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[ { "answer_id": 1392, "body": "<p>I'm not a dentist, and I would look forward to reading other answers (I believe this topic is misunderstood and there is a lack of guidance generally), but these are my top tips:</p>\n\n<p><strong>Don't brush straight after eating</strong></p>\n\n<p>Your mouth becomes acidic after eating, and this can last for 60 minutes or so. So brushing immediately after eating is a bad idea, no matter what you've eaten, because the acidity will temporarily weaken the enamel. </p>\n\n<p><strong>Brush lightly</strong></p>\n\n<p>I believe you can brush too hard, and I've heard that brushing should be more like a gentle tickle, without forcing the brush against your teeth, but I think this is hard to get across, as it is rather subjective. The very term 'brushing' also refers to activities that require physical effort and involve forcing things to move, eg brushing the floor or brushing your hair straight, so I'm not surprised if people over do it. Television has also been flooded with toothbrush adverts over the years, which normally contain an animation illustrating particles being 'brushed off' the tooth, and this gives the impression that some force is required.\nAlso, use a toothbrush with soft bristles. </p>\n\n<p><strong>Don't rinse</strong></p>\n\n<p>If you rinse your mouth immediately after brushing, most of the residual toothpaste will be washed out completely, but if you don't rinse then the active ingredients are given a bit longer to help clean your teeth. </p>\n\n<p><strong>Use a circular action</strong> </p>\n\n<p>If you use a small circular action when you brush, then you'll increase the contact of the bristles with the gaps between your teeth, and the circular motion can help to ease out little bits. If you simply move the toothbrush over and along the teeth, there will be less contact with the gaps. </p>\n", "score": 3 }, { "answer_id": 25749, "body": "<p>There are a number of techniques available to brush one's teeth and gums.\nNow each technique has its own indications and contraindications.\nTo name a few these include, modified bass technique, charter's technique, horizontal scrub technique, vertical, Stillman, etc etc.<a href=\"https://periobasics.com/tooth-brushing-techniques/\" rel=\"nofollow noreferrer\">Reference</a></p>\n<p>Now as you have mentioned that the best technique for someone who has healthy teeth and healthy gums, and considering that individual is dextrous.</p>\n<p>A number of researches and studies have been done to find out the best technique for plaque removal.\nAnd all of them have presented similar results.</p>\n<blockquote>\n<p>This review has found that, compared to all the prevalent\ntoothbrushing techniques, modified Bass/Bass technique is the most effective in reducing plaque and gingivitis.\n<a href=\"https://www.google.com/url?sa=t&amp;source=web&amp;rct=j&amp;url=https://www.jcdr.net/articles/PDF/12204/32186_CE%5BRa1%5D_F(SL)_PF1(AB_SHU)_PFA(SHU)_PB(AB_SL)_PN(SHU).pdf&amp;ved=2ahUKEwj1gJ_02fXuAhVKAXIKHVCED-gQFjAVegQIDBAC&amp;usg=AOvVaw0wlr_qTMS8hTt4_ym6flW_&amp;cshid=1613729391294\" rel=\"nofollow noreferrer\">Reference</a></p>\n</blockquote>\n<p>Another <a href=\"https://www.google.com/url?sa=t&amp;source=web&amp;rct=j&amp;url=https://www.researchgate.net/publication/283495464_Tooth_Brush_and_Brushing_Technique&amp;ved=2ahUKEwj1gJ_02fXuAhVKAXIKHVCED-gQFjAUegQIIRAC&amp;usg=AOvVaw0_7SwaIJlJFBVzJN_VlvsY&amp;cshid=1613729391294\" rel=\"nofollow noreferrer\">article</a> to claim that modified bass technique is the most effective method-</p>\n<blockquote>\n<p>Most widely accepted and most effective method.</p>\n</blockquote>\n<p>Now how to do the modified bass technique?</p>\n<p><img src=\"https://i.stack.imgur.com/3N2DF.jpg\" alt=\"enter image description here\" /></p>\n<p><img src=\"https://i.stack.imgur.com/kH0ob.jpg\" alt=\"enter image description here\" /></p>\n<p><img src=\"https://i.stack.imgur.com/rIv4S.jpg\" alt=\"enter image description here\" /></p>\n<p><a href=\"https://www.sensodyne.in/blogs/tooth-brushing-techniques.html\" rel=\"nofollow noreferrer\">Reference</a></p>\n<p><a href=\"https://www.ada.org/en/member-center/oral-health-topics/toothbrushes\" rel=\"nofollow noreferrer\">American Dental Association</a> also suggests this same technique.\nAlso according to ADA,</p>\n<blockquote>\n<p>Regardless of the technique used, brushing should touch upon all surfaces—inner, outer and chewing. Also, when brushing, the ADA recommends that people use a soft-bristled toothbrush and apply gentle pressure, both of which may help reduce the risk of gingival injury</p>\n</blockquote>\n<p><a href=\"https://www.ada.org/en/member-center/oral-health-topics/toothbrushes\" rel=\"nofollow noreferrer\">Reference</a></p>\n<p>You may also find other helpful instructions in the same website regarding toothpastes, toothbrushes, etc.</p>\n<p>Hope I have satisfactorily answered your question :)</p>\n", "score": 1 } ]

[ "dentistry", "hygiene" ]

[ { "answer_id": 1443, "body": "<p>The HPV vaccine is <em>most</em> effective when preventing you from initial infection. While common, it's possible you haven't been infected with HPV. Even if you are, there is some benefit to still being vaccinated if you're HPV positive. The reason for this is that there are a number of different types of HPV virus, and the vaccine should provide you some protection against types you have not already acquired. From <a href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm\">this MMWR report</a>, \"Human Papillomavirus Vaccination: Recommendations of the Advisory Committee on Immunization Practices\":</p>\n\n<blockquote>\n <p>In the phase III trials, among females aged 16–26 years who had HPV\n vaccine type DNA detected at study enrollment (either seropositive or\n seronegative), there was no efficacy against progression to disease or\n impact on clearance of infection of that type (114,120). However, HPV4\n had 100% efficacy for prevention of CIN2+ attributable to types not\n already acquired (120). Among persons seropositive to the relevant HPV\n type but HPV DNA-negative, too few cases were detected to evaluate\n efficacy, but disease incidence was low and all cases occurred in the\n placebo group.</p>\n</blockquote>\n\n<p>and</p>\n\n<blockquote>\n <p>HPV vaccination can provide protection against infection with HPV\n vaccine types not already acquired. Therefore, vaccination is\n recommended through the recommended age for females regardless of\n whether they have an abnormal Pap test result, and for females or\n males regardless of known HPV infection, HPV-associated precancer\n lesions, or anogenital warts. Females who have abnormalities on\n cervical cancer screening are likely to be infected with one or more\n genital HPV types. With increasing severity of Pap test findings, the\n likelihood of infection with HPV 16 or HPV 18 increases (70), and the\n expected benefit of vaccination decreases. Females who have had HPV\n testing as part of cervical cancer screening might have information\n about their HPV status. Males or females with AIN are likely infected\n with HPV. The presence of anogenital warts or a history of anogenital\n warts indicates present or past infection with HPV, most often HPV 6\n or HPV 11. Although vaccination is still recommended, patients should\n be advised that vaccination will not have any therapeutic effect on an\n existing HPV infection, HPV-associated precancer lesion, cancer, or\n anogenital warts.</p>\n</blockquote>\n\n<p>In short: It is likely still worth getting vaccinated to protect you from other strains of HPV.</p>\n", "score": 9 } ]

[ "vaccination", "virus", "effectiveness", "vaccine", "hpv" ]

