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[ { "answer_id": 14087, "body": "<p>If we are talking about <a href=\"https://en.wikipedia.org/wiki/Tactile_corpuscle\" rel=\"nofollow noreferrer\">Tactile corpuscle</a> or Meissner's corpuscles and <a href=\"https://en.wikipedia.org/wiki/Lamellar_corpuscle\" rel=\"nofollow noreferrer\">Lamellar corpuscle</a> it would be the fingertips followed by lips.</p>\n<p>I did not find a reference in English, only a <a href=\"https://books.google.de/books?id=jwUjBAAAQBAJ&amp;pg=PA376&amp;lpg=PA376&amp;dq=%22Meissner-K%C3%B6rperchen%22+h%C3%B6chste+dichte&amp;source=bl&amp;ots=oEPxFkoYdY&amp;sig=bXTN27hyrrCBvvqfvYgTt5IMEDg&amp;hl=de&amp;sa=X&amp;ved=0ahUKEwiO2tS23YbXAhWkIsAKHbETCy04ChDoAQgvMAI#v=onepage&amp;q=%22Meissner-K%C3%B6rperchen%22%20h%C3%B6chste%20dichte&amp;f=false\" rel=\"nofollow noreferrer\">German</a>:</p>\n<blockquote>\n<p>Die Fingerspitzen weisen die höchste Rezeptorendichte auf. Damit wird Begreifen möglich.</p>\n<p>^{<em>Lang, Phillip, Lang, Florian</em>: Basiswissen Physiology, Springer-Verlag, 2007; Seite 376}</p>\n<p>The fingertips have the highest density of receptors. This is why grasping is possible.</p>\n<p>^{Translation into English}</p>\n</blockquote>\n<p>The all over highest density in receptors can be found in the <a href=\"https://en.wikipedia.org/wiki/Fovea_centralis\" rel=\"nofollow noreferrer\">Fovea centralis</a>.</p>\n", "score": 3 }, { "answer_id": 14085, "body": "<p>The largest organ in your body does -- the skin.</p>\n\n<p>The most sensitive area would be any distal (meaning the farthest away) extremities. Areas that require fine control (such as dexterity). Your finger tips or genitals would be #1.</p>\n", "score": 2 }, { "answer_id": 14114, "body": "<h2>If you want to build a vibrator, you need to look for erogenous zones, not just sensitive zones</h2>\n<blockquote>\n<p>An erogenous zone (from Greek ἔρως, érōs &quot;love&quot; and English -genous &quot;producing&quot; from Greek -γενής, -genḗs &quot;born&quot;) is an area of the human body that has heightened sensitivity, the stimulation of which may generate a sexual response, such as relaxation, the production of sexual fantasies, sexual arousal and orgasm.</p>\n<p>^{<em><a href=\"https://en.wikipedia.org/wiki/Erogenous_zone#Specific_zones\" rel=\"nofollow noreferrer\">Wikipedia.Org</a></em>}</p>\n</blockquote>\n<p><a href=\"http://www.cirp.org/library/anatomy/winkelmann/\" rel=\"nofollow noreferrer\">This article gives a good overview</a>:</p>\n<blockquote>\n<p><strong>There are two types of erogenous zones: nonspecific and specific. Those of the nonspecific type depend upon exaggeration of a basic tickle sensation.</strong> Specific erogenous zones, the mucocutaneous zones of human and animal, have special neural and cutaneous anatomic characteristics. The mucocutaneous end-organs in any given species appear to be identical in all of the the zones. The endings of the primates are markedly different from those of lower animals. <strong>Development of the nerve endings is principally postfetal and may coincide with the organization of oral, anal and genital patterns of behavior.</strong></p>\n<p>^{<em>Winkelmann, RK. (1959). &quot;<a href=\"http://www.cirp.org/library/anatomy/winkelmann/\" rel=\"nofollow noreferrer\">Erogenous zones: their nerve supply and significance</a>&quot;. Mayo Clin Proc. 34 (2): 39–47.</em>}</p>\n</blockquote>\n", "score": 1 } ]

[ "neurology", "nerves", "tactile-touch" ]

[ { "answer_id": 14153, "body": "<p>This has to be a speculative answer. <a href=\"https://well.blogs.nytimes.com/2013/01/23/putting-a-number-to-smokings-toll/\" rel=\"nofollow noreferrer\">Putting a Number on Smoking’s Toll</a>?\nImportant is this: </p>\n\n<blockquote>\n <p>People who quit between 25 and 34 years of age <em>gained about 10 years of life</em> compared to those who continued to smoke.</p>\n</blockquote>\n\n<p>Positive changes are not to be discounted. And stopping reduces risks.</p>\n\n<blockquote>\n <p><a href=\"https://www.oncolink.org/risk-and-prevention/smoking-tobacco-and-cancer/former-smokers-and-cancer-risk\" rel=\"nofollow noreferrer\">Many current and former smokers want to know their risk of developing lung cancer in numbers. For example, some people want information such as \"I have a 10% chance of developing the disease.\" Assigning a number to risk is very complicated and is often hard to interpret – while one person may think 10% is a high chance, another thinks that is a relatively low number. And for the person who is in that 10% and develops the cancer, the number is meaningless. Remember that statistics like these are numbers based on large groups of people. It can be difficult to translate what that means for any one individual. In other words, don't let the number convince you that it is okay to continue smoking.</a></p>\n \n <ul>\n <li><p>5 years after quitting <br>\n Your risk of stroke is reduced to that of a non-smoker 2-5 years after quitting. The risk of cancer of the mouth, throat, esophagus and bladder is cut in half after 5 years. (US Surgeon General's Report, 2010)</p></li>\n <li><p>10 years after quitting<br>\n The lung cancer death rate is about half that of a person who is still smoking. (US Surgeon General's Report, 2010)</p></li>\n <li><p>15 years after quitting<br>\n The risk of coronary heart disease is that of a non-smoker's. (US Surgeon General's Report, 1990)</p></li>\n </ul>\n</blockquote>\n\n<p>These are findings just about a subgroup of risks and they are presented to encourage people to stop smoking. Since <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27613764\" rel=\"nofollow noreferrer\">reduction</a> of smoking or smoking cessation seems always <a href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/smo/benefits\" rel=\"nofollow noreferrer\">beneficial</a>, this is much more motivating and indeed a positive outlook. The longer you live <em>after you stop</em> smoking, the stronger the <a href=\"https://www.webmd.com/smoking-cessation/news/20080506/quit-smoking-death-risk-drops-fast#1\" rel=\"nofollow noreferrer\">reduction of risks</a> related to <a href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm\" rel=\"nofollow noreferrer\">smoking</a>. </p>\n\n<p>But that is not precisely what is asked for here. Calculating the reduced life expectancy by simply subtracting the risks or reductions mentioned above does not work very well. (Of course you can always do the math, but numbers can get meaningless.)</p>\n\n<p>The calculation of expected negativity just criticised may be done as follows:\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117323/\" rel=\"nofollow noreferrer\">Time for a smoke? One cigarette reduces your life by 11 minutes</a>:</p>\n\n<p>10 years x 365 days x 20 cigarettes = 73000 cowboy moments </p>\n\n<p>73000 cm x 11 rf = 803000 minutes lr</p>\n\n<p>Exact calculations for the risks of an individual are impossible. Also keep in mind that the above calculation is based on just one paper, that only assigned and calculated numbers. That is quite different from measuring it. And applied to everyone the above formula is very imprecise, since there are many contributing factors, like <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26581335\" rel=\"nofollow noreferrer\">age of smoking initiation</a>, simply left out.</p>\n\n<p>To look at the first quote from another perspective:</p>\n\n<blockquote>\n <p><a href=\"http://www.stopsmokingcenter.net/education/benefits.aspx\" rel=\"nofollow noreferrer\">Life Expectancy</a></p>\n \n <ul>\n <li>If a smoker quits before age 35, their life expectancy is the same as non-smokers.</li>\n <li>If a smoker quits between the age of 35 and 65, add 5 years to their life expectancy as compared to others who continues to smoke.</li>\n <li>If a smoker quits between the age of 65 and 74, add 1 year to their life expectancy as compared to someone who continues to smoke.</li>\n </ul>\n</blockquote>\n", "score": 2 } ]

[ "smoking", "lungs", "life-expectancy" ]

[ { "answer_id": 14141, "body": "<p>Since 'the cure' or rather a vaccine against the virus is still only on the horizon, affected populations have to resort to prevention measures and supportive care, once the infection breaks out. Even with a vaccine, <a href=\"http://whqlibdoc.who.int/publications/1982/9241700661_eng.pdf\" rel=\"nofollow noreferrer\">mosquito population control</a> and bite prevention will be necessary to control chikungunya disease.</p>\n\n<p><a href=\"http://www.nejm.org/doi/10.1056/NEJMp1408509\" rel=\"nofollow noreferrer\">Chikungunya at the Door — Déjà Vu All Over Again</a></p>\n\n<blockquote>\n <p>We now face a new threat posed by the unrelated chikungunya virus, which causes a disease clinically similar to dengue in a similar epidemiologic pattern, which is transmitted by the same mosquito vectors, and for which we also lack vaccines and specific treatments. […] Thus, the current chikungunya threat to the United States must be met primarily with standard public health approaches such as mosquito control and avoidance. In addition, there is an important role for astute clinicians in diagnosing and reporting the disease when it occurs.</p>\n</blockquote>\n\n<p>The Do's include limiting the habitat and reach of the mosquitos. \nIf possible any open <a href=\"https://en.wikipedia.org/wiki/Stagnant_water\" rel=\"nofollow noreferrer\">still waters</a> should be <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC149385/\" rel=\"nofollow noreferrer\">drained</a>, <a href=\"http://www.who.int/denguecontrol/control_strategies/en/\" rel=\"nofollow noreferrer\">closed</a> or <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK143163/\" rel=\"nofollow noreferrer\">covered</a>. Uneven spots of ground where puddles are forming after a rain should be filled with earth or other material. Wholes in a road should be fixed as soon as possible.</p>\n\n<p>Tightly woven <a href=\"https://en.wikipedia.org/wiki/Window_screen\" rel=\"nofollow noreferrer\">screens</a> in front of doors and windows might help to keep the insects out of homes, <a href=\"http://www.sciencedirect.com/science/article/pii/S0001706X09001910\" rel=\"nofollow noreferrer\">nets</a> around beds to keep those already in away from sleeping humans. Wearing long clothes helps to prevent the incidents of bites.</p>\n\n<p>Insect <a href=\"https://en.wikipedia.org/wiki/Insect_repellent\" rel=\"nofollow noreferrer\">repellent</a> chemicals like <a href=\"https://en.wikipedia.org/wiki/DEET\" rel=\"nofollow noreferrer\">DEET</a>, <a href=\"https://doi.org/10.2987%2F8756-971X%282006%2922%5B507%3APARBMR%5D2.0.CO%3B2\" rel=\"nofollow noreferrer\">p-Menthane-3,8-diol</a> or <a href=\"https://en.wikipedia.org/wiki/Icaridin\" rel=\"nofollow noreferrer\">Icaridin</a> applied to the exposed skin, clothing and even parts of a house structure might help to keep them away. If those strong chemicals arr either not available, not affordable or not well tolerated by the people who should apply them, much weaker <a href=\"https://en.wikipedia.org/wiki/Insect_repellent#Common_natural_insect_repellents\" rel=\"nofollow noreferrer\">natural repellents</a> might be worth a try. </p>\n\n<p>Since the disease vector is an insect, very <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925229/\" rel=\"nofollow noreferrer\">targeted</a> and limited usage of pesticides might be an option to consider. This is an option that has rather wide spread consequences beyond just <a href=\"https://en.wikipedia.org/wiki/Integrated_pest_management\" rel=\"nofollow noreferrer\">killing</a> the mosquitos and those might develop resistance or already are <a href=\"http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005054\" rel=\"nofollow noreferrer\">resistant</a> to the chemicals to employed there. Most of those insecticides are not really safe for humans to use and the actual way they are used (misused, misapplied, over-dosed, under-dosed etc.) might have a net effect that's undesirable.</p>\n\n<p>A more humane and less environmental destructive method of <a href=\"https://en.wikipedia.org/wiki/Insect_trap\" rel=\"nofollow noreferrer\">limiting</a> the number of mosquitos is to <a href=\"https://youtu.be/VAT3Kq_w_VM\" rel=\"nofollow noreferrer\">trap</a> them. Their are two ways in principle to achieve this: either sexual stimulation with pheromones, leading the insects to sticky traps from where they do not escape. Or exploiting their <a href=\"https://www.youtube.com/watch?v=rovuyeXl42Y\" rel=\"nofollow noreferrer\">target acquisition</a> system, by presenting them <a href=\"https://www.youtube.com/watch?v=pNjyLRQutXs\" rel=\"nofollow noreferrer\">decoy</a> signals that will steer a significant number of them away from humans and animals and into the traps.</p>\n\n<p>Since a significant number of infections result from bites of the insects while being outside, long clothing, repellents should be among the first things to do for individuals. A number of larger scale fan traps might be worth to try in a community effort to decrease the spread of the insects and reduce the number of bites for people being outside.</p>\n\n<p>Although it is about the similar disease called Dengue fever, this guide:\n<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK143163/\" rel=\"nofollow noreferrer\">Vector Management and Delivery of Vector Control Services</a> – and others like it – should be read and everything in there that an individual can do should be put into action and tried as soon as possible. If any aspect in there is of a size too large for individuals these components should be addressed by the local community and even escalated to higher authorities.</p>\n", "score": 3 }, { "answer_id": 14139, "body": "<p>The only effective management of viruses is by vaccination. In this way diseases such as measles have been eradicated from some countries.</p>\n\n<p>Currently there is no vaccine available so ecological measures such as controlling the mosquito vector need to be employed.</p>\n\n<p>Vaccines are under development eg. <a href=\"http://www.nature.com/nm/journal/v23/n2/full/nm.4253.html\" rel=\"nofollow noreferrer\">http://www.nature.com/nm/journal/v23/n2/full/nm.4253.html</a></p>\n", "score": 2 } ]

[ "effectiveness", "disease", "cure", "mosquito" ]

[ { "answer_id": 14206, "body": "<p>There are just too many factors to give an easy clean answer to this question. To limit the problem, lets assume the individual is wearing <a href=\"https://en.wikipedia.org/wiki/Clothing_insulation\" rel=\"nofollow noreferrer\">1 CLO</a> of clothing in still dry air. Further, lets assume that this person has a surface area of 2 m (a little bigger than the typical male, but it makes the math easier). Finally, lets assume they can indefinitely produce 300 Watts of heat (this is about 6000 calories a day). This means their heat output is 150 W/m^2. Then solving</p>\n\n<pre><code>T = (31 − 0.155·P·R)°C\n</code></pre>\n\n<p>with R=1 and P=150 gives a temperature of 8°C.</p>\n", "score": 3 } ]

[ "body-temperature", "air-temperature", "hypothermia" ]

[ { "answer_id": 14226, "body": "<p>Well, yes, but don't worry.</p>\n\n<blockquote>\n <p>New antibiotics that are active against resistant bacteria are required. Bacteria have lived on the Earth for several billion years. During this time, they encountered in nature a wide range of naturally occurring antibiotics. To survive, bacteria developed antibiotic resistance mechanisms. Therefore, it is not surprising that they have become resistant to most of the natural antimicrobial agents that have been developed over the past 50 years. This resistance increasingly limits the effectiveness of current antimicrobial drugs. The problem is not just antibiotic resistance but also multidrug resistance. [From: <a href=\"https://www.nature.com/ja/journal/v62/n1/full/ja200816a.html\" rel=\"nofollow noreferrer\">Microbial drug discovery: 80 years of progress</a>]</p>\n</blockquote>\n\n<p>That means the <a href=\"https://en.wikipedia.org/wiki/Penicillium_roqueforti\" rel=\"nofollow noreferrer\">Penicillium roqueforti</a> is in a constant fight with bacteria since 'forever' using its antibiotics to gain the upper hand when used in cheese. Those bacteria responsible for any infection coming into contact with those antibiotics and surviving the encounter will be somehow more resistant to those chemicals than before the encounter. They may have very well been resistant to those before. </p>\n\n<blockquote>\n <p><a href=\"http://www.springer.com/de/book/9780387708409\" rel=\"nofollow noreferrer\">These survivors may be naturally resistant to the antibiotic ingested, or they may have acquired resistance during therapy. Sometimes the patient was already colonized with resistant organisms before treatment had even begun.</a> </p>\n</blockquote>\n\n<p>And this is of a very small concern because blue cheese mould are not producing antibiotics or other chemicals of use as a medical agent for pathogenic human infections with bacteria. Those <a href=\"https://en.wikipedia.org/wiki/Roquefortine_C\" rel=\"nofollow noreferrer\">chemicals</a> are either <a href=\"https://www.researchgate.net/profile/Arved_Lompe/publication/291983856_Die_gesundheitliche_Unbedenklichheit_von_Penicillium_caseicolum_P_camemberti_and_P_roqueforti_II_Biologische_Prufung_auf_Toxinbildungsvermogen_an_Zellkulturen_The_harmlessness_to_health_of_Penicillium/links/56af4d9308aeaa696f2fe2ce/Die-gesundheitliche-Unbedenklichheit-von-Penicillium-caseicolum-P-camemberti-and-P-roqueforti-II-Biologische-Pruefung-auf-Toxinbildungsvermoegen-an-Zellkulturen-The-harmlessness-to-health-of-Penicill.pdf\" rel=\"nofollow noreferrer\">very weak</a> or in <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2231314\" rel=\"nofollow noreferrer\">very low</a> concentrations.</p>\n\n<p>Penicillium is a very large group of species and not every member of this family produces useful drugs. Resistance to antibiotics is an evolutionary process and evolution favours minimalism in regard to developing new features. Eating these cheeses, if properly prepared and stored, should not increase resistance against prescription drugs we use currently under the term antibiotics. </p>\n\n<p>So, after detailing some very nit-picky technicalities let me clarify my opening statement to: No. These cheeses will not cause problems with resistance to prescription drugs.</p>\n", "score": 5 } ]

[ "antibacterial-resistance" ]

[ { "answer_id": 14244, "body": "<p><a href=\"http://www.springer.com/cda/content/document/cda_downloaddocument/9780387754291-c1.pdf?SGWID=0-0-45-512104-p173797705\" rel=\"noreferrer\">One method of food sterilisation involves vacuum-sealing</a>. This is why there was negative pressure in the can¹ and why the lid got sucked in as soon as it was able to move.</p>\n\n<p>Bacteria creating positive pressure is due to digestion and excretion of gasses, which have a lower density and thus result in higher pressure. I am unaware of any bacteria or other germs that will excrete substances significantly condensed so that a negative pressure will result.</p>\n\n<hr>\n\n<p>¹: Ironically, what made you think the product might be spoiled is what ensured the product wouldn’t get spoiled.</p>\n", "score": 6 } ]

[ "food-safety" ]

[ { "answer_id": 14366, "body": "<p>If the runner can't drink then dehydration will be the first thing that takes him out. Water is the one essential thing he's going to lose rapidly through sweat, urine and respiration, and as he loses it he's going to lose electrolytes along with it. </p>\n\n<p>The end result will be disabling muscle cramps, weakness, and exhaustion. If he somehow continues on despite these things, cardiac arrhythmias may follow due to electrolyte imbalances.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1318513/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1318513/</a></p>\n", "score": 6 }, { "answer_id": 14353, "body": "<p>It's been my understanding that a buildup of lactic acid (aka lactate) eventually causes the muscles to stop being able to process glucose. <a href=\"https://www.scientificamerican.com/article/why-does-lactic-acid-buil/\" rel=\"nofollow noreferrer\">This article</a> from Scientific American describes the processes the muscles use to convert to an anaerobic process as muscle performance outpaces oxygen supplies. The pertinent passage:<br><blockquote>A side effect of high lactate levels is an increase in the acidity of the muscle cells, along with disruptions of other metabolites. The same metabolic pathways that permit the breakdown of glucose to energy perform poorly in this acidic environment.</blockquote></p>\n", "score": 3 } ]

[ "exercise", "muscle", "fatigue", "heart" ]

[ { "answer_id": 14401, "body": "<p>First of all: even brushing with nothing – except the dry brush – is better for dental hygiene than doing nothing at all. Before the invention of the <a href=\"https://en.wikipedia.org/wiki/Toothbrush#History\" rel=\"nofollow noreferrer\">tooth brush</a> people were actively caring for their teeth. One interesting example is found in the \"<a href=\"https://en.wikipedia.org/wiki/Salvadora_persica\" rel=\"nofollow noreferrer\">toothbrush tree</a>\", which has a number of beneficial attributes.</p>\n\n<p>To address the questions:</p>\n\n<ol>\n<li><p>Abrasiveness is usually no big problem for the gums. Tooth enamel is another story, but: \n<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29056187\" rel=\"nofollow noreferrer\">Baking soda as an abrasive in toothpastes: Mechanism of action and safety and effectiveness considerations:</a> </p>\n\n<blockquote>\n <p><strong>Conclusions:</strong>\n On the basis of the collected evidence, baking soda has an intrinsic low-abrasive nature because of its comparatively lower hardness in relation to enamel and dentin. Baking soda toothpastes also may contain other ingredients, which can increase their stain removal effectiveness and, consequently, abrasivity.<br>\n <strong>Practical Implications:</strong>\n Even those formulations have abrasivity well within the safety limit regulatory agencies have established and, therefore, can be considered safe.</p>\n</blockquote></li>\n<li><p>For plastic retainers <em>after rinsing</em> in your mouth? Totally inert.</p></li>\n<li><p>If you do not have a regular toothpaste, <em>then</em> baking soda is a nice alternative. But fluoride containing pastes are usually considered way superior. For \"remineralisation\": <a href=\"https://en.wikipedia.org/wiki/Tooth_enamel\" rel=\"nofollow noreferrer\">tooth enamel</a> is mainly built from <a href=\"https://en.wikipedia.org/wiki/Hydroxylapatite\" rel=\"nofollow noreferrer\">hydroxylapatite</a>. Sodium bicarbonate is usually very low in Ca₁₀(PO₄)₆(OH)₂, that is calcium, phosphorous, or beneficial trace elements like strontium and fluoride. <br> The <em>direct</em> contribution to remineralisation has to be considered zero. The neutralising effect of the soda\n(<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29056184\" rel=\"nofollow noreferrer\">Evidence for biofilm acid neutralization by baking soda</a>) might contribute a little bit to enable the natural capacity of your saliva to remineralise. </p></li>\n<li><p>Test the baking soda on any piece of plastic, like a bowl or a cup. It will not do anything to it.</p></li>\n</ol>\n\n<p>That might look very safe and effective now. Reading certain studies just emphasises this:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29056186\" rel=\"nofollow noreferrer\">Stain removal and whitening by baking soda dentifrice: A review of literature:</a> <br>\n <strong>Conclusions:</strong>\n The evidence available in the literature indicates that baking soda-based dentifrices are effective and safe for tooth stain removal and consequently whitening. A number of clinical studies have also shown that baking soda-based dentifrices are more effective in stain removal and whitening than some non-baking soda-containing dentifrices with a higher abrasivity. So far, research efforts have mainly focused on stain removal and tooth-whitening efficacy and clinical safety of baking soda dentifrices used with manual toothbrushes, with only a few studies investigating their effects using powered toothbrushes, for which further research is encouraged.\n <strong>Practical Implications:</strong>\n As part of a daily oral hygiene practice, baking soda-based dentifrice is a desirable, alternative or additional measure for tooth stain removal and whitening.</p>\n</blockquote>\n\n<p>But this should not be misread! <br>\nAll of the above just says that the plan from the question is not really dangerous. Baking soda and xylitol may even be a quite clever combination compared to soda alone. <br>\nComparing toothpaste on this basis with regular paste containing fluoride shows the superiority of added fluoride for maintaining oral health in numerous studies, for example:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26087570\" rel=\"nofollow noreferrer\">Comparing three toothpastes in controlling plaque and gingivitis: A 6-month clinical study:</a><br>\n After 6 months, subjects assigned to the triclosan/copolymer/fluoride group exhibited statistically significant reductions in gingival index scores and plaque index scores as compared to subjects assigned to the herbal/bicarbonate group by 35.4% and 48.9%, respectively. There were no statistically significant differences in gingival index and plaque index between subjects in the herbal/ bicarbonate group and those in the fluoride group. The triclosan/copolymer/fluoride dentifrice was statistically significantly more effective in reducing gingivitis and dental plaque than the herbal/bicarbonate dentifrice, and this difference in efficacy was clinically meaningful.</p>\n</blockquote>\n\n<p>That means unless your local drinking water is very high in fluoride or you drink large amounts of green or black tea (containing large amounts of fluoride) tooth pastes with fluoride will be much better at protecting dental health.</p>\n", "score": 2 } ]

[ "oral-health", "tooth-decay", "toothpaste", "retainers", "baking-soda" ]

[ { "answer_id": 19394, "body": "<p>In many cases they do reflect the actual diagnosis. \nIt depends on the disease in question.</p>\n\n<ul>\n<li><p>eMerge network work on validation is for example here: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715338\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715338</a>. In that study, they used ICD-based definitions but also other available data.</p></li>\n<li><p>Similar work in diabetes mellitus diagnosis is also published (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416392/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416392/</a>)</p></li>\n<li><p>Validation research tries to arrive at positive predictive value. E.g., <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/30480162\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/30480162</a></p></li>\n<li><p>In Japan, the PPV for AMI was 82.5%. (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/30477501\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/30477501</a>)</p></li>\n</ul>\n", "score": 3 } ]

[ "statistics", "diagnosis", "health-informatics", "medical-records", "icd-intrntl-classif-disea" ]

[ { "answer_id": 14432, "body": "<p>Yes, anal sex is the most risky method of sex with the highest possible chances for HIV infection.</p>\n\n<p>This is clearly said in the official <a href=\"https://www.cdc.gov/hiv/risk/analsex.html\" rel=\"noreferrer\">Centers for Disease Control and Prevention website</a>:</p>\n\n<blockquote>\n <p>Anal sex is the riskiest sexual behavior for getting and transmitting HIV for men and women.</p>\n</blockquote>\n\n<p>As for the reason, it's neither the penis nor the anus directly. They separate the reasoning for the receptive partner (<em>bottom</em>) and insertive partner (<em>top</em>):</p>\n\n<ul>\n<li><blockquote>\n <p>The bottom’s risk of getting HIV is very high because the lining of the rectum is thin and may allow HIV to enter the body during anal sex.</p>\n</blockquote></li>\n<li><blockquote>\n <p>HIV may enter the top partner’s body through the opening at the tip of the penis (or urethra) or through small cuts, scratches, or open sores on the penis.</p>\n</blockquote></li>\n</ul>\n\n<p>Do note, that article and all above quotes refer to anal sex when the receptive partner can be either male or female. (As it's common belief that gay anal sex is more risky, which is not true.)</p>\n", "score": 5 }, { "answer_id": 15554, "body": "<p><strong>Major Edit:</strong> Corrected extremely incorrect stats</p>\n\n<p>The vagina, being \"designed\" (evolutionary speaking) for intercourse, has a lining which is reasonably good at fending off pathogens, particularly viruses like HIV. If there are no breaks in this lining (such as from rough sex), the risk of contracting HIV from a single sexual encounter with someone with a high viral load (ie. Lots of virus in their blood, and thus lots to pass on in their other bodily fluids) isn't as high as one might expect. That clearly isn't low enough to condone risky behaviour, but it's enough to affect the spread of the disease, especially because, like many STDs, HIV is more often spread through one-time sexual encounters (mainly casual sex and prostitution) than within a committed relationship.</p>\n\n<p>In contrast, the rectum (the anus is just the opening; the rectum is the actual part of the gut inside) is not \"designed\" for intercourse, and has very poor defenses against pathogens. The risk of the receptive partner in anal sex contracting HIV from a penetrating partner with a high viral load is an order of magnitude higher than from vaginally intercourse</p>\n\n<p>Finally, because of the lack of natural lubrication in the rectum and anal orifice, anal sex is much more likely to result in (minor) damage to the penetrating partner's penis, which increases the risk of the penetrating partner contracting HIV.</p>\n\n<p>In short:</p>\n\n<ul>\n<li><p>The rectum <strong>does not contain substantially more HIV particles than the vagina</strong>; but</p></li>\n<li><p>The rectum is <strong>more vulnerable to infection</strong> by the HI virus, and</p></li>\n<li><p>Anal sex is more likely to be \"rough\" on the penetrating partner's penis, making the penis <strong>more vulnerable to infection by the virus</strong> as well.</p></li>\n</ul>\n\n<p>Thus, anal sex (regardless of the sex/gender of the participants) has a <strong>much higher risk of HIV transmission to the receptive partner</strong>, and a less elevated but still <strong>increased risk of transmission to the penetrating partner</strong>.</p>\n\n<p>This may be part of the reason that HIV was once much more common in the homosexual population. The main reason, though, is that homosexuals and heterosexuals (by definition) don't often have sexual contact with each other, and bisexuality was quite rare in the era when HIV first emerged.</p>\n\n<p>Most likely, a gay man happened to contract the virus relatively early in its spread (ie. Before it was widespread), purely by chance, and it just took a while for it to \"cross the gap\" into the heterosexual population. </p>\n\n<p><strong>Source:</strong></p>\n\n<p>Patel, P., Borkowf, C., Brooks, J., Lasry, A., Lansky, A. and Mermin, J. (2014). Estimating per-act HIV transmission risk. AIDS, 28(10), pp.1509-1519.</p>\n", "score": 3 } ]

[ "sex", "penis", "hiv", "anus", "vagina" ]

[ { "answer_id": 14448, "body": "<p>The most credible source for diagnosis and evaluation of mental conditions is the <a href=\"https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders\" rel=\"nofollow noreferrer\">Diagnostic and Statistical Manual of Mental Disorders (DSM)</a>, which is published and updated every few years by the <a href=\"https://www.psychiatry.org/\" rel=\"nofollow noreferrer\">American Psychiatric Association</a>. The latest and most updated edition is the 5th edition.</p>\n\n<p>Despite being a professional manual and guidelines for psychologists and psychiatrists, the criteria for diagnosis that are listed for each psychiatric condition covered in the book are (mostly) written in a style that laymen can also understand.</p>\n\n<p><a href=\"https://i2.wp.com/eiko-fried.com/wp-content/uploads/Screen-Shot-2018-07-17-at-16.57.18-450x381.png?resize=450%2C381\" rel=\"nofollow noreferrer\">Here</a> is a reprint of the diagnostic criteria for Major Depressive Disorder, and <a href=\"https://www.aafp.org/afp/2015/1115/hi-res/afp20151115p896-t2.gif\" rel=\"nofollow noreferrer\">here</a> is a reprint of the diagnostic criteria for Obsessive-Compulsive Disorder (OCD).</p>\n\n<p>Please note: </p>\n\n<ol>\n<li>Due to the nature of this subject (i.e. wide diversity of presentations), a person does not necessarily have to exhibit <strong>all</strong> of the signs in order to be diagnosed with a certain mental condition.\n<br>This point may be illustrated by the beginning of the Major Depressive Disorder entry: \"<strong>Five (or more)</strong> of the following symptoms have been present during the same 2-week period and represent a change from previous functioning...\"</li>\n<li>Diagnosis is best left for medical professionals, but there is great benefit in early detection of relevant signs by family members or friends. If you are asking as a non-professional, then read through the criteria and be observant. This may save a life.</li>\n</ol>\n", "score": 8 } ]

[ "depression", "suicide" ]

[ { "answer_id": 14544, "body": "<p>Not sure about the US case, but for UK <a href=\"http://www.who.int/medicines/publications/druginformation/issues/WHO-DI-22-2.pdf\" rel=\"nofollow noreferrer\">I found</a></p>\n\n<blockquote>\n <p>Dydrogesterone withdrawn\n for commercial reasons\n United Kingdom — Dydrogesterone\n (Duphaston ®) is to be withdrawn from\n the market from March 2008 for commercial\n reasons. Dydrogesterone was licensed\n for use in several indications,\n including threatened or recurrent miscarriage,\n dysfunctional uterine bleeding, and\n hormone replacement therapy.\n A Public Assessment Report has reviewed\n evidence for the efficacy of\n progesterone and dydrogesterone in the\n maintenance of pregnancy in women with\n threatened miscarriage or recurrent\n miscarriage.\n For several decades, progesterone and\n progestogens (such as dydrogesterone)\n have been used to maintain early pregnancy.\n However, this practice seems to\n have been based on theoretical considerations\n rather than robust evidence of\n efficacy. Although the methodological and\n ethical difficulties associated with conducting\n efficacy trials in these indications\n need to be considered, the quality of\n much of the evidence is generally poor\n relative to today’s standards.</p>\n \n <p>Reference: Medicines and Healthcare\n products Regulatory Agency (MHRA) information\n release.</p>\n</blockquote>\n\n<p>The verbiage <a href=\"https://www.federalregister.gov/documents/2017/09/06/2017-18816/determination-that-gynorest-dydrogesterone-oral-tablets-5-milligrams-and-10-milligrams-were-not\" rel=\"nofollow noreferrer\">provided by the FDA</a> is a bit more obscure</p>\n\n<blockquote>\n <p>We have carefully reviewed our files for records concerning the withdrawal of GYNOREST (dydrogesterone) oral tablets, 5 mg and 10 mg, from sale. We have also independently evaluated relevant literature and data for possible post-marketing adverse events. We have found no information that would indicate that this drug product was withdrawn from sale for reasons of safety or effectiveness.</p>\n</blockquote>\n\n<p>What I read into that is \"withdrawn for commercial reasons\".</p>\n", "score": 2 } ]

[ "endocrinology" ]

