow noreferrer\">Lecturio</a>, <a href=\"https://www.researchgate.net/figure/Common-causes-of-isotonic-hypotonic-and-hypertonic-dehydration_tbl1_281126067\" rel=\"nofollow noreferrer\">ResearchGate</a>)</p>\n<p><strong><em>Hypotonic</em> dehydration:</strong> (<a href=\"https://www.lecturio.com/magazine/dehydration/\" rel=\"nofollow noreferrer\">Lecturio</a>)</p>\n<ul>\n<li>Blood osmolality: &lt;275 mOsm/kg</li>\n<li>Blood sodium &lt;135 mmol/L</li>\n<li>24-hour urine volume: increased or decreased</li>\n<li>Urine specific gravity: decreased or increased</li>\n</ul>\n<p>Possible causes: treating dehydration in small children or marathon runners with fluids that contain little or no sodium, gastrointestinal obstruction or fistula, pancreatitis, Addison’s disease, chronic malnutrition, cystic fibrosis with excessive salt loss in sweat, salt-wasting nephropathy, prolonged treatment of high blood pressure with low-sodium diet and thiazide diuretics ( hydrochlorothiazide), furosemide, osmotic diuretics (mannitol) (<a href=\"https://www.lecturio.com/magazine/dehydration/\" rel=\"nofollow noreferrer\">Lecturio</a>, <a href=\"https://www.researchgate.net/figure/Common-causes-of-isotonic-hypotonic-and-hypertonic-dehydration_tbl1_281126067\" rel=\"nofollow noreferrer\">ResearchGate</a>)</p>\n<p>In most cases of dehydration, the blood urea nitrogen (BUN)/creatinine ratio will be increased to &gt;20:1 (<a href=\"http://Volume%20depletion%20leads%20to%20enhanced%20proximal%20tubule%20salt%20and%20water%20retention,%20thereby%20increasing%20the%20passive%20reabsorption%20of%20urea,%20leading%20to%20a%20rise%20in%20the%20normal%20blood%20urea%20nitrogen%20(BUN)%20to%20creatinine%20ratio%20from%20the%20normal%20level%20of%2010:1%20to%20over%2020:1.\" rel=\"nofollow noreferrer\">ScienceDirect</a>, <a href=\"https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&amp;contentid=urea_nitrogen_serum\" rel=\"nofollow noreferrer\">Rochester.edu</a>).</p>\n<p><strong>Total body water</strong></p>\n<p>There are various methods to measure total body water, such as flowing afterglow–mass spectrometry (<a href=\"https://academic.oup.com/ajcn/article/76/6/1295/4689575\" rel=\"nofollow noreferrer\">AJCN, 2002</a>), but they are not used to evaluate hydration status, because this can not be determined just by knowing the absolute or relative amount of water in the body, which vary greatly with age, body weight and the percent of fat and muscle tissue.</p>\n<blockquote>\n<p>Accurate measurements of total body water (TBW) are of value in many\nphysiologic and pathophysiologic circumstances. A fundamental aspect\nof body composition, TBW is influenced by nutritional status (1) and\nwater homeostasis (2). In renal medicine, where both these aspects of\nbody composition can be adversely affected (3), TBW is of particular\nimportance because it also determines the volume of distribution of\nwater-soluble uremic toxins (4).</p>\n</blockquote>\n<p><strong>In conclusion:</strong></p>\n<ul>\n<li>Plain water can be just fine for <em>optimal</em> hydration. Adding sugars and glucose into it can promote water absorption and retention (<em>longer</em> stay of water in your body), but this is not relevant for an otherweise healthy person in the everyday life.</li>\n<li>When the hydration status is tested, the results from a <em>combination</em> of blood and urine tests need to be considered.</li>\n</ul>\n", "score": 2 } ]

[ "test", "hydration" ]

[ { "answer_id": 20149, "body": "<p>I would suggest the <a href=\"https://en.wikipedia.org/wiki/Arthur_Amos_Noyes\" rel=\"nofollow noreferrer\">Noyes</a>-<a href=\"https://en.wikipedia.org/wiki/Willis_R._Whitney\" rel=\"nofollow noreferrer\">Whitney</a> equation:</p>\n\n<blockquote>\n <p>dW\\dt = DA(C_s - C)\\L</p>\n</blockquote>\n\n<p>wnere:</p>\n\n<ul>\n<li>dW\\dt is the rate of dissolution.</li>\n<li>A is the surface area of the solid.</li>\n<li>C is the concentration of the solid in the bulk dissolution medium.</li>\n<li>C_s is the concentration of the solid in the diffusion layer surrounding the solid.