[ { "answer_id": 1492, "body": "<p>This answer is based on normal situations (examples of an abnormal situations include patrolling in high temperatures in full protective gear, and strenuous exercise, especially in heat/cold) and normal health.</p>\n\n<p>I'm going to go on record here as a renegade who does <em>not</em> believe in an \"8 glasses of water a day\" (1.9 L) regimen for normal healthy people in normal circumstances. My belief is, <em>if you're thirsty, drink something</em>; make sure at least some of the time, it's water. If you're drinking caffeinated beverages or alcohol, drink a little more water.</p>\n\n<p>Most people will disbelieve this because of the popular press's obsession with 8 8-ounce glasses (1.9 L) per day myth. So some science is in order.</p>\n\n<p>Total water intake includes water in beverages, water in food, and water intake. Daily water <em>needs</em> vary depending on humidity, temperature (sweating), physical exercise etc. But normal, healthy people regulate their daily water balance incredibly well despite changes in size/development (some factors, such as dementia, etc. can interfere with hydration.) <em>In general</em>, as long as food and fluids are readily available, people only need to drink when they are thirsty. (Obviously strenuous exercise, illness, and other special circumstances require a different approach.)</p>\n\n<p>People born around the same time I was spent a large part of their lives never having seen people drink purchased water or toting bottles of water everywhere, and were probably as amused as I was to see the explosive growth of the bottled water industry.</p>\n\n<p>The Institutes of Medicine's Food and Nutrition Board issued a new report in 2004 establishing nutrient recommendations on \"water, salt and potassium to maintain health and reduce chronic disease risk\". They stated that the vast majority of healthy people adequately meet their daily hydration needs <strong>by letting thirst be their guide</strong>. In a press release:</p>\n\n<blockquote>\n <p>\"We don't offer any rule of thumb based on how many glasses of water people should drink each day because our hydration needs can be met through a variety of sources in addition to drinking water,\" said Lawrence Appel, chair of the panel that wrote the report and professor of medicine, epidemiology, and international health, Johns Hopkins University, Baltimore. \"While drinking water is a frequent choice for hydration, people also get water from juice, milk, coffee, tea, soda, fruits, vegetables, and other foods and beverages as well. Moreover, we concluded that <em>on a daily basis, people get adequate amounts of water from normal drinking behavior -- consumption of beverages at meals and in other social situations -- and by letting their thirst guide them</em>.\" </p>\n</blockquote>\n\n<p>The report did not specify exact requirements for water, but </p>\n\n<blockquote>\n <p>set general recommendations for women at approximately 2.7 liters (91 ounces) of total water - <em>from all beverages and foods</em> - each day, and men an average of approximately 3.7 liters (125 ounces daily) of total water. </p>\n</blockquote>\n\n<p>The panel did not set an upper level for water.</p>\n\n<p>They also stated that caffeinated beverages counted towards fluid requirements:</p>\n\n<blockquote>\n <p>About 80 percent of people's total water intake comes from drinking water and beverages -- including caffeinated beverages -- and the other 20 percent is derived from food.</p>\n</blockquote>\n\n<p>How will drinking even more water than necessary benefit people? Many ways. Here are a few that I can think of:</p>\n\n<ul>\n<li><p><strong>Decreased food intake</strong>: drinking a glass of water half an hour before a meal has been shown to slightly decrease the amount of food a person will eat <em>without any distractions</em>.</p></li>\n<li><p><strong>Decreased spending</strong> on high-calorie drinks: drinking water decreases thirst. <em>Maybe</em> the decrease is enough to discourage reaching for unnecessarily high-calorie beverages. Unfortunately water doesn't taste as good as sugary beverages. :(</p></li>\n<li><p><strong>Increased cardiovascular health</strong>: drinking excess water, then using <em>a bathroom several flights up or down from the floor people work on</em> (walking, not using the elevator) will promote a bit of decent exercise several times/day.</p></li>\n<li><p><strong>Increased spiritual well being</strong>: Before drinking, meditating for a few minutes (think about life without clean water to drink, to bathe in, to launder clothes, etc.; imagining a drought seriously impacting people, then thinking about water available for drinking) and experiencing gratitude for the gift of it is beneficial. Gratitude has been shown in many studies to increase happiness.</p></li>\n</ul>\n\n<p>There are medical conditions wherein drinking more than as guided by thirst is recommended, but that is a different question.</p>\n\n<p>_{<a href=\"http://ajpregu.physiology.org/content/283/5/R993\">“Drink at least eight glasses of water a day.” Really? Is there scientific evidence for “8 × 8”?</a>}<br>\n_{<a href=\"http://iom.nationalacademies.org/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx\">Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate</a>}<br>\n_{<a href=\"http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10925\">Report Sets Dietary Intake Levels for Water, Salt, and Potassium\nTo Maintain Health and Reduce Chronic Disease Risk</a>}<br>\n_{<a href=\"http://psycnet.apa.org/journals/psp/84/2/377/\">Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life.</a>}</p>\n", "score": 13 }, { "answer_id": 8902, "body": "<p>Probably you may safely ignore all those recommendations. Quote from \"<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151163/\" rel=\"nofollow\">Medical myths</a>\" article published in British Medical Journal):</p>\n\n<blockquote>\n <p>(...) existing studies suggest that adequate fluid intake is usually met through typical daily consumption of juice, milk, and even caffeinated drinks. In contrast, drinking excess amounts of water can be dangerous, resulting in water intoxication, hyponatraemia, and even death.</p>\n</blockquote>\n\n<p>About the lack of evidence to the popular 8 glasses / 2 litres recommendation:</p>\n\n<blockquote>\n <p>The complete lack of evidence supporting the recommendation to drink six to eight glasses of water a day is exhaustively catalogued in an <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12376390\" rel=\"nofollow\">invited review by Heinz Valtin in the American Journal of Physiology</a>.</p>\n</blockquote>\n", "score": 1 } ]

[ "water" ]

[ { "answer_id": 1517, "body": "<p>You start with your doctor. You can also learn about how memory is made from reading new material.</p>\n<p>No one can answer you over the internet regarding your particular problem; a neurologist would be able to test you for serious health problems regarding your memory, ability to concentrate, etc. But a few general guidelines can be given that might help those young, healthy people who feel they have mentally &quot;slowed down&quot;.</p>\n<p>People of all ages can have problems with their thyroid gland. Virtually every cell in your body is dependent on this <em>master gland's</em> product. Both hypothryoidism and hyperthyroidism can affect thinking, from subtly to profoundly.^[1] If your diet is deficient in any way, tests for that can be done as well.</p>\n<p>You are very young for early onset Alzheimer's &amp; Dementia, but you can be tested for that as well. (The likelihood of having such a cognitive impairment with no other symptoms whatsoever - and without anyone else noticing it - are small.)</p>\n<p>Many, many people worry about their ability to concentrate. I remember feeling mentally sluggish enough decades ago to take the then much-touted herbal supplement <em>ginko biloba</em> (it hasn't been shown to do anything; don't waste your money.) The point is, that was three decades ago, I was young, concerned, and in a demanding profession, and I'm fine.</p>\n<p>Cognitive science has given us some good information about learning; maybe this will help people identify when memory problems are &quot;normal&quot;. Here, I'll deal mainly with reading, concentration, and learning together. And since it might all be new to you, you will very likely need to read it more than once.</p>\n<p>Cognitive load theory and schema (learning) theory^[2][3] go hand in hand in <em>learning</em>. <em>Schemas</em> are frameworks of information (imagine an empty skyscraper in your mind; you want to fill those rooms with what each needs to work and communicate with other rooms, so that in the end, you'll have a pretty-well functioning skyscraper with communication between all the departments.)</p>\n<p>Schemas start as very basic (&quot;This is a cell&quot;) and become more complex and facile (&quot;NADH-Q oxidoreductase, Q-cytochrome c oxidoreductase, and cytochrome c oxidase are mitochondrial transmembranous enzyme complexes responsible for oxidative phosphorylation, etc.&quot;) Schemas allow (and are the basic unit of) <em>Long Term Memory</em> (LTM). To learn something, we need a framework (&quot;cell&quot;) into which we can stick a fact before we can remember it for more than a very few minutes. (Do you think you can remember what you just read about &quot;mitochondrial transmembranous enzyme complexes&quot;? I highly doubt it.)</p>\n<p>The more we know about something (the better our schemas are), the more easily we learn. <em>Working memory</em> (WM) allows us to process what we are exposed to and place it <em>into a schema</em> so that we can remember it. Like a computer, we have limited working memory (processing ability) available to us at any given time. Efficient processing results in placing material into a schema which then facilitates Long Term Memory (LTM). Efficient processing -&gt; Long Term Memory (LTM).</p>\n<blockquote>\n<ul>\n<li><p>Inefficient Processing (IP) -&gt; <em>&quot;What Did I Just Read?&quot;</em> (I know I read it, I know it was in a language I understand, I understood it, but I can't remember what it said.) IP blocks schema identification which then blocks LTM. Failed schema identification means leads to inability to use information.</p>\n</li>\n<li><p>Efficient processing (EP) -&gt; <em>&quot;OK, That Makes Sense; What's Next?&quot;</em> (This relates to things I know; how does it relate to things I'm about to be exposed to?) EP allows schema identification which then allows LTM.</p>\n</li>\n</ul>\n</blockquote>\n<p>Where does cognitive load come in? Cognitive Load takes up processing speed (reducing working memory). If cognitive load is great enough, all working memory is used up, and we will be unable to identify/form a schema.</p>\n<p>There are several types of Cognitive load:</p>\n<ul>\n<li><em>intrinsic</em> (how complex is the information?)</li>\n<li><em>extrinsic</em>/ineffective (a bunch of things including distractions, emotionally demanding states [stress, anxiety, even the anxiety you feel when you see something new], and especially <em>the way in which material is presented</em>, i.e. does it induce splitting of attention? etc.)</li>\n<li><em>germane</em> (what's left over to actually form schemas). They are (kind of) additive. Good schemas <em>reduce</em> cognitive load (increasing working memory).</li>\n</ul>\n<p>They are (kind of) additive. Good schemas reduce cognitive load thereby increasing working memory.</p>\n<p>If you are reading at your limit of working memory, one final additional 'load' (resulting in cognitive overload) will make you unable to remember what you have just/will immediately read.</p>\n<p>Because cognitive overload <em>does not disappear immediately upon reduction of load</em>, you need a few moments to experience reduced load before you regain working memory.</p>\n<p>An example: you read something while at the very edge of working memory. You realize that you have not remembered what you read, so you decrease attention splits (you commit to reread with intent.) Because you need a few moments of reduced load before your second reading, it might not sink in (now you become concerned, further increasing cognitive load), whereas if you got up, sipped water, and sat down again, you might have enough recovery time to regain working memory.</p>\n<p>In an interview with Felipe De Brigard, PhD of the Center for Cognitive Neuroscience at Duke University, He emphasizes the importance of good sleep and giving learning tasks one's full attention:</p>\n<blockquote>\n<ul>\n<li>I also like to highlight the importance of attending to the information we want to encode. In today's world, people love to multitask. But, unfortunately, multitasking is very detrimental to memory consolidation. Attention and working memory are of the essence for information to be encoded. If you divide your attention between two events, you fail to fully encode either of them; at best, you end up half-encoding both of them.</li>\n</ul>\n</blockquote>\n<p>A very minor example of cognitive overload: if 100 people write <em>which</em> or <em>else</em> or other word you're familiar with 30 times in one minute, ~70% will begin to doubt that it is a real word. This is because of the increase of extrinsic load resulting in cognitive overload.</p>\n<p>You might pay attention when your mind starts to not absorb material to see if anything like this is going on (How well is the material presented? Am I experiencing distractions (&quot;not having so many surrounding words helps&quot;)? Am I feeling stressed? Does a short break/turning off the music/etc. help? Try reading something undemanding (a line in a recipe book if you like cooking, or a few lines from a favorite book you've read a few times. Is your memory better with this more familiar and less working-memory-requiring information?)</p>\n<p>The linked site presents different models of presenting information that promotes schema formation, identification and processing in different situations, and links to further work.</p>\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17543038\" rel=\"nofollow noreferrer\">1 Thyroid hormones, learning and memory.</a>}<br />\n_{<a href=\"http://coral.ufsm.br/tielletcab/Apostilas/cognitive_load_theory_sweller.pdf\" rel=\"nofollow noreferrer\">2 COGNITIVE LOAD THEORY, LEARNING DIFFICULTY, AND INSTRUCTIONAL DESIGN</a>}<br />\n_{<a href=\"http://prezi.com/1apjupioiqts/schema-theory-and-cognitive-load-theory/\" rel=\"nofollow noreferrer\">3 Schema Theory and Cognitive Load Theory</a></p>\n<p>_{General references}<br />\n_{<a href=\"http://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/basics/definition/con-20026392\" rel=\"nofollow noreferrer\">Mild cognitive impairment</a>}<br />\n_{<a href=\"http://archneur.jamanetwork.com/article.aspx?articleid=774828\" rel=\"nofollow noreferrer\">Mild Cognitive Impairment: Clinical Characterization and Outcome</a>}<br />\n_{<a href=\"http://www.alz.org/alzheimers_disease_early_onset.asp\" rel=\"nofollow noreferrer\">Younger/Early Onset Alzheimer's and Dementia</a>}</p>\n<p>}</p>\n", "score": 3 } ]