[ { "answer_id": 14602, "body": "<p>Stockholm Syndrome does exist. It has an exceptionally high face validity. It does have this attribute due to many case reports available in the non-medical newspapers. You see a pattern, you have a desire to name it.</p>\n\n<p>The trick of taxonomy is trying to explain this behaviour pattern, many psychological theories stand at the ready: </p>\n\n<p><a href=\"http://journals.sagepub.com/doi/abs/10.1080/00048670701261178\" rel=\"nofollow noreferrer\">Traumatic Entrapment, Appeasement and Complex Post-Traumatic Stress Disorder: Evolutionary Perspectives of Hostage Reactions, Domestic Abuse and the Stockholm Syndrome:</a></p>\n\n<blockquote>\n <p>Evolutionary theory and cross-species comparisons are explored to shed new insights into behavioural responses to traumatic entrapment, examining their relationships to the Stockholm syndrome (a specific response to traumatic entrapment) and complex post-traumatic stress disorder (PTSD). […]\n The neurobiological basis of defensive behaviours underlying PTSD is explored with reference to the triune brain model. Victims of protracted traumatic entrapment under certain circumstances may display the Stockholm syndrome, which involves paradoxically positive relationships with their oppressors that may persist beyond release. Similar responses are observed in many mammalian species, especially primates. Ethological concepts including dominance hierarchies, reverted escape, de-escalation and conditional reconciliation appear relevant and are illustrated. These phenomena are commonly encountered in victims of severe abuse and understanding these concepts may assist clinical management. Appeasement is the mammalian defence most relevant to the survival challenge presented by traumatic entrapment and appears to be the foundation of complex PTSD. Evolutionary perspectives have considerable potential to bridge and integrate neurobiology and the social sciences with respect to traumatic stress responses.</p>\n</blockquote>\n\n<p>To properly diagnose a new \"syndrome\" you need to measure \"symptoms\", and <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3415129\" rel=\"nofollow noreferrer\">make comparisons</a> to enable a differential diagnosis. One such scale applying the concept of \"Stockholm Syndrome\" to dating complications is presented here:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8555117\" rel=\"nofollow noreferrer\"><strong>A scale for identifying \"Stockholm syndrome\" reactions in young dating women: factor structure, reliability, and validity:</strong></a></p>\n</blockquote>\n\n<p>But the whole process is hampered by the rarity in which subjects are scientifically examined compared to the media coverage if such a case is presumed to be present. That concept is now apparently highly attractive for lay persons to explain counter intuitive behaviour up to a point that Stockholm Syndrome now almost replaced the previously assumed intuitive behavioural response of intense hatred. That is the weakness expressed by different researchers in the question. Psychological and psychiatric symptoms, disorders and syndromes are highly influenced or even dependent on culture. (cf. DSM and homosexuality). At the moment the process of clearly defining Stockholm syndrome as a distinct category that is really sharply defined against alternatives and related concepts is not finished:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18028254\" rel=\"nofollow noreferrer\"><strong>‘Stockholm syndrome’: psychiatric diagnosis or urban myth?</strong></a>\n The existing literature on the subject of ‘Stockholm syndrome’ is sparse; the majority of the literature is based on case reports with little reference to how ‘Stockholm syndrome’ was diagnosed and what, if any, is its significance in terms of management of victims. ‘Stockholm syndrome’ is rarely mentioned in peer-reviewed academic research.[…]<br>\n In summary, a systematic literature review has identified large gaps in research into ‘Stockholm syndrome’. Existing literature does very little to support its existence yet case studies demonstrate a possible pattern in the behaviour and experiences of people labelled with it. We found similarities between widely reported cases studies into hostage ⁄ kidnap victims that could be used as the basis for diagnostic criteria. We also suggest that labelling the hostage victim with a psychiatric syndrome makes their story more readable and more likely to boost media circulation. The mystery of the origins of psychiatric illness holds society with fascination; psychiatry does not deal in absolute values and definitions, it is easy for the media to have free reign with medical terms, such as ‘Stockholm syndrome’ that have, as yet not received comprehensive assessment and validating criteria.</p>\n</blockquote>\n", "score": 4 }, { "answer_id": 18246, "body": "<p>Stockholm Syndrome certainly does exist. It is a manifestation of capture-bonding, an evolutionary psychology[1] term for the evolved psychological mechanism[2] behind Stockholm syndrome. John Tooby (then a graduate student at Harvard University) originated the concept and its ramifications in the early 1980s, though he did not publish.[3] The term is fairly widely used on the Web and has begun to show up in books. [4]</p>\n\n<p>In the view of evolutionary psychology, \"the mind is a set of information-processing machines that were designed by natural selection to solve adaptive problems faced by our hunter-gatherer ancestors.\" [5]</p>\n\n<p>One of the \"adaptive problems faced by our hunter-gatherer ancestors,\" particularly our female ancestors, was being abducted by another band. Life in the human \"environment of evolutionary adaptiveness\" (EEA) is thought by researchers such as Azar Gat to be similar to that of the few remaining hunter-gatherer societies. \"Deadly violence is also regularly activated in competition over women. . . . Abduction of women, rape, . . . are widespread direct causes of reproductive conflict . . .\" [6] I.e., being captured [7] and having their dependent children killed might have been fairly common. [8] Women who resisted capture in such situations risked being killed. [9]</p>\n\n<p>Azar Gat argues that war and abductions (capture) were typical of human prehistory. [10] When selection is intense and persistent, adaptive traits (such as capture-bonding) become universal to the population or species.</p>\n\n<p>Capture-bonding as an evolutionary psychology mechanism can be used to understand historical events from the Rape of the Sabine Women to the hundreds of accounts of Europeans (mostly women) who were captured and assimilated into Native American tribes. Cynthia Ann Parker (1836 capture) is both an example of the mechanism working and it failing to work when she was captured again much later in life. Evolutionary psychology reasoning would lead you to expect that capture-bonding would be more effective at a younger age when there was more reproductive potential at risk. She did very well evolutionary terms because her son Quanah Parker had 25 children. Mary Jemison (1750 capture) was a very famous case. The last one (1851 capture) may have been Olive Oatman.</p>\n\n<p>Partial activation of the capture-bonding psychological trait may lie behind Battered-wife syndrome, military basic training, fraternity hazing, and sex practices such as sadism/masochism or bondage/discipline. [11]</p>\n\n<p>References</p>\n\n<ol>\n<li><p>\"My contention, simply put, is that the evolutionary approach is the only approach in the social and behavioral sciences that deals with why, in an ultimate sense, people behave as they do. As such, it often unmasks the universal hypocrisies of our species, peering behind self-serving notions about our moral and social values to reveal the darker side of human nature. (Silverman 2003) Confessions of a Closet Sociobiologist: Darwinian Movement in Psychology <a href=\"http://www.epjournal.net/filestore/ep0119.pdf\" rel=\"nofollow noreferrer\">http://www.epjournal.net/filestore/ep0119.pdf</a></p></li>\n<li><p>Consider the mysterious behavior of Elizabeth Smart in Salt Lake City in 2003 or that of Patty Hearst when she was abducted in 1974. In both cases, the victims bonded to their captors and resisted leaving them. The evolutionary origin of this psychological trait, known as the Stockholm syndrome (or more descriptively as capture-bonding) almost certainly comes from millions of years of evolutionary selection where our ancestors-usually our female ancestors-were being violently captured from one tribe by another. Those who had the psychological traits (ultimately gene-based mechanisms) that led them to socially reorient after a few days (i.e., bond) to their captors often survived to pass on the trait. Those who continued to resist, because they didn't have this trait, often became breakfast. Evolutionary Psychology, Memes and the Origin of War, Mankind Quarterly, Volume XLVI Number 4, Summer 2006.</p></li>\n<li><p>source: Leda Cosmides</p></li>\n<li><p>From Princess to Prisoner By Linda C. Mcjunckins <a href=\"http://books.google.com/books?id=f8lS3RMhv7oC&amp;pg=PA211&amp;dq=capture+bonding&amp;sig=XT21yLbFDdm\" rel=\"nofollow noreferrer\">http://books.google.com/books?id=f8lS3RMhv7oC&amp;pg=PA211&amp;dq=capture+bonding&amp;sig=XT21yLbFDdm</a></p></li>\n<li><p>Evolutionary Psychology: A Primer - Leda Cosmides &amp; John Tooby\nPublished in Anthropological Quarterly, 73.2 (2000), 74-88. </p></li>\n<li><p>THE HUMAN MOTIVATIONAL COMPLEX: EVOLUTIONARY THEORY AND THE CAUSES OF HUNTER-GATHERER FIGHTING Azar Gat Part II: Proximate, Subordinate, and Derivative Causes\"</p></li>\n<li><p>\"The percentage of females in the lowland villages who have been abducted is significantly higher: 17% compared to 11.7% in the highland villages.\" (Napoleon Chagnon quoted at Sexual Polarization in Warrior Cultures)</p></li>\n<li><p>\"Elena Valero, a Brazilian woman, was kidnapped by Yanomamo warriors when she was eleven years old . . . . But none were so horrifying as the second [raid]: ‘They killed so many.’ . . . The man then took the baby by his feet and bashed him against the rocks . . . .\" (Hrdy quoted in Sexual Polarization in Warrior Cultures)</p></li>\n<li><p>\"The Shaur and Achuar Jivaros, once deadly enemies . . . . A significant goal of these wars was geared toward the annihilation of the enemy tribe, including women and children. . . . . There were, however, many instances where the women and children were taken as prisoners . . . . A woman who fights, or a woman who refuses to accompany the victorious war-party to their homes and serve a new master, exposes herself to the risk of suffering the same fate as her men-folk.\" (Up de Graff also in Sexual Polarization in Warrior Cultures)</p></li>\n<li><p>Published in Anthropological Quarterly, 73.2 (2000), 74-88. THE HUMAN MOTIVATIONAL COMPLEX: EVOLUTIONARY THEORY AND THE CAUSES OF HUNTER-GATHERER FIGHTING Azar Gat Part II: Proximate, Subordinate, and Derivative Causes\"</p></li>\n<li><p>Being captured by neighboring tribes was a relatively common event for women in human history if anything like the recent history of the few remaining primitive tribes. In some of those tribes (Yanomamo, for instance) practically everyone in the tribe is descended from a captive within the last three generations. Perhaps as high as one in ten of females were abducted and incorporated into the tribe that captured them. Once you understand the evolutionary origin of this trait and its critical nature in genetic survival and reproduction in the ancestral human environment, related mysterious human psychological traits fall into place. Battered-wife syndrome is an example of activating the capture-bonding psychological mechanism, as are military basic training, fraternity bonding by hazing, and sex practices such as sadism/masochism or bondage/discipline. Evolutionary Psychology, Memes and the Origin of War, H. Keith Henson, Mankind Quarterly, Volume XLVI Number 4, Summer 2006.</p></li>\n</ol>\n", "score": 1 } ]

[ "mental-health", "medical-myths", "psychologist-psychology", "ebm-evidence-based-med", "stockholm-syndrome" ]

[ { "answer_id": 14677, "body": "<p>Some signs of addiction are enlarged pupils, increased alertness and energy, loss of interest in food and sleep, increased talkativeness, rapid mood changes, increased heart rate, nasal congestion. You can read about these and other symptoms in the articles <a href=\"https://luxury.rehabs.com/cocaine-addiction/symptoms-and-signs/\" rel=\"nofollow noreferrer\">Cocaine Addiction Signs and Symptoms</a> and <a href=\"https://drugabuse.com/library/cocaine-abuse/\" rel=\"nofollow noreferrer\">Cocaine Abuse</a>.</p>\n", "score": 3 } ]

[ "symptoms", "recreational-drugs", "addiction", "inhalation", "substance-abuse" ]

[ { "answer_id": 16470, "body": "<p><strong>The question,</strong> as I understand it: Should the current recommendations about a low-FODMAP diet, which is also low-prebiotic and thus potentially harmful, be changed?</p>\n\n<p><strong>Short answer:</strong> There is <em>some evidence</em> that a low-FODMAP diet can reduce symptoms in individuals with fructose malabsorption and irritable bowel syndrome but <em>no clear evidence</em> about its harms. So, I don't think the diet should be changed, but some aspects could be reconsidered:</p>\n\n<ul>\n<li>A low-FODMAP diet needs to be only as strict as necessary to prevent symptoms.</li>\n<li>Individuals with IBS should try to treat their problems by solving their psychological issues and not only by a low-FODMAP diet.</li>\n</ul>\n\n<hr>\n\n<p><em>(FODMAPs - Fermentable Oligo-, Di- and Monosaccharides and Polyols include: nondigestible oligosaccharides, lactose, fructose and sugar alcohols - sorbitol, xylitol, etc. From this list, only certain oligosaccharides are considered prebiotics (<a href=\"https://academic.oup.com/jn/article/137/3/830S/4664774\" rel=\"nofollow noreferrer\">article</a>, or directly, <a href=\"https://academic.oup.com/view-large/111067401\" rel=\"nofollow noreferrer\">table 4</a>). Prebiotics are nutrients that promote the growth of beneficial intestinal microbes.)</em></p>\n\n<hr>\n\n<p><em>In certain gastrointestinal conditions, mainly fructose malabsorption, FODMAPs are poorly absorbed in the small intestine, so they reach the large intestine, where they feed normal intestinal bacteria, which produce excessive gas, and also cause osmotic diarrhea. The aim of a low-FODMAP diet is to reduce the feeding of the intestinal bacteria and thus reduce the symptoms.</em></p>\n\n<hr>\n\n<p><strong>EVIDENCE:</strong></p>\n\n<p><strong>1. A low-FODMAP diet can reduce symptoms in fructose malabsorption and IBS.</strong></p>\n\n<p>Most study reviews, including the ones from 2016-2017 linked here, provide some evidence that a low-FODMAP diet decreases symptoms in individuals with fructose malabsorption (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28233394\" rel=\"nofollow noreferrer\">1</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934501/\" rel=\"nofollow noreferrer\">2</a>) and diarrhea-predominant irritable bowel syndrome (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760846/\" rel=\"nofollow noreferrer\">3</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027396/\" rel=\"nofollow noreferrer\">4</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555627/\" rel=\"nofollow noreferrer\">5</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918736/\" rel=\"nofollow noreferrer\">6</a>).</p>\n\n<p><strong>2. A low-FODMAP diet can reduce symptoms in Crohn's disease, but does not likely prevent the disease itself.</strong></p>\n\n<p>A low-FODMAP diet can be used as a temporary measure to reduce symptoms in Crohn's disease (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843040/\" rel=\"nofollow noreferrer\">PMC</a>). <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15948806\" rel=\"nofollow noreferrer\">On the other hand</a>, there is no convincing evidence that this diet decreases the risk of developing Crohn's disease.</p>\n\n<p><strong>3. Is a low-FODMAP diet potentially harmful?</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390324/\" rel=\"nofollow noreferrer\">This</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372955/\" rel=\"nofollow noreferrer\">this</a> review from 2017 raise concern that a low-FODMAP diet may lead to nutrient deficiency and suboptimal intestinal flora and that...more research is needed.</p>\n\n<p><strong>CONCLUSIONS:</strong></p>\n\n<ol>\n<li>Even if there is a lot of evidence that high-fiber diet, which is often also high-prebiotic, can be beneficial for health (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23609775\" rel=\"nofollow noreferrer\">PubMed</a>), there seems to be no clear evidence that a low-FODMAP diet, which is also low-prebiotic, is harmful.</li>\n<li>Every therapeutic approach, including a low-FODMAP diet, is justifiable until the health benefits outweigh the possible harms. For example, in fructose malabsorption, a commonly documented significant reduction in symptoms seems to outweigh theoretically possible but non-documented harms.</li>\n</ol>\n", "score": 5 } ]

[ "fibre", "gut-microbiota-flora", "fodmap" ]

[ { "answer_id": 17539, "body": "<p>Without ultrasound you’d discover by palpation - feeling the abdomen. </p>\n\n<p>Each baby has two poles - the head and the bottom. If you can feel three clearly separate poles there must be at least two babies in there. </p>\n\n<p>It’s difficult to feel 5 poles which would be needed to confirm triplets. </p>\n\n<p>Alternatively, sometimes you can clearly identify poles which are heads - in which case the number of heads you can feel puts a lower bound on the number of babies. </p>\n\n<p>This isn’t a particularly reliable approach - it’s easy to underestimate the number of babies. So multiple babies are often still a surprise if there is no access to imaging. </p>\n", "score": 1 } ]

[ "obstetrics", "medical-history", "ancient-medicine" ]

[ { "answer_id": 14720, "body": "<p>Succinylcholine, or <a href=\"https://en.wikipedia.org/wiki/Suxamethonium_chloride\" rel=\"nofollow noreferrer\">Suxamethonium chloride</a>, is an 'interesting choice' for this kind or purpose.</p>\n\n<p>As a muscle relaxant with a relatively short duration it will paralyse the victim, cause breathing to stop and then death. Depending on dosage and wether your perpetrator carries a breathing apparatus for mechanical ventilation with him.</p>\n\n<p>If the victim remains conscious she will feel extremely helpless and terrified on the psychological side. Physical reactions during or afterwards might include:</p>\n\n<blockquote>\n <ul>\n <li>Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.</li>\n <li>Signs of a high potassium level like a heartbeat that does not feel normal; - change in thinking clearly and with logic; feeling weak, lightheaded, or dizzy; feel like passing out; numbness or tingling; or shortness of breath.</li>\n <li>Slow heartbeat.</li>\n <li>Very bad dizziness or passing out.</li>\n <li>Very bad headache.</li>\n <li>Muscle pain.</li>\n <li>Twitching.</li>\n <li>Not able to pass urine or change in how much urine is passed.</li>\n <li>A heartbeat that does not feel normal.</li>\n <li>Chest pain or pressure.</li>\n <li>More eye pressure.</li>\n <li>Trouble breathing, slow breathing, or shallow breathing.</li>\n <li>This medicine may cause a very bad and sometimes deadly problem called malignant hyperthermia. Call your doctor right away if you have a fast heartbeat, fast breathing, fever, or spasm or stiffness of the jaw muscles.<br>\n (<a href=\"https://www.drugs.com/cdi/succinylcholine.html\" rel=\"nofollow noreferrer\">From: drugs.com/succinylcholine</a> more personal <a href=\"https://www.drugs.com/comments/succinylcholine/for-anesthesia.html\" rel=\"nofollow noreferrer\">\"review\" stories found here</a>)</li>\n </ul>\n</blockquote>\n\n<p>But the fun doesn't stop there. From <br>\n<a href=\"https://www.rxlist.com/anectine-drug.htm\" rel=\"nofollow noreferrer\">Generic Name: succinylcholine chloride\nBrand Name: Anectine:</a></p>\n\n<blockquote>\n <p>The average dose required to produce neuromuscular blockade and to facilitate tracheal intubation is 0.6 mg/kg ANECTINE (succinylcholine chloride) Injection given intravenously. The optimum dose will vary among individuals and may be from 0.3 to 1.1 mg/kg for adults. Following administration of doses in this range, neuromuscular blockade develops in about 1 minute; maximum blockade may persist for about 2 minutes, after which recovery takes place within 4 to 6 minutes. However, very large doses may result in more prolonged blockade. A 5- to 10-mg test dose may be used to determine the sensitivity of the patient and the individual recovery time. […] The dose of succinylcholine administered by infusion depends upon the duration of the surgical procedure and the need for muscle relaxation. The average rate for an adult ranges between 2.5 and 4.3 mg per minute.<br><br>\n SIDE EFFECTS</p>\n \n <p>Adverse reactions to succinylcholine consist primarily of an extension of its pharmacological actions. Succinylcholine causes profound muscle relaxation resulting in respiratory depression to the point of apnea; this effect may be prolonged. Hypersensitivity reactions, including anaphylaxis, may occur in rare instances. The following additional adverse reactions have been reported: cardiac arrest, malignant hyperthermia, arrhythmias, bradycardia, tachycardia, hypertension, hypotension, hyperkalemia, prolonged respiratory depression or apnea, increased intraocular pressure, muscle fasciculation, jaw rigidity, postoperative muscle pain, rhabdomyolysis with possible myoglobinuric acute renal failure, excessive salivation, and rash.</p>\n \n <p>There have been post-marketing reports of severe allergic reactions (anaphylactic and anaphylactoid reactions) associated with use of neuromuscular blocking agents, including ANECTINE (succinylcholine chloride) . These reactions, in some cases, have been life-threatening and fatal. Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency</p>\n \n <p><strong>WARNINGS</strong></p>\n \n <p>SUCCINYLCHOLINE SHOULD BE USED ONLY BY THOSE SKILLED IN THE MANAGEMENT OF ARTIFICIAL RESPIRATION AND ONLY WHEN FACILITIES ARE INSTANTLY AVAILABLE FOR TRACHEAL INTUBATION AND FOR PROVIDING ADEQUATE VENTILATION OF THE PATIENT, INCLUDING THE ADMINISTRATION OF OXYGEN UNDER POSITIVE PRESSURE AND THE ELIMINATION OF CARBON DIOXIDE. THE CLINICIAN MUST BE PREPARED TO ASSIST OR CONTROL RESPIRATION.</p>\n \n <p>TO AVOID DISTRESS TO THE PATIENT, SUCCINYLCHOLINE SHOULD NOT BE ADMINISTERED BEFORE UNCONSCIOUSNESS HAS BEEN INDUCED. IN EMERGENCY SITUATIONS, HOWEVER, IT MAY BE NECESSARY TO ADMINISTER SUCCINYLCHOLINE BEFORE UNCONSCIOUSNESS IS INDUCED.</p>\n \n <p>SUCCINYLCHOLINE IS METABOLIZED BY PLASMA CHOLINESTERASE AND SHOULD BE USED WITH CAUTION, IF AT ALL, IN PATIENTS KNOWN TO BE OR SUSPECTED OF BEING HOMOZYGOUS FOR THE ATYPICAL PLASMA CHOLINESTERASE GENE.</p>\n</blockquote>\n\n<p>In conclusion: this will not work very well. Relatively safe and effective in the hands of experts and the right setting, in a criminal plan this will lead to disaster if the plan didn't involve sending the kidnapping victim <a href=\"https://www.gizmodo.com.au/2012/05/the-history-of-sux-the-worlds-most-discrete-murder-weapon/\" rel=\"nofollow noreferrer\">back in pieces</a> from the start. If you insist on using this drug: for similar effects you might look at curare's effects, which might be easier to come by.</p>\n", "score": 3 } ]

[ "drug-interactions", "unconsciousness" ]

[ { "answer_id": 17877, "body": "<p><strong>Essential nutrient</strong> means any substance normally consumed as a constituent of food which is <em>needed for growth and development and/or the maintenance of life</em> and which cannot be synthesized in adequate amounts by the body (<a href=\"http://www.fao.org/fao-who-codexalimentarius/sh-proxy/jp/?lnk=1&amp;url=https%253A%252F%252Fworkspace.fao.org%252Fsites%252Fcodex%252FStandards%252FCAC%2BGL%2B9-1987%252FCXG_009e_2015.pdf\" rel=\"nofollow noreferrer\">fao.org</a>).</p>\n\n<p><strong>Dietary fiber</strong> does not meet the criteria of being needed for life/growth, so, strictly speaking, it is not an essential nutrient. Anyway, according to some authors \"dietary fiber is essential for a healthy diet\" (<a href=\"https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983\" rel=\"nofollow noreferrer\">Mayo Clinic</a>), for example, insoluble fiber may help maintain bowel regularity and soluble fiber may contribute to intestinal health and lower cholesterol levels. Fiber may also slow down digestion and thus help to control blood sugar levels (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883628/\" rel=\"nofollow noreferrer\">PubMed</a>).</p>\n\n<p><strong>Inuits</strong> do not eat only meat but also plant foods, such as berries, tubers, roots, seaweed...(<a href=\"https://en.wikipedia.org/wiki/Inuit_cuisine\" rel=\"nofollow noreferrer\">Wikipedia: Inuit Cuisine</a>) and, according to the documentary The Last Ice Hunters, some commercial food delivered from Denmark.</p>\n\n<p>Results of <a href=\"http://www.jbc.org/content/87/3/651.full.pdf\" rel=\"nofollow noreferrer\">a 1930 experiment</a>, in which 2 men were eating exclusively meat (no plant food and hence no fiber) for a year:</p>\n\n<blockquote>\n <p>At the end of the year, the subjects were mentally alert, physically\n active, and showed no specific physical changes in any system of the\n body. </p>\n \n <p>The control of the bowels was not disturbed...</p>\n \n <p>...the clinical observations and laboratory studies gave no evidence\n that any ill effects had occurred...</p>\n</blockquote>\n\n<p>From this very small experiment it is not possible to reliably predict long-term effects of lack of fiber in humans, though.</p>\n\n<p><strong>Conclusion:</strong> While not essential for life, fiber can be good for health, <em>especially for bowel regularity.</em></p>\n", "score": 5 } ]

[ "diet", "digestion", "fibre", "meat", "indigestion" ]

[ { "answer_id": 14947, "body": "<p><em>Disclaimer : I am not a <s>lawyer</s> biologist, please consider my interpretations with caution.</em></p>\n\n<p>Note that <a href=\"https://biology.stackexchange.com/questions/69413/how-much-does-sprayed-water-remove-bacteria/69536#69536\">plain water by itself wash a large amount of bacteria</a>, especially when coupled with rubbing — and a shower usually lasts much longer than 15 s. There may be significant differences between the adhesion of bacteria tested in these studies and bacteria of the skin flora, though. (Or it may imply that antibacterial soaps only have a small effect, hence the mitigate results reported below.)</p>\n\n<p>Anyway, <em><a href=\"http://onlinelibrary.wiley.com/book/10.1002/9781118025338\" rel=\"nofollow noreferrer\">Innate Immune System of Skin and Oral Mucosa</a></em> (Nava Dayan &amp; Philip W. Wertz, 2011) provides interesting informations on the effects of antibacterial soaps. I don't have access to the full book (and to its bibliography neither) but found the following extracts <a href=\"https://books.google.fr/books?id=cjUWuvBkg2wC\" rel=\"nofollow noreferrer\">on google books</a>.</p>\n\n<p>The section</p>\n\n<blockquote>\n <h2>5.3 PROTECTIVE ROLE OF RESIDENT MICROFLORA</h2>\n</blockquote>\n\n<p>Contains a cautious consideration :</p>\n\n<blockquote>\n <p>This protective role of normal flora suggests that an excessive use of antimicrobial skin cleansers because of not exhibiting a selective mode of action may make the skin vulnerable to infection by more hostile Gram-negative bacteria rather than protecting it [43-45].</p>\n</blockquote>\n\n<p>The following section is of particular interest (I had only access to pages 96-97, though) :</p>\n\n<blockquote>\n <h2>5.6 EFFECTS OF SKIN-CLEANSING PRODUCTS ON SKIN MICROFLORA AND SKIN IMMUNITY</h2>\n</blockquote>\n\n<p>About skin flora population :</p>\n\n<blockquote>\n <p>A comparative study on the effects of antibacterial deodorant soap containing triclocarban versus a plain soap on the skin flora found no significant difference in total colony counts [192]. However, more <em>S. epidermidis</em> was observed with plain soap, while washing with deodorant soap resulted in higher colonization of <em>Acinetobacter calcoaceticus</em> and <em>Micrococcus luteus</em>.</p>\n</blockquote>\n\n<p>A latter sentence about another soap using the same antibacterial seems to contradict the above observation (maybe because of different settings or concentrations ?), though :</p>\n\n<blockquote>\n <p>Both antibacterial soaps showed significant reductions in the skin flora</p>\n</blockquote>\n\n<p>About microbiota regeneration :</p>\n\n<blockquote>\n <p>These observations may indicate that mere washing of skin with plain or antibacterial soap does not disturb or alter the bacterial population in any significant way. Antimicrobials may cause reduction in the density of the skin flora for a short duration, and the skin flora tend to regrow to the previous level within 24-48 h.</p>\n</blockquote>\n\n<p>About invasion of pathogenic bacteria :</p>\n\n<blockquote>\n <p>There are also some misconceptions that regular use of antibacterial soap would lead to sterile condition and increase the risk of invasion by pathogenic organisms. […] [As of 2011] no evidence exists that the use of antimicrobial products may alter the ecology of resident skin bacteria that would lead to the overgrowth of pathogenic bacteria [185]. </p>\n</blockquote>\n\n<p>About resistance against antibiotics : [<strong>beware, likely outdated information, see DoctorWhom's comments</strong> — I'll edit with more details when I find some time to dig this topic]</p>\n\n<blockquote>\n <p>Does the regular use of antibacterial soap by general population could lead [sic] to the emergence of resistant pathogens ? This issue has been widely debated in the scientific community [166-169]. [As of 2011] there has been no evidence of the development of cross-resistance to antibiotics due to the use of antibacterial wash products in the community [170-171].</p>\n</blockquote>\n\n<p><strong>Last but not least</strong>, I guess details are on a page I don't have access to but the authors state that</p>\n\n<blockquote>\n <p>the use of antimicrobials may induce irritant and allergic contact dermatitis in some users</p>\n</blockquote>\n\n<p>Finally, I guess this quote is a good summary of the state-of-art on the topic as of 2011 :</p>\n\n<blockquote>\n <p>Clearly, more work would be needed to clearly understand the effect of long-term usage of antimicrobial-containing skin cleansers on skin microbiota.</p>\n</blockquote>\n\n<p>However, the question is not about antibacterial soaps, but about antibacterial <em>water</em>. During a shower, soap is generally applied only for a few seconds on the skin before being rinsed. On the other hand, the skin is typically exposed to water during more or less 10 minutes, which is <strong>about 60 times longer</strong>. Assuming a similar antibacterial power, the effects of antibacterial water would be much larger than those of antibacterial soaps (all other things being equal, e.g. rubbing).</p>\n\n<p>It would therefore probably be safer to avoid showering with such water.</p>\n", "score": 1 }, { "answer_id": 14948, "body": "<p>Routinely killing your skin microbiota is indeed a bad idea. Using &quot;germicidal water&quot; as the usual shower water would do just that and very likely cause more problems than it should like to solve.</p>\n<p>However, looking at the &quot;device&quot;, a seemingly simple shower head's description:</p>\n<blockquote>\n<ul>\n<li>Transforms tap water into energized &amp; ionized water. Get unlimited ionized water from faucets .</li>\n<li>Sanitizing* ability to help remove and separate harmful materials</li>\n<li>3rd Prize in 2010 Korean Invention Patent Conference with Korea &amp; World Patent</li>\n<li>Easy to install on all faucets, No Maintenance Costs, Semi-permanent use</li>\n<li>Helps remove free radicals, rancid smell, dirt, pollutants, skin problems</li>\n</ul>\n<p>Multi-Ionizer SH is an anion high pressure handheld shower head. The energized and ionized water effectively removes dirt, oil, dust, contaminants and oxidized materials. It helps to clean and energize your whole body and removes dead skin cells. It produces more than 200,000 negative ions per cc while Yosemite waterfall produces 100,000 anions per cc. You can enjoy highly refreshing shower. Ionized water from Multi-ionizer also has a sanitizing effect as it kills over 99.9%* of most non-tough, non aquatic harmful bacteria(E. coli , E. coli O157:H7, Salmonella, VRE), which helps to remove rancid odors. *When used as directed. See Directions for Use. *Directions For Use 1. For Sanitizing: Spray fresh ionized water on nonporous hard surfaces for 10 seconds and then wipe the surface completely dry with a clean cloth to kill over 99.9% of most non-tough, non-aquatic harmful bacteria (E. coli , E. coli O157:H7, Salmonella, VRE) . Use only freshest ionized water. . 2. For Cleaning: Use fresh ionized water on nonporous hard surfaces such as stainless steels, glasses, coppers, ceramics, marbles etc as a general purpose cleaner (chemical free). To clean porous soft surfaces such as plastics, clothes, rubber etc, use detergent by up to 20 % of normal usage for best cleaning results. To remove old or oily or stubborn dirt, a bit of detergent can be used with a soft brush and then spray ionized water.</p>\n<p>(Quotes from two selling places on the net)</p>\n</blockquote>\n<p>This is quite unclear in how this supposed to work and even though there appears to be an <a href=\"https://www.arirangion.com.hk/images/report/emsl_full_report.pdf\" rel=\"nofollow noreferrer\">analytical report</a>, prizes and patents awarded, this does actually mean nothing. Nothing good.</p>\n<p>How is this <em>supposed</em> to work? There is no energy source, no consumables to replace in this shower head.<br>\nThe comparison with <a href=\"https://en.wikipedia.org/wiki/Yosemite_Falls\" rel=\"nofollow noreferrer\">Yosemite Falls</a> is interesting. A <a href=\"http://www.atmos-chem-phys.net/12/3687/2012/acp-12-3687-2012.pdf\" rel=\"nofollow noreferrer\">natural waterfall is claimed to provide half the effect</a> of this product? What would be the result of comparing this product with an ordinary shower head? Is the water from the waterfall germicidal?</p>\n<p>Well, water is known to dilute bacteria and also removes quite some smells. And this effect is greatly enhanced if you do what you apparently always do when showering: &quot;use detergent by up to 20 % of normal usage for best cleaning results.&quot;</p>\n<p>This may be a shower head with a good internal design. Without a sound explanation of the functional principles or any proof provided by manufacturer or sellers that all these effects are really there to observe: one of many bogus\nproducts on the market. Although ironically it is probably not so harmful to your skin, compared to normal water from other shower heads, since it just will not work as advertised.</p>\n", "score": 1 } ]

[ "water", "bacteria" ]

[ { "answer_id": 15026, "body": "<p>When reading radiographs in human health, the x-rays are read as though facing the patient. So, when you have a PA chest x-ray ( or dorsoventral view for a dog ) the x-rays enter the posterior surface, exit the anterior surface to hit the imaging surface. This used to be x-ray film. So, the right side of the chest appears on the right of the film, and the left side on the left. But the sides are switched so you actually read the films as though looking from the anterior side of the patient i.e. facing the patient.</p>\n\n<p>When taking an AP film, the patient is positioned so that the posterior surface is now closest to the film, and the patient's left is on the left of the film. And that's the way the film is read, from the front.</p>\n\n<p>I've noticed some DV images of animals are not switched so that the R is on the left but apparently most are. But I'm guessing that vets also read DV and VD images of the thorax as though facing the ventral surface.</p>\n\n<p>BTW, when taking horizontal or transverse CT slices through the human thorax, the view shown is that from caudal to cranial, i.e. looking upwards to the head.</p>\n\n<p><a href=\"https://www.radiologymasterclass.co.uk/tutorials/chest/chest_quality/chest_xray_quality_projection\" rel=\"nofollow noreferrer\">https://www.radiologymasterclass.co.uk/tutorials/chest/chest_quality/chest_xray_quality_projection</a></p>\n\n<p>And here's an <a href=\"https://www.bcftechnology.com/veterinary-learning/small-animal-learning/head/skull-dorsoventral-canine-x-ray-positioning-guide/\" rel=\"nofollow noreferrer\">example of a canine head using the DorsoVentral positioning</a></p>\n\n<p><a href=\"https://i.stack.imgur.com/lJ4uS.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/lJ4uS.png\" alt=\"doggie head positioning\"></a></p>\n\n<p><a href=\"https://i.stack.imgur.com/7SlwG.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/7SlwG.png\" alt=\"DV canine head\"></a></p>\n\n<p>and you can see that the image is not reversed which I presume is because this is the normal way to read these type of images.</p>\n\n<p>TL;DR - it's a convention used to reduce cognitive loading on radiologists.</p>\n", "score": 4 }, { "answer_id": 15213, "body": "<p>Think about it as a mirror. If I a-ray all the teeth for example. That means I mirror the mouth to the sheet. Now when I read the paper I need to invert the paper and look at it. The right side was ascribed on the right side and the left on the left of the paper. Once inverted the sides take a flip. I am gonna see the right side on the left and the left on the right. The key is to think about it as mirroring the picture and then you gotta switch it to view the picture.</p>\n", "score": 0 } ]

[ "x-rays" ]

[ { "answer_id": 15043, "body": "<p>In the American system of Dentistry, there are three levels:</p>\n\n<blockquote>\n <ul>\n <li>Dentist</li>\n <li>Orthodontist</li>\n <li>Board Certified Orthodontist</li>\n </ul>\n</blockquote>\n\n<p>This is visually demonstrated by the ABO <a href=\"https://www.americanboardortho.com/general-public/what-is-a-board-certified-orthodontist/\" rel=\"noreferrer\">here</a>.</p>\n\n<p>Dentists have passed sufficient tests to qualify for <a href=\"http://www.ada.org/en\" rel=\"noreferrer\">ADA</a> membership. This is about 160,000 members in the USA.</p>\n\n<p>Orthodontists have passed sufficient tests to qualify for <a href=\"https://www.aaoinfo.org/1/about\" rel=\"noreferrer\">AAO</a> membership, which includes about 19,000 members.</p>\n\n<p>Once you have passed these tests, you can voluntarily study and take exams offered by the <a href=\"https://www.americanboardortho.com\" rel=\"noreferrer\">ABO</a>, which need renewing every 10 years.</p>\n\n<p>The ABO is recognized by both the ADA and AAO (in fact it is their <em>only</em> recognized orthodontic board). About 150 members became Board Certified, or renewed, in <a href=\"https://www.americanboardortho.com/media/5190/abo-announces-newly-certified-or-recertified-orthodontists-september-2017-examination.pdf\" rel=\"noreferrer\">September 2017</a>.</p>\n\n<p>Just for reference, they have a Facebook page:</p>\n\n<ul>\n<li><a href=\"https://www.facebook.com/pg/American-Board-of-Orthodontics-409192062500370/about/?ref=page_internal\" rel=\"noreferrer\">Facebook</a></li>\n</ul>\n\n<p>and provide a list of questions to ask your potential orthodontist:</p>\n\n<ul>\n<li><a href=\"https://www.americanboardortho.com/general-public/how-to-choose-an-orthodontist/what-to-ask-before-you-choose/\" rel=\"noreferrer\">Questions</a></li>\n</ul>\n", "score": 5 }, { "answer_id": 16464, "body": "<p>AAO: is just an association that almost all ortho's belong to by default. ABO: is a board certification status that indicates that the doctor has gone through the optional process to become a diplomate of the ABO. Most ABO certified doc's are going to be very good. Doc's that are not ABO certified are by no means inferior, they have just not gone through the process yet. You cannot really use AAO/ABO as an accurate way to decide if a doctor is better than another doctor.</p>\n", "score": 0 } ]

[ "dentistry" ]

[ { "answer_id": 15095, "body": "<p>As you've stated BID = bis in die = twice a day. \nAccording to a standard dosage sheet from the University of Florida, BID = every 12 hours. </p>\n\n<p>However, I was reading a forum for nurses [See References] and there seems to be variations on BID (roughly 8-12 hours apart) depending on the hospital. </p>\n\n<p>If possible, contact your nurse/physician for the clearest clarification. </p>\n\n<hr>\n\n<p>References:</p>\n\n<p>University of Florida Standards:\n<a href=\"http://professionals.ufhealth.org/files/2011/11/1007-drugs-therapy-bulletin.pdf\" rel=\"noreferrer\">http://professionals.ufhealth.org/files/2011/11/1007-drugs-therapy-bulletin.pdf</a></p>\n\n<p>Forum: \n<a href=\"http://allnurses.com/first-year-after/bid-strictly-every-795661.html\" rel=\"noreferrer\">http://allnurses.com/first-year-after/bid-strictly-every-795661.html</a></p>\n", "score": 7 } ]

[ "dosage" ]