</li>\n<li>D is the diffusion coefficient.</li>\n<li>L is the diffusion layer thickness.</li>\n</ul>\n\n<p>can easily be adapted into a dermal equation.</p>\n\n<p>(Sourced from <a href=\"https://en.wikipedia.org/wiki/Absorption_(pharmacology)\" rel=\"nofollow noreferrer\">Wikipedia</a>)</p>\n\n<p>I would believe that the normal rules of physics for <a href=\"https://en.wikipedia.org/wiki/Absorption_(chemistry)\" rel=\"nofollow noreferrer\">absorption</a>, e.g. water\\towel, apply.</p>\n\n<p>Wikipedia also suggests <a href=\"https://en.wikipedia.org/wiki/Absorption_(skin)#Indirect_measurement\" rel=\"nofollow noreferrer\">several formula</a> that are applicable to skin only:</p>\n\n<blockquote>\n <p>Dermally absorbed dose rate = concentration in water x surface area exposed x exposure time x permeability coefficient x conversion factors.</p>\n</blockquote>\n\n<p>for one.</p>\n", "score": 2 }, { "answer_id": 20153, "body": "<p>I don't think that it is possible for anyone \"at home\" to calculate or otherwise accurately predict the absorption percent and therefore systemic effectiveness or side effect of a topically applied drug from its physio-chemical properties, but it is possible to <em>measure</em> these parameters for every single drug during its development.</p>\n\n<p>Drug and skin factors (roughly from more to less important) that <em>increase systemic drug bioavailability</em> are listed below.</p>\n\n<h2><strong>DRUG FACTORS</strong></h2>\n\n<h2>1) Molecular weight</h2>\n\n<p>Drugs with molecular weight greater than 400-500 Daltons are hardly absorbed (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10839713\" rel=\"nofollow noreferrer\">Experimental Dermatology</a> and <a href=\"http://drugdelivery.chbe.gatech.edu/Papers/2012/Prausnitz%20Derm%20Book%20Chapter%202012.pdf\" rel=\"nofollow noreferrer\">here</a>).</p>\n\n<p>Molecular weight of some transdermal drugs (<a href=\"https://www.sciencedirect.com/science/article/pii/S1461534700002959\" rel=\"nofollow noreferrer\">Pharmaceutical Science &amp; Technology Today, 2000, Table 1</a>):</p>\n\n<ul>\n<li>Scopolamine: 303</li>\n<li>Clonidine: 230</li>\n<li>Glyceryl trinitrate: 227</li>\n<li>Estradiol: 272</li>\n<li>Fentanyl: 337</li>\n<li>Testosterone: 288</li>\n</ul>\n\n<p>The molecular weight of <strong>minoxidil</strong> is 212 Daltons (<a href=\"https://books.google.com/books?id=DW7oCAAAQBAJ&amp;pg=PA772&amp;lpg=PA772&amp;dq=minoxidil%20%22daltons%22&amp;source=bl&amp;ots=wmLYMhta71&amp;sig=ACfU3U2by1UmsWeBkh5q9RPseRrhSc0Wig&amp;hl=en&amp;sa=X&amp;ved=2ahUKEwi36sS1yfrkAhXR26QKHXenDGsQ6AEwAnoECAcQAQ#v=onepage&amp;q=minoxidil%20%22daltons%22&amp;f=false\" rel=\"nofollow noreferrer\">Replacement of Renal Function by Dialysis: A textbook of dialysis</a>).</p>\n\n<p><a href=\"http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/pancreas/insulin.html\" rel=\"nofollow noreferrer\">Insulin</a>, for example, has a molecular weight ~6,000 Daltons and is <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152630/\" rel=\"nofollow noreferrer\">not absorbed through intact skin</a>.</p>\n\n<h2>2) Ionization</h2>\n\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0021967304011318?via%3Dihub\" rel=\"nofollow noreferrer\">Non-ionized (pH neutral)</a> drugs are absorbed better than ionized ones.</p>\n\n<h2>3) Lipid vs water solubility</h2>\n\n<p>Lipid-soluble (lipophilic) drugs tend to be absorbed better than water soluble (hydrophilic) ones (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947480/pdf/canmedaj01582-0072.pdf\" rel=\"nofollow noreferrer\">PubMed</a>). Molecules, that are not lipid-soluble (at least a bit), such as <a href=\"https://adc.bmj.com/content/archdischild/62/3/220.full.pdf\" rel=\"nofollow noreferrer\">water</a>, may not be absorbed in any meaningful amounts, despite their low molecular weight.