[ "mental-health" ]

[ { "answer_id": 1807, "body": "<blockquote>\n <p>A doctor mentioned Helicobacter pylori as a possible culprit for both of those symptoms.</p>\n</blockquote>\n\n<p>H.pylori infection is a latent infection in the human stomach mucous layer <a href=\"http://emedicine.medscape.com/article/176938-overview#a1\" rel=\"nofollow\">(1)</a><a href=\"https://en.wikipedia.org/wiki/Helicobacter_pylori\" rel=\"nofollow\">(2)</a>. This infection is basically asymptomatic. This infection, however, may cause chronic gastritis. Chronic gastritis is also asymptomatic in most people. Heart burn is not a typical sign of chronic gastritis. In addition to chronic gastritis, H.pylori is able to harm the protective layer in the stomach lining. Since the surroundings in stomach are very acidic (pH~2), any damage done to the protective layer predisposes to stomach ulcer since the gastric acid damages the deeper layers of the stomach lining. These ulcers are usually symptomatic and can cause heartburn and pain in the upper abdomen. NSAIDs can harm the protective layer of stomach in the same way as H.pylori and there they predispose to ulcers also.</p>\n\n<p>However, I find it very difficult to believe that helicobacter would cause migraine. There is at least <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25356058\" rel=\"nofollow\">one meta-analysis</a> and <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25232230\" rel=\"nofollow\">a review article</a> on this subject. Both are published in a quite questionable Open Access journal. The studies included in the meta-analysis are all quite low quality studies. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23159967\" rel=\"nofollow\">Another study</a> conducted on Iran seems quite dubious also. This study has caused some concerns, as can be seen in PubMed. </p>\n\n<p>The causal relationship between H.pylori eradication and migraine can be studied quite easily and safely in large populations. As so, I am suspicious with regard to these studies since there are no randomized controlled trials published in high quality medical journals on this matter. </p>\n\n<blockquote>\n <p>Are there any efficient tests to determine if one is in fact \"infected\" with the bacteria?</p>\n</blockquote>\n\n<p><a href=\"http://www.nejm.org/doi/full/10.1056/NEJMcp1001110\" rel=\"nofollow\">A quite recent review article</a> in the New England Journal of Medicine outlines the current <em>non-endoscopic</em> diagnostic modalities:</p>\n\n<ul>\n<li>Serologic test (=a blood sample to assess for h.pylori antigens) is widely available and cheap. Remains positive even after an eradication</li>\n<li><a href=\"https://en.wikipedia.org/wiki/Urea_breath_test\" rel=\"nofollow\">Urea breath test</a> has high positive and negative predictive values. Results are affected by the use of proton pump inhibitors and antibiotics.</li>\n<li>Fecal antigen test has also positive and negative predictive values. No the most convenient test for patients (not surprised).</li>\n</ul>\n\n<blockquote>\n <p>Are treatments required when there's no presence of stomach ulcers?</p>\n</blockquote>\n\n<p>There is absolutely no indication to eradicate H.pylori in patients who are totally asymptomatic. The prevalence of H.pylori infection is so high that half of the world total population should be on antibiotics. Moreover, if the eradication of H.pylori is successful, you will receive almost surely within the next weeks. If one is diagnosed with an ulcer, a reflux disease or h.pylori is seen tissue samples obtained during gastroscopy or the reason of dyspepsia is suspected to be H.pylori infection, the eradication is reasonable.</p>\n", "score": 3 } ]

[ "infection", "digestion", "bacteria" ]

[ { "answer_id": 3060, "body": "<p>Collagen is not an easy-to-digest protein and generally requires collagenase for efficient digestion. Without digestion, it cannot be absorbed. Moreover, collagen has to be deposited in the right site.</p>\n\n<p>So irrespective of whether collagen is completely digested or not, it cannot be specifically useful for replacing the lost collagen in the joints. </p>\n\n<p>There are two modified amino acids in collagen- hydroxyproline and hydroxylysine, which are essential for the structural integrity of the protein. Vitamin-C is involved in natural production of these amino acids in the body from the unmodified amino acids and hence the deficiency of Vit-C results in scurvy. </p>\n\n<p>Hydroxyproline and hydroxylysine, given as supplements may have some positive effects in healing of injuries ^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15338346\" rel=\"nofollow\">[ref]</a>} (I am not too sure about this). In general, a good diet would be sufficient and talking collagen as a supplement is, IMO, <strong>not useful</strong>.</p>\n", "score": 4 }, { "answer_id": 3051, "body": "<p>I had thought that collagen was about the same as chondroitin and glucosamine, in that there wasn't much evidence to support the notion that it is a viable supplement.</p>\n\n<p>However, when I went looking for some studies on it, I was surprised, in that there are several studies that show improvement in articulation (movement at a joint) and pain, especially in arthritic and injury affected people.</p>\n\n<p><a href=\"http://www.tandfonline.com/doi/abs/10.1185/030079908X291967#.Ve2t_vS0f9o\" rel=\"nofollow\">This study</a> was done over 24 weeks, with athletes suffering from joint pain, and there was a marked improvement across the cohort (97 usable athletes out of 147 selected) in several pain and inflammation markers.</p>\n\n<p>A <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2764342/\" rel=\"nofollow\">second study</a> also showed marked improvement in pain and quality of life in osteoarthritis sufferers using undenatured collagen (type II).</p>\n\n<p>These studies as well as the two others that I have linked without summation, suggest that collagen supplements have a healing effect when injured or suffering from degenerative disease (Such as arthritis), however I was unable to find any studies focusing on prevention using collagen (Which is notoriously hard to prove, if they never get it, you don't know if it was the collagen or not).</p>\n\n<p><a href=\"http://www.andjrnl.org/article/S0002-8223%2809%2900290-9/abstract?cc=y=\" rel=\"nofollow\">Whey and Collagen effect on nitrogen balance</a></p>\n\n<p><a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2885.2009.01079.x/abstract?systemMessage=Wiley%20Online%20Library%20and%20related%20systems%20will%20have%203%20hours%20of%20downtime%20on%20Saturday%2012th%20September%202015%20from%2010%3A00-13%3A00%20BST%20%2F%2005%3A00-08%3A00%20EDT%20%2F%2017%3A00-20%3A00%20SGT%20for%20essential%20maintenance.%20%20Apologies%20for%20the%20inconvenience.\" rel=\"nofollow\">Arthritic pain in horses</a></p>\n", "score": 3 } ]

[ "diet", "proteins", "amino-acids" ]

[ { "answer_id": 4447, "body": "<p>According to the <a href=\"http://www.nhs.uk/chq/pages/2026.aspx?CategoryID=70&amp;SubCategoryID=174\" rel=\"noreferrer\">NHS</a>, it is safe to fly with a perforated eardrum. They say that it may even cause less discomfort because air can pass more easily through the hole that has formed in your eardrum. You did mention that the hole has appeared to have scabbed over, but that still shouldn't put you at a risk of furthering the damage to your ear. It might cause a bit more discomfort, but more damage won't occur and the healing process won't slow down.</p>\n\n<hr>\n\n<p>^{<a href=\"http://www.nhs.uk/chq/pages/2026.aspx?CategoryID=70&amp;SubCategoryID=174\" rel=\"noreferrer\">NHS: Is it safe to fly with a perforated eardrum?</a>}</p>\n", "score": 6 } ]

[ "ear", "eardrum", "perforate-perforation", "barotrauma", "aviation" ]

[ { "answer_id": 3118, "body": "<p>Only two things affect the synthesis of vitamin D, and those are the amount of UVB photons penetrating the skin and the person's age. See my <a href=\"http://What%20determines%20the%20amount%20of%20vitamin%20D%20synthesized%20by%20the%20body?%20Solely%20the%20amount%20of%20UVB%20photons%20penetrating%20the%20skin%20and%20the%20person&#39;s%20age:\" rel=\"nofollow\">previous answer</a> for an explanation and citations.</p>\n\n<p>So if we disregard age the only question becomes do light boxes supply adequate UVB to synthesize adequate vitamin D? From what I can tell from a review of the products out there, the answer is probably not. Lights adequate to treat SAD aren't adequate to generate vitamin D, and a light that supplied adequate UVB would be dangerous if misused. </p>\n\n<p>But in my mind the final nail in the coffin for light therapy is <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10888476\" rel=\"nofollow\">this study</a>:</p>\n\n<blockquote>\n <p>All subjects receiving vitamin D improved in all outcome measures. The\n phototherapy group showed no significant change in depression scale\n measures. Vitamin D status improved in both groups (74% vitamin D\n group, p &lt; 0.005 and 36% phototherapy group, p &lt; 0.01).</p>\n</blockquote>\n\n<p>In short, although phototherapy improved vitamin D levels, it did so only half as well as supplements, and unlike supplements it had no effect on depression.</p>\n", "score": 6 } ]