[ { "answer_id": 15111, "body": "<p>Yes: muscle tissue is denser than adipose tissue:</p>\n\n<ul>\n<li>Adipose tissue has a density of ~0.9 g/ml</li>\n<li>Skeletal tissue has a density of ~1.06 g/ml</li>\n</ul>\n\n<p>_{<a href=\"https://en.wikipedia.org/wiki/Adipose_tissue#Physical_properties\" rel=\"nofollow noreferrer\">Source: Wikipedia</a>; with references to the scientific literature.}</p>\n\n<p>This means that, per volume, skeletal muscles weigh more than fat. However, skeletal muscle (which you gain by exercising) only contributes a fraction to the overall lean body mass. Another substantial contributor is water, and the amount of water in the body varies drastically.</p>\n\n<p>To quote <a href=\"https://inbodyusa.com/blogs/inbodyblog/45434945-lean-body-mass-and-muscle-mass-whats-the-difference\" rel=\"nofollow noreferrer\">“InBody”</a>:</p>\n\n<blockquote>\n <ul>\n <li>Lean Mass gains, when they do occur, are largely increases in body water</li>\n <li>It’s difficult to say with any certainty how much any Lean Body Mass increase is due to Skeletal Muscle Mass without using sophisticated tools</li>\n </ul>\n</blockquote>\n\n<p>And they have bad news for you:</p>\n\n<blockquote>\n <p><strong>[Do] not try to use a scale to measure changes in Lean Body Mass or Skeletal Muscle Mass.</strong> It’s impossible […]</p>\n</blockquote>\n\n<p>You should therefore track your exercise progress differently. As for tracking the progress of your diet, it may seem tempting to measure body fat percentage. Unfortunately this <em>also</em> requires sophisticated tools: those home-use scales that give you body fat estimates <a href=\"https://www.consumerreports.org/body-fat-scales/body-fat-scale-review/\" rel=\"nofollow noreferrer\">are unreliable</a>.</p>\n", "score": 2 } ]

[ "weight-loss", "weightlifting" ]

[ { "answer_id": 15175, "body": "<p>I asked a couple of medical doctors about this and they said a rabies vaccine was not necessary. The rabies vaccine is indicated for people at high risk of exposure to the rabies virus such as researchers working with rabies, veterinarians, and animal control personnel. </p>\n\n<p>They do however recommend staying current with tetanus vaccines as an outdoor cat could possibly pick up some of the bacteria that causes tetanus in their claws and possibly transmit it to a person if they scratch them.</p>\n", "score": 3 }, { "answer_id": 15174, "body": "<p>Based on data of the <a href=\"https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html\" rel=\"nofollow noreferrer\">Center for Disease Control and Prevention</a>, the number of annual human fatalities due to rabies is less than 5 in the entire US. Thus, that put the chances to much less than 1% for a family of 5 over 10 years. So, I conclude it does not seem to be worth having the pre-exposure vaccination in abundance of caution. </p>\n", "score": 0 } ]

[ "vaccination" ]

[ { "answer_id": 15193, "body": "<p>The WHO put out <a href=\"https://www.reuters.com/article/us-japan-nuclear-cancer/higher-cancer-risk-after-fukushima-nuclear-disaster-who-idUSBRE91R0D420130228\" rel=\"nofollow noreferrer\">a statement</a> in February 2013 addressing the health risks. Certain groups of people got fairly high doses of radiation:</p>\n\n<blockquote>\n <p>Apart from emergency workers, the most affected people were those who\n remained in some highly contaminated towns and villages to the\n northwest of the power station for up to four months before\n evacuation.</p>\n</blockquote>\n\n<p>These people will experience health risks, including increased risks of thyroid cancer:</p>\n\n<blockquote>\n <p>The WHO estimated that there was a 70 percent higher risk of females\n exposed as infants developing thyroid cancer over their lifetime...\n The radiation exposure means about 1.25 out of every 100 girls in the\n area could develop thyroid cancer over their lifetime, instead of the\n natural rate of about 0.75 percent.</p>\n</blockquote>\n\n<p>And other cancers:</p>\n\n<blockquote>\n <p>In the most contaminated area there was a 7 percent higher risk of\n leukemia in males exposed as infants, and a 6 percent higher risk of\n breast cancer in females exposed as infants. Overall, girls had a 4\n percent increased risk of developing solid cancers.</p>\n</blockquote>\n\n<p>However, <strong>outside of those high-risk groups of people, risk is minimal:</strong></p>\n\n<blockquote>\n <p>There was no discernible increase in health risks expected outside\n Japan, the WHO said in a 200-page report which was based on an\n assessment by international experts.</p>\n \n <p>“In the rest of Fukushima prefecture and in particular neighboring\n countries and the rest of the world, the estimated increased cancer\n risk is negligible. It’s within the variation of normal background\n rates,” said Angelika Tritscher, acting director of WHO’s department\n of food safety.</p>\n</blockquote>\n", "score": 3 } ]

[ "risks", "nuclear-radiation" ]

[ { "answer_id": 15225, "body": "<p>Not necessarily.</p>\n\n<p>Here are <a href=\"https://emedicine.medscape.com/article/1836438-overview?pa=HiQh5%2FEf9UfE%2FN54Y3TCs0Z6PTqz0I3hWUnwiLVCL06qCBUyPbH5dZwNG0PX6d%2FiNFsYxDuz%2Fz2hge3aAwEFsw%3D%3D\" rel=\"noreferrer\">some examples</a> that aren't good candidates for closing with sutures:</p>\n\n<ul>\n<li>A wound that is much wider than it is deep-- a bad road rash abrasion, for example. </li>\n<li><p>A wound with extremely fragile or messy margins (I treated a patient a few weeks ago whose food processor turned on while her hand was in there scooping food out).</p></li>\n<li><p>A wound that has lots of dead tissue (such as when there is a flap of skin with poor blood supply)</p></li>\n<li><p>A very dirty or contaminated wound (for example a cat bite, which is deep and filled with bacteria).</p></li>\n</ul>\n\n<p>These wounds are not amenable to suturing, aka <a href=\"https://emedicine.medscape.com/article/1836438-overview?pa=HiQh5%2FEf9UfE%2FN54Y3TCs0Z6PTqz0I3hWUnwiLVCL06qCBUyPbH5dZwNG0PX6d%2FiNFsYxDuz%2Fz2hge3aAwEFsw%3D%3D\" rel=\"noreferrer\">closing via primary intention.</a> Instead, they are allowed to close via secondary intention, which essentially means heal on its own.</p>\n\n<p>For wounds that should be sutured, there are <a href=\"https://www.doctors.net.uk/_datastore/ecme/mod1226/Suture%20Evidence%20Based%20Review_for%20proofreading_revised.pdf\" rel=\"noreferrer\">many techniques</a> that allow you to closely appose irregular wound margins.</p>\n", "score": 7 } ]

[ "surgery", "sutures" ]

[ { "answer_id": 15351, "body": "<p>Well I have successfully used a precordial thump to cardiorevert someone but that was long before we had things such as guidelines. And a crash cart was close by.</p>\n\n<p>It is thought that it should only be used when witnessing the onset of ventricular fibrillation or pulseless ventricular tachycardia but it also has the unfortunate possibility of converting that rhythm to a more lethal rhythm such as asystole. But one study showed it worked the best in asystole. Presumably because it can't get worse.</p>\n\n<p>The energy delivered by a thump in the correct location is about 5 Joules compared with e.g. 300 Joules from a defibrillator. </p>\n\n<p>The number needed to treat is 13-50, but the numbers needed to make the rhythm worse is 2-10. So the patient will be better off statistically if you don't employ this technique.</p>\n\n<p><a href=\"https://canadiem.org/the-precordial-thump-good-bad-or-ugly/\" rel=\"nofollow noreferrer\">https://canadiem.org/the-precordial-thump-good-bad-or-ugly/</a></p>\n", "score": 3 } ]

[ "cardiac-arrest" ]

[ { "answer_id": 15518, "body": "<p>Clearly if there's a risk of fire, then giving oxygen outside the hospital risks fire. And in neonates, high flow oxygen can cause oxygen toxicity.</p>\n<p>If there is no such risk, then the main objection is that by removing the hypoxic respiratory drive in patients with hypercapnic respiratory failure the patient then stops breathing.</p>\n<blockquote>\n<p>The risks of oxygen therapy are oxygen toxicity and carbon dioxide narcosis. Pulmonary oxygen toxicity rarely occurs when a fractional concentration of oxygen in inspired gas (FiO2) lower than 0.6 is used; therefore, an attempt to lower the inspired oxygen concentration to this level should be made in critically ill patients.</p>\n<p>Carbon dioxide narcosis occasionally occurs when some patients with hypercapnia are given oxygen to breathe. Arterial carbon dioxide tension (PaCO2) increases sharply and progressively with severe respiratory acidosis, somnolence, and coma. The mechanism is primarily the reversal of pulmonary vasoconstriction and the increase in dead space ventilation.</p>\n</blockquote>\n<p><a href=\"https://emedicine.medscape.com/article/167981-treatment\" rel=\"nofollow noreferrer\">https://emedicine.medscape.com/article/167981-treatment</a></p>\n<p>With particular reference to those prone to respiratory failure, the <a href=\"http://thorax.bmj.com/content/thoraxjnl/63/Suppl_6/vi1.full.pdf\" rel=\"nofollow noreferrer\">BTS 2008 guidelines</a> state</p>\n<blockquote>\n<p>Some patients with COPD and other conditions are\nvulnerable to repeated episodes of hypercapnic respiratory\nfailure. In these cases it is recommended that treatment\nshould be based on the results of previous blood gas\nestimations during acute exacerbations because hypercapnic\nrespiratory failure can occur even if the saturation is\nbelow 88%. For patients with prior hypercapnic failure\n(requiring non-invasive ventilation or intermittent positive\npressure ventilation) who do not have an alert card, it is\nrecommended that treatment should be commenced using\na 28% Venturi mask at 4 l/min in prehospital care or a 24%\nVenturi mask at 2–4 l/min in hospital settings with an\ninitial target saturation of 88–92% pending urgent blood\ngas results. These patients should be treated as a high\npriority by emergency services and the oxygen dose should\nbe reduced if the saturation exceeds 92%. [Grade D]</p>\n</blockquote>\n", "score": 3 }, { "answer_id": 15563, "body": "<p>In addition to circumstances where an oxygen source would itself be a hazard for external reasons, and in those with chronic type 2 respiratory failure as pointed out <a href=\"https://health.stackexchange.com/a/15518/8653\">in Graham Chie's answer</a>; there is a move away from providing supplementary O₂ in those with myocardial infarction (in line with <a href=\"https://clinicaltrials.gov/show/NCT01272713\" rel=\"nofollow noreferrer\">AVOID</a>, which assessed both pre- and in-hospital supplementation, and <a href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1706222\" rel=\"nofollow noreferrer\">DETO2X-AMI</a>)</p>\n\n<p>In an update to the <a href=\"https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/2017-emergency-oxygen-guideline/bts-guideline-for-oxygen-use-in-adults-in-healthcare-and-emergency-settings/\" rel=\"nofollow noreferrer\">BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings</a> (July 2017), this is stated as:</p>\n\n<blockquote>\n <p>Myocardial infarction and acute coronary\n syndromes </p>\n \n <p>Most patients with acute coronary artery syndromes are not hypoxaemic and the benefits/harms of oxygen therapy are unknown in such cases. <strong>Unnecessary use of high concentration oxygen may increase infarct size</strong>.</p>\n</blockquote>\n\n<p>-- Table 3, <em>Conditions for which patients should be monitored closely but oxygen therapy is not required unless the patient is hypoxaemic</em>; emphasis mine.</p>\n\n<p>Other conditions listed in this table include:</p>\n\n<ul>\n<li><strong>stroke</strong> (\"Most patients with stroke are not hypoxaemic. Oxygen therapy may be harmful for non-hypoxaemic patients with mild–moderate strokes\")</li>\n<li><strong>Hyperventilation or dysfunctional breathing</strong></li>\n<li><strong>Most poisonings and drug overdoses</strong></li>\n<li><strong>Poisoning with paraquat or bleomycin</strong> (\"Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen.\")</li>\n<li><strong>Metabolic and renal disorders</strong></li>\n<li><strong>Acute and subacute neurological and muscular\nconditions producing muscle weakness</strong></li>\n<li><strong>Pregnancy and obstetric emergencies</strong> (\"Oxygen therapy may be harmful to the fetus if the mother is not hypoxaemic\")</li>\n</ul>\n\n<p>(<em>I have included rationale where potential harm could be considered a contraindication</em>)</p>\n\n<p>Of course, not all of these are necessarily going to be offered supplementary oxygen <em>outside</em> of a hospital setting.</p>\n\n<p>This guideline does apply to paramedics and other out-of-hospital users:</p>\n\n<blockquote>\n <p><strong>1.2 Intended users of the guideline and target patient\n populations</strong></p>\n \n <p>This guideline is mainly intended for use by all healthcare professionals\n who may be involved in emergency oxygen use. This will include ambulance staff, first responders, paramedics, doctors, nurses, midwives, physiotherapists, pharmacists and all other healthcare professionals who may deal with ill or breathless patients.</p>\n</blockquote>\n", "score": 3 } ]

[ "emergency", "oxygenation" ]

[ { "answer_id": 15566, "body": "<p>The issue is that antibiotics are not without side effects and the use of most antibiotics carry a risk for developing <a href=\"https://www.jwatch.org/na31482/2013/06/24/antibiotic-classes-and-risk-clostridium\" rel=\"nofollow noreferrer\">Clostridium Difficile</a>. If you take more than one class of antibiotic, your risk increases based on the risk associated with the second antibiotic if not more.</p>\n\n<p>Furthermore, there's the <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831151/\" rel=\"nofollow noreferrer\">deleterious effect</a> on the human biome when using antibiotic therapy in the first place:</p>\n\n<blockquote>\n <p>Mounting evidence shows that antibiotics influence the function of the immune system, our ability to resist infection, and our capacity for processing food. Therefore, it is now more important than ever to revisit how we use antibiotics.</p>\n</blockquote>\n\n<p>On the other hand, certain bacterial infections are known to develop resistance during the course of treatment, and that's why current antituberculosis therapy uses 4 drugs concurrently.</p>\n\n<blockquote>\n <p>Given the complications observed in treatment with streptomycin and the efficacy observed for both streptomycin and PAS individually, the MRC decided to extend their first RCT to include the first combination antimicrobial regimen using both of these agents. In this new trial, the MRC found that, in contrast to streptomycin monotherapy, which yielded streptomycin resistance in 70% of cases after 120 days, combination therapy yielded streptomycin resistance in at most 9% of cases and in 0% of cases in regimens with intermittent streptomycin administration every 3 days </p>\n</blockquote>\n\n<p><a href=\"http://mbio.asm.org/content/8/2/e01586-16.full\" rel=\"nofollow noreferrer\">http://mbio.asm.org/content/8/2/e01586-16.full</a></p>\n", "score": 4 } ]

[ "antibiotics" ]

[ { "answer_id": 15668, "body": "<p><strong>Previous</strong> estimates were at 1 in a 1000 patients (1‰) suffer from intraoperative awareness:</p>\n<blockquote>\n<p>The medical literature suggests that in- traoperative awareness with recall while under general anesthesia may occur to some degree at a frequency of approximately 1 – 2 in 1,000 anesthetics. Most patients experiencing intraoperative awareness do not feel any pain.</p>\n<p>^{Source: American Association of Nurse Anaesthetists, <a href=\"https://www.aana.com/docs/default-source/pr-aana-com-web-documents-(all)/patients/awareness_brochure0110.pdf?sfvrsn=801d49b1_4\" rel=\"nofollow noreferrer\">Patient Awareness Brochure</a>.}</p>\n</blockquote>\n<p>However, the 5th National Audit Project (NAP5) conducted a study on accidental awareness during general anaesthesia in 2014 <a href=\"https://www.sciencedaily.com/releases/2014/09/140915114534.htm\" rel=\"nofollow noreferrer\">with the largest test group so far</a> <strong>found that incidents were as low as 1 in 19.000 cases</strong>. This huge project has been compiled into a book (with the chapters available as PDF here), below are just some extracts:</p>\n<blockquote>\n<p><a href=\"https://i.stack.imgur.com/3SFVr.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/3SFVr.png\" alt=\"enter image description here\" /></a>\n^{<em>Source:</em> <em>5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland</em>: <a href=\"http://www.nationalauditprojects.org.uk/NAP5report\" rel=\"nofollow noreferrer\">Accidental Awareness during General Anaesthesia in the United Kingdom and Ireland.</a> <strong>Report and findings of the 5th National Audit Project</strong>, Chapter 6, p. 40. 2014}</p>\n</blockquote>\n<p>However, not all incidents were accompanied with pain or distress:</p>\n<blockquote>\n<p>The proportion of patients judged to have experienced distress at the time of the AAGA increased with Michigan score (Figure 7.5): distress was most common when pain and paralysis were experienced together, with 17 of 22 patients reporting distress (77%).\n<a href=\"https://i.stack.imgur.com/Q7Jhj.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Q7Jhj.png\" alt=\"enter image description here\" /></a></p>\n<p>^{<em>Source:</em> <em>5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland</em>: <a href=\"http://www.nationalauditprojects.org.uk/NAP5report\" rel=\"nofollow noreferrer\">Accidental Awareness during General Anaesthesia in the United Kingdom and Ireland.</a> <strong>Report and findings of the 5th National Audit Project</strong>, Chapter 7, p. 51. 2014}</p>\n</blockquote>\n<p>This means that of the on-average 0.0051% cases of AAGA, only 77% reported distress, and of those 77%, 80% experienced pain and paralysis, the sort of locked-in-experience that is presented in most newspapers.</p>\n<p>The actual chance of such a locked-in-experience is thus 0.0031%.</p>\n<p>As a comparison, below is a table of risks of lifetime-death by cause.\n<a href=\"https://i.stack.imgur.com/1pRKy.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/1pRKy.png\" alt=\"enter image description here\" /></a></p>\n<p>^{Values taken from: <strong>National Safety Council</strong>, <a href=\"http://www.nsc.org/learn/safety-knowledge/Pages/injury-facts-chart.aspx\" rel=\"nofollow noreferrer\">What Are the Odds of Dying From...</a>, 2017. nsc.org.}</p>\n", "score": 3 } ]

[ "surgery", "anesthesia" ]

[ { "answer_id": 15674, "body": "<p>This appears to be from a very old study</p>\n\n<blockquote>\n <p>The rate of chronic bronchitis among relighters (39·7%) was higher than the rate (32·9%) among the remaining cigarette smokers. The difference was of high statistical significance (P&lt;0·001), and the same pattern was maintained when age and consumption were standardized. After allowing for a trend towards lower social class and a preference for plain as opposed to filter cigarettes the rate of chronic bronchitis among relighters was about 15% greater than that of the remaining cigarette smokers.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1610789/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1610789/</a></p>\n\n<p>And there doesn't appear to be any subsequent study that replicates the findings rendering the findings preliminary.</p>\n", "score": 3 } ]

[ "cancer", "research", "smoking" ]

[ { "answer_id": 16017, "body": "<p>It's best to choose the time period for sleeping such that <a href=\"https://www.webmd.com/sleep-disorders/tc/shift-work-sleep-disorder-topic-overview#1\" rel=\"nofollow noreferrer\">it doesn't need to be changed often</a>, as this leads to better sleep quality. If this means that you need to sleep during daytime, then you need to make sure your bedroom is very dark and soundproof (or you need to use earplugs).</p>\n\n<p>Note also that the official time is based on arbitrary decisions, e.g. in China they only have one time zone even though the Sun will rise 5 hours later in the far West of the country compared to the Eastern part. </p>\n", "score": 1 } ]

[ "sleep", "sleep-cycles" ]

[ { "answer_id": 16014, "body": "<h3>The medical term for the natural paralysis that occurs while a person is in REM sleep – most often cited as 'official' in English – seems to be: <em>REM atonia</em>.</h3>\n\n<p>The medical condition associated with hypnagogic sleep paralysis is coded in ICD10 with G47: sleep disorders / G47.4: (according to <a href=\"https://de.wikipedia.org/wiki/Schlafparalyse\" rel=\"nofollow noreferrer\">German Wikipedia</a>) – or <a href=\"http://apps.who.int/classifications/icd10/browse/2016/en#/G47.8\" rel=\"nofollow noreferrer\">G47.8</a> Other sleep disorders, G83.8 \"Other specified paralytic syndromes\" (according to <a href=\"https://en.wikipedia.org/wiki/Sleep_paralysis\" rel=\"nofollow noreferrer\">English Wikipedia</a>).</p>\n\n<p>Interestingly the German Wikipedia states that <em>Schlafparalyse</em> (=sleep paralysis) is the proper term in German to use with muscle relaxation during real sleep. –– Conscious feelings of paralysis are more often described as \"<a href=\"https://www.onmeda.de/magazin/schlaflaehmung.html\" rel=\"nofollow noreferrer\">hypgnagoge Schlaflähmung</a>\" (= hypnagogic sleep paralyss; but using only true German word components for the compound word)</p>\n\n<p><a href=\"https://de.wikipedia.org/wiki/Schlafparalyse\" rel=\"nofollow noreferrer\">de.Wikpedia: Schlafparalyse</a>:</p>\n\n<blockquote>\n <p>Im Englischen wird sleep paralysis ausschließlich für die Störung verwendet, während die natürliche Lähmung während des normalen Schlafes REM atonia genannt wird.<br>\n (In English sleep paralysis is used exclusively for the disorder, while natural paralysis during normal sleep is called REM atonia.)</p>\n</blockquote>\n\n<p><strong>REM-atonia</strong> in <a href=\"https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep\" rel=\"nofollow noreferrer\">Rapid eye movement sleep</a>:</p>\n\n<blockquote>\n <p>Organisms in REM sleep suspend central homeostasis, allowing large fluctuations in respiration, thermoregulation, and circulation which do not occur in any other modes of sleeping or waking. <strong>The body abruptly loses muscle tone, a state known as REM atonia.</strong></p>\n</blockquote>\n\n<p>But it doesn't get much better:<br>\n<strong><a href=\"https://www.medicinenet.com/script/main/art.asp?articlekey=9811\" rel=\"nofollow noreferrer\">MedicineNet –– Medical Definition of Atonia, REM sleep:</a></strong></p>\n\n<blockquote>\n <p>Atonia, REM sleep: See: Sleep paralysis<br>\n --> Sleep paralysis: Medically, sleep paralysis is sometimes called waking paralysis, predormital (before-sleep) paralysis, postdormital (after-sleep) paralysis, and REM sleep atonia.</p>\n</blockquote>\n\n<p>In <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579970/\" rel=\"nofollow noreferrer\">\"Unraveling the Mechanisms of REM Sleep Atonia\"</a> the phenomenon is called:</p>\n\n<blockquote>\n <p>We agree with the commentators that determining mechanisms of <strong>rapid eye movement (REM) sleep motor atonia</strong> is of major scientific importance and clinical relevance. The concept that REM atonia is under the control of one physiological mechanism and one neurotransmitter pathway has seduced many of us. </p>\n</blockquote>\n\n<p>In summary, it seems that \"sleep paralysis\" is actually not that far off a choice to use for REM atonia judging by real world word usage. But in any case a further qualification like \"during real sleep\"?</p>\n\n<p>This excerpt seems to set a very straght record:</p>\n\n<blockquote>\n <p>Neural mechanisms prevent us from acting out our dreams during REM sleep. This normal “paralysis” during REM known as REM atonia is altered in patients with narcolepsy. Sleep paralysis is the intrusion of the normal atonia of REM sleep into wakefulness. The patient experiences inability to move with preserved aware- ness of surroundings. Sleep paralysis typically occurs during sleep–wake transitions or arousals.<br>\n _{Lourdes M. DelRosso and Romy Hoque: \"Central Nervous System Hypersomnias\", in Raman K. Malhotra (ed): \"Sleepy or Sleepless. Clinical Approach to the Sleep Patient\", Springer: Cham, Heidelberg, 2015, p 54.}</p>\n</blockquote>\n", "score": 3 } ]

[ "sleep", "terminology" ]

[ { "answer_id": 16044, "body": "<p>The American label^{<strong>1</strong>} says \"sodium\", it does not say \"salt\". Surprising accuracy, but it really is just that one half of the salt molecule that counts and that is counted! It's really just the sodium. Only Na and not NaCl.</p>\n\n<blockquote>\n <p><strong>Sodium:</strong>\n What It Is<br>\n The words “salt” and “sodium” are often used interchangeably, but they do not mean the same thing. Sodium is a mineral and one of the chemical elements found in salt. Salt (also known by its chemical name, sodium chloride) is a crystal-like compound that is abundant in nature and is used to flavor and preserve food.<br>\n <a href=\"https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/factsheets/Sodium.pdf\" rel=\"nofollow noreferrer\">FDA: factsheets: Sodium.pdf</a></p>\n</blockquote>\n\n<p>\"Salts\" are also different from NaCl alone (e.g. KNO₃ for meats) and very common sources from the industry include Sodium nitrate, Sodium citrate, Monosodium glutamate [MSG], Sodium benzoate, Baking powder, Baking soda.</p>\n\n<p>To quickly estimate the salt equivalent of label-Na: 1g Na ~> 2.5g NaCl </p>\n\n<p>This should result for the example, \"a 20 fluid ounce bottle of Coke currently says that it has 75mg of 'Sodium' in it.\"<br>\nThis means 75mg of sodium ions Na⁺ and this equals roughly 187,5mg of the dissolved table salt molecule NaCl.<br>\n_{Although a cola typically contains no salt at all according to the <a href=\"https://www.coca-cola.co.uk/drinks/coca-cola/coca-cola\" rel=\"nofollow noreferrer\">official Coca Cola website UK: Salt=0g</a>, or <a href=\"https://ndb.nal.usda.gov/ndb/search/list?qlookup=14400\" rel=\"nofollow noreferrer\">4mg/100g according to the USDA</a> and usually very few sodium from other sources (example <a href=\"http://www.opensoda.org/?p=130\" rel=\"nofollow noreferrer\">OpenCola, v2009</a>: Sodium Citrate, Sodium Benzoate).} </p>\n\n<p>To quote from <a href=\"http://www.worldactiononsalt.com/less/how/labels/\" rel=\"nofollow noreferrer\">Reading Labels (worldactiononsalt)</a>:</p>\n\n<blockquote>\n <blockquote>\n <ul>\n <li>Foods high in salt have more than 1.5g salt / 100g (or 0.6g sodium / 100g)</li>\n <li>Foods low in salt have less than 0.3g salt /100g (or 0.1g sodium / 100g)</li>\n </ul>\n </blockquote>\n \n <p>Calculating the salt content of food\n Some food labels may only state the sodium content.\n To convert sodium to salt, you need to multiply the amount by 2.5.\n For example, 1g of sodium per 100g = 2.5 grams of salt per 100g</p>\n \n <p>You then need to know the weight of the serving portion in grams e.g. 30g</p>\n \n <p>Then divide the concentration of salt per 100g by 100 and multiply by the serving size.<br>\n e.g. Kellogg’s Rice Krispies contain 0.65g of sodium per 100g and 1 bowl (serving) is 30g;</p>\n \n <p>0.65g sodium per 100g x 2.5 = 1.6g salt per 100g<br>\n 1.6 ÷ 100 = 0.01 salt per 1g of Rice Krispies<br>\n 0.1 x 30 = 0.3g salt per 30g serving </p>\n \n <p>The maximum recommended intake for the day for a child aged 3 is 2g. Therefore, 1 bowl of the breakfast cereal contains around one-sixth (15%) of the recommended intake for the whole day.</p>\n</blockquote>\n\n<p>Further information can be found at <a href=\"https://www.thekitchn.com/a-guide-to-sodium-labeling-sodium-savvy-205267\" rel=\"nofollow noreferrer\">What Sodium Labels Mean: A Guide to Decoding Sodium Labels</a>.</p>\n\n<blockquote>\n <p>Many people think of salt and sodium as being the same thing, but they aren’t. Sodium is a mineral that occurs throughout nature in more than 80 forms. It is the sixth most abundant naturally occurring element on the planet, and it is essential to many of life’s functions. In the human body, in particular, sodium is crucial in maintaining the intricate balance of fluids in and around the body’s cells, and we can’t live without it.<br>\n <strong>Ninety percent of the sodium we eat comes in the form of salt.</strong> Salt is a naturally occurring compound that consists of 40 percent sodium and 60 percent chloride.</p>\n</blockquote>\n\n<p>Source: <a href=\"http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Recipes/American-Heart-Association-Eat-Less-Salt-Sample-Recipes_UCM_452096_Article.jsp\" rel=\"nofollow noreferrer\">American Heart Association: \"Eat Less Salt\", Clarkson Potter: New York, 2013.</a></p>\n\n<hr>\n\n<p>_{1: Alas, the EU seems to go backward on this and proscribes now again on labels to use \"salt\" instead of \"sodium\". (<a href=\"https://www.lebensmittelklarheit.de/forum/natrium-kennzeichnung\" rel=\"nofollow noreferrer\">Natrium-Kennzeichnung</a>)}</p>\n", "score": 6 }, { "answer_id": 16063, "body": "<p>It refers to exactly what is says - Na.</p>\n\n<p>It would be Na not the ion.</p>\n\n<p>Na is not just from NaCl. It is in baking soda.</p>\n\n<p>Look up nutrition on table salt<br>\n<a href=\"http://www.calorieking.com/foods/calories-in-herbs-spices-table-salt_f-ZmlkPTY0NTAw.html\" rel=\"nofollow noreferrer\">NaCl nutrition</a><br>\n100 mg NaCl has 38.758 mg of Na<br>\nWhich is consistent with molecular weight of 11 and 17. </p>\n", "score": 1 } ]

[ "labeling", "sodium" ]

[ { "answer_id": 16619, "body": "<p>The mechanism of stress hives (urticaria):</p>\n\n<p>Stress, for example, <a href=\"https://acaai.org/allergies/types/skin-allergies/hives-urticaria\" rel=\"nofollow noreferrer\">emotional stress</a> or <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15909063\" rel=\"nofollow noreferrer\">insomnia</a> triggers the <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16461989\" rel=\"nofollow noreferrer\">mast cells</a> in the skin to release histamine. Histamine dilates the small arteries in the skin and makes them \"porous,\" which allows some fluid from the blood to escape into the space between the cells.</p>\n", "score": 3 }, { "answer_id": 16313, "body": "<p>I spoke with a doctor the other day and they said that the body releases histamines when under stress. The histamines are there to attack foreign bodies, however there are none from stress. They then \"attack\" the skin and cause it to become inflamed and produce hives. </p>\n", "score": 1 } ]

[ "dermatology", "stress" ]

[ { "answer_id": 16300, "body": "<p>Your question demonstrates a key understanding of homeostatic mechanisms: in many cases, long-term pharmaceutical modulation leads to compensatory changes that blunt the effects of the modulation. This can lead to <a href=\"https://en.wikipedia.org/wiki/Rebound_effect\" rel=\"nofollow noreferrer\">rebound effects</a> and sometimes <a href=\"https://en.wikipedia.org/wiki/Physical_dependence\" rel=\"nofollow noreferrer\">physical/physiological dependence</a>.</p>\n\n<p>Your hypothesis is good, however, you have the mechanism wrong in this case. Blocking adenosine receptors tends to increase the <strong><em>expression of receptors</em></strong>, especially the adenosine A₁ receptor, rather than the production of the agonist adenosine. Interestingly, this seems to be regulated not by increased transcription (mRNA production) but instead by later mechanisms (Johansson et al. 1993).</p>\n\n<p>Receptor expression changes rather than agonist production changes tends to be a general rule for similar circumstances, though there are certainly exceptions as well. Altering receptor levels is a more reliable homeostatic mechanism, because often a given agonist acts on many different receptors with different affinities. It is also the cells expressing the receptors that have the most direct way to assay the level of receptor activation. In order to change agonist production levels, you would need a communication mechanism where the receptor cells signal back to the agonist producing cells, whereas receptor expression can be controlled all within the receptor cells.</p>\n\n<p>References</p>\n\n<hr>\n\n<p>Fredholm, B. B. (1982). Adenosine actions and adenosine receptors after 1 week treatment with caffeine. Acta Physiologica, 115(2), 283-286.</p>\n\n<p>Johansson, B., Ahlberg, S., van der Ploeg, I., Brené, S., Lindefors, N., Persson, H., &amp; Fredholm, B. B. (1993). Effect of long term caffeine treatment on A 1 and A 2 adenosine receptor binding and on mRNA levels in rat brain. Naunyn-Schmiedeberg's archives of pharmacology, 347(4), 407-414.</p>\n\n<p>Ramkumar, V., Bumgarner, J. R., Jacobson, K. A., &amp; Stiles, G. L. (1988). Multiple components of the A1 adenosine receptor-adenylate cyclase system are regulated in rat cerebral cortex by chronic caffeine ingestion. The Journal of clinical investigation, 82(1), 242-247.</p>\n\n<p>Svenningsson, P., Nomikos, G. G., &amp; Fredholm, B. B. (1999). The stimulatory action and the development of tolerance to caffeine is associated with alterations in gene expression in specific brain regions. Journal of Neuroscience, 19(10), 4011-4022.</p>\n", "score": 4 } ]

[ "sleep", "sleep-cycles", "coffee" ]

[ { "answer_id": 16380, "body": "<p>To first establish a baseline: Reading is great for your brain, your mind, your intellect. But it can be bad for everything else. You sit, you concentrate, you stress your eyes.</p>\n\n<p>It is such a common causal connection that the NHS simplifies the analysis of causes for myopia down to genes and:</p>\n\n<blockquote>\n <p>Short-sightedness (myopia) usually occurs when the eyes grow slightly too long, which means they're unable to produce a clear image of objects in the distance.<br>\n It's not clear exactly why this happens, but it's thought to be the result of a combination of genetic and environmental factors that disrupt the normal development of the eye.<br>\n <strong>Too little time outdoors</strong><br>\n Research has found that spending time playing outside as a child may reduce your chances of becoming short-sighted, and existing short-sightedness may progress less quickly.<br>\n This may be related to light levels outdoors being much brighter than indoors. Both sport and relaxation outdoors appear to be beneficial in reducing the risk of short-sightedness.<br>\n <strong>Excessive close work</strong><br>\n Spending a lot of time focusing your eyes on nearby objects, such as reading, writing and possibly using hand-held devices (phones and tablets) and computers can also increase your risk of developing short-sightedness.<br>\n An \"everything in moderation\" approach is therefore generally recommended. Although children should be encouraged to read, they should also spend some time away from reading and computer games each day doing outdoor activities.<br>\n _{<a href=\"https://www.nhs.uk/conditions/short-sightedness/causes/\" rel=\"nofollow noreferrer\">NHS: Short-sightedness (myopia), Causes</a> (2015)}</p>\n</blockquote>\n\n<p>\"Too little time outdoors\" is a shortcut for expressing giving the muscles and lenses of your eyes a workout with natural variation. Outdoors you usually have to focus objects that vary quite a bit in terms of distance etc. The evidence is slowly coming in for interventions regarding these stresses to improve things:</p>\n\n<blockquote>\n <p>A stronger effect was found at a school in southern Taiwan, where teachers were asked to send children outside for all 80 minutes of their daily break time instead of giving them the choice to stay inside. After one year, doctors had diagnosed myopia in 8% of the children, compared with 18% at a nearby school\n _{Elie Dolgin: <a href=\"https://www.nature.com/polopoly_fs/1.17120!/menu/main/topColumns/topLeftColumn/pdf/519276a.pdf?origin=ppub\" rel=\"nofollow noreferrer\">\"The Myopia Boom. Short-Sightedness is Reaching Epidemic Proportions. Some Scientists Think they have Found a Reason Why.\"</a> Nature, Vol. 519, 19 March 2015, 276–278. Also, compare with <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-1313.1987.tb00760.x\" rel=\"nofollow noreferrer\">David L. Ehrlich: \"Near Vision Stress: Vergence Adaptation and Accommodative Fatigue\", OPO, Volume 7, Issue 4 1987.</a>}</p>\n</blockquote>\n\n<p>Reading on screens is so much worse that its effects got their own term: <a href=\"https://en.wikipedia.org/wiki/Computer_vision_syndrome\" rel=\"nofollow noreferrer\">Computer vision syndrome</a>.</p>\n\n<blockquote>\n <p>Some decades back, before the advent of computers, the office work involved a range of activities, including typing, filing, reading and writing etc. All these activities are different from each other and needed different types of posture and vision, causing a natural break from each activity. With the computer all these activities were combined and needed no change of posture or vision of the user from his desktop. It certainly improved the quality of the work and efficiency but caused ocular problems, such as dry eye, redness, irritation, eye strain, tired eyes, temporary blurred vision, light sensitivity and muscular problems that stem from using a computer. All these symptoms collectively referred to as computer vision syndrome, which comprised of ocular surface abnormalities or accommodative spasms and/or extra-ocular (ergonomic) aetiologies due to improper posture such as neck and upper back pain and headache.<br>\n The major contributors to CVS is thought to be the dry eye, the visual effects of video display terminals (VDT) such as lighting, glare, display quality, refresh rates and radiation and positioning of computer monitors.<br>\n _{<a href=\"https://gmj.sljol.info/article/10.4038/gmj.v11i1.1115/galley/1023/\" rel=\"nofollow noreferrer\">Saman Wimalasundera: \"Computer vision syndrome\", Galle Medical Journal, Vol 11: No. 1, September 2006.</a>}</p>\n</blockquote>\n\n<p>Since now we have <a href=\"https://health.economictimes.indiatimes.com/news/diagnostics/millions-at-risk-of-computer-vision-syndrome/52515980?redirect=1\" rel=\"nofollow noreferrer\">Millions at risk of computer vision syndrome</a> it seems quite easy to refer to this simplified risk hierarchy: no reading, paper reading, screen reading. But it should be clear that this problem is indeed one that can be mitigated with adhering to proper ergonomic principles. Apart from the behaviour a user/reader might adapt, such as variation in distance, breaks, body posture, the different sources – or better surfaces – of reading material should be watched out for. A high gloss magazine read on a sunny beach might be quite stressful for the eyes whereas an ergonomic, non-glare, high resolution display might fare quite a bit better.</p>\n\n<blockquote>\n <p>Significant eye symptoms relate to VDU use often occur and should not be underestimated. The increasing use of electronic devices with flat-panel display should prompt users to take appropriate measures to prevent or to relieve the eye symptoms arising from their use.<br>\n _{<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916147/\" rel=\"nofollow noreferrer\">Esteban Porcar et al.: \"Visual and ocular effects from the use of flat-panel displays\", Int J Ophthalmol. 2016; 9(6): 881–885.</a> doi:10.18240/ijo.2016.06.16}</p>\n</blockquote>\n\n<p>While these ergonomics were theoretically known for a long time and the progressivists promised a brighter future (pun intended):</p>\n\n<blockquote>\n <p>Most people now have some contact with computers either at work or at home. With survey evidence suggesting that perhaps 50% or more of these individ- uals complain of some form of eye problems associ- ated with using computers, eye-care professionals, ergonomists and engineers are faced with a major chal- lenge. Improvements in display technologies continue apace and the next generation of displays will produce images of equivalent quality to typeset hardcopy. Speech recognition and synthesis are already available and this and other technologies are likely to reduce the visual demands of interacting with a computer.<br>\n In the meantime, solving the problems of individual users requires a holistic approach, taking account of workstation design, workpractices and psychological factors as well as optometric data.<br>\n _{<a href=\"https://www.sciencedirect.com/science/article/pii/S0275540897000677\" rel=\"nofollow noreferrer\">W.DavidThomson: \"Eye problems and visual display terminals—the facts and the fallacies\", Ophthalmic and Physiological Optics, Volume 18, Issue 2, March 1998, Pages 111-119</a>}</p>\n</blockquote>\n\n<p>it seems that neither consumers nor some vendors and producers seem to really care. One of the largest manufacturers of displays, in phones, tablets, desktops and laptops has indeed not a single non-glare display on offer. If this is an oversight from the manufacturer, you still should not buy such a rotten fruit if you value your eyesight and have to read from displays.</p>\n", "score": 2 }, { "answer_id": 16376, "body": "<p>Reading on paper is way better from all perspectives. When you read on paper you are able to focus more and you are not putting pressure on your eyes and your brain passes the signals which help you stay relaxed. While on the other hand, when you read on any electronic device you are much more likely to damage your eyesight as well as weaken your brain. Doctors say a person must have 10 minutes break in 1 hour of continues using laptop or Tab. This is very important otherwise he/she may harm his/her mental as well as physical health.</p>\n", "score": 1 } ]