</p>\n\n<blockquote>\n <p><strong>Minoxidil</strong>... is used orally as a systemic antihypertensive drug with vasodilatory activity. Topically, it is used in cases of\n androgenetic alopecia and other types of baldness. The ingredient is\n <em>lipophylic,</em> and the <em>resorption rate is 2–3%. The concentrations in the serum are far below therapeutic levels (to treat hypertension) in adults (<a href=\"https://www.sciencedirect.com/topics/neuroscience/minoxidil\" rel=\"nofollow noreferrer\">ScienceDirect</a>).</em></p>\n</blockquote>\n\n<h2>4) Vehicle</h2>\n\n<p>Drugs that are mainly water-soluble can be absorbed better in water-based vehicles. Occlusive vehicles (that keep the water in the skin) can greatly increase absorption of certain drugs (<a href=\"http://www.inchem.org/documents/ehc/ehc/ehc235.pdf\" rel=\"nofollow noreferrer\">Inchem</a>).</p>\n\n<p>Lipid-soluble drugs can be absorbed better in lipid vehicles. Lipid solvents (acetone) increase drug permeation after <em>prolonged</em> use (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947480/pdf/canmedaj01582-0072.pdf\" rel=\"nofollow noreferrer\">PubMed</a>).</p>\n\n<p>A vehicle can increase the absorption of a drug for at least 6 times (as shown in the table 124.3 in <a href=\"http://drugdelivery.chbe.gatech.edu/Papers/2012/Prausnitz%20Derm%20Book%20Chapter%202012.pdf\" rel=\"nofollow noreferrer\">this article</a>.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165169/\" rel=\"nofollow noreferrer\">Oleic acid</a> (a fatty acid) and <a href=\"https://www.researchgate.net/publication/26308987_Relative_Uptake_of_Minoxidil_into_Appendages_and_Stratum_Corneum_and_Permeation_through_Human_Skin_In_Vitro\" rel=\"nofollow noreferrer\">ethanol</a> in the vehicle can increase the absorption of <strong>minoxidil</strong> into the skin (not into the blood) by 10 fold (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165169/\" rel=\"nofollow noreferrer\">Medicines, 2018</a>).</p>\n\n<h2><strong>SKIN and OTHER FACTORS</strong></h2>\n\n<h2>1) Anatomical site</h2>\n\n<p>Dermal absorption <em>rate</em> can greatly depend on the anatomical site - a study with hydrocortisone (<a href=\"https://www2.mst.dk/udgiv/publications/2009/978-87-7052-980-8/html/kap07_eng.htm\" rel=\"nofollow noreferrer\">mst.dk</a>):</p>\n\n<blockquote>\n <p>Here the skin on the\n scrotum had the highest permeability and the increasing rate over the\n areas was as follows: plantar &lt; palmar &lt; back &lt; scalp &lt; axilla &lt;\n forehead &lt; scrotum. The penetration rate from the foot to the scrotum\n varied 42-fold.</p>\n</blockquote>\n\n<h2>2) Skin hydration</h2>\n\n<p>Skin hydration through soaking, moisturizing or humidity can increase the absorption of hydrophylic drugs (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25514222\" rel=\"nofollow noreferrer\">Molecules</a>). </p>\n\n<h2>3) Tape striping</h2>\n\n<p>Stripping the uppermost layer of the skin (stratum corneum) by a tape can greatly improve the absorption of some drugs (<a href=\"http://drugdelivery.chbe.gatech.edu/Papers/2012/Prausnitz%20Derm%20Book%20Chapter%202012.pdf\" rel=\"nofollow noreferrer\">here</a>).</p>\n\n<h2>4) Skin disease</h2>\n\n<p>The impairment of stratum corneum in skin diseases, such as eczema and psoriasis, can increase drug absorption (<a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.15065\" rel=\"nofollow noreferrer\">BJD</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947480/pdf/canmedaj01582-0072.pdf\" rel=\"nofollow noreferrer\">PubMed</a>).</p>\n\n<h2>5) Contact time</h2>\n\n<p>One study about minoxidil showed that the absorption percent can increase with the duration of a drug being applied on the skin (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2395092\" rel=\"nofollow noreferrer\">J Pharm Sci</a>).</p>\n\n<hr>\n\n<p>Factors that <strong>decease dermal absorption:</strong></p>\n\n<ul>\n<li>Binding. Some substances get trapped (to various extents) in the skin due to binding, for example, certain metal ions (Hg2+), quaternary ammonium ions, heterocyclic ammonium ions, sulfonium salts and quinines (<a href=\"http://www.inchem.org/documents/ehc/ehc/ehc235.pdf\" rel=\"nofollow noreferrer\">Inchem, p.26</a>).</li>\n</ul>\n", "score": 2 } ]

[ "drug-metabolism", "absorption-absorb" ]