[ "micronutrients", "deficiency", "light" ]

[ { "answer_id": 3186, "body": "<p>Generally, for determining normal range of any parameter, a reasonably large sample of apparently healthy population is tested for that parameter. The normal range is then taken to be 2.5th to 97.5th percentile value. Values above and below this range are categorized as abnormal (abnormally low or high). </p>\n\n<p>For some parameters, e.g. eyesight, one side of range is better than normal and may be called super-normal and not abnormal.</p>\n\n<p>Round, convenient values are often taken as limits of normal ranges and mild/moderate/severe categories, so that they can be easily remembered and applied in busy clinics. Some of the blood sugar, blood pressure and BMI cutoffs follow this principle. </p>\n\n<p>For some parameters, prospective studies of outcome (life expectancy, morbidity and mortality) may show a particular range to be the best or optimal and such range may be used to determine normality. Yu Chen et al (<a href=\"http://www.bmj.com/content/347/bmj.f5446\" rel=\"nofollow\">http://www.bmj.com/content/347/bmj.f5446</a>) found a U shaped association between BMI of Asians and cardiovascular deaths.</p>\n\n<p>The risk is often continuous, but the values are categorized into groups so that odds ratio can be calculated. Odds ratio provides easy method to compare risk in different categories. Regarding BMI, the World Health Organization page (<a href=\"http://apps.who.int/bmi/index.jsp?introPage=intro_3.html\" rel=\"nofollow\">http://apps.who.int/bmi/index.jsp?introPage=intro_3.html</a>) also mentions: </p>\n\n<blockquote>\n <p>The health risks associated with increasing BMI are continuous and the\n interpretation of BMI gradings in relation to risk may differ for\n different populations.</p>\n</blockquote>\n\n<p>There are many who strongly oppose conversion of continuous data to categorical: <a href=\"http://biostat.mc.vanderbilt.edu/wiki/Main/CatContinuous\" rel=\"nofollow\">http://biostat.mc.vanderbilt.edu/wiki/Main/CatContinuous</a></p>\n", "score": 5 } ]

[ "biological-parameter" ]

[ { "answer_id": 3339, "body": "<p>People who sleep less than 6 hours and people who sleep more than 9 hours have been found to have a greater risk of suffering from adverse health effects, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19645960\" rel=\"noreferrer\">see e.g. here</a>. But one cannot conclude from such observed correlations that changing sleeping behavior will help, this requires one to analyze the cause of these correlations. The way long sleep is associated with increased mortality is not well understood, as mentioned in <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727192/\" rel=\"noreferrer\">this article</a>: </p>\n\n<blockquote>\n <p>It is therefore possible that long duration of sleep might be a consequence of, rather than a causative risk factor for, unrecognized chronic comorbidity, which in turn could explain the higher risk of mortality, particularly mortality from noncardiovascular causes, observed in many studies (1–4). Long sleep duration might represent a useful diagnostic tool for detecting other subclinical or undiagnosed mental or physical comorbidity (13).</p>\n</blockquote>\n", "score": 2 }, { "answer_id": 31179, "body": "<p>For the causes of mortality with short and long sleep, the first linked article in @CountIblis' answer (<a href=\"https://doi.org/10.1111/j.1365-2869.2008.00732.x\" rel=\"nofollow noreferrer\">Gallicchio &amp; Kalesan, 2009</a>) states that</p>\n<blockquote>\n<p>The specific mechanisms underlying the association between sleep duration and mortality are unclear.</p>\n</blockquote>\n<p>However,</p>\n<h2>For short sleep (generally shorter than 7 hours)</h2>\n<blockquote>\n<p>A number of experimental studies have shown that short sleep causes potentially adverse endocrinologic, immunologic, and metabolic effects (<a href=\"https://doi.org/10.1046/j.1365-2796.2003.01195.x\" rel=\"nofollow noreferrer\">Akerstedt and Nilsson, 2003</a>; <a href=\"https://doi.org/10.1016/j.smrv.2007.01.002\" rel=\"nofollow noreferrer\">Knutson <em>et al.</em>, 2007</a>; Spiegel <em>et al.</em>, 2005). For example, Spiegel <em>et al.</em> (2005) showed in a laboratory-based study that restricted sleep among 11 healthy men was associated with impaired glucose tolerance, higher evening cortisol levels, alterations in sympathetic nervous system activity, and a reduction in leptin secretion.</p>\n</blockquote>\n<h2>For long sleep (generally longer than 9 hours)</h2>\n<blockquote>\n<p>Unlike short sleep, long sleep has not consistently been shown to be associated with certain adverse medical conditions such as diabetes and hypertension, although studies have reported that long sleep is associated with obesity and stroke (<a href=\"https://doi.org/10.1161/STROKEAHA.108.521773\" rel=\"nofollow noreferrer\">Chen <em>et al.</em>, 2008</a>; <a href=\"https://doi.org/10.1016/j.smrv.2008.03.001\" rel=\"nofollow noreferrer\">Marshall <em>et al.</em>, 2008</a>). Further, adjustment for health conditions in studies examining the association between long sleep and mortality has not resulted in an attenuation of the association.</p>\n</blockquote>\n<h2>References</h2>\n<p>Åkerstedt, T., &amp; Nilsson, P. M. (2003). Sleep as restitution: an introduction. <em>Journal of internal medicine, 254</em>(1), 6-12. <a href=\"https://doi.org/10.1046/j.1365-2796.2003.01195.x\" rel=\"nofollow noreferrer\">https://doi.org/10.1046/j.1365-2796.2003.01195.x</a></p>\n<p>Chen, J. C., Brunner, R. L., Ren, H., Wassertheil-Smoller, S., Larson, J. C., Levine, D. W., ... &amp; Stefanick, M. L. (2008). Sleep duration and risk of ischemic stroke in postmenopausal women. <em>Stroke, 39</em>(12), 3185-3192. <a href=\"https://doi.org/10.1161/STROKEAHA.108.521773\" rel=\"nofollow noreferrer\">https://doi.org/10.1161/STROKEAHA.108.521773</a></p>\n<p>Gallicchio, L., &amp; Kalesan, B. (2009). Sleep duration and mortality: a systematic review and meta‐analysis. Journal of sleep research, 18(2), 148-158. <a href=\"https://doi.org/10.1111/j.1365-2869.2008.00732.x\" rel=\"nofollow noreferrer\">https://doi.org/10.1111/j.1365-2869.2008.00732.x</a></p>\n<p>Knutson, K. L., Spiegel, K., Penev, P., &amp; Van Cauter, E. (2007). The metabolic consequences of sleep deprivation. <em>Sleep medicine reviews, 11</em>(3), 163-178. <a href=\"https://doi.org/10.1016/j.smrv.2007.01.002\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/j.smrv.2007.01.002</a></p>\n<p>Marshall, N. S., Glozier, N., &amp; Grunstein, R. R. (2008). Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep medicine reviews, 12(4), 289-298. <a href=\"https://doi.org/10.1016/j.smrv.2008.03.001\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/j.smrv.2008.03.001</a></p>\n<p>Spiegel, K., Leproult, R. and Van Cauter, E. Metabolic and endocrine changes. In: C. Kushida (Ed.) (2005) <em>Sleep deprivation: basic science, physiology and behavior</em>. New York: Marcel Dekker. 293–318.</p>\n", "score": 1 } ]

[ "sleep", "sleep-cycles" ]

[ { "answer_id": 5728, "body": "<ol>\n<li>Reading is better for dark text on light background than for light text on dark background.</li>\n</ol>\n\n<blockquote>\n <p>We investigated the underlying mechanism by assessing pupil size and proofreading performance when reading positive and negative polarity texts. In particular, we tested the display luminance hypothesis which postulates that the typically greater brightness of positive compared to negative polarity displays leads to smaller pupil sizes and, hence, a sharper retinal image and better perception of detail. Indeed, pupil sizes were smaller and proofreading performance was better with positive than with negative polarity displays. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25135324\" rel=\"nofollow\">Source: Smaller pupil size and better proofreading performance with positive than with negative polarity displays</a></p>\n</blockquote>\n\n<ol start=\"2\">\n<li>Higher brightness of light background displays is said to lead to an improved detail understanding.</li>\n</ol>\n\n<blockquote>\n <p>The findings are in line with the assumption that the typically higher luminance of positive polarity displays leads to an improved perception of detail. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25141597\" rel=\"nofollow\">Source: Positive display polarity is particularly advantageous for small character sizes</a></p>\n</blockquote>\n", "score": 3 } ]

[ "eye", "computers" ]

[ { "answer_id": 3423, "body": "<p>Drug levels rise to reach a steady state in about 4-5 doses. Moreover, occurrence of increased potassium (hyperkalemia) also depends on other factors, especially kidney function. Hyperkalemia is much commoner if kidney function is impaired. Also, if person is on other drugs that cause rise in potassium, hyperkalemia is more likely. These drugs include ACE (angiotensin converting enzyme) inhibitors and spironolactone. These 2 are mentioned here since they are also used for conditions where ARBs may be used, namely heart failure and high blood pressure. </p>\n\n<p>Quoting from 'DRUG INTERACTIONS' part of <a href=\"http://www.drugs.com/pro/losartan.html\" rel=\"noreferrer\">http://www.drugs.com/pro/losartan.html</a></p>\n\n<blockquote>\n <p>As with other drugs that block angiotensin II or its effects,\n concomitant use of potassium-sparing diuretics (e.g., spironolactone,\n triamterene, amiloride), potassium supplements, or salt substitutes\n containing potassium may lead to increases in serum potassium.</p>\n</blockquote>\n\n<p>The effect on potassium is through blocking effect of aldosterone axis so it is an immediate effect. </p>\n", "score": 6 } ]