[ "eye", "computers", "lifestyle", "effectiveness", "vision" ]

[ { "answer_id": 16312, "body": "<p>According to various <strong>dictionaries,</strong> edema includes the accumulation of the fluid in the cells, between the cells (interstitial space) and in the body cavities, so, yes, hydrothorax could be considered a subtype of edema.</p>\n\n<p><a href=\"https://medical-dictionary.thefreedictionary.com/edema\" rel=\"nofollow noreferrer\">TheFreeDictionary</a>:</p>\n\n<blockquote>\n <p>edema the accumulation of excess fluid in a fluid compartment.\n Formerly called dropsy and hydrops. This accumulation can occur in the\n cells (cellular edema), in the intercellular spaces within tissues\n (interstitial edema), or in potential spaces within the body. Edema\n may also be classified by location, such as pulmonary edema or brain\n edema; types found in certain locations have specific names, such as\n ascites (peritoneal cavity), hydrothorax (pleural cavity), or\n hydropericardium (pericardial sac).</p>\n</blockquote>\n\n<p><a href=\"https://www.merriam-webster.com/dictionary/edema\" rel=\"nofollow noreferrer\">Merriam-Webster:</a></p>\n\n<blockquote>\n <p>Edema - an abnormal infiltration and excess accumulation of serous\n fluid in connective tissue or in a serous cavity</p>\n</blockquote>\n\n<p>But, in a real world, a doctor will not likely <strong>use</strong> the term edema for fluid in a body cavity.</p>\n\n<p>The term <em>lung edema</em> is exclusively used for the fluid in the lung tissue (parenchyma) and the term <em>hydrtothorax</em> or <em>pleural effusion</em> for the fluid in the pleural space. In this case, calling hydrothorax edema would be totally confusing, even if it may be formally correct.</p>\n", "score": 2 } ]

[ "terminology", "edema" ]

[ { "answer_id": 16370, "body": "<h3>tl;dr: The terminology used to compare plant proteins is used on a level of abstraction too high to give meaningful medical results. Prolamins are too broad of a chemical category to assay their biology and qualities in disease.</h3>\n<p><a href=\"https://en.wikipedia.org/wiki/Gluten-related_disorders\" rel=\"nofollow noreferrer\">Gluten-related disorders</a> is a less than ideal term for a wide variety of disorders involving grains. While <a href=\"https://en.wikipedia.org/wiki/Coeliac_disease\" rel=\"nofollow noreferrer\">coeliac disease</a> is triggered by wheat gluten, a <a href=\"https://en.wikipedia.org/wiki/Wheat_allergy\" rel=\"nofollow noreferrer\">wheat allergy</a> is less well placed into this analytical category. For the consumer's sake of simplicity the equation of gluten=wheat like grains makes some sense, as a gluten-free product usually is also free of wheat.</p>\n<p>But all storage proteins in grasses are classified into four groups, called Osborne fractions:</p>\n<ol>\n<li><a href=\"https://en.wikipedia.org/wiki/Albumin\" rel=\"nofollow noreferrer\">Albumin</a>: water soluble, sometimes called leukosin in wheat (most likely allergen)</li>\n<li><a href=\"https://en.wikipedia.org/wiki/Globulin\" rel=\"nofollow noreferrer\">Globulin</a>: soluble in salt-water, called edestin in wheat</li>\n<li><a href=\"https://en.wikipedia.org/wiki/Prolamin\" rel=\"nofollow noreferrer\">Prolamin</a>: soluble in strong ethanol, called gliadine in wheat and oryzin in rice (not to be confused with the enzyme, but because of the name double often called just prolamin)</li>\n<li><a href=\"https://en.wikipedia.org/wiki/Glutelin\" rel=\"nofollow noreferrer\">Glutelin</a>: alkali/acid-soluble to non-soluble, called glutenin in wheat and oryzenin in rice</li>\n</ol>\n<p>That is a very broad classification system for a mixture of several proteins in one group (or &quot;family&quot;) based on very basic properties. The actual contents, configurations and other chemical, biological or medical qualities of the various proteins are not really covered with this scheme. But it is already apparent that although the proteins from rice and wheat may be classified similarly but are different enough to get their different names early on.</p>\n<p>For StackExchange-simplicity's sake let's concentrate on the example of coeliac disease:</p>\n<blockquote>\n<p>Celiac disease (CD) is more than just an “allergy” or “sensitivity” to wheat and gluten. It is a lifelong, <strong>permanent intolerance to the gliadin fraction of wheat protein and its related alcohol-soluble proteins (prolamins) found in rye and barley.</strong> In patients with the genetic susceptibility to CD, ingesting these proteins leads to an autoimmune enteropathy that will self-perpetuate as long as these foods remain in the diet. The good news is that, unlike most autoimmune conditions, removal of the environmental trigger (gluten) from the diet of a biopsy-proven celiac results in complete symptomatic and histologic resolution of the disease in the majority of patients.<br />\nDifferentiating CD from wheat allergy, gluten sensitivity, and other autoimmune gastrointestinal (GI) diseases (such as Crohn’s disease) can be challenging.<br />\n_{From: Michelle Maria Pietzak: &quot;Dietary Supplements in Celiac Disease&quot;, in: S. Devi Rampertab &amp; Gerard E. Mullin (Eds.): &quot;Celiac Disease&quot;, Humana Press: New York, Heidelberg, 2014, p137.)}</p>\n</blockquote>\n<p>If is only the gliadin fraction and the closely related proteins in rye and barley that trigger this disease, then how does gliadin compare to oryzin?</p>\n<blockquote>\n<p>A singular feature of rice is that prolamin, which represents the major endosperm storage protein in other cereals except, oats (Shewry and Halford, 2002), is a minor protein in all rice grain milling fractions, whereas glutelin is the dominant protein in brown and milled rice. The proportion of albumin, globulin, glutelin and prolamin has been reported to be 5–10, 7–17, 75–81 and 3–6%, respectively, in brown rice, 4–6, 6–13, 79–83 and 2–7%, respectively, in milled rice, and 24–43, 13–36, 22–45 and 1– 5%, respectively, in rice bran (Adebiyi et al., 2009; Agboola et al., 2005; Cao et al., 2009; Ju et al., 2001; Juliano, 1985; Zhao et al., 2012).</p>\n<p>Rice prolamin has been reported to be composed of three polypeptide groups having MW of 10, 13 and 16 kDa, with the 13 kDa prolamin being predominant, as determined by SDS-PAGE (Hibino et al., 1989; Ogawa et al., 1987). In the current study, prolamin showed one major band with MW of about 10 kDa. Also, two minor subunits of about 18 kDa and 31–32 kDa were present, most likely due to cross-contamination with glutelin. The method used to extract the rice protein fractions from RF coupled with their solubilisation in the strong reducing buffer prior to SDS-PAGE analysis, provided good resolution of the proteins characterising the different fractions, which allowed the identification of the protein subunits of the intact rice protein ingredients.<br />\n_{<a href=\"https://www.sciencedirect.com/science/article/pii/S0889157516302423\" rel=\"nofollow noreferrer\">Luca Amagliania et al.: &quot;Composition and protein profile analysis of rice protein ingredients&quot;, Journal of Food Composition and Analysis\nVolume 59, June 2017, Pages 18-26</a>, [DOI].(<a href=\"https://doi.org/10.1016/j.jfca.2016.12.026\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/j.jfca.2016.12.026</a>)}</p>\n</blockquote>\n<p>The <em>exact</em> structure of all the components making up a fraction of these proteins is not known yet. But it is clear that rice oryzin/prolamin does not trigger the following:</p>\n<blockquote>\n<p>Dietary gluten storage proteins from wheat, rye, and barley contain protein sequences that elicit a diverse array of immunological response. Oats do not typi- cally elicit an immunological response unless there is sufficient cross-contamination from milling and handling of gluten-rich grains (i.e., wheat). Alpha-2 gliadin (α2-gliadin) contains a 33 amino acid sequence that is resistant to digestion by human gut and pancreatic enzymes and is a classic CD antigen.\nIn order to mount an immunological response to gluten proteins, a number of events need to take place. The antigen must breach the protective barrier of the small intestine to be presented to the B and T cells of the mucosal immune system by major histocompatibility complex molecules (MHCs) present on antigen- presenting cells (APCs) such as dendritic cells. Gluten proteins appear to traverse the cells and leak between cells due to defective regulation of tight junction proteins such as zonulin-1, providing a target for therapy <a href=\"https://en.wikipedia.org/wiki/Albumin\" rel=\"nofollow noreferrer\">4</a>. A number of agents can initiate a breach in barrier function (i.e., infections, nonsteroidal medications, bacterial overgrowth); thus, defective permeability may be an antecedent to disease develop- ment as proposed by Fasano. The resultant processing of indigestible gluten anti- gens by the mucosal immune system leads to active small intestine inflammation whose inflammatory cytokines can further loosen the tight junctions and promote further entry of more gluten peptides to perpetuate the vicious cycle.\nThe enzyme tissue transglutaminase (TTG) removes the amide group from glutamine of gluten peptides such α2-gliadin, leaving it in a highly negatively charged state, which increases its affinity and binding to MHC HLA-DQ2.5 or DQ8. The aforementioned antibodies against TTG and deamidated gliadin become an important screening tool for CD.<br />\n_{Gerard E. Mullin 2014 (above), chap. Pathobiology, p2.}</p>\n</blockquote>\n", "score": 3 } ]

[ "gluten", "rice" ]

[ { "answer_id": 16515, "body": "<p>Apparently, the difference is not very severe:</p>\n<blockquote>\n<p>^{Die Regel: Kälteschutz: Silberseite nach innen, Sonnenschutz: Silberseite nach außen wird auch von Herstellern angegeben. Jedoch ist der Unterschied in der IR-Reflexion laut Untersuchungen vernachlässigbar und soll nur einen Unterschied von 1°C bewirken können, wobei die silber-farbene Seite zu 99% und die gold-farbene Seite zu 97% IR-Wärmestrahlung reflektieren soll.}</p>\n<p>Generally, the silver side should be turned outwards as cold protection and the golden side as heat protection. Nevertheless, the difference in IR-reflections are - according to studies - irrelevant and only lead to a difference of 1°C, whereas the silver side reflects 99% of heat radiation and golden side 97% respectively.</p>\n<p>Source: <a href=\"https://www.medicounter.de/rettungsdecke-160-x-220-cm-gold-silber.html\" rel=\"nofollow noreferrer\">Product Description at MediCounter</a></p>\n</blockquote>\n<p>More or less the same text can be found at the German wikipedia entry, where a pamphlet from the Hans-Hepp Company is sourced, but I haven't yet found the pamphlet.</p>\n<p>Other producers claim that <a href=\"https://www.doccheckshop.de/oxid-oxid-8/oxid-oxid-12/oxid-oxid/DocCheck-Rettungsdecke.html\" rel=\"nofollow noreferrer\">only 85% of body heat are reflected</a>. I have contacted both shops and both state that the production team gave them the numbers and that they have no knowledge of studies/tests performed to back this up.</p>\n", "score": 2 } ]

[ "first-aid" ]

[ { "answer_id": 16555, "body": "<ul>\n<li><p><strong>Atrophia bulbi</strong> (<em>with shrinkage</em>)</p>\n\n<p>It occurs <em>with shrinkage</em> and also <em>without shrinkage</em>. In <em>without shrinkage</em>, generally the eye is of normal size, but the globe can be enlarged due to glaucoma. In <em>with shrinkage</em>, the globe becomes soft,small and partially collapsed. Atrophy is present in the intraocular tissues but the relationship between the tissues are relatively intact.The horizontal and verical rectal muscles are pulled off which gives the globe a cuboid-like appearance rather than a spherical one. The intraocular pressure (IOP) is decreased. The anterior chamber collapses and the cornea becomes edematous and opacified. <br></p></li>\n<li><p><strong>Phthisis bulbi</strong> <br></p>\n\n<p>It is also called as <em>atrophia bulbi with disorganization</em>. The globe becomes small, mostly under an average diameter of 16-19 mm(noraml is 24-26 mm). The sclera becomes thickened and the cornea is opacified. Intraocular ossification(bone-formation) may also occur. The bowman layer, lens and retina are calcified. Proliferation and metaplasia of the retinal pigment epithelium (RPE) leads to drusen formation of the eye.</p></li>\n</ul>\n\n<blockquote>\n <p><a href=\"https://i.stack.imgur.com/WR52c.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/WR52c.jpg\" alt=\"enter image description here\"></a><br>[Source <a href=\"https://books.google.co.in/books?id=g8U0AwAAQBAJ&amp;printsec=frontcover&amp;dq=The+massachusetts+eye&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwiyv_ubtsvbAhVBpZQKHUF-DPMQ6AEIJjAA#v=onepage&amp;q=The%20massachusetts%20eye&amp;f=false\" rel=\"nofollow noreferrer\">4</a>]</p>\n</blockquote>\n\n<hr>\n\n<p><strong>References:</strong></p>\n\n<p>1: <a href=\"https://www.aao.org/bcscsnippetdetail.aspx?id=8ede24ac-d9bc-4ea8-8e19-38e73830cea6\" rel=\"nofollow noreferrer\">AMERICAN ACADEMY OF OPHTHALMOLOGY</a> </p>\n\n<p>2: <a href=\"https://books.google.co.in/books?id=m-AMO4gkTtMC&amp;printsec=frontcover&amp;dq=Essentials+of+ophthalmology&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwiupa_rtMvbAhXEKY8KHamzCnQQ6AEIJjAA#v=onepage&amp;q=Essentials%20of%20ophthalmology&amp;f=false\" rel=\"nofollow noreferrer\">Essentials of Ophthalmology\nBy Neil J. Friedman, Peter K. Kaiser</a></p>\n\n<p>3: <a href=\"https://books.google.co.in/books?id=V9lV7iSrJvEC&amp;printsec=frontcover&amp;dq=Ocular+pathology&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwjvv7LFtcvbAhWMRY8KHd2aDEEQ6AEINDAC#v=onepage&amp;q=Ocular%20pathology&amp;f=false\" rel=\"nofollow noreferrer\">Ocular Pathology\nBy Myron Yanoff, Joseph William Sassani</a></p>\n\n<p>4: <a href=\"https://books.google.co.in/books?id=g8U0AwAAQBAJ&amp;printsec=frontcover&amp;dq=The+massachusetts+eye&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwiyv_ubtsvbAhVBpZQKHUF-DPMQ6AEIJjAA#v=onepage&amp;q=The%20massachusetts%20eye&amp;f=false\" rel=\"nofollow noreferrer\">The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology \n ...By Neil J. Friedman, Peter K. Kaiser, Roberto Pineda II</a></p>\n\n<p>5: <a href=\"https://books.google.co.in/books?id=yI_TBwAAQBAJ&amp;printsec=frontcover&amp;dq=Pathology+of+the+eye&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwjWl5fxtsvbAhXGQo8KHUGaBAsQ6AEIJjAA#v=onepage&amp;q=Pathology%20of%20the%20eye&amp;f=false\" rel=\"nofollow noreferrer\">Pathology of the Eye\nBy G.O.H. Naumann, D.J. Apple</a></p>\n", "score": 2 } ]

[ "eye", "terminology", "anatomy", "opthalmology" ]

[ { "answer_id": 16652, "body": "<p>ICD-10 is a classification system which can be used to record certain disease states of a patient, e.g. <code>I50</code> meaning \"Heart failure\" or <code>I50.1</code> meaning \"Left ventricular failure\".</p>\n\n<p>SNOMED CT provides multiple advantages:</p>\n\n<ol>\n<li>SNOMED CT covers all clinical terms, not just disease states. For example we can say <code>85232009</code> meaning \"left heart failure\" but we could also say <code>163053002</code> meaning \"raised JVP\", <code>162965007</code> meaning \"lung crackles heard\", <code>421346005</code> meaning \"3+ pitting oedema\".</li>\n</ol>\n\n<p>Alternatively, we could say <code>315261000000101</code> meaning \"patient advised to attend emergency department\", <code>239471000000109</code> meaning \"emergency ambulance call\" and <code>1079771000000108</code> meaning \"transported by ambulance\".</p>\n\n<ol start=\"2\">\n<li>SNOMED CT has a grammar, allowing the creation of \"expressions\". For example, we can say:</li>\n</ol>\n\n<p><code>236721000000106</code> meaning \"Implantation of intravenous dual chamber cardiac pacemaker system (procedure)\"</p>\n\n<p><code>236721000000106:363704007=91470000</code> meaning \"Implantation of intravenous dual chamber cardiac pacemaker system (procedure) into the axilla\"</p>\n\n<p><code>236721000000106:363704007=91470000, 272741003 = 7771000</code> meaning \"Implantation of intravenous dual chamber cardiac pacemaker system (procedure) into the axilla, left side\"</p>\n\n<ol start=\"3\">\n<li>SNOMED CT is far more granular than ICD-10. There are many more specific codes. Furthermore, SNOMED CT expressions as above allow almost any clinical concept to be described in detail.</li>\n</ol>\n\n<p>I would strongly recommend this guide for learning more about SNOMED CT (<a href=\"https://confluence.ihtsdotools.org/display/DOCSTART/SNOMED+CT+Starter+Guide\" rel=\"nofollow noreferrer\">https://confluence.ihtsdotools.org/display/DOCSTART/SNOMED+CT+Starter+Guide</a>)</p>\n", "score": 4 } ]

[ "health-informatics", "icd-intrntl-classif-disea" ]

[ { "answer_id": 16657, "body": "<p>Mata is onto that issue for quite some time:</p>\n<blockquote>\n<p><a href=\"https://doi.org/10.1359/jbmr.080705\" rel=\"nofollow noreferrer\">Zhan Huang Timothy D Sargeant James F Hulvat Alvaro Mata Pablo Bringas Jr Chung‐Yan Koh Samuel I Stupp Malcolm L Snead: &quot;Bioactive Nanofibers Instruct Cells to Proliferate and Differentiate During Enamel Regeneration&quot;, JBMR, Volume23, Issue12, December 2008, Pages 1995-2006</a></p>\n</blockquote>\n<p>His latest publication has a less obvious on-topic title:</p>\n<blockquote>\n<p><a href=\"https://doi.org/10.1038/s41467-018-04319-0\" rel=\"nofollow noreferrer\">Sherif Elsharkawy, Maisoon Al-Jawad, Maria F. Pantano, Esther Tejeda-Montes, Khushbu Mehta, Hasan Jamal, Shweta Agarwal, Kseniya Shuturminska, Alistair Rice, Nadezda V. Tarakina, Rory M. Wilson, Andy J. Bushby, Matilde Alonso, Jose C. Rodriguez-Cabello, Ettore Barbieri, Armando del Río Hernández, Molly M. Stevens, Nicola M. Pugno, Paul Anderson &amp; Alvaro Mata: &quot;Protein disorder–order interplay to guide the growth of hierarchical mineralized structures&quot;, Nature Communicationsvolume 9, Article number: 2145 (2018)</a><br />\nA major goal in materials science is to develop bioinspired functional materials based on the precise control of molecular building blocks across length scales. Here we report a protein-mediated mineralization process that takes advantage of disorder–order interplay using elastin-like recombinamers to program organic–inorganic interactions into hierarchically ordered mineralized structures. The materials comprise elongated apatite nanocrystals that are aligned and organized into microscopic prisms, which grow together into spherulite-like structures hundreds of micrometers in diameter that come together to fill macroscopic areas. The structures can be grown over large uneven surfaces and native tissues as acid-resistant membranes or coatings with tuneable hierarchy, stiffness, and hardness. Our study represents a potential strategy for complex materials design that may open opportunities for hard tissue repair and provide insights into the role of molecular disorder in human physiology and pathology.</p>\n</blockquote>\n<p>A more accessible press release is found at</p>\n<blockquote>\n<p><a href=\"https://www.qmul.ac.uk/media/news/2018/se/scientists-develop-material-that-could-regenerate-dental-enamel-.html\" rel=\"nofollow noreferrer\">Scientists develop material that could regenerate dental enamel</a>\nResearchers at Queen Mary University of London have developed a new way to grow mineralised materials which could regenerate hard tissues such as dental enamel and bone.</p>\n</blockquote>\n<p>While incredibly promising we might want to hold out horse for a little bit longer:</p>\n<blockquote>\n<p>The research team is now looking into developing applications for this material.</p>\n<p>“The technology could benefit many people and [commercialization] is the ultimate goal of our work,” says Alvaro Mata, who led the research group.[…]\n“It is certainly a possibility,” Mata elaborates. “The kinds of regenerative challenges that we are talking about will require collaboration between disciplines and integration of different technologies. We are very keen to collaborate with different people to make things happen.”[…]\nThe UK seems to be a hotspot for research into tooth regeneration. At King’s College London, researchers performed experiments in mice that showed that an Alzheimer’s drug stimulated natural repair processes in stem cells found inside teeth to fill cavities.</p>\n<p>On the industrial side of things, the Swiss company Credentis is developing protein molecules that help apatite crystals form new enamel and using its technology in a range of oral care products, from toothpaste and mouthwash to chewing gum. The British company BioMin Technologies uses glass-ceramic biomaterials that release phosphate molecules in response to acidic conditions in order to repair dental enamel.</p>\n<p>With the combined efforts in biotech and academia, it’s exciting to think we may one day be able to regenerate our enamel and coax our teeth into filling their own cavities. Who knows, these research efforts may help us avoid another uncomfortable visit to the dentist.<br />\n_{<a href=\"https://labiotech.eu/dental-enamel-biopolymers/\" rel=\"nofollow noreferrer\">British Researchers Regenerate Tooth Enamel With Biopolymers</a>}</p>\n</blockquote>\n", "score": 3 }, { "answer_id": 16658, "body": "<p>I was going to post a possible answer when @LangLangC posted some interesting articles.</p>\n\n<p>Interestingly there is another atricle:</p>\n\n<blockquote>\n <p><a href=\"https://doi.org/10.3389/fphys.2017.00368\" rel=\"nofollow noreferrer\">Shuturminska, K., Tarakina, N. V., Azevedo, H. S., Bushby, A. J., Mata, A., Anderson, P., &amp; Al-Jawad, M. (2017). Elastin-Like Protein, with Statherin Derived Peptide, Controls Fluorapatite Formation and Morphology. <em>Frontiers in physiology</em>, 8, 368.</a><br>\n The process of enamel biomineralization is multi-step, complex and mediated by organic molecules. The lack of cells in mature enamel leaves it unable to regenerate and hence novel ways of growing enamel-like structures are currently being investigated. Recently, elastin-like protein (ELP) with the analog <em>N</em>-terminal sequence of statherin (STNA₁₅-ELP) has been used to regenerate mineralized tissue. Here, the STNA₁₅-ELP has been mineralized in constrained and unconstrained conditions in a fluoridated solution. We demonstrate that the control of STNA₁₅-ELP delivery to the mineralizing solution can form layered ordered fluorapatite mineral, via a brushite precursor. We propose that the use of a constrained STNA₁₅-ELP system can lead to the development of novel, bioinspired enamel therapeutics.</p>\n</blockquote>\n", "score": 1 } ]

[ "dentistry", "reference-request" ]

[ { "answer_id": 16901, "body": "<p>The main risk of Tylenol (aka acetaminophen/paracetamol) is liver damage, as <a href=\"https://www.fda.gov/forconsumers/consumerupdates/ucm168830.htm\" rel=\"nofollow noreferrer\">this article</a> from the FDA advises: </p>\n\n<blockquote>\n <p>This drug is generally considered safe when used according to the directions on its labeling. But taking more than the recommended amount can cause liver damage, ranging from abnormalities in liver function blood tests, to acute liver failure, and even death.</p>\n</blockquote>\n\n<p>Liver damage may take awhile to develop:</p>\n\n<blockquote>\n <p>You may not notice the signs and symptoms of liver damage right away because they take time to appear. Or, you may mistake early symptoms of liver damage (for example, loss of appetite, nausea, and vomiting) for something else, like the flu. Liver damage can develop into liver failure or death over several days. </p>\n</blockquote>\n\n<p><a href=\"https://www.rxlist.com/consumer_acetaminophen_tylenol/drugs-condition.htm\" rel=\"nofollow noreferrer\">RxList</a> recommends the maximum dosage as 3250 mg (3.250 grams) per day, which is pretty much in line with everything else I've read.<br><br>As I said in comments, nearly all drugs have some sort of side effects. That said, acetaminophen appears to be safe when taken as directed. While taking acetaminophen, you need to pay close attention to any other medications you may be taking that may include acetaminophen, such as cough and cold remedies. You also need to be careful that you're not taxing your liver with other things like alcohol.<br><br><b>Edit:</b> In response to comments:<br>The aforementioned link to RxList also advises that up to 4 grams per day may be taken<b> under the care of a healthcare professional</b>, who will, presumably, monitor your hepatic function. Do not take this dose unless you are under the care of said professional! This statement in no way endorses this dosage.</p>\n", "score": 7 } ]

[ "drug-interactions", "nsaids-pain-meds", "otc-over-the-counter", "acetaminophen" ]

[ { "answer_id": 16898, "body": "<p>What happens during cooling and reaheating pasta (or other starchy foods, such as potatoes or rice) is that some starch is converted into <strong>resistant starch.</strong> \"Resistant\" means resistant to digestion, like fiber.</p>\n\n<p><a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/nbu.12244\" rel=\"nofollow noreferrer\">Resistant starch</a> is less digestible, so it results in lower glucose spikes:</p>\n\n<blockquote>\n <p>Replacing digestible starch with resistant starch induces a lower\n blood glucose rise after a meal.</p>\n</blockquote>\n\n<p>Because it's less digestible, it also contains less calories (~2 Cal/g).</p>\n\n<p>Resistant starch is known for few decades, but I don't think it has became a popular way of controlling blood glucose levels or weight, at least not on medical diabetes sites...The preparation sounds complicated and there may be an issue with the taste...</p>\n\n<p>One type of resistant starch is in cooled and reheated pasta; <a href=\"https://academic.oup.com/advances/article/4/6/587/4595564\" rel=\"nofollow noreferrer\">other types</a> are in whole grain products, legumes, green bananas and in foods with added \"modified starch.\"</p>\n", "score": 2 } ]

[ "diet", "glycemic-index" ]

[ { "answer_id": 16939, "body": "<h2>Breathing difficulties during sleep determined to be caused by the narrowing or closing of their airway</h2>\n\n<p>Breathing difficulties during sleep indicates suffering of Obstructive Sleep Apnoea (OSA). Support is available in the UK from the charity called <a href=\"http://www.sleep-apnoea-trust.org\" rel=\"nofollow noreferrer\">The Sleep Apnoea Trust Association (SATA)</a></p>\n\n<p>There are two types of breathing interruption characteristic of OSA (<a href=\"https://www.nhs.uk/conditions/obstructive-sleep-apnoea\" rel=\"nofollow noreferrer\">NHS, 2016</a>):</p>\n\n<ul>\n<li><strong>apnoea</strong><br>where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it's called an apnoea when the airflow is blocked for 10 seconds or more</li>\n<li><strong>hypopnoea</strong><br>a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more</li>\n</ul>\n\n<h2>Treatment Methods</h2>\n\n<p>There are 3 main forms of treatment available (<a href=\"https://www.nhs.uk/conditions/obstructive-sleep-apnoea/#treating-osa\" rel=\"nofollow noreferrer\">NHS, 2016</a> &amp; <a href=\"http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/treatment-sleep-apnoea\" rel=\"nofollow noreferrer\">SATA, n.d.</a>):</p>\n\n<ul>\n<li><strong>lifestyle changes</strong><br>such as losing excess weight, cutting down on alcohol and sleeping on your side</li>\n<li><strong>wearing a mandibular advancement device (MAD) - also known as mandibular splints</strong><br>this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep<br><br>There are 2 forms of mandibular splints available\n\n<ul>\n<li><strong>One bought in the high street<br>(Cost is cheap in comparison to other methods but by personal experience, they only last a month or so at best before having to by another one.)</strong><br>These are moulded to the shape of your jawline by warming up in hot water and clenching your teeth together with the splint in place with your bottom jaw forward whilst the mould cools and sets.</li>\n<li><strong>One bought through your dentist<br>(More expensive than through the high street, but said to last a few years)</strong><br>These are created and provided through your dentist in order to be custom made to fit your jaw perfectly. There are different types which you can discuss with your dentist in order to select the right one for you.</li>\n</ul></li>\n<li><strong>using a continuous positive airway pressure (CPAP) device<br>(These are generally for more severe/chronic OSA and some models can be more expensive than others)</strong><br>these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask</li>\n</ul>\n\n<h2>References</h2>\n\n<p>NHS (2016). <em>Obstructive sleep apnoea</em> [Online]<br>Retrieved from: <a href=\"https://www.nhs.uk/conditions/obstructive-sleep-apnoea\" rel=\"nofollow noreferrer\">https://www.nhs.uk/conditions/obstructive-sleep-apnoea</a></p>\n\n<p>SATA (n.d.). Treatment of Sleep Apnoea <em>The Sleep Apnoea Trust Association</em> [Online]<br>Retrieved from: <a href=\"http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/treatment-sleep-apnoea\" rel=\"nofollow noreferrer\">http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/treatment-sleep-apnoea</a></p>\n", "score": 2 }, { "answer_id": 16934, "body": "<p>Reducing risk factors like overweight, alcohol, sedatives and smoking is important and it can sometimes be minimized by sleeping on the side rather than supine.\nBut obstructive sleep apnea causes major health problems due to increased blood pressure (especially cardiovascular events like stroke or heart attacks) so CPAP should definitely be considered. Otherwise a good blood preassure control with medication (and with the lifestyle changes mentioned above) are essential.</p>\n\n<p>You can read about it in this article: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549693/\" rel=\"nofollow noreferrer\">Obstructive sleep apnoea syndrome and its management</a></p>\n\n<p>There is a section <strong>Alternatives to PAP</strong> which might be the most relevant for your question.</p>\n", "score": 1 } ]

[ "sleep", "breathing", "technology", "respiratory-system" ]

[ { "answer_id": 17070, "body": "<p>Some doctors think there is not enough evidence that low cholesterol levels are harmful.</p>\n\n<p><a href=\"https://www.health.harvard.edu/heart-health/is-my-ldl-cholesterol-too-low\" rel=\"nofollow noreferrer\">Ask the doctor: Is my LDL cholesterol too low? (Harvard.edu, 2012)</a></p>\n\n<blockquote>\n <p>There really isn't evidence of harm from driving your LDL too low. In\n the past, some scientists worried that extremely low LDL levels could\n result in blood vessel ruptures and perhaps increase the risk of\n getting certain types of cancer. Those concerns have faded after\n neither occurred in large clinical trials that involved reducing\n people's LDL to very low levels.</p>\n \n <p>Still, taking larger doses of atorvastatin...increases the risk of\n statin side effects, which include muscle and liver damage. For that\n reason, moving to a lower dose is a good idea.</p>\n</blockquote>\n\n<p><a href=\"https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/cholesterol-level/faq-20057952\" rel=\"nofollow noreferrer\">Can your total cholesterol level be too low? (Mayo Clinic)</a></p>\n\n<blockquote>\n <p>Although the risks are rare, very low levels of LDL cholesterol may be\n associated with an increased risk of:</p>\n \n <ul>\n <li>Cancer</li>\n <li>Hemorrhagic stroke</li>\n <li>Depression</li>\n <li>Anxiety</li>\n <li>Preterm birth and low birth weight if your cholesterol is low while you're pregnant</li>\n </ul>\n \n <p>The potential risk of lowering LDL cholesterol to very low levels has\n not been confirmed, and its association with certain health risks is\n still under debate.</p>\n</blockquote>\n\n<p>Still, according to some studies, there might be some risks of too low cholesterol levels (usually caused by taking statins).</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247776/\" rel=\"nofollow noreferrer\">Low Cholesterol is Associated with Mortality from Cardiovascular Diseases: A Dynamic Cohort Study in Korean Adults (PubMed)</a></p>\n\n<blockquote>\n <p>Groups with the lowest group having TC &lt; 160 mg/dL as well as the\n highest group having >= 240 mg/dL were associated with higher\n cardiovascular disease mortality...Based on the results of this study,\n caution should be taken in prescribing statins for primary prevention\n among people at low cardiovascular risk in Korean adults.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299064/\" rel=\"nofollow noreferrer\">Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case–control study (PubMed, 2012)</a></p>\n\n<blockquote>\n <p>This study confirms an increased risk of primary intracerebral\n hemorrhage associated with low cholesterol both in men and women,\n especially in older individuals.</p>\n</blockquote>\n\n<p>One who has very low cholesterol levels can discuss with a doctor about adjusting the dose or statins or even stopping them.</p>\n", "score": 2 } ]

[ "cholesterol" ]

[ { "answer_id": 17149, "body": "<p>Pentasa is one brand name for a drug called mesalazine (or mesalamine). While immunosuppressant drugs are often used on the management of Crohn’s disease, this is not one of them. It is in a group of drugs called aminosalicylates (somewhat similar to aspirin and non-steroidal anti-inflammatory drugs, but the mechanism of action is a little different).</p>\n\n<p>It works through an anti-inflammatory effect on the walls of the bowel by inhibiting inflammatory compounds called prostaglandin E2 and leukotrienes. It can be administered orally or rectally, depending on the affected part of the bowel.</p>\n\n<p>Here is a <a href=\"https://patient.info/health/inflammatory-bowel-disease/crohns-disease\" rel=\"nofollow noreferrer\">link</a> to a useful advice leaflet about Crohn’s disease and its treatments.</p>\n\n<p>Source: <a href=\"https://bnf.nice.org.uk/#Search?q=Pentasa\" rel=\"nofollow noreferrer\">British National Formulary</a></p>\n", "score": 5 } ]