[ "medications" ]

[ { "answer_id": 8978, "body": "<p>Research results are somewhat inconsistent but generally seem to be unfavorable to vitamins alone (in contrast to vitamins in combination with <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351422/\" rel=\"nofollow\">other things</a>).</p>\n\n<p>From \"<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928210/\" rel=\"nofollow\">Prevention and treatment of the common cold: making sense of the evidence</a>\" (2014):</p>\n\n<blockquote>\n <p>Zinc appears to be effective in reducing the number of colds per year, at least in children. (...) vitamin D and echinacea showed no evidence of benefit. Vitamin C may provide some benefit in people under physical stress (e.g., marathon runners or soldiers in subarctic environments), but no meaningful benefit has been shown for the average patient. (...) Evidence for interventions aimed at preventing and treating the common cold is frequently of poor quality, and results are inconsistent. The best evidence for the prevention of the common cold supports physical interventions (e.g., handwashing) and possibly the use of zinc supplements.</p>\n</blockquote>\n\n<p>(Caution: be aware, that intranasal zinc may induce some adverse effects, i.e. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16467707\" rel=\"nofollow\">anosmia syndrome</a>.)</p>\n\n<p>From \"<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23440782\" rel=\"nofollow\">Vitamin C for preventing and treating the common cold.</a>\" (2013):</p>\n\n<blockquote>\n <p>The <strong>failure</strong> of vitamin C supplementation to reduce the incidence of colds in the general population indicates that routine vitamin C supplementation is not justified</p>\n</blockquote>\n\n<p>From \"<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/27184276\" rel=\"nofollow\">The effect of exercise on prevention of the common cold: a meta-analysis of randomized controlled trial studies.</a>\" (2015):</p>\n\n<blockquote>\n <p>Dietary supplements, such as vitamin C and E, are used by many people, especially athletes. The users often believe that high dosages of supplements improve health (resistance to illness and disease) and physical performance. These assumptions are, however, generally <strong>not</strong> supported in the scientific literature.</p>\n</blockquote>\n\n<p>From \"Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis\" (2012):</p>\n\n<blockquote>\n <p>On the basis of this study, we can conclude that vitamin D is useful in prevention of respiratory tract infections. But looking at the availability of only five clinical trials there is need of conduction of more clinical trials so that more valid conclusion can be reached.</p>\n</blockquote>\n\n<p>From \"<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23032549\" rel=\"nofollow\">Effect of vitamin D3 supplementation on upper respiratory tract infections in healthy adults: the VIDARIS randomized controlled trial.</a>\" (2012):</p>\n\n<blockquote>\n <p>(...) monthly administration of 100,000 IU of vitamin D did <strong>not</strong> reduce the incidence or severity of URTIs in healthy adults.</p>\n</blockquote>\n", "score": 2 } ]

[ "micronutrients", "common-cold", "supplement" ]

[ { "answer_id": 4696, "body": "<p>Yes, there are ways.</p>\n\n<ul>\n<li>First, make sure the stomach is not squeezed by a tight belt or similar. </li>\n<li>One can support gas movement by massaging the belly. </li>\n<li>Since some gases tend to move upwards, changing one's position in a way that the exit is elevated can help (<em>e.g.</em> doggy style).</li>\n<li>Some herbs also help a bit, for example a spoon of caraway filled with hot water in a cup and drink after 5-10 mins.</li>\n<li>A hot-water bottle reduces the cramps.</li>\n</ul>\n\n<p><a href=\"http://www.brighamandwomens.org/Patients_Visitors/pcs/nutrition/services/healtheweightforwomen/special_topics/intelihealth0504.aspx\" rel=\"noreferrer\">http://www.brighamandwomens.org/Patients_Visitors/pcs/nutrition/services/healtheweightforwomen/special_topics/intelihealth0504.aspx</a></p>\n\n<p>for infants:</p>\n\n<p><a href=\"http://www.webmd.com/parenting/baby/features/infant-gas\" rel=\"noreferrer\">http://www.webmd.com/parenting/baby/features/infant-gas</a></p>\n", "score": 5 }, { "answer_id": 4793, "body": "<p>In addition to the home-remedies suggested by Marzipanherz - the warm bottle is a good one - there are pharmacological therapeutic options out there.</p>\n<p><strong>Gas-X, Mylicon, others</strong> ^{<a href=\"https://en.wikipedia.org/wiki/Simethicone#Availability\" rel=\"nofollow noreferrer\">1</a>}</p>\n<p>Simethicone (an inert mixture of polymers stabilized with silicon dioxide)</p>\n<p>Gas can become trapped in small bubbles in the gut. Simethicone is known for its ability to collapse bubbles by forming a thin layer on their surface.^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8083482\" rel=\"nofollow noreferrer\">2</a>} This decreases the volume of gas in the GI tract, but it's unclear if this has a therapeutic effect.</p>\n<p><strong>BEANO</strong></p>\n<p>(alpha-galactosidase preparation)</p>\n<p>Another option is to diminish the creation of new gas if your gas is being caused by a particular kind of food, in this case, foods containing the trisaccharide raffinose.^{<a href=\"https://en.wikipedia.org/wiki/Raffinose\" rel=\"nofollow noreferrer\">3</a>} Foods containing raffinose include things like beans, cabbage, brussels, sprouts. We can't digest this on our own, so it ferments in our stomachs and causes gas. The compound α-GAL in BEANO breaks raffinose down to galactose, which we can digest.</p>\n<p>References</p>\n<p>1: <a href=\"https://en.wikipedia.org/wiki/Simethicone#Availability\" rel=\"nofollow noreferrer\">A more comprehensive list of simethicone containing drugs</a></p>\n<p>2: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8083482\" rel=\"nofollow noreferrer\">Mechanism of antifoaming action of simethicone.</a></p>\n<p>3: <a href=\"https://en.wikipedia.org/wiki/Raffinose\" rel=\"nofollow noreferrer\">Wikipedia: Raffinose</a></p>\n", "score": 3 }, { "answer_id": 12041, "body": "<p>You should try with Mint leaves and peppermint tea that's will help you a lot , but try with natural leaves not the one that sell in the store</p>\n", "score": 1 } ]

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

[ { "answer_id": 16660, "body": "<p>A <a href=\"https://www.researchgate.net/profile/Petteri_Sjoegren/publication/273034823_Stability_and_Side_Effects_of_Orthodontic_Retainers_-A_Systematic_Review/links/54f58af10cf2eed5d737fefc.pdf\" rel=\"nofollow noreferrer\">systematic review</a> of the side effects of retainers said nothing about sleep related side effects, so they probably are not a significant problem. There are a few related studies that look at an assortment of othodontic treatments and how they affect sleep. I've included them below. An orthodontist would be able to give a more concrete answer.</p>\n\n<p>Also, note that some types of retainers are actually used to treat sleep apnea and related sleep issues (see <a href=\"https://sacramentodentistry.com/dental-events/invisalign-and-sleep-apnea/\" rel=\"nofollow noreferrer\">this</a> for example).</p>\n\n<p><strong>TLDR;</strong> Orthodontic treatments such as braces and and retainers can, in general, affect sleep and sleep quality (for good and bad). However, there seems to be little direct research into what specific sleep related side affects retainers cause. </p>\n\n<h2>Dry Mouth</h2>\n\n<p>From <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24554561\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/24554561</a> (I think this one was looking at braces)</p>\n\n<blockquote>\n <p>The subjective parameters taste,\n dry mouth and breath odor did not show statistical\n differences. </p>\n</blockquote>\n\n<h2>Quality of sleep:</h2>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18984392\" rel=\"nofollow noreferrer\">Impact of orthodontic appliances on sleep quality</a>:</p>\n\n<blockquote>\n <p><strong>CONCLUSIONS:</strong> In young orthodontic patients, there appears to be no difference in sleep quality with or without the overnight use of these appliances after they have been worn for a minimum of 3 months.</p>\n</blockquote>\n\n<p>However, contradicting that study is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23455981\" rel=\"nofollow noreferrer\">this</a> <a href=\"http://sbdmj.lsmuni.lt/124/124-04.pdf\" rel=\"nofollow noreferrer\">one</a>:</p>\n\n<blockquote>\n <p>Impaired sleep the most rarely\n occurred for patients treated with removable appliances\n (40.6%) and braces (51.1%) and the most\n frequently for patients treated with functional appliances\n (85.7%) and braces, and head gears (88.9%). </p>\n</blockquote>\n\n<h2>Sleep Apnea</h2>\n\n<p>There's no evidence that I'm aware of that retainers (or other orthodontic retainers) cause sleep apnea. Similar devices are sometimes used to treat it, though.</p>\n\n<p>However, people who need braces, retainers, etc. may be at higher risk for it. From the intro of an <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/6939331\" rel=\"nofollow noreferrer\">ape study</a> apparently conducted because of similar complaints:</p>\n\n<blockquote>\n <p>Oral respiration associated with obstruction of the nasal airway is a common finding among patients seeking orthodontic treatment.</p>\n</blockquote>\n", "score": 3 } ]

[ "sleep", "lifestyle", "retainers" ]