[ "gastroenterology", "crohns", "immunosuppressant" ]

[ { "answer_id": 17216, "body": "<p>It seems deceptively simple to just assume a <a href=\"https://en.wikipedia.org/wiki/Calorimeter#Bomb_calorimeters\" rel=\"nofollow noreferrer\">bomb calorimeter</a> is still used. Manufacturers of these things <a href=\"https://www.ddscalorimeters.com/nutritionfood-analysis-applications/\" rel=\"nofollow noreferrer\">seem convinced</a> of their utility, naturally.</p>\n\n<blockquote>\n <p>The original method used to determine the number of kcals in a given food directly measured the energy it produced.The food was placed in a sealed container surrounded by water--an apparatus known as a bomb calorimeter. The food was completely burned and the resulting rise in water temperature was measured. This method is not frequently used today.<br>\n According to the National Data Lab (NDL), most of the calorie values in the USDA and industry food tables are based on an indirect calorie estimation made using the so-called Atwater system. In this system, calories are not determined directly by burning the foods. Instead, the total caloric value is calculated by adding up the calories provided by the energy-containing nutrients: protein, carbohydrate, fat and alcohol. Because carbohydrates contain some fiber that is not digested and utilized by the body, the fiber component is usually subtracted from the total carbohydrate before calculating the calories.\n The Atwater system uses the average values of 4 Kcal/g for protein, 4 Kcal/g for carbohydrate, and 9 Kcal/g for fat. Alcohol is calculated at 7 Kcal/g. (These numbers were originally determined by burning and then averaging.) Thus the label on an energy bar that contains 10 g of protein, 20 g of carbohydrate and 9 g of fat would read 201 kcals or Calories. A complete discussion of this subject and the calories contained in more than 6,000 foods may be found on the National Data Lab web site at <a href=\"http://www.nal.usda.gov/fnic/foodcomp/\" rel=\"nofollow noreferrer\">http://www.nal.usda.gov/fnic/foodcomp/</a>. At this site you can also download the food database to a handheld computer. Another online tool that allows the user to total the calorie content of several foods is the Nutrition Analysis Tool at <a href=\"http://www.nat.uiuc.edu\" rel=\"nofollow noreferrer\">http://www.nat.uiuc.edu</a>.<br>\n _{<a href=\"https://www.scientificamerican.com/article/how-do-food-manufacturers/\" rel=\"nofollow noreferrer\">How Do Food Manufacturers Calculate the Calorie Count of Packaged Foods?, Scientific American, 2003.</a>}</p>\n</blockquote>\n\n<p>But it is not prudent to again <em>assume</em> this it. It varies</p>\n\n<blockquote>\n <h2><strong><a href=\"https://www.esha.com/calorie-calculation-country/\" rel=\"nofollow noreferrer\">Calorie Calculation by Country</a></strong></h2>\n \n <p><strong>Calorie Calculations in the United States</strong></p>\n \n <p>In the U.S., there are six accepted methods. The two most frequently used are the 4-4-9 formula and the Atwater method.</p>\n \n <p>4-4-9. In the U.S., most manufacturers use the 4-4-9 method, which assumes that each gram of protein contributes 4 Calories to the caloric total, each gram of carbohydrates contributes 4 Calories, and each gram of fat contributes 9 Calories.<br>\n Atwater. The USDA SR database, in contrast, commonly uses the Atwater method. The Atwater method uses more precise figures based on food type when assigning Calories values per gram to protein, carbohydrate, and fat. Find the Atwater table here.<br>\n 4-4-9 adjusted for non-digestible carbohydrates and sugar alcohols. (Total carbohydrates less non-digestible carbs and sugar alcohols.) For soluble non-digestible carbohydrates, a factor of 2 Calories per gram (rather than 4) is used, and sugar alcohols use specific factors listed in No. 6 below.<br>\n Specific food factors approved by the FDA.<br>\n Bomb calorimetry. This process involves burning a food item to see how much heat it releases, which is directly convertible to Calories since, as we know, one Calorie equals the amount of energy required to heat one kilogram of water by one degree Celsius. Note the adjustment for Calories from protein in the CFR.<br>\n General factors for caloric value of sugar alcohols: Isomalt = 2.0 Calories per gram, lactitol = 2.0 Calories per gram, xylitol = 2.4 Calories per gram, maltitol = 2.1 Calories per gram, sorbitol = 2.6 Calories per gram, hydrogenated starch hydrolysates = 3.0 Calories per gram, mannitol = 1.6 Calories per gram, and erythritol = 0 Calories per gram.</p>\n \n <p>For more information, see the U.S. food labeling regulations <a href=\"https://www.ecfr.gov/cgi-bin/text-idx?SID=a94277d83556d01a86b5728b2f66fb7b&amp;mc=true&amp;node=se21.2.101_19&amp;rgn=div8\" rel=\"nofollow noreferrer\">here</a>.</p>\n \n <p><strong>Calorie Calculations in the European Union</strong></p>\n \n <p>The declared values in the nutrition table are average values and must be based on:</p>\n \n <p>Total value. A calculation from the known or actual average values of the ingredients used.\n Known data. A calculation from generally established and accepted data.\n Estimates. (The same concept as 4-4-9 and 4-4-9-7) The energy value to be declared shall be calculated using the following conversion factors:</p>\n\n<pre><code>carbohydrate (except polyols): 17 kJ/g (4 Cal/g)\npolyols: 10 kJ/g (2,4 Cal/g)\nprotein: 17 kJ/g (4 Cal/g)\nfat: 37 kJ/g (9 Cal/g)\nsalatrims: 25 kJ/g (6 Cal/g)\nalcohol (ethanol), 29 kJ/g (7 Cal/g)\norganic acid: 13 kJ/g (3 Cal/g)\nfibre: 8 kJ/g (2 Cal/g)\nerythritol: 0 kJ/g (0 Cal/g)\n</code></pre>\n \n <p>For more information, see the EU food labeling regulations <a href=\"http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011R1169\" rel=\"nofollow noreferrer\">here</a>.</p>\n</blockquote>\n\n<p>The overall accuracies of such measruemnts with a bomb calorimeter is actually a frequent question: </p>\n\n<blockquote>\n <p>The calorific content is measured with a device known as the bomb calorimeter. A sample of food is placed in an airtight chamber - the 'bomb' - which is filled with pure oxygen and then placed in a tank of water. The food is ignited by an electric spark so it completely burns up. The temperature increase in the water is measured and the actual energy content of the food can then be calculated, either in old-fashioned calories or more modern joules. <strong>This method is not completely accurate, as it is rather crude when compared to the way the human body uses food.</strong> For example, proteins are completely burned up in the bomb calorimeter, whereas in the human body some of them would be used not for energy but for the production of things like skin, hair, mucus and muscle tissue. Incidentally, the subject is well covered in most biology textbooks for A-level and above, as well as in the occasional Open University programme on television.</p>\n \n <p>The four sources of food energy - protein, fat, carbohydrate and alcohol - yield 4, 9, 3.75 and 7 calories per gram respectively. The calorie value of a food is usually estimated by multiplying the protein, fat, carbohydrate and alcohol content by the appropriate factors. Many food manufacturers do not carry out chemical analyses but instead estimate the calorie content using values for ingredients derived from tables published by HMSO. <strong>Such calculations are normally within 10 per cent of the actual value.</strong>\n _{<a href=\"https://www.theguardian.com/notesandqueries/query/0,,-1061,00.html\" rel=\"nofollow noreferrer\">How do food companies work out the number of calories in their products?</a>}</p>\n</blockquote>\n\n<p>More detail can be found in this <a href=\"http://www.fao.org/uploads/media/FAO_2003_Food_Energy_02.pdf\" rel=\"nofollow noreferrer\">Food energy – methods of analysis and conversion factors</a>, FAO FOOD AND NUTRITION PAPER, 77, Report of a technical workshop Rome, 3–6 December 2002.</p>\n\n<p>In summary, bomb calorimetry gives very precise values for <a href=\"https://en.wikipedia.org/wiki/Calorimetry\" rel=\"nofollow noreferrer\">caloric</a> content. But we need for nutritional analysis <a href=\"https://books.google.com/books?id=y2vTBwAAQBAJ&amp;lpg=PA65\" rel=\"nofollow noreferrer\"><em>calorific</em> content</a>.</p>\n", "score": 1 } ]

[ "nutrition" ]

[ { "answer_id": 17502, "body": "<p>Partly the additional sizing information required for contacts (Diameter and curvature of the cornea are needed for contact lenses but not for glasses) and the power also changes because the physical distance between the eye and the lens is different.</p>\n\n<p><strong>References:</strong></p>\n\n<p><a href=\"https://www.allaboutvision.com/contacts/faq/cls-vs-glasses-rx.htm\" rel=\"nofollow noreferrer\">Here</a> is a page explaining the differences between the two prescription types with explanation as to what the different values mean.</p>\n", "score": 3 } ]

[ "prescription", "optometry", "glasses", "contact-lenses", "eye-exam" ]

[ { "answer_id": 17627, "body": "<p>To find the answer to this I had to find out the <a href=\"https://en.wikipedia.org/wiki/Postpartum_bleeding#Prevention\" rel=\"nofollow noreferrer\">prevention measures and management</a> of Postpartum Haemorrhage (PPH).</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Oxytocin\" rel=\"nofollow noreferrer\">Oxytocin</a> is typically used right after the delivery of the baby to prevent PPH (<a href=\"https://onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.13098\" rel=\"nofollow noreferrer\">Weeks, 2015</a>). <a href=\"https://en.wikipedia.org/wiki/Misoprostol\" rel=\"nofollow noreferrer\">Misoprostol</a> may be used in areas where oxytocin is not available. Nipple stimulation and breastfeeding triggers the release of natural oxytocin in the body, therefore it is thought that encouraging the baby to suckle soon after birth may reduce the risk of PPH for the mother (<a href=\"https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010845.pub2/epdf/full\" rel=\"nofollow noreferrer\">Abedi, et al. 2016</a>). The review by Abedi et al. (2016) looking into this did not find enough good research to say whether or not nipple stimulation did reduce PPH. More research is needed to answer this question.</p>\n<p>So with this in mind, it seems that Oxytocin is a big clue.</p>\n<p>The <a href=\"https://en.wikipedia.org/wiki/Oxytocin#Physiological\" rel=\"nofollow noreferrer\">physiological effects of Oxytocin</a> include uterine contraction. This is important for cervical dilation before birth, and oxytocin causes contractions during the second and third stages of labour. This also serves to assist the uterus in clotting the placental attachment point postpartum.</p>\n<p>The answer to my question is that <strong>contraction of the uterine muscles during labour compresses the blood vessels and reduces flow, thereby increasing the likelihood of coagulation and preventing haemorrhage</strong> (<a href=\"https://doi.org/10.1016/B978-0-323-04318-2.50022-4\" rel=\"nofollow noreferrer\">Carroll, 2007</a>).</p>\n<blockquote>\n<p>At parturition, only 0.5 L [just over 1 US Pint or 0.88 UK Pints] of maternal blood is lost, with the remaining excess volume lost gradually (<a href=\"https://doi.org/10.1016/B978-0-323-04318-2.50022-4\" rel=\"nofollow noreferrer\">Carroll, 2007</a>).</p>\n</blockquote>\n<p>If the placenta (or part of it) is still attached or detached but still in the womb, there is no way the uterus can contract enough to compress the blood vessels.</p>\n<p>A lack of uterine muscle contraction or <a href=\"https://en.wikipedia.org/wiki/Uterine_atony\" rel=\"nofollow noreferrer\">uterine atony</a> (a loss of tone in the uterine musculature), however, can also lead to an acute haemorrhage, as the uterine blood vessels are not sufficiently compressed. This is where the management of PPH comes in.</p>\n<p>Uterine massage is a simple first line treatment as it helps the uterus to contract to reduce bleeding (<a href=\"https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006431.pub3/epdf/full\" rel=\"nofollow noreferrer\">Hofmeyr, et al. 2008</a>). Although the evidence around the effectiveness of uterine massage is inconclusive, it is common practice after the delivery of the placenta.</p>\n<p>The WHO recommendations (<a href=\"http://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf\" rel=\"nofollow noreferrer\">WHO, 2012</a>) include intravenous oxytocin. <a href=\"https://en.wikipedia.org/wiki/Ergotamine\" rel=\"nofollow noreferrer\">Ergotamine</a> may also be used (<a href=\"https://onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.13098\" rel=\"nofollow noreferrer\">Weeks, 2015</a>).</p>\n<h2>References</h2>\n<p>Abedi, P., Jahanfar, S., Namvar, F., &amp; Lee, J. (2016). Breastfeeding or nipple stimulation for reducing postpartum haemorrhage in the third stage of labour. <em>Cochrane Database of Systematic Reviews</em>, (1). doi: <a href=\"https://doi.org/10.1002/14651858.CD010845.pub2\" rel=\"nofollow noreferrer\">10.1002/14651858.CD010845.pub2.</a> PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26816300\" rel=\"nofollow noreferrer\">26816300</a></p>\n<p>Carroll, R. G. (2007). <em>Elsevier's Integrated Physiology</em> Chapter 16 - Life Span, Philadelphia, pp 197-208. PA: Mosby doi: <a href=\"https://doi.org/10.1016/B978-0-323-04318-2.50022-4\" rel=\"nofollow noreferrer\">10.1016/B978-0-323-04318-2.50022-4</a></p>\n<p>Hofmeyr, G. J., Abdel‐Aleem, H., &amp; Abdel‐Aleem, M. A. (2008). Uterine massage for preventing postpartum haemorrhage. <em>Cochrane Database of Systematic Reviews</em>, (3). doi: <a href=\"https://doi.org/10.1002/14651858.CD006431.pub2\" rel=\"nofollow noreferrer\">10.1002/14651858.CD006431.pub2</a> PMID: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18646154\" rel=\"nofollow noreferrer\">18646154</a></p>\n<p>Weeks, A. (2015). The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?. <em>BJOG: An International Journal of Obstetrics &amp; Gynaecology</em>, 122(2), 202-210. doi: <a href=\"https://doi.org/10.1111/1471-0528.13098\" rel=\"nofollow noreferrer\">10.1111/1471-0528.13098</a></p>\n<p>WHO (2012). <em>WHO recommendations for the prevention and treatment of postpartum haemorrhage</em>. Geneva: World Health Organization.<br><strong>Available in 5 languages</strong> via <a href=\"http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en\" rel=\"nofollow noreferrer\">http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en</a></p>\n", "score": 1 } ]

[ "obstetrics", "childbirth" ]

[ { "answer_id": 17695, "body": "<p>There are really two distinct questions here, but they are common.</p>\n<ol>\n<li>Is cancer heritable?</li>\n<li>Is cancer (or cancer risk) contagious?</li>\n</ol>\n<h3>tl;dr</h3>\n<ol>\n<li>Most cancer cases are not heritable. Some are. Heritable cases have particular characteristics (early onset, more than one close relative, often with cancer at multiple sites).</li>\n<li>Cancer is not contagious. Some cancer risk factors are contagious.</li>\n</ol>\n<h2>Is cancer heritable?</h2>\n<p>As Knudson, who developed the <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC389051/\" rel=\"noreferrer\">two-hit hypothesis</a>, liked to say <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=12124744\" rel=\"noreferrer\">Cancer is a genetic disease of somatic cells</a>. This is related, but different in important ways from a genetic disease of individuals. Tumor cells are genetically distinct from non tumor cells in an individual with cancer. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=12175530\" rel=\"noreferrer\">Though there are hereditary forms of most cancers, the great majority of cancer cases are not hereditary</a>). That is to say, in most cases, the mutations that lead to the formation of the cancer are not inherited from a person's parents. A family history of cancer becomes significant to a clinician when there is an early age at onset in two or more close relatives (See Robbins and Cotran Pathologic Basis of Disease, Ch. 7). Often, these hereditary cancers involve multiple tumors (see the second Knudson reference above, as well as <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=9616740\" rel=\"noreferrer\">here</a>). Relevant to the hypothetical case here, breast cancer in a woman in her 60s would not suggest a hereditary form a cancer that would be associated with a higher risk of cancer in the son. Breast cancer in a woman 45 or younger would make a hereditary form of cancer more likely, which would be associated with a <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809938/\" rel=\"noreferrer\">higher risk of cancer in her son</a>. There are other risk factors to be considered, though (e.g., multiple close relatives with breast or ovarian cancer, being of Ashkenazi Jewishish heritage, among others). Guidelines for testing for the involved genes are <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480128/\" rel=\"noreferrer\">in flux</a>.</p>\n<p>In summary, in this hypothetical case, it is unlikely that the son is at higher risk of any cancer.</p>\n<h2>Is cancer or cancer risk contagious?</h2>\n<p>The general question here is complex. The specific question here can be answered relatively easily, though.</p>\n<p>Here, the specific question seems to be: in a hypothetical scenario, given a mother with breast cancer, is there a risk of sexual transmission from the mother's son to his wife. The answer here is quite clearly no. As discussed above, the potential risk for the son here is that of a hereditary cancer syndrome. That risk is minimal, but if it wasn't, hereditary cancer syndromes are not transmitted horizontally through sexual contact.</p>\n<p>The more complicated question has two parts itself:</p>\n<p>a. is cancer contagious\nb. is cancer risk contagious</p>\n<h3>Is cancer contagious?</h3>\n<p>Transmission of tumor cells from one individual to another happens, but is quite rare. Though tumor cells do metastasize in an individual, when this occurs, tumor seeds must be able to evade the immune system and find an environment suitable for adhesion and replication. Tumor associated cells (non cancerous cells that regulate the microenvironment to make it favorable for growth and replication) are discussed in this 2011 <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21376230\" rel=\"noreferrer\">Hanahan and Weinberg paper</a>. There are similarities to infectious processes, but cancer is not measles. Tumor cells don't shed in comparable numbers, aren't adapted for immune escape in a separate host, and don't express appropriate adhesion proteins for portals of entry on a new host or readily induce tumor associated niches in a new host. The cases where person-to-person transmission of cancer via tumor cell inoculation does occur seem to demonstrate more how cancer cells are not infectious agents.</p>\n<ul>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12177614\" rel=\"noreferrer\">Donor-related tumors in transplant patients</a> occur in immunosuppressed patients, but are still rare. The low frequency of transmission seems to be due, in part, to screening. The fact that we see this at all demonstrates the significance of transmission route and immune escape.</p>\n</li>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946918/\" rel=\"noreferrer\">Maternal-fetal, and in utero twin-twin</a> seem to be exceedingly rare, but have occurred, again, demonstrating the existence, but poor efficiency of transmission</p>\n</li>\n<li><p><a href=\"http://science.sciencemag.org/content/125/3239/158.long\" rel=\"noreferrer\">Inoculation of volunteers with tumor cells</a> in a problematic series of experiments at Sloan Kettering in the 50s, transplantation of tumor cells into patients with other cancers, resulted in growth, recurrence after excision, and death in some cases. Transplantation into healthy volunteers (yes, they did this) resulted in nodules that spontaneously regressed. This experiment has since been interpreted as evidence for immune system control of transplanted tumor system in healthy individuals, as compared to growth and progression in a receptive niche in a cancer patient.</p>\n</li>\n</ul>\n<p><em>So person-to-person transmission of cancer cells is rare, seemingly because, unlike an infectious microbe, there is not a suitable receptor for adhesion at an exposed or accessible site, a suitable environment for replication, and adaptations for immune escape by tumor cells in the original host are not effective in a new host.</em></p>\n<p>As a side note, there are contagious cancers in other species, but this doesn't seem to be particularly relevant to a question about whether cancer (or cancer risk) can be transmitted between two humans.</p>\n<h3>Is cancer risk contagious</h3>\n<p>17% of cancer cases worldwide are attributable to infectious agents (see Cecil Medicine, Ch. 183), these include viruses (e.g., HPV, hepatitis B and C, HIV, Epstein-Barr, and human herpesvirus-8) and bacteria (e.g., <em>H. pylori</em>). These are all contagious. At least somewhat related to the question, many of them are transmitted through sexual contact.</p>\n", "score": 7 } ]

[ "cancer", "breast", "heredity" ]

[ { "answer_id": 17714, "body": "<p>ACEI work on the renin–angiotensin–aldosterone system (<a href=\"http://ukrocharity.org/kidney-disease/the-renin-angiotensin-system-and-blood-pressure-control/\" rel=\"noreferrer\">RAAS</a>) whereas Ca++ blockers primarily work on cardiac contractility, HR, and vessel constriction.</p>\n<p>For the ACE-Inhibitor:</p>\n<blockquote>\n<p>Cells in the kidney release the enzyme, renin. Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin I. An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolizes angiotensin I into angiotensin II. Angiotensin II causes blood vessels to constrict and blood pressure to increase.</p>\n<p>^{Source: ibid}</p>\n</blockquote>\n<p>An ACE-Inhibitor inhibits the functioning of the ACE Enzyme, so less angiotensin II is produced and hence blood-vessels widen, which results in a lower blood pressure.</p>\n<p>For CCB:</p>\n<blockquote>\n<p>CCBs reduce blood pressure by limiting the amount of calcium or the rate at which calcium flows into the heart muscle and arterial cell walls. Calcium stimulates the heart to contract more forcefully. When calcium flow is limited, your heart’s contractions aren’t as strong with each beat, and your blood vessels are able to relax. This leads to lower blood pressure.</p>\n<p>^{Source: <a href=\"https://www.healthline.com/health/heart-disease/calcium-channel-blockers#how-they-work\" rel=\"noreferrer\">Healthline.com</a>}</p>\n</blockquote>\n<p><a href=\"https://www.uptodate.com/contents/high-blood-pressure-treatment-in-adults-beyond-the-basics\" rel=\"noreferrer\">This is a good article</a> for patient education on HTN treatments.</p>\n<hr />\n<p>It is seen clinically all the time that someone responds better to one class of medication than another. We see patients whose BP drops dangerously low with a tiny dose of an ACEI, and others whose BP is barely touched by high doses. High blood pressure is multifactoral and individuals may have different responses to medications for several reasons.</p>\n<ul>\n<li><p>Pharmacokinetics: Liver enzymes process (activate OR break down)\nmedications at different rates AND/OR kidneys excrete at different\nrates</p>\n</li>\n<li><p>The mechanism of blood pressure dysregulation: may differ, e.g. more related to vessel stiffness vs RAA dysregulation</p>\n</li>\n</ul>\n", "score": 5 }, { "answer_id": 17720, "body": "<p>As @DoctorWhom says, there is a great deal of variability in the effectiveness of single agents for blood pressure control. There are <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7755948\" rel=\"nofollow noreferrer\">some</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">subgroups</a> of patients who are more likely to respond or not respond to certain drugs, though. In the U.S., Black Americans tend to be less likely to respond to ACE inhibitors (and more likely to respond to thiazide diuretics, though that wasn't a drug in the question), and this difference is incorporated into the guidelines for choosing initial monotherapy (a single drug). There is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7755948\" rel=\"nofollow noreferrer\">some evidence</a> that older patients are also less likely to respond to ACE inhibitors, but this <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386598/\" rel=\"nofollow noreferrer\">isn't quite as clear cut</a>. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=10737282\" rel=\"nofollow noreferrer\">Regional differences</a> may be more important than racial differences, suggesting the effect is mediated by environment and lifestyle, rather than genetics. </p>\n\n<p>For a while, European guidelines recommended exactly the pattern described in the OP for older or non-white patients (avoid ACE-inhibitors, use calcium channel blockers), because these patients were often observed to have low renin hypertension (see @DoctorWhom's answer, ACE-inhibitors work by inhibiting the renin-angiotensin-aldosterone, or RAA, axis, so a low renin hypertension wouldn't be improved with this therapy). <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24107724\" rel=\"nofollow noreferrer\">Updated European guidelines</a> no longer make that recommendation. Regardless (outside of disease related reasons for choosing or avoiding a specific drug class) the best approach is to find and stick with a drug or combination that <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">brings blood pressure to the desired target</a>.</p>\n\n<p>Importantly, for anyone who might be reading this and wondering why a particular combination of antihypertensive drugs were chosen in their case, these drugs are generally given to reduce the risk of vascular and heart disease (e.g., heart attack, stroke, heart failure, and others). They target a disease determinant, blood pressure. There are goals related to that determinant, but the primary goal is downstream of the elevated blood pressure. Because of this, there are sometimes reasons to choose a drug that is more effective at preventing the end point of concern for a particular individual. These reasons might not be explained to a patient. I wish we were better at this. Some medications provide nice immediate positive feedback when taken and some don't. I've often seen patients who were put on a beta-blocker after a heart attack stop taking it, and I have to explain that their cardiologist didn't put them on the beta blocker to help them feel better, but to keep them from dying. You can read about this in a very dry, slightly impenetrable format in the most recent <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">US guidelines</a>, and in, I think, a more readable format in Cecil Medicine Ch 67. </p>\n", "score": 4 } ]

[ "hypertension" ]

[ { "answer_id": 17814, "body": "<p>Not by ICD10 code that I am aware of. But there are for diagnoses, which is obviously what ICD10 codes for. There are a variety of sites that bring together references by topic. Most require a $subscription. Some examples used in the USA include</p>\n\n<ul>\n<li>UpToDate (usually incorporates recent research into consensus report, but may lag behind new studies)</li>\n<li>Medscape (similarly may lag, look carefully at article date)</li>\n<li>Epocrates</li>\n<li>Dynamed</li>\n<li>Societies like AAFP, AAP etc have by-topic research and guidelines </li>\n<li>Pubmed (the ultimate hub for search by topic, results are scientific journals published)</li>\n</ul>\n\n<p>There are some resources that are integrated into the EMR, depending on the EMR build, which might use ICD10 coding to query their database. </p>\n\n<p>If someone finds something, definitely share it.</p>\n", "score": 4 } ]

[ "treatment-options" ]

[ { "answer_id": 17838, "body": "<p>Type 1 and Type 2 diabetic patients can eat sugar under specific conditions. <br>\nWhite and brown sugar are pretty much identical (from a \"diabetic\" viewpoint) and they respectively have a <strong>Glycemic Index of <a href=\"https://academic.oup.com/ajcn/article-abstract/34/3/362/4692881\" rel=\"noreferrer\">(+-10)</a> 68 and 64</strong> according to the Linus Pauling Institute.<br>\nSo as a summary, no. Brown sugar <strong>affects</strong> the Blood Sugar level of a Diabetic patient similarly to white sugar.</p>\n", "score": 10 } ]

[ "diabetes", "sugar" ]

[ { "answer_id": 17844, "body": "<h3>What is Clinical Decision Support?</h3>\n<p>This ends up getting a little bogged down in compliance mumbo jumbo, but <a href=\"https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MedicaidEHStage3_Obj3.pdf\" rel=\"nofollow noreferrer\">Clinical Decision Support</a> is defined by the US centers for medicare and medicaid services as:</p>\n<blockquote>\n<p>Health information technology functionality that builds upon the foundation of an electronic health record to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.</p>\n</blockquote>\n<p>I've spelled out the abbreviated terms in this definition.</p>\n<p>You can understand CDS as a general concept (electronic tools to support clinical decision making), but generally, it's used to refer to US requirements for &quot;meaningful use&quot; of an electronic health record.</p>\n<h3>Meaningful Use</h3>\n<p>In US healthcare, the phrase &quot;meaningful use&quot; is almost a synonym for electronic health record (on wikipedia, <a href=\"https://en.wikipedia.org/wiki/Electronic_health_record#Meaningful_use\" rel=\"nofollow noreferrer\">meaningful use redirects to the EHR article</a>), but the phrase comes from the <a href=\"https://www.gpo.gov/fdsys/pkg/PLAW-111publ5/html/PLAW-111publ5.htm\" rel=\"nofollow noreferrer\">HITECH act</a>, a 2009 law that gave incentive payments for transitioning to electronic health records (and using those electronic records in a meaningful way).</p>\n<h3>Is it really required?</h3>\n<p>Strictly speaking, you can practice medicine in the US without using an electronic health record or clinical decision support, but, if you do, you won't have access to funds the federal government has set aside for modernizing health care, and in some cases, you will also be paid less for services. EHR rules are typically described as &quot;required&quot; when they mean &quot;required in order to qualify as meaningful use&quot;.</p>\n<h3>What is the official reasoning behind making it required?</h3>\n<p>One of the main goals of the HITECH act (see link above) was development of a health information technology infrastructure that improved health care quality and reduced errors. Decision support tools directly support these goals. <a href=\"https://www.healthit.gov/\" rel=\"nofollow noreferrer\">HealthIT.gov</a>, the website for the office set up by the HITECH act, has <a href=\"https://www.healthit.gov/topic/safety/clinical-decision-support\" rel=\"nofollow noreferrer\">a page that spells out the official reasons</a>. Some highlights:</p>\n<blockquote>\n<p>CDS has a number of important benefits, including:</p>\n<ul>\n<li><p>Increased quality of care and enhanced health outcomes</p>\n</li>\n<li><p>Avoidance of errors and adverse events</p>\n</li>\n<li><p>Improved efficiency, cost-benefit, and provider and patient satisfaction</p>\n</li>\n</ul>\n<p>Health information technologies designed to improve clinical decision making are particularly attractive for their ability to address the growing information overload clinicians face, and to provide a platform for integrating evidence-based knowledge into care delivery</p>\n</blockquote>\n<p>Of note, though one of the official reasons for requiring CDS for meaningful use is &quot;growing information overload&quot;, in order to qualify, you only need <a href=\"https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MedicaidEHStage3_Obj3.pdf\" rel=\"nofollow noreferrer\">5 clinical decision support interventions, a drug-drug and drug-allergy check</a>. I believe these are useful things to do, but targeting 5 quality measures seems fairly limited if the goal is to help with &quot;information overload&quot;. If it's truly &quot;general and person specific information, intelligently filtered and organized, at appropriate times&quot;, I hope we can move beyond pop up alerts for a few quality measures.</p>\n", "score": 3 } ]

[ "practice-of-medicine", "diagnostics", "health-informatics" ]

[ { "answer_id": 17889, "body": "<p>UpToDate has a couple <a href=\"https://www.uptodate.com/contents/endoscopic-ultrasound-in-patients-with-suspected-choledocholithiasis?search=eus&amp;source=search_result&amp;selectedTitle=4~150&amp;usage_type=default&amp;display_rank=4#H3\" rel=\"noreferrer\">(1)</a> <a href=\"https://www.uptodate.com/contents/choledocholithiasis-clinical-manifestations-diagnosis-and-management?sectionName=Diagnostic%20approach&amp;topicRef=2660&amp;anchor=H17164458&amp;source=see_link#H972627978\" rel=\"noreferrer\">(2)</a> pretty good articles discussing current research and recs on the use of endoscopic ultrasound (EUS). As it is behind a paywall (which some hospitals pay for, so you might be able to access it at a local institution), Medscape has a couple good articles as well <a href=\"https://www.medscape.com/viewarticle/717345_4\" rel=\"noreferrer\">(3)</a> <a href=\"https://www.medscape.com/viewarticle/407974\" rel=\"noreferrer\">(4)</a>. </p>\n\n<p>I cannot accurately speak for national or international standards of practice, but your question asks for an individual's viewpoint from primary care in the US or UK, and is specific to gallbladder disease. From my experience in the US, the standard of practice for outpatient primary care management of non-emergent suspected gallbladder disease remains to start with transabdominal ultrasonography with liver function tests. I have very rarely seen EUS be ordered in the primary setting, and never yet as the initial test. </p>\n\n<p>This is likely because although EUS is more sensitive and specific than transabdominal ultrasound, it is more invasive, costly, difficult, time-consuming, requires sedation, and risks are - although fairly low - still higher than transabdominal US. Thus transabdominal US is a more reasonable first step, with the knowledge that it is not 100% sensitive and thus additional testing is required for high suspicion. In that case, depending on the suspected pathology, additional testing is ordered and sometimes referral made to a gastroenterologist or general surgeon. </p>\n\n<p>A gastroenterologist's practice may be different, however. And of course ER/inpatient management is different due to patient acuity, but in most cases, transabdominal is still the initial test. Again due to lower sensitivity it is not sufficient to <em>rule out</em> if suspicion is high enough; however, if it does find something, it provides a quick answer.</p>\n\n<p>This is not a comprehensive discussion on its use, but it addresses your primary question. I would be interested in hearing from practitioners in different locations if EUS is more broadly used in primary settings.</p>\n\n<p>References</p>\n\n<ul>\n<li><a href=\"https://www.uptodate.com/contents/endoscopic-ultrasound-in-patients-with-suspected-choledocholithiasis?search=eus&amp;source=search_result&amp;selectedTitle=4~150&amp;usage_type=default&amp;display_rank=4#H3\" rel=\"noreferrer\">https://www.uptodate.com/contents/endoscopic-ultrasound-in-patients-with-suspected-choledocholithiasis?search=eus&amp;source=search_result&amp;selectedTitle=4~150&amp;usage_type=default&amp;display_rank=4#H3</a></li>\n<li><a href=\"https://www.uptodate.com/contents/choledocholithiasis-clinical-manifestations-diagnosis-and-management?sectionName=Diagnostic%20approach&amp;topicRef=2660&amp;anchor=H17164458&amp;source=see_link#H972627978\" rel=\"noreferrer\">https://www.uptodate.com/contents/choledocholithiasis-clinical-manifestations-diagnosis-and-management?sectionName=Diagnostic%20approach&amp;topicRef=2660&amp;anchor=H17164458&amp;source=see_link#H972627978</a></li>\n<li><a href=\"https://www.medscape.com/viewarticle/717345_4\" rel=\"noreferrer\">https://www.medscape.com/viewarticle/717345_4</a></li>\n<li><a href=\"https://www.medscape.com/viewarticle/407974\" rel=\"noreferrer\">https://www.medscape.com/viewarticle/407974</a></li>\n</ul>\n", "score": 5 } ]

[ "diagnosis", "gallbladder", "ultrasounds" ]

[ { "answer_id": 17895, "body": "<p>Point of attachment and direction of force development.</p>\n\n<p>This is like trying to move a door near the handle or at the hinges. Lever forces are weak in one case and almost absent in the other case. It is a difference between small and negligible. </p>\n\n<p>The <em>M pronator teres</em> is already very weak for flexing the elbow, as it is attached at a quite suboptimal position to exert much force in that regard. The <em>M supinator</em> is attached at the elbow but even lower and the direction of force development would also be just about minimally conducive for that.:</p>\n\n<blockquote>\n <p><a href=\"https://i.stack.imgur.com/U9oaD.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/U9oaD.png\" alt=\"enter image description here\"></a>\n <a href=\"https://i.stack.imgur.com/k77Eb.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/k77Ebs.png\" alt=\"enter image description here\"></a>\n <a href=\"https://i.stack.imgur.com/JPQeM.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/JPQeMs.png\" alt=\"enter image description here\"></a> (click to enlarge)\n First picture from WP, 2nd &amp; 3rd from Nigel Palastanga &amp; Roger Soames: \"Anatomy &amp; Human Movement\", Churchill Livingstone: Edinburgh, London, ⁶2011. (German edition, pp69.)<br>\n <a href=\"https://i.stack.imgur.com/CjnQ8.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/CjnQ8s.png\" alt=\"enter image description here\"></a>\n <a href=\"https://i.stack.imgur.com/KEMDi.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/KEMDis.png\" alt=\"enter image description here\"></a> (English edition, pp74.)</p>\n</blockquote>\n\n<p>To quote Palastanga &amp; Soames:</p>\n\n<blockquote>\n <p><strong>Supinator</strong><br>\n Deep in the upper part of the forearm, supinator lies concealed by the superficial muscles as it surrounds the upper end of the radius. Its two heads arise in a continuous manner from the <em>inferior aspect</em> of the <em>lateral epicondyle</em> of the <em>humerus</em>, the <em>radial collateral ligament</em>, the <em>annular ligament</em>, the <em>supinator crest</em> and <em>fossa</em> of the <em>ulna</em>. It is often convenient, however, to think of supinator as arising by two heads, humeral and ulnar, between which passes the posterior interosseous nerve to gain access to the extensor compartment of the forearm. From this extensive origin, the muscle fibres pass downwards and laterally to wrap around the upper third of the radius. They insert into the <em>posterior, lateral</em> and <em>anterior aspects</em> of the <em>radius</em>, as far forwards as the anterior margin between the neck and the attachment of pronator teres.</p>\n \n <p>As its name suggests, supinator supinates the forearm, in which there is an anterolateral movement of the distal end of the radius around the ulna causing the two bones to lie parallel to each other. Unless a particularly powerful supinatory action is required, supinator is probably the prime mover. However, if a powerful movement is required, biceps brachii is also recruited. It must be remembered, however, that biceps brachii cannot function as a supinator with the elbow fully extended, and consequently powerful supinatory movements are performed with the elbow flexed to about 120 .</p>\n \n <p><strong>Pronator teres</strong><br>\n Forming the medial border of the cubital fossa at the elbow, pronator teres is the most lateral of the superficial muscles in the flexor compartment of the forearm. It arises by two heads – the humeral head and the ulnar head. The humeral head arises from the lower part of the <em>medial supracondylar ridge</em> and adjacent <em>intermuscular septum</em>, as well as from the common flexor origin on the <em>medial epicondyle</em> of the <em>humerus</em> and the covering fascia. The ulnar head arises from the <em>pronator ridge</em> on the <em>ulna,</em> which runs downwards from the medial part of the <em>coronoid process,</em> joining the humeral head on its deep surface. Between these two heads passes the median nerve. The muscle fibres pass downwards and laterally to attach via a flattened tendon into a <em>roughened oval area</em> on the middle of the <em>lateral surface</em> of the <em>radius</em>.</p>\n \n <p>Pronator teres pronates the forearm by producing an anteromedial movement of the lower end of the radius across the ulna, carrying the hand with it. Pronator teres is also a weak flexor of the elbow.</p>\n</blockquote>\n", "score": 3 } ]