[ { "answer_id": 4584, "body": "<p>This is a broad question, but here are just a few major things to take into consideration after a surgical procedure. Early mobility has been shown for many years to be a major predictor of postoperative outcome, even in something like a hip fracture, where you would think rest was mandatory. The rapidity with which one returns to preoperative levels of independence in activities of daily living decreases postoperative morbidity and optimizes psychological well-being.</p>\n\n<p>Complications of \"resting\" </p>\n\n<p>Postoperative pulmonary complications, specifically atelectasis and pneumonia, are the leading cause of postoperative morbidity and death. Confinement to bed is a very serious risk factor for atelectasis and pneumonia. After surgery - especially upper abdominal surgery - sufficiently deep breathing needed to prevent some degree of pulmonary compromise is painful. If you're up and moving, you will (voluntarily and involuntarily) be taking more and deeper breaths than you will at rest (characterized by shallower respirations), especially if you're on pain medications.</p>\n\n<p>Venous stasis and thromboembolism commonly occur postoperatively in patients who remain immobile. This is largely preventable with simple ambulation. It hurts to walk around after surgery, to be sure, but it's a lot better than suffering from a largely preventable pulmonary embolism.</p>\n\n<blockquote>\n <p>All efforts should be made to enforce postoperative movement, which is possible with adequate pain relief.</p>\n</blockquote>\n\n<p>Loss of strength</p>\n\n<p>Bedrest results in loss of muscle mass and progressively more weakness. While it's not as great a consideration in younger adults as older adults, it is still considerable and, again, is largely preventable. Moving improves strength recovery, appetite, decreases stress, and overall increases feelings of well-being.</p>\n\n<p>Pain Medications</p>\n\n<p>Opioid medications usually given perioperatively can slow your bowels to almost a stand still (it's called <em>ileus</em>) and can result in painful gas buildup and constipation. Moving, and to a lesser extent dietary changes, encourage the bowels to be less sluggish, as does a switch to non-opioid pain medications.</p>\n\n<p>Why \"rest\"? </p>\n\n<p>Most people think healing is impaired by early movement after surgery. While this is true of some surgeries, it is far from true for all of them. When the risk of resting outweighs the benefits, the goal is to get patients moving.</p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/atelectasis/basics/definition/con-20034847\">Atelectasis</a><br>\n<a href=\"http://www.sciencedirect.com/science/article/pii/S0147956305800044\">Postoperative atelectasis and pneumonia</a><br>\n<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119685/\">Management of patients in fast track surgery</a></p>\n", "score": 11 }, { "answer_id": 4614, "body": "<p>I have accepted an answer, but want to add one of my own with some more details I have observed as I go through the process (it's Day 5 today.)</p>\n\n<p>First, this is <strong>something you can do</strong> to help yourself feel better. Compared to lying in bed, in pain, bored, possibly lonely and scared, and not sure what happens next, just waiting to get better. Giving you something you can do that will improve yourself will, in and of itself, improve you, even if nothing physiological was happening.</p>\n\n<p>Second, it really does work. The vast majority of the pain and effort is simply in getting onto your feet. I noticed quite dramatically that once I had taken 5 or 10 steps I began to feel much better. My pain went down, my strength went up. I am not sure if that was because of increased heart rate and respiration, or the venous return from walking, but there was unmistakably an improvement simply from walking. Several times I would complete the walking distance I had set myself and want to do double or triple that because it was making me feel better.</p>\n\n<p>Third, while you are lying in bed everything is insanely difficult. To reach over and get your drink might involve 10 or more different movements, each of which hurt. Just shifting your weight a little or moving an inch or two to one side you have to fight gravity, drag your body against the bed, etc. Blowing your nose, drinking, changing an uncomfortable position - these things are too hard to do. But when you're vertical, it's far less work to lean a little or turn a little. So you look after your needs better. That means you're less likely to be dehydrated, or to have a coughing fit from stuff you snuffled and swallowed that you should have blown out, or to hurt from lying the wrong way for an hour. This is even more important at home where you don't have beds that can lie you up and down, or tables that swing over the bed to keep things within reach.</p>\n\n<p>Fourth, as with my previous abdominal surgeries I notice that I often need to pee without feeling that sensation of needing to pee at all. Since I'm up and moving anyway, I can stop by the toilet and see if I need to go. Invariably I feel much better, with a huge reduction in pain and improvement in movement, once my bladder is empty. But I hadn't felt an urge that would have pushed me to go through the pain of standing up to deal with it.</p>\n\n<p>Fifth, if this is the norm, especially in the hospital, it makes it easy to spot people who are not recovering at the expected pace. If everyone just lies in bed for 5-6 days waiting to get better, some of them will be majorly ill but you might not notice. If everyone gets up and walks around, the one who can't will stick out like a sore thumb and their infection or whatever will be noticed hours or even days sooner.</p>\n\n<p>While I am still not clear on the exact mechanism that makes this work, I can report that it really does work, on a very small time scale. If you feel awful, getting up and walking for one minute can make you feel better. I still find this counter-intuitive but am pleased that it's standard procedure where I (and my relative) live, because it's clearly helpful.</p>\n", "score": 3 }, { "answer_id": 4579, "body": "<p>There may be multiple reasons why your doctor advised you to move around after a surgery.</p>\n\n<p>One common theme that most surgeons follow is to avoid deep venous thrombosis and pulmonary embolism. Post surgery, if the patients are bed ridden for too long, blood tends to accumulate in their calf muscle where there is a secondary blood pump that is active only if those muscles are working. Pooling of blood in the calf muscles increases the risk of formation of clots there, and these clots may be sent to lungs causing pulmonary embolism. Acute pulmonary embolism is a potentially life threatening state, and requires immediate treatment. So if the patient is at risk for developing pulmonary embolism before the surgery, the doctor would want to get in you on your feet as soon as possible. But if the patient is having too much difficulty while walking then there are equipment like calf massagers that does the job. Also, getting the patient on feet early creates a positive attitude and has shown to <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24646333\" rel=\"nofollow\">improve and speed up recovery</a> in patients. </p>\n\n<p>That said, there are conditions where the doctor would want you to do absolute bed rest, such as the conditions where there is increased risk of suture getting ripped due to increased abdominal pain. So if you have too much discomfort, then that is something that you would want to discuss with your doctor. </p>\n", "score": 2 } ]

[ "surgery", "recovery" ]

[ { "answer_id": 5894, "body": "<p>Fat provides with energy, like bread or pasta. You are forgetting that there is also a need for vitamines, minerals, proteins and fibers. If not from hunger, the person would be in extremely bad condition, leading to death from illness and carence.</p>\n\n<p>However, you are right that apart from these carences, it should deplete all fat reserve (and muscle as well), before dying from such.</p>\n", "score": 1 }, { "answer_id": 5907, "body": "<p>Suppose you also get essential vitamins and minerals to prevent dying from shortages of these as pointed out by Blue Elephant. Then, you can still die while still being overweight due to the fact that the human body cannot convert fat to glucose. We cannot do without glucose, e.g. brain cells need to use glucose, they cannot burn fat. When we run out of glucose, we can generate glucose by breaking down proteins, which leads to a loss of muscle mass. So, you'll start to starve well before running out of fat reserves once you've lost almost all of your muscle mass and the protein breakdown process starts to affect essential organs.</p>\n", "score": 1 } ]

[ "nutrition", "weight-loss" ]

[ { "answer_id": 5982, "body": "<blockquote>\n<p>...the inactive ingredients, which by definition do not affect the efficacy of the drug.</p>\n</blockquote>\n<p>They <em>can</em> however have an effect on other physiological aspects of a human body, that's why, as far as I know, there <em>can</em> be a difference between various brands or generics.</p>\n<p>Answering your question:</p>\n<ol>\n<li><strong>Sometimes patients have allergies towards a component of a generic (for example its colourant) in which case the doctor has a medical reasoning to pick a brand drug.</strong></li>\n<li>One other reason for a doctor to prescribe a specific brand (or to\ndisallow others or generics) is that he has made good experience\nwith that specific one.</li>\n<li>Another reason is that he is following\nstudies or guidelines which suggest or require a specific drug in\norder to be compliant, which is sometimes necessary, because</li>\n<li>Some health insurances only pay for the patient a certain brand drug (though they also often prefer cheaper generics, as far as I know)</li>\n<li>If the health insurance pays any kind of drug, or the patient is paying on his own, then the doctor could prescribe a specific drug also because he was convinced by pharmaceutical representatives to try out new drugs they advertise</li>\n<li>Also, if paid by the patient, those new drugs can be prescribed and the results could be collected (anonymously) and handed to the pharmaceutical companies (for evaluation) which in turn pay the doctor some legal compensation</li>\n<li>Well and there are gifts:</li>\n</ol>\n<blockquote>\n<p>A recent letter in the Journal of the American Medical Association illustrates how effective drug advertising can be. It describes a patient who came into the hospital with an infected insect bite. The intern who first saw the patient first sensibly wanted to prescribe a nice, inexpensive penicillin, which is the drug of choice for a minor infection. But the resident overruled the intern and favored a more &quot;modern&quot; choice for this &quot;severely&quot; ill patient. He decided the patient had to have a brand-new antibiotic…at $183 a day.</p>\n<p>The attending physician who supervised the house officers checked into the incident. It turned out the resident had just been wined and dined by the drug representative whose company made the new antibiotic.</p>\n</blockquote>\n<p><a href=\"https://www.scu.edu/ethics/focus-areas/bioethics/resources/prescribing-under-the-influence/\" rel=\"nofollow noreferrer\">https://www.scu.edu/ethics/focus-areas/bioethics/resources/prescribing-under-the-influence/</a></p>\n<p>More to this topic:</p>\n<blockquote>\n<p>“Gift-giving is an extremely effective marketing tool because it triggers in the recipient the basic human tendency to reciprocate whether the recipient is conscious of it or not,”</p>\n</blockquote>\n<p><a href=\"http://jnci.oxfordjournals.org/content/94/15/1119.full\" rel=\"nofollow noreferrer\">http://jnci.oxfordjournals.org/content/94/15/1119.full</a></p>\n<p>These are a few points that came into my mind from my experience and/or conversations (as a medical student) with doctors in clinics and doctor's offices in Germany.</p>\n", "score": 6 } ]

[ "medications" ]

[ { "answer_id": 12895, "body": "<p>Assuming that we are talking about the risk of having intercourse one time under the conditions you described, and assuming you do not know if your male partner had an STD, and provided your partner used a latex or polyurethane condom labeled as protective against disease, the risk of contracting HIV, gonorrhea, chlamydia, and trichomoniasis quite low (it is <strong>very unlikely</strong> that you contracted any of those STDs), although it is not zero. </p>\n\n<p>The risk of contracting genital ulcer diseases (herpes, syphilis, chancroid) and HPV (human papillomavirus) infections, even with proper condom use, is somewhat higher, although it is <strong>statistically unlikely</strong> that you contracted one of those STDs from one-time intercourse as you described. </p>\n\n<p>Of course, the best advice (which you will see on any authoritative website, journal article, or from your own doctor) is: <strong>\"When in doubt, get it checked out.\"</strong> And in general, regular STD testing is the best way to prevent the spread of STDs (if you know you have an STD, you can either not have sex or inform your partner(s) and take preventative measures) and to treat them early and more effectively if you happen to contract one. Talk with your doctor, a local health clinic, or other health provider about how often you should get tested.</p>\n\n<p>Here is some related information that might be helpful:</p>\n\n<p><a href=\"https://www.fda.gov/ForPatients/Illness/HIVAIDS/ucm126372.htm\" rel=\"noreferrer\">From the FDA</a> (United States Food &amp; Drug Administration):</p>\n\n<blockquote>\n <p><strong>Will a condom guarantee I won't get a sexually transmitted infection?</strong></p>\n \n <p>When used consistently and correctly, condoms are highly effective in\n preventing HIV. They are also effective at preventing sexually\n transmitted diseases (STDs) that are transmitted through bodily\n fluids, such as gonorrhea and chlamydia. However, they provide less\n protection against STDs spread through skin-to-skin contact like human\n papillomavirus (genital warts), genital herpes, and syphilis. Although\n highly effective when used consistently and correctly, there is still\n a chance of getting HIV if you only use condoms, so adding other\n prevention methods can further reduce your risk.</p>\n \n <p><strong>How can I get the most protection from condoms?</strong></p>\n \n <p>It is best to read the label on the packaging the condom came in\n before using the condom.</p>\n \n <p>Choose the right kind of condoms to prevent disease.</p>\n \n <p>Store them in a cool, dry place. Storing condoms near heat (your back\n pocket or glove compartment) can make them weaker and less effective.</p>\n \n <p>Remember to use a new condom every time you have sex. </p>\n \n <p><strong>How does a condom protect against sexually transmitted infection?</strong></p>\n \n <p>A condom acts as a barrier or wall to keep blood, or semen, or vaginal\n fluids from passing from one person to the other during intercourse.\n These fluids can harbor germs such as HIV and other sexually\n transmitted infections. If no condom is used, the germs can pass from\n the infected partner to the uninfected partner.</p>\n \n <p><strong>How do I choose the right kind of condoms to prevent disease?</strong></p>\n \n <p>Always read the label. Look for two things:</p>\n \n <p>The condoms should be made of <em>latex</em>, or <em>polyurethane</em> condoms for\n people sensitive or allergic to latex. Tests have shown that latex and\n polyurethane condoms (including the female condom) can prevent the\n passage of the HIV, hepatitis and herpes viruses. But <strong>natural\n (lambskin) condoms may not do this</strong>.</p>\n \n <p><em>The package should say that the condoms are to prevent disease.</em> If the package doesn't say anything about preventing disease, the condoms\n may not provide the protection you want, even though they may be the\n most expensive ones you can buy.</p>\n \n <p>Novelty condoms will not say anything about either disease prevention\n or pregnancy prevention on the package. They are intended only for\n sexual stimulation, not protection.</p>\n \n <p>Condoms which do not cover the entire penis are not labeled for\n disease prevention and should not be used for this purpose. For proper\n protection, a condom must unroll to cover the entire penis. This is\n another good reason to read the label carefully. <em>(emphasis added)</em></p>\n</blockquote>\n\n<hr>\n\n<p>This is a pretty amazing website that provides links to <strong>28 different STD Risk Calculators</strong>: <a href=\"http://www.calculators.org/health/std-risk.php\" rel=\"noreferrer\">http://www.calculators.org/health/std-risk.php</a> . </p>\n\n<hr>\n\n<p>Here is a <strong>quick, easy-to-read table</strong> that tells you which sexually transmitted diseases you can contract depending on whether you have anal or vaginal intercourse and whether or not the 'penetrating' male uses a condom: <a href=\"https://smartsexresource.com/sites/default/files/Anal-Vaginal-Sex-Table-v3.png\" rel=\"noreferrer\">https://smartsexresource.com/sites/default/files/Anal-Vaginal-Sex-Table-v3.png</a></p>\n\n<p>The website also has tables for oral sex and other types of sex: <a href=\"https://smartsexresource.com/about-stis/know-your-chances-0\" rel=\"noreferrer\">https://smartsexresource.com/about-stis/know-your-chances-0</a></p>\n\n<hr>\n\n<p>Here is a <strong>Fact Sheet</strong> from the United States Centers for Disease Control that gives a quick overview of STD prevalence in the U.S. for 2015:</p>\n\n<p><a href=\"https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/STD-Trends-508.pdf\" rel=\"noreferrer\">CDC Fact Sheet: Reported STDs in the United States</a> (PDF) – Summary of trends and highlights of data from 2015 Surveillance</p>\n\n<hr>\n\n<p>More info on <a href=\"https://www.stdcheck.com/blog/stds-you-can-get-while-wearing-a-condom/\" rel=\"noreferrer\"><strong>STDs You Can Get While Wearing A Condom</strong></a> - Molluscum Contagiosum, Pubic Lice/Crabs, Syphilis, Genital herpes, and HPV (human papillomavirus).</p>\n\n<hr>\n\n<p>The U.S. Center for Disease Control and Prevention (CDC) offers a <strong><em>Condoms and STDs: Fact Sheet for Public Health Personnel</em></strong>, which is slightly more technical than the public fact sheet, but most readers here will understand it and I like the detail it provides. <a href=\"https://www.cdc.gov/condomeffectiveness/latex.html\" rel=\"noreferrer\">HTML version</a> | <a href=\"https://www.cdc.gov/condomeffectiveness/docs/Condoms_and_STDS.pdf\" rel=\"noreferrer\">PDF version</a></p>\n\n<hr>\n\n<p>From the <em>Advocates for Youth</em> website, <strong>Condom Effectiveness</strong> provides well-referenced information about the efficacy of condom use for various STDs. <a href=\"http://www.advocatesforyouth.org/publications/publications-a-z/416-condom-effectiveness\" rel=\"noreferrer\">HTML version</a> | <a href=\"http://www.advocatesforyouth.org/storage/advfy/documents/fscondomeffectiveness2005.pdf\" rel=\"noreferrer\">PDF version</a></p>\n", "score": 6 } ]

[ "disease-transmission", "sti", "condom", "proper-use" ]

[ { "answer_id": 14549, "body": "<p>Heroin is a special case of substance addiction, because of the tremendous withdrawal side effects. In general, substance addiction recovery doesn't require a gradual approach. In fact, from what I know about OCD, which has some similarities, I suspect that a gradual approach would be more difficult to succeed with.</p>\n\n<p><a href=\"https://www.addiction.com/addiction-a-to-z/porn-addiction/porn-addiction-treatment/\" rel=\"nofollow noreferrer\">https://www.addiction.com/addiction-a-to-z/porn-addiction/porn-addiction-treatment/</a> states that recovery from a pornography addiction will generally involve</p>\n\n<blockquote>\n <p>counseling such as cognitive behavioral therapy (CBT), coupled with group therapy, 12-step and other social support groups and perhaps alternative therapies such as art therapy, equine therapy (working with horses), EMDR (eye movement desensitization and reprocessing) and the like.</p>\n</blockquote>\n\n<p>I have done some reading about exposure treatments for OCD, skin picking and hair pulling, and I have helped my son with his home exercises for OCD (with guidance from his therapist). Another term for exposure treatments is Exposure and Response Prevention. I wrote up an overview about our experience with it <a href=\"https://academia.stackexchange.com/a/78073/32436\">here</a>.</p>\n\n<p>I see some overlap between pornography addiction and OCD. One of the OCD symptoms my son has had is an electronics addiction. At school he was given a Chromebook to carry around all day and use in all his classes. It was connected to the internet. He started spending his school day surfing the internet, and started failing classes.</p>\n\n<p>The internet is often used for viewing pornography.</p>\n\n<p>One of the things that makes it so difficult to get this under control is that frequently one uses the computer for other things as well, and it's a slippery slope to go from writing a necessary email to surfing pornography sites.</p>\n\n<p>If you want to read more about this, I recommend the articles by Fred Penzel: <a href=\"http://www.wsps.info/index.php?option=com_content&amp;view=category&amp;id=36:ocd-and-related-subjects-by-frederick-penzel-phd&amp;layout=default\" rel=\"nofollow noreferrer\">http://www.wsps.info/index.php?option=com_content&amp;view=category&amp;id=36:ocd-and-related-subjects-by-frederick-penzel-phd&amp;layout=default</a></p>\n", "score": 2 }, { "answer_id": 9778, "body": "<ol>\n<li><p>Detoxification (the process by which the body rids itself of a drug)</p></li>\n<li><p>Behavioral counseling</p></li>\n<li><p>Medication (for opioid, tobacco, or alcohol addiction)</p></li>\n<li><p>Evaluation and treatment for co-occurring mental health issues such as depression and anxiety</p></li>\n<li><p>Long-term follow-up to prevent relapse</p></li>\n</ol>\n\n<p>A range of care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed. Follow-up care may include community- or family-based recovery support systems.</p>\n\n<p><a href=\"https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction\" rel=\"nofollow\">https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction</a></p>\n", "score": 1 }, { "answer_id": 14546, "body": "<p>Most (proposed) behavioral addictions aren't that well studied (or accepted in the DSM). Gambling is the exception, so you may want to look at how that is treated. Also, there are no accepted standards for <a href=\"http://www.apa.org/monitor/2014/04/pornography.aspx\" rel=\"nofollow noreferrer\">what is porn addiction vs. normal use</a>. And since you ask about depression in a different question: increase in porn use can be a symptom of depression or bipolar [hypo]mania.</p>\n", "score": 1 } ]