[ "muscle" ]

[ { "answer_id": 17900, "body": "<p>Psychology is an important component of the human sexual response. Mental health conditions such as depression and anxiety spectrum disorders can significantly change an individual's sexual response. Sexual dysfunction such as anorgasmia (difficulty achieving orgasm), decreased libido (lower sex drive), lower arousal state, and erectile dysfunction (difficulty achieving or maintaining full erection) are a common symptom reported in individuals with depression and other mental health conditions.</p>\n\n<p>Furthermore, many medications (especially those that alter neurophysiology) also have the potential to interfere with the sexual response. Not all that take these medications have the same sexual side effects, but there are medications with higher rates of sexual side effects than others.</p>\n\n<p>Most individuals who experience SSRI-induced sexual dysfunction see improvement either through switching to a different medication, or via psychotherapy (focused on sexual response) and \"retraining the response.\" There are infrequent but existing cases of persistent SSRI-induced sexual dysfunction, such as in <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18173768\" rel=\"noreferrer\">this study by Csoka et al</a>, where they cite </p>\n\n<blockquote>\n <p>\"mechanistic hypotheses including persistent endocrine and epigenetic\n gene expression alterations.\"</p>\n</blockquote>\n\n<p>This is less clear in lithium, as there are far fewer studies. A paper in 2015 titled <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25619161\" rel=\"noreferrer\">\"Lithium and sexual dysfunction: an under-researched area\"</a> explored the literature and found it lacking in robust studies on the topic. They emphasize that </p>\n\n<blockquote>\n <p>\"Sexual dysfunction during lithium treatment appears significantly\n associated with a lower level of overall functioning and may reduce\n compliance\"</p>\n</blockquote>\n\n<p>which is why this topic is certainly an important issue to address, as <a href=\"https://ebmh.bmj.com/content/ebmental/18/1/1.full.pdf\" rel=\"noreferrer\">maintenance therapy is a critical component of supporting mental health stability</a> - especially for those struggling with disorders that involve mania and/or psychoses.</p>\n\n<p>Treatment of lithium and other medication-induced sexual dysfunction can certainly be successful, but may require effort and different modes of therapy - for which both medications and sexual psychotherapy exist. I hesitate to get into the specifics, as it would be of greatest benefit for an individual struggling with this to discuss his/her specific situation with the prescribing physician, and also possibly a psychologist.</p>\n\n<p><em>This is what my initial review has yielded. I will continue to update this with additional information that I find. Please feel free to recommend additional resources.</em></p>\n\n<p>Resources:</p>\n\n<ul>\n<li><a href=\"https://www.aafp.org/afp/2000/0701/p127.html\" rel=\"noreferrer\">https://www.aafp.org/afp/2000/0701/p127.html</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18173768\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/18173768</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25619161\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/25619161</a></li>\n<li><a href=\"https://ebmh.bmj.com/content/ebmental/18/1/1.full.pdf\" rel=\"noreferrer\">https://ebmh.bmj.com/content/ebmental/18/1/1.full.pdf</a></li>\n</ul>\n", "score": 5 } ]

[ "irreversible-damage", "sexuality", "lithium" ]

[ { "answer_id": 17907, "body": "<p>There is evidence that delaying or refusing immunization puts children at risk of disease <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/19482753/\" rel=\"noreferrer\">here</a> and <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/20048244/\" rel=\"noreferrer\">here</a>. There is also <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=24843064\" rel=\"noreferrer\">evidence</a> that delaying or spreading out MMR or MMRV in particular puts children at greater risk of reactions (febrile seizures), rather then reducing the risk. I'm not aware of any study demonstrating the opposite.</p>\n", "score": 6 } ]

[ "vaccination", "infectious-diseases", "microbiology" ]

[ { "answer_id": 17922, "body": "<blockquote>\n <p>What are the outcomes of uterine rupture?</p>\n</blockquote>\n\n<p>Treatment of uterine rupture is surgical. Goals are stopping the hemorrhage, delivering the baby, and repairing the uterus if possible. </p>\n\n<p>The range of risks is similar to the range of risks of a cesarean delivery (infection, blood loss, thromboembolism, hysterectomy, organ injury, adhesions, extended hospital stay, extended recovery time, risks associated with anesthesia, maternal mortality, fetal injury, fetal respiratory problems, fetal neurological problems, and perinatal death, see Williams Obstetrics). Single center reports vary, due in part to the characteristics of their patient population, so it is difficult to pin down a useful rate for comparison, but generally the risks would seem to be higher. A <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1216316/\" rel=\"noreferrer\">population level study in Canada</a> looking at all maternal morbidity from 1991 - 2001, reported 4 total cases of maternal death after uterine rupture in those 10 years, from which we can calculate a risk of 2 per 1,000 uterine ruptures. This is much higher than with cesarean (varies, but, Williams puts it at 2.2 per 100,000, and with a comparable population the risk of maternal mortality after vaginal delivery is 0.2 per 100,000), but the <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20502301\" rel=\"noreferrer\">2010 NIH consensus statement on VBAC</a> states there have been no reported maternal deaths due to uterine rupture, presumably using US data alone.</p>\n\n<p>Other than maternal mortality, the primary risks of uterine rupture are hysterectomy (14-33 percent) and perinatal death (6 percent) (see the NIH consensus statement).</p>\n\n<p>I would note, also, the risk of uterine rupture is reported and probably presented when discussing VBAC, as less than 1%, but the specific risk is highly dependent on specific maternal and uterine characteristics. A classic (vertical) cesarean incision (which is generally not done anymore), for example, carries a higher risk than a low transverse incision, and a poor closure (single-layer) also carries a higher risk. Much of what drives the reported risk of uterine rupture during TOLAC is based on surgical techniques from many decades ago. You can read more about this in the NIH consensus statement I linked to above.</p>\n", "score": 7 } ]

[ "birth", "uterus", "vaginal-delivery", "childbirth" ]

[ { "answer_id": 17994, "body": "<p>It is not a fast heart rate but the underlying mechanisms that can affect health. The mechanisms involved in exercise can be beneficial and those in anxiety harmful.</p>\n\n<p><strong>EXERCISE</strong></p>\n\n<p><a href=\"https://www.cdc.gov/nccdphp/sgr/pdf/chap3.pdf\" rel=\"nofollow noreferrer\">Physiological responses and long-term adaptations to exercise (CDC.gov)</a>:</p>\n\n<blockquote>\n <p>...the <strong>cardiovascular response to exercise</strong> is directly proportional to\n the <strong>skeletal muscle oxygen demands</strong> for any given rate of work...</p>\n</blockquote>\n\n<p>Table 3.2 from the same source shows cardiovascular changes after 6 months of endurance training, for example, <strong><em>increased heart volume, increased stroke volume at rest, lower systolic blood pressure at rest and increased blood volume.</em></strong></p>\n\n<p>Long-term exercise and the associated increased oxygen demand also results in <strong><em>more dense capillary network in the heart and skeletal muscles,</em></strong> and therefore their better oxygen and nutrients supply.</p>\n\n<p>Regular exercise can have other benefits, such as <strong><em>easier maintenance of healthy body weight, increased muscle mass, lung volume and insulin sensitivity, and lower LDL cholesterol</em></strong> (<a href=\"https://www.cdc.gov/nccdphp/sgr/pdf/chap3.pdf\" rel=\"nofollow noreferrer\">CDC.gov</a>) and <strong><em>mortality</em></strong> (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574458/\" rel=\"nofollow noreferrer\">PubMed</a>).</p>\n\n<p><strong>ANXIETY</strong></p>\n\n<p>In anxiety, there is no increase in skeletal muscle oxygen demand, so there should be no cardiovascular benefits (concluding from the quoted part from the CDC.gov above). In contrary, mechanisms involved in long-term anxiety my be harmful for the heart:</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150179/\" rel=\"nofollow noreferrer\">Anxiety and cardiovascular risk...(PubMed)</a>:</p>\n\n<blockquote>\n <p>...anxiety appears to predict <strong><em>more cardiovascular symptoms...and\n cardiovascular events.</em></strong></p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149447/\" rel=\"nofollow noreferrer\">Anxiety disorders and cardiovascular disease (PubMed)</a>:</p>\n\n<blockquote>\n <p>The relationships between anxiety disorders and\n cardiac outcomes likely are mediated by both <strong><em>behavioral and\n physiologic mechanisms, including autonomic dysfunction, inflammation,\n and platelet aggregation.</em></strong></p>\n</blockquote>\n", "score": 5 } ]

[ "exercise", "cardiology", "anxiety-disorders" ]

[ { "answer_id": 18019, "body": "<p>There is a mixed, but largely unconvincing evidence that increased moisture within the nose would help to prevent or cure flu or common cold.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/books/NBK279542/\" rel=\"nofollow noreferrer\">Common colds: Relief for a stuffy nose, cough and sore throat (Informed Health Online)</a>:</p>\n\n<blockquote>\n <p>Many people find it pleasant to breathe in (inhale) steam ...But this\n kind of inhalation doesn't have a clear effect on cold symptoms.</p>\n</blockquote>\n\n<p>Dehydration can make your nasal mucosa dry, but:</p>\n\n<blockquote>\n <p>Drinking a lot of fluids is also often recommended if you have a cold.\n There's no scientific proof that this will help, though.</p>\n</blockquote>\n\n<p>In <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18209140/\" rel=\"nofollow noreferrer\">one 2008 study in 401 children 6-10 years old</a>, nasal irrigation with saline solution decreased and shortened symptoms in some children with common cold or flu. But in <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451967/\" rel=\"nofollow noreferrer\">several similar studies</a>, nasal irrigation had no effect.</p>\n\n<p>Important to know: Even antiviral drugs can effectively shorten the duration of flu when taken within 24-48 hour after the onset of symptoms (<a href=\"https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm\" rel=\"nofollow noreferrer\">CDC.gov</a>). This also likely applies for any nasal moisturizer, because viruses act within the cells, where can't be reached by drugs or moisture.</p>\n", "score": 3 } ]

[ "infection", "bacteria", "virus", "influenza", "humidifier" ]

[ { "answer_id": 18051, "body": "<p><strong>Question: Does eating (fatty) fish help to lower high blood pressure or does it help only when eaten instead of red meat?</strong></p>\n\n<p><strong>Answer: Merely increasing fish, including oily fish, consumption without other dietary changes (especially losing excessive weight) may not help to reduce blood pressure.</strong></p>\n\n<p><strong>FISH</strong></p>\n\n<p><a href=\"https://academic.oup.com/advances/article/8/6/793/4772207\" rel=\"nofollow noreferrer\">Food Groups and Risk of Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies (Academic.oup, 2017)</a>:</p>\n\n<blockquote>\n <p>In our study, fish consumption was associated with a <em>slight increase\n in hypertension risk.</em></p>\n</blockquote>\n\n<p><strong>FATTY FISH</strong></p>\n\n<p><a href=\"https://academic.oup.com/ajcn/article/108/3/576/5095501#\" rel=\"nofollow noreferrer\">Food groups and intermediate disease markers: a systematic review and network meta-analysis of randomized trials (Academic.oup.com, 2018)</a>:</p>\n\n<blockquote>\n <p>Consumption of fatty fish resulted in significant improvements in\n triglycerides and HDL cholesterol, whereas <em>no effects were observed\n for...systolic and diastolic blood pressure.</em></p>\n</blockquote>\n\n<p><strong>RED MEAT</strong></p>\n\n<p>According to one systematic review (<a href=\"https://watermark.silverchair.com/an017178.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAp0wggKZBgkqhkiG9w0BBwagggKKMIIChgIBADCCAn8GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMM8GwYaHQHY42pfzLAgEQgIICUC8fFC1hv8wybTm7yYHKADn_yKbw_1ukT6hNkIdsK-Z1WKl6OvXYLEPbXNgnn37w-EF4nvI7yREVUB5iOwy19QV6P7HoDIhvP9PQWHg6Xa6Auw9uI7hs_7n4Cm9xzapWEjjV68X1QWnHzB3oamtGJDVhOS1ZczCCcB_BvP3O8dNAdIL7JRKNJOIUf0yukILNMiY5EwD9y9Z4jCZbH63iQBsJPjF5b6G82NLDSJG1DFHnvcgKyUrsN8BD5O-XyUhA6WflXyHS9xyLuCPOYkCVw0gwUqYPRx2nWvMOKt4js8vZOqD79kI66-kZrQ3-aYj1ZPdi9elEiuExoaUmAwIu0F_qG-60diwXwk-P-RkfUrzDKQrXMh1B05p5j2qu_N6acxFBwJL0nAIKbDyCYqMh-VXUpKfFtWIHfImUc_Oyhd9bz6nkKhRhc2KAQrmCFb7UegyOP05mu9ps9cqbFkbskzcsrHW8DqbRIOMCWPjhgRjg3lptzlTe7RZTfjqExcNh_H_Vl2WM5GXWkbuMTL8hJdMY1UFKw8M2VchNUdp9qckC6054Qgs9vsqLfZk2A5tnv47gNMW_0eN-m93YR8llieQ4p1j0OcaPUBL-LP4pi7c9_EAdAvMwpOp2eXuHhlIu5Jw-5pwiZ57iReAzJUPvvLxQZ6MUMJFjiwpNxLFzd6yJsbYvbI4P9QeLLCs-YoIlxXUxci54I8uuA4mvNxye0w3sFfYRrY1JQNp6cOeXoi4gk4DrfYOg6L5iO0EklGR30HFENumknFUY126XidWCSq8\" rel=\"nofollow noreferrer\">American Society of Nutrition, 2017</a>), consumption of red meat is associated with high blood pressure, but in some other studies (<a href=\"https://www.researchgate.net/publication/264390710_Processed_and_unprocessed_red_meat_consumption_and_hypertension_in_women\" rel=\"nofollow noreferrer\">ResearchGate, 2014</a>; <a href=\"https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0252-7\" rel=\"nofollow noreferrer\">Nutrition Journal, 2017</a>) no such association have been found.</p>\n\n<p><strong>THE DIET AS A WHOLE</strong></p>\n\n<p><a href=\"https://www.cnpp.usda.gov/sites/default/files/usda_nutrition_evidence_flbrary/DietaryPatternsReport-FullFinal.pdf\" rel=\"nofollow noreferrer\">A Series of Systematic Reviews on the Relationship Between Dietary Patterns and \nHealth Outcomes (USDA.gov, 2014)</a>:</p>\n\n<blockquote>\n <p>There is strong and consistent evidence that <em>consumption of a DASH\n [Dietary Approaches to Stop Hypertension] diet results in reduced\n blood pressure in adults with above optimal blood pressure...</em> A\n dietary pattern consistent with the DASH diet is rich in fruits,\n vegetables, low-fat dairy, fish, whole grains, fiber, potassium, and\n other minerals at recommended levels, and low in red and processed\n meat, sugar-sweetened foods and drinks, saturated fat, cholesterol,\n and sodium.</p>\n</blockquote>\n", "score": 2 }, { "answer_id": 18085, "body": "<p>According to the <a href=\"http://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids\" rel=\"nofollow noreferrer\">American Heart Association</a> should have fish high in omega 3 fatty acid twice a week.</p>\n\n<blockquote>\n <p>The American Heart Association recommends eating fish (particularly\n fatty fish) at least two times (two servings) a week. Each serving is\n 3.5 ounce cooked, or about ¾ cup of flaked fish. Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are\n high in omega-3 fatty acids.</p>\n \n <p>Increasing omega-3 fatty acid consumption through foods is preferable.\n However, those with coronary artery disease, may not get enough\n omega-3 by diet alone. These people may want to talk to their doctor\n about supplements. And for those with high triglycerides, even larger\n doses could help.</p>\n \n <p>Omega-3 fatty acids also decrease triglyceride levels, slow growth\n rate of atherosclerotic plaque, and lower blood pressure (slightly).</p>\n</blockquote>\n", "score": 0 } ]

[ "nutrition", "diet", "heart", "fish", "hypertension" ]

[ { "answer_id": 18106, "body": "<p>The sunlight through the window does not stimulate vitamin D synthesis in the skin.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897598/\" rel=\"noreferrer\">Sunlight and Vitamin D (PubMed)</a>:</p>\n\n<blockquote>\n <p>Since glass absorbs all UVB radiation, exposure of the skin to\n sunlight that passes through glass, plexiglass, and plastic will not\n result in any production of vitamin D3 in the skin.</p>\n</blockquote>\n\n<p>The sunlight reflected from the surfaces, especially snow, can contribute to vitamin D synthesis in the skin.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897581/\" rel=\"noreferrer\">Vitamin D status and sun exposure in India (PubMed)</a>:</p>\n\n<blockquote>\n <p>The geophysical parameters like...surface albedo (the fraction of\n light reflected from earth’s surface)...affect vitamin D3 production\n in the human body.</p>\n</blockquote>\n\n<p><a href=\"https://pdfs.semanticscholar.org/a09a/e99dcfa345e232ab2adb27d5961081832edc.pdf\" rel=\"noreferrer\">Who, what, where and when—influences on cutaneous vitamin D synthesis (Progress in Biophysics and Molecular Biology)</a></p>\n\n<blockquote>\n <p>This process becomes significant if surface albedo is high, e.g. if\n covered with fresh snow (albedo ~90%)...With the exception of snow,\n most natural surfaces have a low albedo in the UV, of the order 5% for\n vegetation, 10% for soils and rocks, and up to 20% for dry sand, the\n same as some concretes and cement...</p>\n</blockquote>\n\n<p>and (<a href=\"https://www.researchgate.net/publication/285056396_Vitamin_D_The_truth_about_Vitamin_D_and_sun_exposure_demystified_Finding_the_balance_for_personal_health\" rel=\"noreferrer\">Research Gate</a>)</p>\n\n<blockquote>\n <p>3-5% for water</p>\n</blockquote>\n", "score": 6 }, { "answer_id": 18097, "body": "<p>To produce Vitamin D you need to get radiated by light with wavelengths below 300 nm.\nSo let's look at the reflectance and transmittance of the materials.</p>\n\n<p>A window made of glass has a transmittance of nearly 0 % for UV-Radiation.\n<a href=\"https://physics.stackexchange.com/questions/74638/transmittance-of-glass\">https://physics.stackexchange.com/questions/74638/transmittance-of-glass</a></p>\n\n<p>The reflection depends on the surrounding. Asphalt for example has a reflectance below 5 % whereas the value for snow is close to 100 %.</p>\n\n<p>In general I would assume that reflected light on the northern hemisphere under daily circumstances is not enough for sufficient production of Vitamin D. If you live on a high mountain this might vary.</p>\n", "score": 1 } ]

[ "sun-exposure", "vitamin-d", "sunlight" ]

[ { "answer_id": 18117, "body": "<p>What was once defined as '<a href=\"https://en.wikipedia.org/wiki/Scientific_racism\" rel=\"nofollow noreferrer\">scientific racism</a>' is incompatible with what we know to be science or anthropology. Inter-group differences, supposed to be large in broad terms and used to qualify people, turned out to be much smaller than intra-group differences. And the classifications into 'better' or 'worse' turned out to be completely bogus.</p>\n<p>But that does not mean that genetics do not exist or that systematic genetic differences do not exist. For societal classifications these turned out to be meaningless as well.\nFor medical reasons there were some important variables identified that pertain for example to bone marrow transplants. Certain features of the immune system are more often grouped in similar ethnic groups than between dissimilar ethnic groups.</p>\n<p>The <a href=\"https://bethematch.org/transplant-basics/matching-patients-with-donors/how-does-a-patients-ethnic-background-affect-matching/\" rel=\"nofollow noreferrer\">National Marrow Donor Program summarises it as</a></p>\n<blockquote>\n<p>How does a patient's ethnic background affect matching?<br />\nA patient’s likelihood of finding a matching bone marrow donor or cord blood unit on the Be The Match Registry ranges from 23% to 77% depending on ethnic background. Patients are more likely to match an adult donor of their own ethnic background.</p>\n</blockquote>\n<p>Compare that to blood types. Yes, they exist. As do different colours of skin. But that doesn't mean that A is 'better' than B. They are just differently arranged molecules on blood cells.</p>\n<blockquote>\n<p>Despite the large number of registered potential donors, the NMDP and unrelated HSC registries worldwide continue to face difficulties in identifying matched donors for some patients, in particular racial/ethnic minorities. (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578960/\" rel=\"nofollow noreferrer\">PUBMED</a>)</p>\n<p>Multiple dimensions of self-identification, including race/ethnicity and geographic ancestry were compared to classifications based on ancestry informative markers (AIMs), and the human leukocyte antigen (HLA) genes, which are required for transplant matching. Nearly 20% of responses were inconsistent between reporting race/ethnicity versus geographic ancestry. Despite strong concordance between AIMs and HLA, no measure of self-identification shows complete correspondence with genetic ancestry. In certain cases geographic ancestry reporting matches genetic ancestry not reflected in race/ethnicity identification, but in other cases geographic ancestries show little correspondence to genetic measures, with important differences by gender. However, when respondents assign ancestry to grandparents, we observe sub-groups of individuals with well- defined genetic ancestries, including important differences in HLA frequencies, with implications for transplant matching. While we advocate for tailored questioning to improve accuracy of ancestry ascertainment, collection of donor grandparents’ information will improve the chances of finding matches for many patients, particularly for mixed-ancestry individuals.<br />\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545604/\" rel=\"nofollow noreferrer\">Hollenbach et al.: &quot;Race, Ethnicity and Ancestry in Unrelated Transplant Matching for the National Marrow Donor Program: A Comparison of Multiple Forms of Self-Identification with Genetics&quot;, PLoS One. 2015; 10(8): e0135960.</a></p>\n</blockquote>\n<p>They are not incompatible, as racism would describe it. The request with its specifics is just betting on the increased likelihood of finding a donor from a pool of a minority that has an increased likelihood of containing a match but a decreased likelihood of donors from that pool already registered. They might as well find a match from someone grouped into another ethnicity. It is a game of probabilities.</p>\n<p>Directly about the situation in Israel:</p>\n<blockquote>\n<p>HLA haplotype frequencies in a volunteer bone marrow donor registry should reflect the frequencies of potential transplant recipients served by that registry, a challenge in a country with diverse subethnicities of immigrants from Eastern and Western cultures, such as Israel. We evaluated the likelihood of finding suitable donors for hypothetical patients drawn from defined subethnicities in the Ezer Mizion Bone Marrow Donor Registry (EM BMDR) from donors both within and outside the registry now and during the coming decade. On average, bioinformatics modeling predicts that, given current donor recruitment trends, 6/6 high-resolution HLA match rates for Israelis, which currently stand at 40% to 55% for most subethnicities, will rise by up to 1% per year over the next decade. Subethnicities with historically lower rates of interethnic admixture are less likely to find matches outside of their designated group but will benefit from expansion of the registry, whereas ethnically directed drives will enhance matching rates for currently underrepresented subethnicities. Donor searches for the same cohort using a large extramural registry was of only slight benefit for most of the 19 EM BMDR subethnicities evaluated, confirming that local donor registries that reflect the ethnic diversity of the community being served are best equipped to serve the needs of their respective communities. Contemporary trends of an increasingly multiethnic admixture in Israel may impact the effect of ethnic profiling in assessing future match rates for EM BMDR.<br />\n<a href=\"https://www.sciencedirect.com/science/article/pii/S1083879117303932\" rel=\"nofollow noreferrer\">Halagan et al.: &quot;East Meets West—Impact of Ethnicity on Donor Match Rates in the Ezer Mizion Bone Marrow Donor Registry&quot;, Biology of Blood and Marrow Transplantation, Volume 23, Issue 8, August 2017, Pages 1381-1386</a>, <a href=\"https://doi.org/10.1016/j.bbmt.2017.04.005\" rel=\"nofollow noreferrer\">DOI</a>.</p>\n</blockquote>\n", "score": 5 } ]

[ "dna", "bone-marrow", "race" ]

[ { "answer_id": 18125, "body": "<p>The headache after <strong>lumbar puncture</strong> is common (~30%) and is not migraine headache. The mechanism is not entirely clear but likely involves a drop of cerebrospinal fluid volume and/or pressure <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660496/\" rel=\"nofollow noreferrer\">(PubMed)</a>:</p>\n\n<blockquote>\n <p>There are two possible explanations. Firstly, the low CSF\n [cerebrospinal fluid] volume depletes the cushion of fluid supporting\n the brain and its sensitive meningeal vascular coverings, resulting in\n gravitational traction on the pain‐sensitive intracranial structures\n causing classical headache, which worsens when the patient is upright\n and is relieved on lying down. Secondly, the decrease in CSF volume\n may activate adenosine receptors directly, causing cerebral\n vasodilatation and stretching of pain‐sensitive cerebral structures,\n resulting in headache after lumbar puncture.</p>\n</blockquote>\n\n<p>Also:</p>\n\n<blockquote>\n <p>According to the Headache Classification Committee of the\n International Headache Society, headache after lumbar puncture is\n defined as “bilateral headaches that develop within 7 days after an\n lumbar puncture and disappears within 14 days. The headache worsens\n within 15 min of resuming the upright position, disappears or improves\n within 30 min of resuming the recumbent position”. <em>This definition\n helps to avoid confusion with migraine or simple headache</em> after lumbar\n puncture.</p>\n</blockquote>\n\n<p><strong>A herniated disc that puts pressure on the spinal nerves or spinal cord in the neck</strong> (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28937465\" rel=\"nofollow noreferrer\"><strong>cervical spinal stenosis</strong></a>) can cause \"<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265896/\" rel=\"nofollow noreferrer\">cervicogenic headache</a>.\" This headache is also not migraine headache and</p>\n\n<blockquote>\n <p>is characterized by unilateral headache symptoms arising from the neck\n that radiate to the frontal-temporal and possibly to the supraorbital\n region.</p>\n</blockquote>\n\n<p>Mechanism (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK507862/\" rel=\"nofollow noreferrer\">StatPearls</a>):</p>\n\n<blockquote>\n <p>A cervicogenic headache is thought to be referred pain arising from\n irritation caused by cervical structures innervated by spinal nerves\n C1, C2, and C3.</p>\n</blockquote>\n\n<p>A herniated disc or spinal stenosis in <strong>the thoracic, lumbar or sacral region</strong> as such does not likely cause headache, but it rarely can, if the disc cuts the dura mater and causes CFS leakage leading to spontaneous intracranial hypotension (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817515/\" rel=\"nofollow noreferrer\">PubMed</a>).</p>\n\n<p>I maybe jumped too much on the term \"migraine,\" but I wanted to be accurate. The exact definitions of various types of headache are here: <a href=\"https://www.ichd-3.org/wp-content/uploads/2018/01/The-International-Classification-of-Headache-Disorders-3rd-Edition-2018.pdf\" rel=\"nofollow noreferrer\">The International Classification of Headache Disorders, 3rd edition (2018)</a>.</p>\n", "score": 4 } ]

[ "spine", "migraine", "spinal-cord-compression", "csf-cerebrospinal-fluid" ]

[ { "answer_id": 18133, "body": "<p><a href=\"https://www.aad.org/public/kids/skin/the-layers-of-your-skin\" rel=\"nofollow noreferrer\">The skin has 2 layers</a>: epidermis (the outer) and dermis (the inner). Sliding down the rope may cause an <strong><a href=\"https://en.wikipedia.org/wiki/Abrasion_(medical)\" rel=\"nofollow noreferrer\">abrasion</a></strong> in which only the epidermis is damaged. <strong><a href=\"https://www.utmb.edu/pedi_ed/CoreV2/Dermatology/page_08.htm\" rel=\"nofollow noreferrer\">Scars</a></strong> develop only when the dermis is damaged.</p>\n\n<p><a href=\"https://www.britannica.com/topic/fingerprint\" rel=\"nofollow noreferrer\"><strong>Fingerprints</strong> (Britannica)</a>:</p>\n\n<blockquote>\n <p>Each ridge of the epidermis (outer skin) is dotted with sweat pores\n for its entire length and is anchored to the dermis (inner skin) by a\n double row of peglike protuberances, or papillae. <strong>Injuries such as\n superficial burns, abrasions, or cuts do not affect the ridge\n structure or alter the dermal papillae, and the original pattern is\n duplicated in any new skin that grows.</strong> An injury that destroys the\n dermal papillae, however, will permanently obliterate the ridges.</p>\n</blockquote>\n\n<p><strong>So, the fingerprints after an injury that has left no scars will be likely the same as before, because the dermis has not been damaged.</strong> To prove this, one can ask \"the officials\" to take his/her fingerprints again...</p>\n\n<hr>\n\n<p>Some <strong>chemotherapeutics</strong> can cause \"<a href=\"https://www.oncologynurseadvisor.com/ce-courses/prevention-and-management-of-hand-foot-syndromes/article/174390/\" rel=\"nofollow noreferrer\"><strong>hand-foot syndrome</strong></a>\" with peeling of the epidermal layer of the skin and loss of fingerprints (<a href=\"https://jamanetwork.com/journals/jamaoncology/fullarticle/2546175\" rel=\"nofollow noreferrer\">Jama Oncology</a>):</p>\n\n<blockquote>\n <p>Within 8 weeks of treatment, severe quality loss of fingerprints was\n noticed in 9 patients treated with capecitabine and in 1 patient\n treated with the TKI sunitinib.</p>\n \n <p>Severe fingerprint quality loss recovered completely within 2 to 4\n weeks after treatment discontinuation in all 3 patients who were able\n to provide posttreatment fingerprints</p>\n</blockquote>\n\n<p>The article does not specifically say if the restored fingerprints were the same as before, though.</p>\n", "score": 4 } ]

[ "injury", "fingers", "fingerprint" ]

[ { "answer_id": 18209, "body": "<p>In principle: yes, the gut microbiome can be altered by external exposures. It is the large but and a large range of buts that follow.</p>\n<p>The newborns indeed get their initial &quot;seeding&quot; by birth, <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/20566857/\" rel=\"nofollow noreferrer\">vaginally preferred</a> and from the surface of the mother's body, and everyone and everything else in the surroundings. This is facilitated by two main factors: 1. in the womb the little person is sterile 2. when born the immune system isn't fully developed. Both factors making it way more easy for bacteria – any bacteria – to take a hold.</p>\n<blockquote>\n<p>Under physiological conditions, the fetus is protected from exposure to viable microorganisms. With rupture of membranes and passage through the birth canal, the neonate becomes exposed to bacteria that colonize maternal body surfaces and the environment. These bacteria start to establish the enteric microbiota initially characterized by low bacterial diversity and high interindividual variation. This makes the neonatal and early infant microbiota particularly vulnerable to exogenous interference. On the other hand, the low colonization resistance allows the interventional modification of the early microbiota by oral administration of beneficial bacteria. With time, additional bacterial species colonize the intestine and increase the diversity of the microbiota composition. In combination with the influence of genetic determinants and environmental factors, this ultimately leads to the generation of a mature and highly diverse enteric microbiota that remains relatively stable throughout life.</p>\n</blockquote>\n<p>That means in later life the immune system improves its effectiveness and the ecosystem that initially develops within the gut claims all the niches that are there and defend their own existence against newly arriving species (<a href=\"https://doi.org/10.1007/978-3-319-90545-7_3\" rel=\"nofollow noreferrer\">Hornef, 2018</a>).</p>\n<p>We observe three very different things that make an exception to this &quot;stability in adult life&quot;:</p>\n<ol>\n<li><p>Commensal and symbiotic bacteria (&quot;beneficial&quot;) , as well as unwanted and detrimental ones (&quot;pathogens&quot;), do not exist in a vacuum but under specific, individual conditions. They feed off of your food. Altering the food composition or introducing antibiotics, natural or pharmacologically chosen, alters these conditions and can select in different directions. Antibiotics can even almost erase the ecosystem to point that makes it relatively easy for nasty bugs to spread. (For example until 1978 we called it just &quot;antibiotic associated colitis&quot;, but then identified an infection/dominance with <a href=\"https://en.wikipedia.org/wiki/Clostridium\" rel=\"nofollow noreferrer\">Clostridium</a> <a href=\"https://en.wikipedia.org/wiki/Clostridium_difficile_(bacteria)\" rel=\"nofollow noreferrer\">difficile</a> as the source for that condition.)</p>\n</li>\n<li><p>In school we were told that stomach acids destroys bacteria and that therefore bacteria will not enter the body via food. For most of the bacteria this is the case.<br />\nObviously, we have to keep certain standards of hygiene when eating or preparing food, as E.coli or salmonella for example can make you sick, not only via their toxins, but by multiplying in your gut and replacing the previous owners of that place.</p>\n</li>\n<li><p>This leads to factor 3: one or two very resilient pathogens might not cause trouble, but if they arrive in large enough numbers that chances for trouble increases. Conversely, the exact same principle is true for 'wanted' bacteria, like Mutaflor <a href=\"https://de.wikipedia.org/wiki/Alfred_Ni%C3%9Fle\" rel=\"nofollow noreferrer\">Nissle</a>, <a href=\"https://en.wikipedia.org/wiki/Saccharomyces_boulardii\" rel=\"nofollow noreferrer\">S. boulardii</a>, <a href=\"https://en.wikipedia.org/wiki/Lactobacillus_acidophilus\" rel=\"nofollow noreferrer\">Lactobacilli</a> etc. from fermented foods, sour milk/yoghurt drinks or <a href=\"https://en.wikipedia.org/wiki/Fecal_microbiota_transplant\" rel=\"nofollow noreferrer\">fecal microbiota transplants</a>.</p>\n</li>\n</ol>\n<p>New bacteria arrive all the time in your gut from all sides and sources and they all try very hard to survive. Many of them do not succeed. They have to arrive in sufficiently large numbers, reach the right place and 'fit in' to the existing neighbours and other conditions.</p>\n<p>The extent to which these interactions and alterations occur are hardly predictable. In terms of 'healthy diversity' of the ecosystem in a human gut it <em>may</em> be more beneficial to not wash hands (or <a href=\"https://www.research.va.gov/currents/winter2015/winter2015-11.cfm\" rel=\"nofollow noreferrer\">even directly ingesting feces</a>) in otherwise unsanitary conditions compared to constantly bombarding the intestines with one single industrialised strain from 'pro-biotic yoghurt drinks'. But in most cases this is decidedly <em>not a good idea</em>. As you can get a really big range of really nasty infections via that 'nowash' way alone as well, it is currently advisable to look really closely at a large range of 'donor' characteristics, if this is indeed to be done as some kind of intervention. Obviously, this cannot apply to the bathroom scenario at all.</p>\n<blockquote>\n<p>From a microbiological point of view, the human GIT can be regarded as the best investigated ecological niche of the human body, although some difficulties exist in obtaining representative samples from various parts of the GIT. Moreover, the human GIT probably represents one of the best investigated microbial ecosystems on earth. This fact can be explained due to the great importance of the GIT microbiota in maintaining and driving human health, disease and well-being: on a quantitative basis, humans can be regarded as a super-organism, consisting of 90% microbial cells and even 99% microbial genes, and the vast majority of the microbial diversity is located in the human GIT (Wilson, 2008).<br />\n(Riedel, 2014)</p>\n</blockquote>\n<p>Despite the above, we still do not know nearly enough. 7 billion people, all with unique microbiomes consisting of myriads of species and strains are just too many conditions to analyse. Some of the patterns we think are emerging might be spurious. Just the very general wisdom seems to be certain by now: these mircobiomes are to be viewed as ecosystems that benefit themselves from diversity to gain stability.</p>\n<h2>References</h2>\n<p>Hornef, M. (2018). &quot;Microbiome and Early Life&quot; In: <em>The Gut Microbiome in Health and Disease</em> (pp. 31-47). Springer, Cham. doi: <a href=\"https://doi.org/10.1007/978-3-319-90545-7_3\" rel=\"nofollow noreferrer\">10.1007/978-3-319-90545-7_3</a></p>\n<p>Rosamond Rhodes &amp; Nada Gligorov &amp; Abraham Paul Schwab: &quot;The Human Microbiome. Ethical, Legal and Social Concerns&quot;, Oxford University Press: Oxford, New York, 2013.</p>\n<p>Christian U. Riedel et al.: &quot;The Stomach and Small and Large Intestinal Microbiomes&quot;, in: Julian R. Marchesi: &quot;The Human Microbiota and Microbiome&quot;, Advances in Molecular and Cellular Microbiology, CABI: Wallingford, Boston, 2014.</p>\n", "score": 6 } ]

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

[ { "answer_id": 18316, "body": "<p>Fat cells make up adipose tissues. Most fat in our body is stored in adipose tissue. </p>\n\n<p>It is true that <strong>we do not lose fat cells</strong>. Fat cells would only shrink in size.</p>\n\n<hr>\n\n<p>We do respiration all the time, and we need glucose to do it. The sources of glucose include: direct intake, conversion from other sugars, conversion from lipids.</p>\n\n<p>If we intake small amount of sugars and do vigorous exercise, our body will run out of glucose, and thus start extracting lipids from fat cells, and convert them to glucose for respiration. Therefore, fat cells have less content and would shrink.</p>\n\n<p>The whole process is:</p>\n\n<p>lipid from fat cells -> glucose -> undergoes respiration -> carbon dioxide and water -> exhaled</p>\n\n<p>You may refer to <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18454136\" rel=\"noreferrer\">this</a> for more details.</p>\n", "score": 10 }, { "answer_id": 18364, "body": "<p>Does not really answer your question regarding where fat cells go when you lose weight as it has been already discussed previously by the previous posts, but I had to share the link to the video on \"Where does fat go when you lose it?\". </p>\n\n<p><strong>The biochemistry behind it is:</strong></p>\n\n<p>Fat + Oxygen -> Carbon Dioxide + Water</p>\n\n<p>C₅₅H₁₀₄O₆ + 78O₂ -> 55CO₂ + 52H₂O</p>\n\n<p>Please refer to this video for a very detailed explanation from a Tedx talk: <a href=\"https://www.youtube.com/watch?v=vuIlsN32WaE\" rel=\"nofollow noreferrer\">Mathematics of Weight loss</a></p>\n\n<p>Please refer to this for the article (same author and topic as as the video): <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25516540/\" rel=\"nofollow noreferrer\">When somebody loses weight, where does the fat go?</a></p>\n", "score": 3 } ]

[ "weight", "body-fat" ]

[ { "answer_id": 18374, "body": "<p>Yes, tourniquets are used to creating pressure like you said. But stopping bleedings is not only function of tourniquets. Medical professionals use it also to finding a vessel for taking some blood; because when it is tied to your arm, it will squeeze your vessels in that area. So, the pressure in vessels which front of the tourniquet will be increased; and than that pressure will cause that dilatation of those vessels.</p>\n\n<p>In this way, those vessels will be getting more visible from your arm surface. Then medical professionals find easily a vessel in order to taking some blood.</p>\n", "score": 2 } ]

[ "bleeding" ]

[ { "answer_id": 18303, "body": "<p>If you have kidney stones or you are at increased risk of developing them, ask a doctor if your urine is super- or under-saturated with any substance, such as calcium, oxalate, uric acid, cystine or citrate; this is a crucial info that can tell if any diet can help. Explanation at-a-glance: <a href=\"https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/eating-diet-nutrition\" rel=\"nofollow noreferrer\">Eating, Diet, &amp; Nutrition for Kidney Stones by NIDDK</a>.</p>\n\n<p><strong>Evidence about dietary measures that may help prevent CALCIUM OXALATE stones:</strong></p>\n\n<p><strong>1. High water intake</strong></p>\n\n<p>According to several studies, drinking 3-4 liters of water per day (to produce at least 2 liters of urine/day) can decrease the risk of stones (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/9873212\" rel=\"nofollow noreferrer\">PubMed, 1999</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831051/\" rel=\"nofollow noreferrer\">2016</a>).</p>\n\n<p>Other fluids, such as tea, coffee, wine and beer <em>might</em> also help, but milk, soda and fruit juices <em>might not,</em> according to <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504608/\" rel=\"nofollow noreferrer\">one 2015 systematic review of studies</a>.</p>\n\n<p>It is not clear if hard water (high in Ca and/or Mg) is a risk factor for kidney stones (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934277/\" rel=\"nofollow noreferrer\">PubMed, 2018</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12100915\" rel=\"nofollow noreferrer\">2002</a>).</p>\n\n<p><strong>2. High citrus/citrates intake</strong></p>\n\n<p>Potassium citrate supplements and possibly (?) citrus juices (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428529/\" rel=\"nofollow noreferrer\">PubMed 2017</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26311217\" rel=\"nofollow noreferrer\">2016</a>), which alkalize the urine, can decrease the risk of stones, but this <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26439475\" rel=\"nofollow noreferrer\">2015 Cochrane review</a> does not strongly support this evidence. Additionally, potassium citrate supplements may have a lot of side effects.</p>\n\n<p><strong>3. High dietary calcium intake</strong></p>\n\n<p>Surprisingly, high intake of calcium <em>from foods</em> was associated with lower risk of kidney stones in several big observational studies. On the other hand, calcium <em>supplements</em> may increase the risk. According to <a href=\"https://lpi.oregonstate.edu/mic/minerals/calcium#kidney-stones-prevention\" rel=\"nofollow noreferrer\">Linus Pauling Institute</a>, calcium may inhibit the absorption of oxalate in the intestine and thus its accumulation in the urine.</p>\n\n<p><strong>4. Low sodium (salt) intake</strong></p>\n\n<p>Low sodium intake (&lt; 3.8 g salt/day) decreases calcium excretion in the kidneys and thus the risk of stones (<a href=\"https://lpi.oregonstate.edu/mic/minerals/sodium\" rel=\"nofollow noreferrer\">Linus Pauling Institute</a>).</p>\n\n<p><strong>5. Low oxalate intake</strong></p>\n\n<p><a href=\"https://www.upmc.com/-/media/upmc/patients-visitors/education/unique-pdfs/low-oxalate-diet.pdf\" rel=\"nofollow noreferrer\">Diet low in oxalates</a> can reduce the risk of stones if your urine has too much oxalate (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114711/\" rel=\"nofollow noreferrer\">PubMed, 2016</a>).</p>\n\n<p><strong>For URATE stones,</strong> apart from above measures, <strong>diet low in animal proteins</strong> can help (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15493118\" rel=\"nofollow noreferrer\">PubMed, 2004</a>).</p>\n", "score": 2 } ]

[ "water", "kidney", "urology", "calcium", "kidney-stones" ]

[ { "answer_id": 18296, "body": "<p>Tap‐water iontophoresis (TWI) using direct current (DC) is considered by some to be the most effective therapy in palmoplantar hyperhidrosis, although it is debated that botulinum toxin injections may be better (<a href=\"https://doi.org/10.1111/bjd.17044\" rel=\"noreferrer\">Wade, et al. 2018</a>).</p>\n<h2>How does TWI block sweat glands, and what are the side effects?</h2>\n<p>The mechanism of action is unknown. It is hypothesised that an interrupted stimulus‐secretion‐coupling leads to a functional disturbance of sweat secretion (<a href=\"https://www.sweathelp.org/pdf/Reinauer%201993%20-%20Iontophoresis%20with%20alternating%20current%20and%20direct%20current%20offset.pdf\" rel=\"noreferrer\">Reinauer, et al. 1993</a>), which is most likely a transient functional disturbance of the secretory mechanism of eccrine glands (<a href=\"https://doi.org/10.1007/978-3-319-40221-5_95-2\" rel=\"noreferrer\">Hölzle, 2018</a>).</p>\n<p>Side‐effects of this method are discomfort, with burning and tingling, and skin irritation, including erythema and vesicles. Incorrect use may induce iontophoretic burns at sites of minor skin injury. Elaborate safety measures are required to prevent electric shock (<a href=\"https://www.sweathelp.org/pdf/Reinauer%201993%20-%20Iontophoresis%20with%20alternating%20current%20and%20direct%20current%20offset.pdf\" rel=\"noreferrer\">Reinauer, et al. 1993</a>).</p>\n<h2>References</h2>\n<p>Hölzle E. (2018) Iontophoresis. In: John S., Johansen J., Rustemeyer T., Elsner P., Maibach H. (eds) <em>Kanerva’s Occupational Dermatology</em>, 1-14. doi: <a href=\"https://doi.org/10.1007/978-3-319-40221-5_95-2\" rel=\"noreferrer\">10.1007/978-3-319-40221-5_95-2</a></p>\n<p>Reinauer, S., Neusser, A., Schauf, G., &amp; Hölzle, E. (1993). Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. <em>British Journal of Dermatology, 129</em>(2), 166-169. doi: <a href=\"https://doi.org/10.1111/j.1365-2133.1993.tb03521.x\" rel=\"noreferrer\">10.1111/j.1365-2133.1993.tb03521.x</a></p>\n<p>Wade, R., Llewellyn, A., Jones‐Diette, J., Wright, K., Rice, S., Layton, A. M., ... &amp; Woolacott, N. (2018). Management of hyperhidrosis in secondary care. <em>British Journal of Dermatology, 179</em>(3), e138-e138. doi: <a href=\"https://doi.org/10.1111/bjd.17044\" rel=\"noreferrer\">10.1111/bjd.17044</a></p>\n", "score": 5 }, { "answer_id": 18302, "body": "<p>After some more research it looks like the answers to these questions are indeed still unknown. A recent 2018 article on <a href=\"https://www.cogentoa.com/article/10.1080/2331205X.2018.1486783\" rel=\"nofollow noreferrer\"><em>Proposed mechanism of action of tap water iontophoresis for treatment of hyperhidrosis</em></a> summarizes:</p>\n<blockquote>\n<p>Tap water iontophoresis is commonly used to treat hyperhidrosis, yet the mechanism of action for this treatment remains unknown.</p>\n<p>[...]</p>\n<p>Several hypothesized mechanisms of action have been proposed for this treatment, including the reversible disruption of ion channels (Collin &amp; Whatling, 2000), dermal injury resulting in abnormal keratinization and plugging of the sweat duct (Gordon &amp; Maibach, 1969; Shelley &amp; Horvath, 1950), blockage of neuroglandular transmission (Holze &amp; Ruzicka, 1986), or inhibition of the secretory mechanism at the cellular level. However, studies to date have failed to reveal changes in the eccrine sweat glands or blockages of sweat ducts following iontophoresis (Hill, Baker, &amp; Jansen, 1981; Holze &amp; Ruzicka, 1986), and thus fail to support these hypothesized mechanisms.</p>\n</blockquote>\n<p>The proposed mechanism of action in this article is:</p>\n<blockquote>\n<p>I propose that iontophoresis works via the production of a colloid formed between the products of dark (mucin) and clear (aqueous solution) cells, and the jamming of nanomineral particles inside the lumen and/or the duct of the sweat gland, creating a blockage that temporarily prevents further sweat production or secretion.</p>\n</blockquote>\n<p>Older references on the mechanism of action:</p>\n<ul>\n<li>Reinauer S, Schauf G, Hubert M, Hölzle E (1992): <a href=\"https://www.researchgate.net/publication/296945185_Mechanism_of_action_of_tap_water_iontophoresis_Functional_disturbance_of_the_secretory_epithelium\" rel=\"nofollow noreferrer\">Mechanism of action of tap water iontophoresis: Functional disturbance of the secretory epithelium</a></li>\n<li>Hill AC, Baker GF, Jansen GT (1981): <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7261675\" rel=\"nofollow noreferrer\">Mechanism of action of iontophoresis in the treatment of palmar hyperhidrosis.</a></li>\n</ul>\n<hr />\n<p>In terms of side effects e.g. effects on skin barrier function, there is some related work on saline iontophoresis:</p>\n<ul>\n<li>Singh J, Gross M, Sage B, Davis HT, Maibach HI (2000): <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10908819\" rel=\"nofollow noreferrer\">Effect of saline iontophoresis on skin barrier function and cutaneous irritation in four ethnic groups.</a></li>\n</ul>\n", "score": 3 } ]

[ "dermatology", "neurology", "sweat", "biochemistry", "iontophoresis" ]

[ { "answer_id": 18340, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Gary_Taubes\" rel=\"nofollow noreferrer\">Gary Taubes</a>, the journalist and advocate, did publish such an article:</p>\n<p>Gary Taubes: &quot;The Soft Science of Dietary Fat&quot;, Science, New Series, Vol. 291, No. 5513 (Mar. 30, 2001), pp. 2536-2541+2543-2545 (<a href=\"http://www.jstor.org/stable/3082809\" rel=\"nofollow noreferrer\">jstor</a>) (available <a href=\"http://garytaubes.com/wp-content/uploads/2011/08/Science-The-soft-science-of-dietary-fat.pdf\" rel=\"nofollow noreferrer\">at the author's page</a>)</p>\n<p>In that article, which is solidly written but not a study, more of an opinion piece, the author argues mainly against dietary advice given out despite being far less clear-cut than it ought to be for that kind of intervention. He does not prove anything in that paper, but merely discusses the pros and cons of the issue. That is by far more nuanced what the claimant in question seems to read into and out of it.</p>\n<p>For the claim Jerzy Zięba makes, one might have to look a bit closer at what Taubes writes, or draws:</p>\n<p><a href=\"https://i.stack.imgur.com/iujcW.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/iujcW.png\" alt=\"enter image description here\" /></a></p>\n<blockquote>\n<p>The data were consistent: When investigators tracked all deaths, instead of just heart disease deaths, the cholesterol curves were U-shaped for men and flat for women. In other words, men with cholesterol levels above 240 mg/dl tended to die prematurely from heart disease. But below 160 mg/dl, the men tended to die prematurely from cancer, respiratory and digestive and trauma. As for women, if diseases, anything, the higher their cholesterol, the longer they lived (see graph on p. 2540).</p>\n<p>These mortality data can be interpreted in two ways. One, preferred by low-fat advocates, is that they cannot be meaningful. Rifkind, for instance, told Science that the excess deaths at low cholesterol levels must be due to preexisting conditions. In other words, chronic illness leads to low cholesterol levels, not vice versa. He pointed to the 1990 conference report as the definitive document on the issue and as support for his argument, although the report states unequivocally that this interpretation is not supported by the data.</p>\n<p>The other interpretation is that what a low-fat diet does to serum cholesterol levels, and what that in turn does to arteries, may be only one component of the diet's effect on health. In other words, while low-fat diets might help prevent heart disease, they might also raise susceptibility to other conditions. This is what always worried Ahrens. It's also one reason why the American College of Physicians, for instance, now suggests that cholesterol reduction is certainly worth while for those at high, short-term risk of dying of coronary heart disease but of &quot;much smaller or ...\nuncertain benefit for everyone else.</p>\n</blockquote>\n<p>For a very general assessment of Taubes' work, we might look at his concepts of obesity, how it develops and what to do about that:</p>\n<blockquote>\n<p>However, <em>some</em> of the conclusions that the author reaches are not consistent with current concepts about obesity.<br />\n_{<a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-789X.2008.00476.x\" rel=\"nofollow noreferrer\">Good Calories, Bad Calories by Gary Taubes; New York: AA Knopf –– Review by GA BRay</a> (<a href=\"https://doi.org/10.1111/j.1467-789X.2008.00476.x\" rel=\"nofollow noreferrer\">DOI</a>)}</p>\n</blockquote>\n<p>And with regards to cholesterol levels, the information from Taubes is quoted really unfortunate. As I read it he still doesn't say that very high blood cholesterol is &quot;healthy&quot;, and the author merely argues that the possible dangers associated with it were overestimated in the past. This then is <a href=\"https://www.telegraph.co.uk/science/2016/06/12/high-cholesterol-does-not-cause-heart-disease-new-research-finds/\" rel=\"nofollow noreferrer\">by far</a> not the current consensus, but not really a fringy quack position either:</p>\n<p><a href=\"https://www.pharmaceutical-journal.com/opinion/insight/the-cholesterol-and-calorie-hypotheses-are-both-dead-it-is-time-to-focus-on-the-real-culprit-insulin-resistance/20203046.article?firstPass=false\" rel=\"nofollow noreferrer\">Maryanne Demasi &amp; Robert H Lustig &amp; Aseem Malhotra: &quot;The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance&quot;, Clinical Pharmacist, 14 JUL 2017</a></p>\n<p><a href=\"https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391\" rel=\"nofollow noreferrer\">Uffe Ravnskov et al.: &quot;LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature&quot;, Expert Review of Clinical Pharmacology, Volume 11, 2018 - Issue 10 11 Oct 2018</a> <a href=\"https://doi.org/10.1080/17512433.2018.1519391\" rel=\"nofollow noreferrer\">https://doi.org/10.1080/17512433.2018.1519391</a></p>\n", "score": 4 } ]

[ "cholesterol", "alternative-medicine" ]

[ { "answer_id": 18423, "body": "<p><strong>1.</strong> <a href=\"https://www.hprac.org/en/projects/resources/LiteratureReview_PhysicianAssistants.pdf\" rel=\"nofollow noreferrer\"><strong>Physician Assistants:</strong> A Literature Review (Health Professions Regulatory Advisory Council - HPRAC, 2011\n)</a></p>\n\n<p>The review mentions several studies about the effectiveness of physician assistants.</p>\n\n<hr>\n\n<p><strong>2.</strong> <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3903046/\" rel=\"nofollow noreferrer\">THE CONTRIBUTIONS OF <strong>PHYSICIAN ASSISTANTS</strong> IN PRIMARY CARE SYSTEMS (PubMed, 2012)</a></p>\n\n<blockquote>\n <p>Contemporary studies suggest that PAs can contribute to the successful\n attainment of primary care functions, particularly the provision of\n comprehensive care, accessibility, and accountability.</p>\n</blockquote>\n\n<p><strong>3.</strong> <a href=\"https://www.bmj.com/content/320/7241/1038\" rel=\"nofollow noreferrer\"><strong>Nurse</strong> management of patients with minor illnesses in general practice: multicentre, randomised controlled trial (BMJ, 2000)</a></p>\n\n<blockquote>\n <p>Patients were very satisfied with both nurses and doctors, but they\n were significantly more satisfied with their consultations with nurses\n (mean (SD) score of satisfaction 78.6 (16.0) of 100 points for nurses\n v 76.4 (17.8) for doctors...</p>\n</blockquote>\n\n<hr>\n\n<p><strong>4.</strong> Another one from BMJ, 1995: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2549167/pdf/bmj00585-0032.pdf\" rel=\"nofollow noreferrer\">Establishing a minor illness <strong>nurse</strong> in a busy general practice</a> </p>\n\n<blockquote>\n <ul>\n <li>The nurse managed 86% of patients without contact with the doctor; half required a prescription signing</li>\n <li>Half of patients required only advice on self care, and 79% did not reconsult</li>\n <li>Practice nurses could successfully manage many patients requesting same day appointments with their general practitioner</li>\n <li>Of 696 consultations in six months, 602 (86%) required no doctor contact. 549 (79%) patients did not reconsult about the episode of\n illness, and 343 (50%) patients were given advice on self care only.\n Trained nurses could diagnose and treat a large proportion of patients\n currently consulting general practitioners about minor illness\n provided that the nurse has immediate access to a doctor.</li>\n </ul>\n</blockquote>\n\n<hr>\n", "score": 2 } ]

[ "reference-request" ]

[ { "answer_id": 18494, "body": "<p>A large study of ~8000 patients suggests there is no real benefit to prophylactic oxygen supplementation after acute stroke (Roffe et al., 2017).</p>\n\n<p>American Heart Association/American Stroke Association guidelines (Powers et al., 2018) are for oxygen only for hypoxic patients, with limited evidence of benefit but no evidence of harm. Hyperbaric oxygen is only recommended in cases of air embolism.</p>\n\n<p>These guidelines are supported by Roffe et al., 2017, but they are consistent with the guidelines prior to that study, so this is a case where a large study confirms the standard of care rather than suggesting a shift in paradigm.</p>\n\n<hr>\n\n<p>References:</p>\n\n<p>Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., ... &amp; Jauch, E. C. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49(3), e46-e99.</p>\n\n<p>Roffe, C., Nevatte, T., Sim, J., Bishop, J., Ives, N., Ferdinand, P., &amp; Gray, R. (2017). Effect of routine low-dose oxygen supplementation on death and disability in adults with acute stroke: the stroke oxygen study randomized clinical trial. Jama, 318(12), 1125-1135.</p>\n", "score": 7 } ]

[ "stroke", "oxygen", "ischaemia" ]

[ { "answer_id": 18567, "body": "<p>Mr. Hiroyasu Yamashiro wrote an anwer:</p>\n\n<blockquote>\n <p>Thank you for your question about the paper. \n The meaning of the abbreviations you ask is as follows. \n Thank you.</p>\n \n <p><strong>Sp</strong> - Supraclavicular lymph nodes<br>\n <strong>Ps</strong> - Parasternal lymph nodes </p>\n \n <p>Hiroyasu Yamashiro</p>\n</blockquote>\n", "score": 7 } ]

[ "cancer", "terminology" ]

[ { "answer_id": 24781, "body": "<p>It does make sense for some women and men to get the HPV vaccination at age 27 through 45 years.</p>\n<p>In June 2019, the Advisory Committee on Immunization Practices (ACIP), which advises the CDC about vaccinations, made recommendations about HPV vaccinations that included recommendations about “catch-up vaccination” in adults up to age 26 years along with a separate recommendation about HPV vaccination in adults age 27 through 45 years. These recommendations were published in August 2019.</p>\n<p><a href=\"https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm\" rel=\"nofollow noreferrer\">https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm</a></p>\n<p>The specific statement about HPV vaccination in adults age 27 through 45 years was as follows:</p>\n<blockquote>\n<p>&quot;Adults aged &gt;26 years. Catch-up HPV vaccination is not recommended\nfor <strong>all</strong> [bolded to add emphasis] adults aged &gt;26 years. Instead, shared clinical\ndecision-making regarding HPV vaccination is recommended for <strong>some</strong> [bolded to add emphasis]\nadults aged 27 through 45 years who are not adequately vaccinated.&quot;</p>\n</blockquote>\n<p>This statement can be read as a recommendation AGAINST HPV catch-up vaccination in adults age 27 through 45 years or as a recommendation that is not in favor of HPV catch-up vaccination for all adults in this age group. The following sentence is key---</p>\n<blockquote>\n<p>“<strong>INSTEAD</strong> [bolded to add emphasis], shared decision-making is recommended for\nsome adults age 27 through 45 years.”</p>\n</blockquote>\n<p>Shared decision-making means “discuss this with your doctor and decide what is best for you.”</p>\n<p>Shared decision making is also defined as follows:</p>\n<blockquote>\n<p>Shared decision-making in medicine (SDM) is a process in which both\nthe patient and physician contribute to the medical decision-making\nprocess. Health care providers explain treatments and alternatives to\npatients and help them choose the treatment option that best aligns\nwith their preferences as well as their unique cultural and personal\nbeliefs.</p>\n</blockquote>\n<p><a href=\"https://en.wikipedia.org/wiki/Shared_decision-making_in_medicine\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Shared_decision-making_in_medicine</a></p>\n<p>In June 2019, the American College of Obstetricians and Gynecologists (ACOG), citing the ACIP recommendations, issued more specific guidance about the question of HPV vaccination in adults age 27 through 45 years to its physicians.</p>\n<p><a href=\"https://www.acog.org/news/news-releases/2019/06/acog-statement-on-hpv-vaccination\" rel=\"nofollow noreferrer\">https://www.acog.org/news/news-releases/2019/06/acog-statement-on-hpv-vaccination</a></p>\n<blockquote>\n<p>“Today’s decision from ACIP emphasizes what the data has shown--that\nthe HPV vaccine is safe and effective for use in patients ages 27 to\n45, and that use of the vaccine in this age group should be the result\nof shared decision-making between patients and their trusted\nphysicians.”</p>\n</blockquote>\n<p>ACOG went on to advise its physicians as follows:</p>\n<blockquote>\n<p>“The HPV vaccine can halt transmission of the virus and can prevent\nlife-threatening cancers later in life. Today’s decision from ACIP\nshould encourage physicians to discuss the vaccine routinely with\ntheir 27- to 45-year-old patients and should help more patients feel\nconfident in their decisions to protect themselves by getting\nvaccinated.”</p>\n</blockquote>\n", "score": 1 } ]

[ "vaccination", "hpv" ]

[ { "answer_id": 18516, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Receptive_aphasia\" rel=\"nofollow noreferrer\">Receptive aphasia</a> is a type of <a href=\"https://www.nhs.uk/conditions/aphasia/symptoms/\" rel=\"nofollow noreferrer\">aphasia</a> in which patients have difficulty understanding (\"receiving\") words as opposed to difficulty speaking them. There are more than one possible etiology and it is not diagnostic for a specific pathology, but may suggest something wrong with the temporal lobe due to epilepsy, TIA/stroke, brain damage, medication, or psychiatric condition (NOT an exhaustive list). Of note, anxiety can have various effects on the processes involving speech and memory.</p>\n", "score": 8 } ]

[ "neurology", "terminology", "symptoms", "neuropathy" ]

[ { "answer_id": 18520, "body": "<p>It's not, unless you are using the term \"base\" to refer to the aortic root of the heart rather than the apex.</p>\n\n<p>A systolic \"crescendo-decrescendo murmur\" is the classic description for the murmur resulting from aortic stenosis. The aortic valve is best auscultated at the right upper sternal border.</p>\n\n<p>In the below diagram, the actual valve locations inside the heart are indicated by the colored ovals, but the location that you best HEAR the valve-related murmurs are indicated by the A P T M in circles for Aortic, Pulmonic, Tricuspid, and Mitral. </p>\n\n<p><a href=\"https://i.stack.imgur.com/EQn1x.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/EQn1x.png\" alt=\"enter image description here\"></a></p>\n\n<p>You hear a murmur at a different location than the valve itself because of fluid physics and acoustics. A cardiac murmur is a vibratory process occurring due to fluid mechanics; pathological murmurs are due to blood flow along abnormalities in heart structures. If you look at the course of the aorta, from the aortic valve to the carotids etc, you can see how vibration from narrowed aortic valve would easily radiate there.</p>\n\n<p>Anecdotally, I've often heard it more clearly at the LUSB (left upper sternal border, which is generally the pulmonic region) than the right (RUSB), and I'm not sure why - but it was never the apex where I heard it most clearly. There must be some confusion in your sources.</p>\n\n<p>References:</p>\n\n<ul>\n<li><a href=\"https://depts.washington.edu/physdx/heart/tech.html\" rel=\"noreferrer\">Med school website U Wisc</a></li>\n<li><a href=\"https://www.aafp.org/afp/2011/1001/p793.html\" rel=\"noreferrer\">AAFP Murmur Evaluations in Peds</a></li>\n<li><a href=\"https://accessmedicine.mhmedical.com/content.aspx?sectionid=66487549&amp;bookid=1130\" rel=\"noreferrer\">Harrison's IM</a> (great medical text but lots of detail)</li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/books/NBK345/\" rel=\"noreferrer\">Another detailed medical text</a></li>\n</ul>\n", "score": 5 } ]

[ "cardiology", "heart-disease", "heart" ]

[ { "answer_id": 18535, "body": "<blockquote>\n <p>Does the uterus return to its original (pre-pregnancy) size after a full term birth?</p>\n</blockquote>\n\n<p>Good question. No. Uterine involution, the return of the uterus to the nonpregnant state postpartum, does involve a remarkable decrease in size, but it's not as small as it was before pregnancy. Nonpregnant uterine size increases with what we call parity, or the number of times a woman has carried a pregnancy to term. I can't seem to find the original data on this, but it would likely be an early 20th century (or possibly late 19th) pathology series. The phenomenon is referenced in the pathology literature, e.g., <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC501242/?page=3\" rel=\"noreferrer\">in the section on hysterectomy specimens in this article</a>:</p>\n\n<blockquote>\n <p>Note that the parous uterus (premenopausal adult 75-100 g) is heavier than the nulliparous uterus (premenopausal adult 30-40 g), and weight increases with parity, so that after eight pregnancies a weight of 240 g is normal.</p>\n</blockquote>\n\n<p>This finding (increased uterine size depends on parity) is confirmed in imaging studies, for example, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20664389\" rel=\"noreferrer\">here</a>.</p>\n", "score": 6 } ]

[ "reproduction", "anatomy" ]

[ { "answer_id": 18566, "body": "<p>Sumatriptan activates <em>vascular</em> <a href=\"https://en.wikipedia.org/wiki/5-HT1_receptor\" rel=\"nofollow noreferrer\">5-HT₁ receptors</a>. This results in vasoconstriction, which is what is thought to help the migraines. This is the same idea for giving caffeine, which is also a vasoconstrictor. Taking tryptophan would likely be ineffective for a variety of reasons in terminating a migraine. First, it would have to be ingested and absorbed, which takes time, and then it would have to be metabolized to 5-HT (<a href=\"https://en.wikipedia.org/wiki/Serotonin\" rel=\"nofollow noreferrer\">Serotonin</a>). Even if tryptophan was absorbed in the stomach, it would be ineffective at terminating the migraine in a timely fashion and thus not well tolerated by a patient.</p>\n<p>Second, there is little evidence that oral tryptophan supplementation increases serotonin levels (<a href=\"https://doi.org/10.3945/jn.115.228478\" rel=\"nofollow noreferrer\">Cynober et al., 2016</a>).</p>\n<p><a href=\"https://doi.org/10.3945/jn.115.228478\" rel=\"nofollow noreferrer\">Cynober et al. (2016)</a> states that the subjects urinated out the tryptophan in a &quot;dose dependent fashion.&quot; Further, there was no significant change in their mood with tryptophan supplementation at any dose. This suggests that the tryptophan is not being metabolized into 5-HT. This makes sense, since tryptophan is in our diets, and it would be wild to think that our bodies didn't regulate 5-HT metabolism (that is to say that our bodies just automatically made 5-HT every time we ate something with tryptophan in it).</p>\n<p>If patients do have a serotonin imbalance, it is likely involved in metabolism issues, say some mutation or problem with co-factors or enzymes. Therefore, tryptophan likely isn't a solution.</p>\n<h2>References</h2>\n<p>Cynober, L., Bier, D. M., Kadowaki, M., Morris Jr, S. M., Elango, R., &amp; Smriga, M. (2016). Proposals for Upper Limits of Safe Intake for Arginine and Tryptophan in Young Adults and an Upper Limit of Safe Intake for Leucine in the Elderly–3. <em>The Journal of nutrition, 146</em>(12), 2652S-2654S. doi: <a href=\"https://doi.org/10.3945/jn.115.228478\" rel=\"nofollow noreferrer\">10.3945/jn.115.228478</a></p>\n", "score": 5 } ]

[ "medications", "migraine", "ssri-selective-serotonin" ]

[ { "answer_id": 18636, "body": "<blockquote>\n <p>What happens when a blood vessel is cut during surgery?</p>\n</blockquote>\n\n<p>Blood vessels (not just veins, but arteries also) are transected (cut), ligated (tied off), and/or cauterized (burned closed) in just about every surgical procedure ever. When done appropriately, this does not cause a problem because there is more than one path from the heart to the tissue and more than one path from the tissue back to the heart. This is called <a href=\"https://en.wikipedia.org/wiki/Collateral_circulation\" rel=\"noreferrer\">collateral circulation</a> and often involves <a href=\"https://en.wikipedia.org/wiki/Anastomosis#Circulatory\" rel=\"noreferrer\">vascular anastomoses</a>. In some cases collaterals are quite abundant, for example, the <a href=\"https://en.wikipedia.org/wiki/Rectal_venous_plexus\" rel=\"noreferrer\">rectal plexus</a>, the vascular supply relevant to the title to your question. Hemorrhoids are, in fact, the result of a very particular kind of venous branching, a porto-systemic communication. The rectal and anal circulation are drained through two parallel pathways, the portal circulation (through the <a href=\"https://en.wikipedia.org/wiki/Superior_rectal_vein\" rel=\"noreferrer\">superior rectal vein</a>) and the systemic circulation (through the <a href=\"https://en.wikipedia.org/wiki/Middle_rectal_veins\" rel=\"noreferrer\">middle</a> and <a href=\"https://en.wikipedia.org/wiki/Inferior_rectal_veins\" rel=\"noreferrer\">inferior rectal veins</a>). The <a href=\"https://en.wikipedia.org/wiki/Portal_venous_system\" rel=\"noreferrer\">portal circulation</a> returns blood from the gastrointestinal system to the liver (and from there to the inferior vena cava and the heart), where the systemic circulation returns blood directly to the inferior vena cava (without passing through the portal system of the liver). When the pressure in the portal system increases (whether through pathological <a href=\"https://en.wikipedia.org/wiki/Portal_hypertension\" rel=\"noreferrer\">portal hypertension</a>, or other, temporary nonpathological conditions, e.g., pregnancy), blood is shunted from the portal arm through to the systemic arm, engorging the vessels in a few specific areas. The rectal plexus is one of them, and is a clear demonstration of the principle that there is more than one path back to the heart. </p>\n\n<p>An important part of good surgical technique is identifying which blood vessels can be cut, tied, or burned, and which ones can't (or will result in complications if they are).</p>\n", "score": 6 } ]

[ "surgery", "blood-circulation", "blood-vessels" ]

[ { "answer_id": 18660, "body": "<p><strong><em>What happens <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/2628633/\" rel=\"nofollow noreferrer\">during inversion</a>?</em></strong> </p>\n\n<blockquote>\n <ul>\n <li><p>increase in blood pressure</p></li>\n <li><p>Oxygen uptake increase</p></li>\n <li><p>Heart rate decreased significantly</p></li>\n <li><p>The double product, the frequency of breaths, and tidal volume were not significantly changed</p></li>\n </ul>\n</blockquote>\n\n<p><strong><em>What happens <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/3389990/?i=2&amp;from=/2628633/related\" rel=\"nofollow noreferrer\">post exercise</a></em></strong> ?</p>\n\n<blockquote>\n <p>nonsignificant changes in heart rate, systolic blood pressure, and double product from the pre-inversion baseline standing position. </p>\n</blockquote>\n\n<p><strong><em>What are <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/3190419/?i=4&amp;from=/2628633/related\" rel=\"nofollow noreferrer\">chronic changes</a></em></strong></p>\n\n<blockquote>\n <p>No physiologic adaptations occurred in any of the inverted positions as a result of inversion training. </p>\n</blockquote>\n\n<p><strong><em>Mechanism for maintenance of Blood pressure?</em></strong></p>\n\n<p>There is baroreceptor at aorta and carotid sinus.\nThese receptors have a baroreflex mechanism that helps maintain normal pressure on the brain and other vital organs.</p>\n\n<blockquote>\n <p>As the acute adaptation and resetting are correlated using a graphic analysis, we hypothesize that the baroreceptors can recognize a new pressure level within minutes. The inherent ability incurs downward and upward adaptation as well as resetting at lower and higher holding pressure, respectively.<a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/2376214/\" rel=\"nofollow noreferrer\">link</a></p>\n \n <p>It is important to note that baroreceptors adapt to sustained changes in arterial pressure. For example, if arterial pressure suddenly falls when a person stands, the baroreceptor firing rate will decrease; however, after a period of time, the firing returns to near normal levels as the receptors adapt to the lower pressure. <a href=\"https://www.cvphysiology.com/Blood%20Pressure/BP012\" rel=\"nofollow noreferrer\">CV physiology</a></p>\n</blockquote>\n\n<p><strong><em>Adaptation of carotid and aortic baroreceptors</em></strong></p>\n\n<blockquote>\n <p>the longest measure time for an almost complete adaptation of mechanoreceptors is about 2 days, which is the adaptation time for many carotid and aortic baroreceptors; however some physiologist believes that these specialised baroreceptors never fully adapt.</p>\n</blockquote>\n\n<p>[excerpt from Guyton And Hall textbook of medical physiology]-</p>\n\n<p><a href=\"https://i.stack.imgur.com/irstW.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/irstW.jpg\" alt=\"excerpt from Guyton And Hall\"></a></p>\n\n<p>So, as people practice this handstand posture, slowly the receptors <strong>may start to adapt</strong> or they <strong>might never adapt</strong></p>\n\n<p>Hence, in short, we can say that the body's mechanism either remained the same or adapted a little in long term, while the short term regulation of blood pressure remained the same.</p>\n\n<p><strong><em>Cerebral blood flow</em></strong></p>\n\n<p>With the regulation of BP in mind, we can think further about the regulation of cerebral blood flow.</p>\n\n<blockquote>\n <p>cerebral blood flow is autoregulated extremely well between the arterial pressure limits of 60 mm Hg and 140 mm Hg; further, the cerebral blood flow autoregulation occurs even when the mean arterial pressure Rises to as high as 160 - 180 mm as in case of hypertensive</p>\n</blockquote>\n\n<p>[Ref. Guyton and Hall Physiology]-\n<img src=\"https://i.stack.imgur.com/H64xO.jpg\" alt=\"7]\"></p>\n", "score": 2 } ]

[ "blood", "exercise", "headache", "physiology" ]

[ { "answer_id": 18678, "body": "<p>Effective treatment of suicidality involves treatment of any underlying disorder and multi-modal treatment to address the suicidality directly. For pharmacotherapy, there are few drugs that show clear reduction in suicides. An old <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1642127\" rel=\"noreferrer\">population based retrospective study from Sweden</a> suggests achieving an appropriate dose of SSRI may be effective, but it is, perhaps surprisingly, <a href=\"https://www.bmj.com/content/346/bmj.f3646\" rel=\"noreferrer\">lithium</a> that has the best data on reducing suicides. As far as anxiolytics are concerned, they aren't generally prescribed to reduce the risk of suicide.</p>\n", "score": 5 } ]

[ "suicide" ]

[ { "answer_id": 18681, "body": "<p>Just as aluminium compounds such as:</p>\n\n<ul>\n<li><a href=\"https://en.wikipedia.org/wiki/Aluminium_chlorohydrate\" rel=\"noreferrer\">Aluminium chlorohydrate</a>,</li>\n<li><a href=\"https://en.wikipedia.org/wiki/Aluminium_zirconium_tetrachlorohydrex_gly\" rel=\"noreferrer\">Aluminium zirconium tetrachlorohydrex glycine</a>, and</li>\n<li>Aluminium hydroxybromid</li>\n</ul>\n\n<p>are the antiperspirant active ingredient in deodourants, antibacterials are the active aspect of odour reduction.</p>\n\n<p>Antibacterial ingredients work to eliminate the bacteria that cause bad odours from areas where sweat is common. Many types of deodourants use alcohol ingredients that kill bacteria, while others use artificial chemicals such as <a href=\"https://en.wikipedia.org/wiki/Triclosan\" rel=\"noreferrer\">triclosan</a> (Source: <a href=\"https://www.chemservice.com/news/2014/08/which-chemicals-make-deodorants-and-antiperspirants-work/\" rel=\"noreferrer\">ChemService</a>)</p>\n\n<blockquote>\n <p>Triclosan is used in a number of personal care products including toothpaste. Many people have been critical of this chemical in over-the-counter products. However, the FDA <a href=\"https://www.fda.gov/forconsumers/consumerupdates/ucm205999.htm\" rel=\"noreferrer\">explained that it is not known to cause harm</a> to humans and has been proven to be beneficial in some circumstances, such as fighting gingivitis.</p>\n</blockquote>\n", "score": 5 } ]

[ "bacteria", "antibacterial-resistance" ]

[ { "answer_id": 19116, "body": "<p>There seems to be no study that would mention an association between <strong>peeled jicama root</strong> consumption and Parkinson's disease or any intoxication in humans.</p>\n\n<p><strong>Rotenone</strong> can be found in <strong><a href=\"https://www.britannica.com/plant/jicama\" rel=\"nofollow noreferrer\">jicama seeds, stems and leaves</a></strong> and, according to some <a href=\"https://naturallysavvy.com/eat/jicama-a-veggie-you-should-know-better-recipes/\" rel=\"nofollow noreferrer\">random</a> <a href=\"https://www.emetabolic.com/locations/centers/Mandarin/blog/eat-well/never_thought_youd_be_eating_jicama_root/\" rel=\"nofollow noreferrer\">sources</a> in jicama <strong>root skin.</strong> Severe intoxication can occur after eating jicama seeds (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16241030\" rel=\"nofollow noreferrer\">PubMed, 2005</a>).</p>\n\n<p>I haven't found any source that would claim there is any meaningful amount of rotenone in the <strong>peeled jicama root.</strong></p>\n\n<p><strong>Rotenone as a pesticide</strong> (but not as part of any food) ingestion has been linked to Parkinson's disease in humans, though (<a href=\"https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.1002839\" rel=\"nofollow noreferrer\">Environmental Health Perspective</a>).</p>\n\n<p><strong>In conclusion,</strong> there seems to be no evidence to recommend against daily consumption of peeled jicama roots in aim to avoid any disease.</p>\n", "score": 2 } ]

[ "nutrition", "diet", "food-safety", "toxicity", "toxins" ]

[ { "answer_id": 18851, "body": "<p>The definitions of conscious sedation and procedural sedation certainly blend through one another, but typically \"conscious sedation\" means the patient <em>appears</em> conscious to the provider or bystander, not necessarily the patient. In procedural sedation, a patient may appear asleep or be completely dissociated (such as with ketamine). There are many examples of this on YouTube as people recover from their sedation. To all onlookers they appear conscious, but in many cases, patients don't remember any of their actions. This is why you need a buddy to pick you up from the hospital after your procedure. In neither case should a patient be sedated to the extent that they require airway control.</p>\n\n<p>Facilities (as well as CMS) draw a very definite line between the above terms and general anesthesia. Many units have specific privileges related to the extent at which they can sedate and where. General anesthesia <em>typically</em> occurs in operating theater and <em>typically</em> requires airway control, mechanical ventilation, advanced medications such as paralytics, anesthesia gas, and large volumes of analgesics.</p>\n", "score": 2 } ]

[ "anesthesia", "sedative-sedation" ]

[ { "answer_id": 18918, "body": "<p>Based on the most recent large-scale and high quality Cochrane review on more than 80,000 healthy adults from 52 clinical trials aged 16 to 65 years, including pregnant women, over a single influenza season in North America, South America, and Europe who received vaccination between 1969 and 2009 <a href=\"http://www.thennt.com/nnt/vaccines-preventing-influenza-healthy-individuals/\" rel=\"nofollow noreferrer\">(1)</a>:</p>\n\n<blockquote>\n <p>71 healthy adults need to be vaccinated to prevent one of them experiencing influenza, and 29 healthy adults need to be vaccinated to prevent one of them experiencing an influenza-like illness <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29388196\" rel=\"nofollow noreferrer\">(2)</a></p>\n</blockquote>\n\n<p>These statistics (i.e., 71 and 29) are called number needed to be vaccinated/treated (NNV or NNT) representing the clinical effectiveness of vaccines (NNV) or medications (NNT). <a href=\"http://www.thennt.com/\" rel=\"nofollow noreferrer\">http://www.thennt.com/</a> is a quite useful source to find out such measures of clinical effectiveness of diagnostic, preventive, or therapeutic medical interventions. </p>\n\n<p><strong>Considering the difference between pandemics and seasonal outbreaks:</strong>\nBasically, the current flu vaccines are based on previously recognized sub-types (e.g., in previous epidemics/pandemics). If the virus of an upcoming epidemic/pandemic has been covered in the vaccine, these likelihoods may be true. However, it should be noticed that it is a bit unlikely for a previously well-recognized and covered sub-type to form a pandemic (i.e. an influenza virus that spreads on a worldwide scale and infects a large proportion of the world population [Wikipedia]), unless by mutating to a new pandemic strain. Also, note that studying vaccines' effectiveness against pandemics (the exact protection rate in populations) by current research equipment, methods and budgets is not feasible.<br>\nAlso, we should not forget that human kind has only experienced 5 flu pandemics.</p>\n", "score": 3 } ]

[ "influenza" ]

[ { "answer_id": 18883, "body": "<p>This was answered very well by @anongoodnurse in Biology.SE question <a href=\"https://biology.stackexchange.com/q/58060\">What are the effects of the common cold in an immunodeficient person?</a> plus there was a study by <a href=\"https://doi.org/10.1016/S0002-9343(97)00007-7\" rel=\"noreferrer\">Bowden (1997)</a> which indicated that:</p>\n<blockquote>\n<p>rhinovirus was responsible for 25% of community-acquired VRIs [viral respiratory infections] among bone marrow transplant recipients.</p>\n</blockquote>\n<p>In one small study by <a href=\"https://doi.org/10.1001/archinte.163.3.278\" rel=\"noreferrer\">Greenberg (2003)</a>, rhinovirus in the immunocompromised led to significant mortality from lower respiratory infection:</p>\n<blockquote>\n<p>Among high-risk patients with cancer, rhinovirus infections are often fatal. In a study of 22 immunocompromised blood and marrow transplant recipients who were hospitalized with rhinovirus infections, 7 (32%) developed fatal pneumonia. The remaining patients had infections confined to the upper respiratory tract. In 6 of the 7 fatal cases, rhinovirus had been isolated in bronchoalveolar lavage fluid or an endotracheal aspirate before death.</p>\n</blockquote>\n<p>Note that this is in hospitalised patients; it says nothing of non-hospitalised patients.</p>\n<p>This conclusion has been disputed according to @anongoodnurse, but it can be seen to corroborate Greenburg's 2003 study.</p>\n<p>In a slightly larger study by <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19373660\" rel=\"noreferrer\">Murali et al. (2009)</a> among people with hematological cancers:</p>\n<blockquote>\n<p>Respiratory viral pathogens are a common cause of <em>morbidity</em> in patients with hematologic malignancies. ...Both a rapid viral culture with direct fluorescence antibody (DFA) staining and a PCR-based assay (MultiCode-PLx Respiratory Virus Panel) were performed on patients with hematologic malignancies, who underwent collection of a nasopharyngeal swab or bronchoalveolar lavage from October 2006 to April 2007. Eighty-two samples from 70 patients were obtained; <strong>all patients had upper respiratory tract symptoms.</strong> Respiratory viruses were detected in 10 samples (12%) by conventional virological methods and in 31 samples (38%) by the MultiCode-PLx assay. ...40% of these patients had pneumonia in addition to the upper respiratory tract symptoms. [emphasis added]</p>\n</blockquote>\n<p>@anongoodnurse noted that there is no mention of mortality, but that does not mean a proportion didn't die from pneumonia, just like <a href=\"https://doi.org/10.1001/archinte.163.3.278\" rel=\"noreferrer\">Greenberg (2003)</a> may have found that those with pneumonia had upper respiratory tract infections. He may have just not mentioned it in light of the fact that he wanted to highlight the mortality rate of pneumonia in his cases.</p>\n<p>@anongoodnurse summarised by saying</p>\n<blockquote>\n<p>So long story short, they have stuffy, runny noses, sore throat, cough, etc. Clearly the virus itself causes damage to the mucosa; that is integral to viral replication. After entering a mucosal cell, the virus replicates, then the progeny virus is released by lysis of the cell. This damage itself causes inflammation (not the same as an immune reaction), pain, etc. The major difference seems to be a more severe and prolonged experience.</p>\n</blockquote>\n<p>for which I would add that fatal pneumonia <strong>can</strong> develop from the prolonged infection of rhinovirus.</p>\n<blockquote>\n<p>Rhinovirus infections, although usually limited to the upper respiratory tract, can extend beyond the oropharynx and may cause complications in the lower respiratory tract, including pneumonia (<a href=\"https://doi.org/10.1086/313723\" rel=\"noreferrer\">Imakita, et al. 2000</a>).</p>\n</blockquote>\n<h2>References</h2>\n<p>Bowden, R. A. (1997). Respiratory virus infections after marrow transplant: the Fred Hutchinson Cancer Research Center experience. <em>The American journal of medicine, 102</em>(3), 27-30. doi: <a href=\"https://doi.org/10.1016/S0002-9343(97)00007-7\" rel=\"noreferrer\">10.1016/S0002-9343(97)00007-7</a> pmid: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10868139\" rel=\"noreferrer\">10868139</a></p>\n<p>Greenberg, S. B. (2003). Respiratory consequences of rhinovirus infection. <em>Archives of internal medicine, 163</em>(3), 278-284. doi: <a href=\"https://doi.org/10.1001/archinte.163.3.278\" rel=\"noreferrer\">10.1001/archinte.163.3.278</a></p>\n<p>Imakita, M., Shiraki, K., Yutani, C., &amp; Ishibashi-Ueda, H. (2000). Pneumonia caused by rhinovirus. <em>Clinical infectious diseases, 30</em>(3), 611-612. doi: <a href=\"https://doi.org/10.1086/313723\" rel=\"noreferrer\">10.1086/313723</a></p>\n<p>Murali, S., Langston, A. A., Nolte, F. S., Banks, G., Martin, R., &amp; Caliendo, A. M. (2009). Detection of respiratory viruses with a multiplex polymerase chain reaction assay (MultiCode-PLx Respiratory Virus Panel) in patients with hematologic malignancies. <em>Leukemia &amp; lymphoma, 50</em>(4), 619-624. doi: <a href=\"https://doi.org/10.1080/10428190902777665\" rel=\"noreferrer\">10.1080/10428190902777665</a> pmid: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19373660\" rel=\"noreferrer\">19373660</a></p>\n", "score": 5 } ]

[ "immune-system", "common-cold", "virus" ]

[ { "answer_id": 18977, "body": "<p>I haven't found any source that would claim that a normal level of haptocorrin in saliva is a limiting factor for the absorption of vitamin B12 from supplements.</p>\n\n<p>On the other hand, haptocorrin deficiency can limit the absorption of vitamin B12 even from food thus leading to vitamin B12 deficiency (<a href=\"http://clinchem.aaccjnls.org/content/49/8/1367?ijkey=d46bd3378be475dd8a5670900393b5e9f12ea2ed&amp;keytype2=tf_ipsecsha\" rel=\"nofollow noreferrer\">Clinical Chemistry, 2003</a>).</p>\n\n<p>It is the intrinsic factor that is a bottleneck for the absorption of large oral doses of vitamin B12 <a href=\"https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/\" rel=\"nofollow noreferrer\">(Office of Dietary Supplements)</a>:</p>\n\n<blockquote>\n <p><strong>Approximately 56% of a 1 mcg oral dose of vitamin B12 is absorbed.</strong></p>\n \n <p>Existing evidence does not suggest any differences among forms with\n respect to absorption or bioavailability. However the body’s ability\n to absorb vitamin B12 from dietary supplements is largely limited by\n the capacity of intrinsic factor. For example, <strong>only about 10 mcg of\n a 500 mcg oral supplement is actually absorbed in healthy people.</strong></p>\n</blockquote>\n", "score": 3 } ]

[ "micronutrients", "b-12-supplements" ]

[ { "answer_id": 19087, "body": "<p>In water intoxication, cells do not burst but swell. This can lead to swelling of the entire organs; the most dangerous is <strong>brain swelling,</strong> which is the usual cause of death.</p>\n\n<p>Transitional cell or organ swelling is not already a damage. Brain swelling is different because the swollen brain presses hardly against the skull, which can cause damage. </p>\n\n<p>When you drink excessive amounts of water and do not experience any symptoms within the next 24 hours, it is very unlikely that any permanent damage has occurred in your body. But if you experience symptoms, such as headache, vomiting, confusion, seizures or impaired consciousness, you might later have chronic symptoms related to the brain damage, for example, depression and loss of appetite (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778777/\" rel=\"nofollow noreferrer\">PubMed, 2016</a>). </p>\n\n<hr>\n\n<p>Drinking large amounts of water is dangerous only if it results in <strong>dilutional hyponatremia</strong> - a drop of sodium in the blood, which results in the flux of water from the blood into the cells. This more likely happens if you:</p>\n\n<ul>\n<li>are <em>already well hydrated</em> and drink excessive amount of water several hours in the row (so the kidneys have no time to excrete it)</li>\n<li><em>do not consume any sodium</em> from foods or beverages (but common commercial sport drinks, such as Gatorade, may not contain enough sodium to prevent hyponatremia)</li>\n<li><em>have low body weight</em> (children and women are at higher risk)</li>\n<li><em>exercise,</em> which, in some people, increases secretion of the antidiuretic hormone (which causes water retention)</li>\n<li><em>sweat only little</em></li>\n</ul>\n\n<p>From the above reasons, the amount of water that causes water intoxication is not a fixed number. Examples:</p>\n\n<ul>\n<li>A 22-year old man drinking 6 liters in 3 hours, was in coma, survived after treatment (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924712/\" rel=\"nofollow noreferrer\">PubMed, 2013</a>)</li>\n<li>A 40-year old woman drinking over 4 liters in less than 2 hours, died (<a href=\"http://news.bbc.co.uk/2/hi/uk_news/england/bradford/7779079.stm\" rel=\"nofollow noreferrer\">BBC News, 2008</a>) </li>\n</ul>\n\n<p>According to <a href=\"https://www.researchgate.net/publication/228550291_Current_US_Military_Fluid_Replacement_Guidelines/download\" rel=\"nofollow noreferrer\">Current U.S. Military Fluid Replacement Guidelines (2003)</a>, an adult person should <strong>not drink more than 1.5 liters of water per hour during exercise.</strong></p>\n\n<p>Sources:</p>\n\n<ul>\n<li><a href=\"https://cjasn.asnjournals.org/content/2/1/151.full\" rel=\"nofollow noreferrer\">Exercise Associated Hyponatremia (Clinical Journal of American Society of Nephrology, 2007)</a></li>\n<li><a href=\"https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2015/11/NoakesArticle-September-08.pdf\" rel=\"nofollow noreferrer\">Water Intoxication—Considerations for Patients, Athletes and Physicians (Practical Gastroenterology, 2008)</a></li>\n</ul>\n", "score": 3 } ]

[ "hydration" ]

[ { "answer_id": 19067, "body": "<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2343381/\" rel=\"nofollow noreferrer\">Dehydration</a> usually would result in hypotension (low blood pressure) and reflex tachycardia (rapid pulse) due to decreased circulating blood volume. But depending on several factors, including the sympathetic reflex, transient elevated blood pressure might be seen. </p>\n\n<p>However, hypertension is not diagnosed based on a single value, but repeated elevated values over time. It is a different pathology than a temporary sympathetic reflex, and generally this is not fixed by rehydration. </p>\n\n<p>Good hydration is an important part of good dietary practices that are the foundation for treatment of hypertension. However, diuretics (which reduce fluids) are also often used to treat hypertension. There is a complex fluid balance involved, and it depends on a lot of factors.</p>\n\n<p><strong><em>For any individual's application of these topics, see a physician.</em></strong></p>\n\n<p>Good resources:</p>\n\n<ul>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2343381/\" rel=\"nofollow noreferrer\">Nisha Charkoudian, John R Halliwill, Barbara J Morgan, John H Eisenach, and Michael J Joyner: \"Influences of hydration on post-exercise cardiovascular control in humans\"</a>, J Physiol. 2003 Oct 15; 552(Pt 2): 635–644. Published online 2003 Aug 8. doi: 10.1113/jphysiol.2003.048629 PMCID: PMC2343381, PMID: 14561843</p></li>\n<li><p><a href=\"https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/low-blood-pressure-when-blood-pressure-is-too-low\" rel=\"nofollow noreferrer\">American Heart Association: \"Low Blood Pressure - When Blood Pressure Is Too Low\", 2009.</a> </p></li>\n</ul>\n", "score": 7 } ]

[ "hypertension", "dehydration" ]

[ { "answer_id": 23940, "body": "<p>Yes, it's true.\nA relationship does exist between grinding the teeth and sleep apnea.\nThe term bruxism(sleep bruxism) is used for grinding the teeth during sleep at night.\nIn a <a href=\"https://link.springer.com/article/10.1007/s11325-014-0953-5\" rel=\"nofollow noreferrer\">study</a> it was seen that the patients with obstructive sleep apnea syndrome also demonstrated with sleep bruxism.\nInterestingly treating the sleep apnea syndrome may also prevent sleep bruxism.<a href=\"https://link.springer.com/article/10.1007/s11325-014-0953-5\" rel=\"nofollow noreferrer\">reference</a></p>\n<p>Another good <a href=\"https://www.sciencedirect.com/science/article/pii/S1389945702001302\" rel=\"nofollow noreferrer\">article</a> you may refer, wherein there was a study done proving this relation.</p>\n", "score": 1 } ]

[ "dentistry", "correlation", "sleep-apnea" ]

[ { "answer_id": 19121, "body": "<p>It is very unlikely that the skin would rupture due to internal bleeding.</p>\n\n<p>Adults have about <a href=\"https://www.medicinenet.com/script/main/art.asp?articlekey=21474\" rel=\"nofollow noreferrer\">5.5 liters of blood</a> inside the circulatory system (arteries/veins/heart/pulmonary circulation) or \"intravascular space.\" When about <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200784/\" rel=\"nofollow noreferrer\">40% of blood</a> is lost from the intravascular space (so about 2 liters), the circulatory system collapses, and you die.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065003/\" rel=\"nofollow noreferrer\">Clinical Review: Hemorrhagic Shock (PubMed, 2004)</a>:</p>\n\n<blockquote>\n <p>Intrathoracic injuries, especially to the lung, heart, or the great\n vessels, can result in the loss of several liters of blood into the\n thorax without external evidence of hemorrhage. Intra-abdominal\n injuries to solid organs (spleen and liver) and great vessels\n (ruptured aneurysm, penetrating injury to intra-abdominal vessels) can\n cause rapid loss of the entire blood volume into the abdomen.</p>\n</blockquote>\n\n<p>From these examples you can see that internal bleeding does not break the skin. </p>\n\n<p>During deep breathing, your chest volume can increase by 5 liters and nothing breaks. When gas builds in your intestine, the volume of your abdomen can increase by more than 5 liters, which results in obvious abdominal distension, and the skin does not break.</p>\n\n<p>Let's say that a systolic (upper) arterial blood pressure in a healthy adult is about 120 mm Hg. When an artery breaks and the blood escapes into the chest or abdominal cavity, it instantly loses most of the pressure. If the blood accumulates in a cavity and the pressure within it rises to 120 mm Hg, the blood will no longer escape from the arteries and the pressure in a cavity will no longer increase. But the pressure in the chest or abdominal cavity is very unlikely to increase so much just from few liters of blood, because these cavities are quite expandable, mostly due to the diaphragm muscle that can move up or down a lot. I don't know exact pressures in internal bleeding, but, in one case, removal of 4.5 liters of fluid in a patient with ascites, decreased intraabdominal pressure by only 15 mm Hg (from 45 to 30 mm Hg) (<a href=\"https://www.ajemjournal.com/article/S0735-6757(04)00145-7/fulltext\" rel=\"nofollow noreferrer\">ajemjournal.com</a>).</p>\n\n<p>Another comparison: Average see-level atmospheric pressure is 760 mm Hg. </p>\n\n<p>In <a href=\"https://orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/\" rel=\"nofollow noreferrer\">compartment syndrome</a> (due to bleeding or muscle swelling), the pressure in a limb can increase to as high as <a href=\"https://www.bmj.com/content/bmj/2/6194/818.full.pdf\" rel=\"nofollow noreferrer\">240 mm Hg</a>, but I have never read this would result in skin rupture. Google search for <a href=\"https://www.google.com/search?newwindow=1&amp;ei=Zda6XIy1N6fgkgXi85vADQ&amp;q=%22compartment%20syndrome%22%20%22skin%20rupture%22&amp;oq=%22compartment%20syndrome%22%20%22skin%20rupture%22&amp;gs_l=psy-ab.3...3381.4305..4754...0.0..0.212.740.1j4j1......0....1..gws-wiz.......0i71.Je6332i0rHc\" rel=\"nofollow noreferrer\">\"compartment syndrome\" \"skin rupture\"</a> also does not give any meaningful results.</p>\n\n<p>Somewhat injured skin could break due to a hematoma buildup beneath it, but this is probably not what you are asking.</p>\n\n<p>What happens with the blood in the chest or abdominal cavity? It is slowly decomposed and reabsorbed within weeks/months. Some internal scars (adhesions) may develop as a complication.</p>\n", "score": 6 } ]

[ "internal-bleeding" ]

[ { "answer_id": 19151, "body": "<p><a href=\"https://ec.europa.eu/health//sites/health/files/files/eudralex/vol-2/c/smpc_guideline_rev2_en.pdf#page=18\" rel=\"nofollow noreferrer\">A GUIDELINE ON SUMMARY OF PRODUCT [pharmaceuticals] CHARACTERISTICS (EUROPEAN COMMISSION, 2009)</a></p>\n\n<blockquote>\n <p>In exceptional cases, if a frequency cannot be <em>estimated</em> from the\n available data, an additional category frequency ‘not known’ may be\n used.</p>\n</blockquote>\n\n<p>Sometimes, knowing the number of cases of a drug side effects in a certain group of users is not enough to estimate the frequency of side effects in the entire population. For example, if only one person spontaneously reports a side effect, the <em>reported frequency</em> is known, but this may not be enough to estimate the <em>actual frequency,</em> because the producer does not know how many others experienced side effects.</p>\n\n<p>When the reported frequency is low, the producer can't automatically claim the actual frequency is \"low,\" so they may say it's unknown, but you can assume it is probably low, because...when the reported frequency is high, the producer can automatically estimate the actual frequency is also \"high.\" </p>\n", "score": 7 } ]

[ "side-effects" ]

[ { "answer_id": 19163, "body": "<p>If PCOS is unable to be diagnosed by the presence of the 2 other criteria out of the 3 you listed, then imaging is critical to diagnosis if PCOS is strongly suspected. Diagnosis is important, as treatment can sometimes prevent complications.</p>\n\n<p>Of all imaging modalities, transvaginal ultrasound (TVUS) is the first choice because it gives the best visualization of pelvic organs, as it can get closer to them than transabdominal ultrasound, and the ultrasound technology allows characterization of cysts based on echogenicity.</p>\n\n<p><a href=\"https://i.stack.imgur.com/J7aQx.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/J7aQx.png\" alt=\"transvaginal ultrasonography\"></a></p>\n\n<p>Transvaginal ultrasound is done using a probe that is covered with a condom-like sheath, and covered in lubrication. The probe looks like this:</p>\n\n<p><a href=\"https://i.stack.imgur.com/ikEbL.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/ikEbL.jpg\" alt=\"TVUS probe\"></a></p>\n\n<p>The probe is usually approximately the width of 2 fingers. If a woman is able to tolerate manipulation of tampons, it is less likely to cause trauma to the hymen. Although there is some discomfort with the exam, most women report it is not as traumatic as it seemed it would be. </p>\n\n<p>However, there do exist <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218544/\" rel=\"noreferrer\">alternative recommendations</a> for diagnostic imaging in adolescents prior to sexual debut, which can be applied to virgin adults as well: </p>\n\n<blockquote>\n <p>transabdominal ultrasound is preferred to the transvaginal approach in adolescent girls, but this approach may be technically limited in overweight and obese individuals. </p>\n</blockquote>\n\n<p>\"Technically limited\" means that abdominal fat reduces the ability of ultrasound from outside the abdomen to visualize the ovaries accurately, and therefore may yield inconclusive results. In that case, a transvaginal ultrasound would be preferred. It is possible to start with a transabdominal ultrasound and then get transvaginal if the first is inconclusive. Alternatively, CT scan or MRI are options; however, CT radiation is generally preferred to be avoided unless necessary (it exposes your ovaries to 200+ times the radiation of 1 chest Xray), and MRI is a long and expensive test.</p>\n\n<p>An adolescent or adult with concerns about TVUS should talk with their provider to discuss the viability of alternative imaging options, if imaging is essential to the diagnosis, and perhaps look at an ultrasound probe to reduce concern with the use of the instrument.</p>\n", "score": 6 } ]

[ "pcos", "menstruation", "ovarian-cysts", "transvaginal-ultrasound" ]

[ { "answer_id": 19159, "body": "<p><a href=\"https://www.drugs.com/mmx/lugol-s-solution.html\" rel=\"nofollow noreferrer\">Drugs.com</a> mentions that prolonged use of Lugol's solution (potassium iodide + iodine) can cause <em>confusion,</em> caused by potassium.</p>\n\n<p>In long-term treatment of Grave's disease (overactive thyroid), 10–400 mg iodide per day has been used (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693970/\" rel=\"nofollow noreferrer\">PubMed, 2107</a>).</p>\n\n<p>Various drug websites do not mention psychosis, aggressiveness, illusions or irritability as a side effect of potassium iodide.</p>\n\n<p>Grave's disease symptoms include irritability and anxiety, among others (<a href=\"https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240\" rel=\"nofollow noreferrer\">Mayo Clinic</a>).</p>\n", "score": 4 } ]

[ "thyroid", "psychologist-psychology", "psychiatrist-psychiatry", "antipsychotic" ]

[ { "answer_id": 19300, "body": "<p><strong>Is it possible that antibiotic-resistant bacteria become stronger, that is harder for the immune system to combat?</strong></p>\n\n<p>Short answer: <strong>It depends</strong> on the species of bacteria, immune status of an individual, etc.</p>\n\n<p>The authors of this article: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295033/\" rel=\"nofollow noreferrer\">The Complex Relationship between Virulence and Antibiotic Resistance (PubMed, 2017)</a> make a vague conclusion that:</p>\n\n<blockquote>\n <p>Increased virulence [the potential of certain bacteria to cause\n disease] <em>may</em> naturally evolve in response to or concurrently with\n increased antibiotic resistance...</p>\n</blockquote>\n\n<p>In one study in mice, antibiotic-resistant bacteria were <strong>less virulent</strong> than the antibiotic-sensitive ones. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7799832\" rel=\"nofollow noreferrer\">Comparison of the virulence of methicillin-resistant [MRSA] and methicillin-sensitive Staphylococcus aureus [MSSA] (PubMed, 1994)</a></p>\n\n<blockquote>\n <p>These results indicate that MRSA is less virulent than MSSA in\n normal hosts, but that they are equally virulent in immunocompromised\n hosts.</p>\n</blockquote>\n\n<p>It's not possible to make a general conclusion from a single animal study, though.</p>\n\n<p>Another aspect is that bacteria resistant to one antibiotic are prone to become resistant to other antibiotics. <em>Staphylococcus aureus</em> can become resistant to methicillin (methicillin-resistant S. aureus or MRSA), vancomycin (VRSA) and several other antibiotics (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839888/\" rel=\"nofollow noreferrer\">PubMed, 2009</a>). Furthermore, plasmids (the DNA particles in the bacteria that induce antibiotic-resistance) can spread to other species of bacteria, for example, from staphylococci to enterococci.</p>\n\n<p><strong>If there is a genetic component to fighting off bacterial infections, do the generations since antibiotics have a higher percentage of members who are not going to be as good as people were on average 90 or so years ago at dealing with infections?</strong></p>\n\n<p>Antibiotics helped to survive many \"bacteria-sensitive\" people, and their offsprings may be more sensitive too, so it is <em>possible</em> that today there are more individuals sensitive to bacteria than 90 years ago. However, according to one 2015 study in twins, <a href=\"http://Variation%20in%20the%20Human%20Immune%20System%20Is%20Largely%20Driven%20by%20Non-Heritable%20Influences\" rel=\"nofollow noreferrer\">variation in the human immune system is largely driven by non-heritable influences (Cell.com)</a>.</p>\n", "score": 4 } ]

[ "antibiotics" ]

[ { "answer_id": 19242, "body": "<p>According to USDA Food Composition Database, 1 gram (or even 100 grams) of fish oil from <a href=\"https://ndb.nal.usda.gov/ndb/foods/show/04594?fgcd=&amp;manu=&amp;format=&amp;count=&amp;max=25&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=fish%20oil&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">sardines</a>, <a href=\"https://ndb.nal.usda.gov/ndb/foods/show/04590?fgcd=&amp;manu=&amp;format=&amp;count=&amp;max=25&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=fish%20oil&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">herring</a>, <a href=\"https://ndb.nal.usda.gov/ndb/foods/show/04593?fgcd=&amp;manu=&amp;format=&amp;count=&amp;max=25&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=fish%20oil&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">salmon</a> and <a href=\"https://ndb.nal.usda.gov/ndb/foods/show/04591?fgcd=&amp;manu=&amp;format=&amp;count=&amp;max=25&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=fish%20oil&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">menhaden</a> contains <strong>0 (zero) μg</strong> vitamin A.</p>\n\n<p><a href=\"https://www.nap.edu/read/10026/chapter/6#125\" rel=\"nofollow noreferrer\">Tolerable Upper Intake Levels for Vitamin A (The National Academic Press, 2001)</a></p>\n\n<blockquote>\n <p><strong>Acute toxicity</strong> is characterized by nausea, vomiting, headache, increased cerebrospinal fluid pressure, vertigo, blurred vision,\n muscular incoordination..., and bulging fontanel in infants. These are\n usually transient effects involving single or short-term large doses\n of greater than or equal to <strong>150,000 μg in adults</strong> and\n proportionately less in children.</p>\n \n <p><strong>Chronic toxicity</strong> is usually associated with ingestion of large doses greater than or equal to <strong>30,000 μg/day</strong> <em>for months or years.</em></p>\n</blockquote>\n\n<hr>\n\n<p>According to other sources, such as <a href=\"https://food-nutrition.canada.ca/cnf-fce/serving-portion.do?id=458\" rel=\"nofollow noreferrer\">Canada Nutrient File</a> (you need to click \"generate nutrient profile\") and <a href=\"https://nutritiondata.self.com/facts/fats-and-oils/629/2\" rel=\"nofollow noreferrer\">NutritionData</a>, there is also no vitamin A in fish oil. Not sure how much these databases are different from the USDA one, but you can see there are also no other vitamins and minerals in fish oil; or according to <a href=\"https://nccih.nih.gov/health/omega3/introduction.htm\" rel=\"nofollow noreferrer\">National Center for Complementary and Integrative Health</a>: \"fish oil supplements are the nonvitamin/nonmineral natural products...\" </p>\n\n<p>More sources about vitamin A in fish oil:</p>\n\n<ul>\n<li><a href=\"https://www.drugs.com/fish_oil.html\" rel=\"nofollow noreferrer\">Drugs.com</a> does not even mention vitamin A in fish oil.</li>\n<li><a href=\"https://www.drugbank.ca/drugs/DB13961\" rel=\"nofollow noreferrer\">Drugbank</a> mentions that vitamin A and some other vitamins can be <em>added</em> to <em>some</em> fish oil supplements.</li>\n</ul>\n\n<p>More about vitamin A toxicity:</p>\n\n<p><a href=\"https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/\" rel=\"nofollow noreferrer\">Office of Dietary Supplements by NIH.gov</a> mentions some (unreliable) observational studies in which vitamin A in doses as low as 1,500 μg/day have been \"associated\" with side effects.</p>\n\n<p>According to <a href=\"https://lpi.oregonstate.edu/mic/vitamins/vitamin-A#toxicity\" rel=\"nofollow noreferrer\">Linus Pauling Institute</a>, long-term consumption of vitamin A in doses 8,000-10,000 μg/day vitamin A could be toxic.</p>\n", "score": 4 }, { "answer_id": 19241, "body": "<p>Vitamin A is an important Vitamin in my opinion. See, importance for Children 6-59 months <a href=\"https://www.who.int/elena/titles/vitamina_children/en/\" rel=\"nofollow noreferrer\">https://www.who.int/elena/titles/vitamina_children/en/</a></p>\n\n<p>So age is a consideration. Here is the Pauling Institute article on Vitamin A, Oregon State Univ. <a href=\"https://lpi.oregonstate.edu/mic/vitamins/vitamin-A\" rel=\"nofollow noreferrer\">https://lpi.oregonstate.edu/mic/vitamins/vitamin-A</a> This article also discusses the osteoporosis risk. </p>\n\n<p>How well people convert Beta carotene to Vitamin A is also an issue. Should the government continue to allow beta carotene to stand for Vitamin A in our foodstuffs? Stay tuned. </p>\n\n<p>I would not advise a heavy smoker to ingest too much beta carotene. <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/20155614/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/m/pubmed/20155614/</a></p>\n\n<p>If the fish oil supplements contained a significant amount of pre-formed Vitamin A, then believe me it would be listed on the bottle because there is a bit of hysteria about \"hypervitamintosis A\" at present. </p>\n\n<p>(Some young people in America get the idea that if a little preformed Vitamin A helps acne, then a lot of it could help even more, and they may take a lot of the vitamin, without medical supervision, day after day, and this could potentially be a problem.) </p>\n\n<p>The answer regarding supplementation is \"it depends\", on such things as age, medical condition, whether pregnant or not, medications taken and so on. Work with your doctor to find the right level of Vitamin A for you. </p>\n\n<p>Back to fish oil Omega 3 type supplements, I never know whether the oil could be rancid, or whether it could contain an unhealthy level of heavy metals. They can offer health benefits for the right person, particularly if they become a member at a company like Consumer Labs, and follow the information about the good and bad products in this category. Always inform your doctor of the supplements you are taking. </p>\n\n<p>NB Article: Vitamin A and the retina. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738993/#!po=0.454545\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738993/#!po=0.454545</a> Type 2 Diabetes: <a href=\"https://www.sciencedaily.com/releases/2017/06/170613111649.htm\" rel=\"nofollow noreferrer\">https://www.sciencedaily.com/releases/2017/06/170613111649.htm</a></p>\n", "score": 3 } ]

[ "nutrition", "micronutrients", "supplement", "fish" ]