[ "mental-health", "brain", "addiction", "psychosomatic-illness", "drug-tapering-weaning" ]

[ { "answer_id": 15539, "body": "<p>Pneumococcal pneumonia was the most prevalent form of bacterial pneumonia in the community at over 70% of cases but that number has drastically fallen presumably due to the use of pneumococcal vaccines.</p>\n<blockquote>\n<p>Antibiotics are the mainstay of treatment in S pneumoniae infections. Until the 1970s, essentially all pneumococcal isolates were sensitive to easily achievable levels of most commonly used antibiotics, including penicillins, macrolides, clindamycin, cephalosporins, rifampin, vancomycin, and trimethoprim-sulfamethoxazole. Beginning in the 1990s, many pneumococcal isolates in the United States showed decreased susceptibility to penicillin and other commonly used antibiotics. Continued increases in these isolates have led to the need for re-establishment of susceptibility standards.</p>\n<p>As of 2007, isolates of drug-resistant S pneumoniae have become increasingly common worldwide. The CDC, as well as many state health departments, maintain a population-based surveillance system (the ABC system) that investigates the epidemiology and susceptibility patterns of invasive pneumococcal infections in the United States. In 2010, only 10.6% of all isolates obtained showed intermediate or resistant susceptibility patterns to penicillin (down from 24.8% in 2008; 25.6% in 2007). [6] The prevalence of resistance varies greatly among countries, states, counties, and within populations in particular cities and may be as high as 30%-40% in some locations. [85, 86] Resistance rates are generally higher in most European countries, as well as in Hong Kong and Thailand. [87, 88]</p>\n</blockquote>\n<p>With such high resistance rates, Penicillin is not recommended as drug of first choice to treat pneumonia.</p>\n<p><a href=\"https://emedicine.medscape.com/article/225811-medication\" rel=\"nofollow noreferrer\">https://emedicine.medscape.com/article/225811-medication</a></p>\n<p><a href=\"https://www.cdc.gov/pneumococcal/about/diagnosis-treatment.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/pneumococcal/about/diagnosis-treatment.html</a></p>\n", "score": 2 } ]

[ "antibiotics", "drug-tolerance", "who-world-health-org", "mrsa", "center-disease-control" ]

[ { "answer_id": 23697, "body": "<p>There is a recent paper <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177146/\" rel=\"nofollow noreferrer\">The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2</a> in The journal of Infection, 2020 Apr 23 doi: 10.1016/j.jinf.2020.04.024</p>\n<p>The Conclusion</p>\n<blockquote>\n<p>Community-wide mask wearing may contribute to the control of COVID-19 by reducing the amount of emission of infected saliva and respiratory droplets from individuals with subclinical or mild COVID-19</p>\n</blockquote>\n<p>Please read the paper for further details.</p>\n<p>You can also read the article <a href=\"https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449\" rel=\"nofollow noreferrer\">COVID-19: How much protection do face masks offer?</a> by Mayo Clinic, in which they said</p>\n<blockquote>\n<p>Can face masks help prevent the spread of coronavirus disease 2019 (COVID-19)? Yes, face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the disease</p>\n</blockquote>\n<p>and</p>\n<blockquote>\n<p>Surgical masks may protect others by reducing exposure to the saliva and respiratory secretions of the mask wearer.</p>\n<p>At this time, the U.S. Food and Drug Administration has not approved any type of surgical mask specifically for protection against the COVID-19 virus, but these masks may provide some protection when N95 masks are not available</p>\n</blockquote>\n", "score": 1 } ]

[ "prevention", "common-cold", "statistics", "airborne-transmission" ]

[ { "answer_id": 13580, "body": "<p>There is an excellent wikipedia page about the the procedure called <a href=\"https://en.wikipedia.org/wiki/Tonsillectomy\" rel=\"nofollow noreferrer\">tonsillectomy</a>: \"Although tonsillectomy is performed less frequently than in the 1950s, it remains one of the most common surgical procedures in children in the United States and many other western countries.\"</p>\n\n<p>That WP page is amply sourced with research papers, the following box is just a shortened excerpt.</p>\n\n<blockquote>\n <p><strong>Complications</strong></p>\n \n <p>A recent study states that tonsillectomies in young children (0 to 7\n years) are correlated with weight gain in the years following surgery.</p>\n \n <p>The morbidity rate associated with tonsillectomy is 2% to 4% due to\n post-operative bleeding; the mortality rate is 1 in 15,000, due to\n bleeding, airway obstruction, or anesthesia complications.</p>\n \n <p><strong>Impact on immune system</strong></p>\n \n <p>It remains controversial whether tonsillectomy may negatively affect\n the immune system. However, multiple studies have confirmed\n correlation between a previous history of tonsillectomy and a wide\n range of diseases, such as:</p>\n \n <p>Hodgkin's disease, Non-hodgkin's lymphoma, Laryngeal cancer,\n Esophageal cancer, Thyroid cancer, Breast cancer, Prostate cancer,\n Base of tongue cancer, Leukemia, Asthma, Hay fever, Irritable bowel\n syndrome, Crohn's disease, Appendicitis, Heart attack, Sarcoidosis,\n Rheumatoid arthritis, Multiple sclerosis, Deep neck infection,\n Poliomyelitis, Recurrent cellulitis, Primary biliary cholangitis,\n Chronic rhinosinusitis, Pediatric autoimmune neuropsychiatric\n disorders associated with streptococcal infections.</p>\n \n <p>Moreover, other studies have found that tonsillectomy may lead to:</p>\n \n <ul>\n <li>a decrease in levels of serum immunoglobulin</li>\n <li>a decrease in levels of secretory Immunoglobulin A</li>\n <li>an increased risk of autoimmune disease</li>\n <li>an increase in mortality between the age of 18 and 44</li>\n <li>an increased risk of chronic disease</li>\n <li>an increase in overall cancer risk</li>\n </ul>\n</blockquote>\n\n<p>Mark's comment is basically right:</p>\n\n<blockquote>\n <p>\"The simplified version is that alternative short-term treatments got\n better, and long-term studies showed that the long-term benefits\n mostly didn't exist. Still looking for sources.\"</p>\n</blockquote>\n\n<p>But this is also actually a very prominent example of very widespread bad practice that once was the standard. One study shedding some light on this can be found in the historian <a href=\"http://Bad%20Medicine:%20Doctors%20Doing%20Harm%20Since%20Hippocrates\" rel=\"nofollow noreferrer\">David Wootton's \"Bad Medicine: Doctors Doing Harm Since Hippocrates\"</a>:</p>\n\n<blockquote>\n <p>Moreover Lister’s innovations made possible new types of bad medicine.\n For the first time it was possible to operate on the abdomen, and some\n surgeons proceeded to happily chop out bits and pieces (an appendix\n here, a colon there) not because they were infected, but because they\n might one day become infected––the historian Ann Dally has called this\n ‘fantasy surgery’. These operations never became the norm, but\n tonsillectomies did, and we now know they did more harm than good.\n Worse still, the decision as to whose tonsils should be removed was\n not remotely rational. Of 1,000 11-year-old children in New York in\n 1934, 61 per cent had had tonsillectomies. </p>\n \n <blockquote>\n <p>The remaining 39 percent\n were subjected to examination by a group of physicians, who selected\n 45 percent of these for tonsillectomy and rejected the rest. The\n rejected children were re-examined by another group of physicians, who\n recommended tonsillectomy for 46 per cent of those remaining after the\n first examination. When the rejected children were examined a third\n time, a similar percentage was selected for tonsillectomy so that\n after three examinations only sixty-five children remained who had not\n been recommended for tonsillectomy. These subjects were not further\n examined because the supply of examining physicians ran out.</p>\n </blockquote>\n \n <p>Clearly\n the decision as to who should have a tonsillectomy was entirely\n arbitrary. This was bad medicine alive and well in the 1930s.</p>\n</blockquote>\n\n<p>First: do no harm. Since tonsillitis is still a common problem, the actual illness may be differently classified or diagnosed today. There may be other treatments available. But just cutting it out was of questionable effectiveness in the first place, could and did lead to a number of side effects and unwanted complications or long term effects. Together with the observation that most of the time not even the official guidelines were able to ensure a good practice, and many doctors were apparently unable to follow them, it is a good thing that this tonsillectomy fad is further falling out of fashion. </p>\n", "score": 4 } ]

[ "history", "tonsillitis", "tonsil-tonsillectomy", "medical-history" ]

[ { "answer_id": 13410, "body": "<p>When thinking about the nervous system, most people think about the brain and spinal cord: the CNS. However, the <a href=\"https://en.wikipedia.org/wiki/Enteric_nervous_system\" rel=\"noreferrer\">enteric nervous system</a> controlling gut function has another ~500 million neurons.</p>\n\n<p>Among other things, these neurons coordinate the <a href=\"https://en.wikipedia.org/wiki/Peristalsis\" rel=\"noreferrer\">peristaltic contractions</a> of the gut which act to move food through the digestive system.</p>\n\n<p>Peristalsis is under the control of several neurotransmitters and neuromodulators. One of these is acetylcholine. One of the two major classes of acetylcholine receptors are known as the <a href=\"https://en.wikipedia.org/wiki/Nicotinic_acetylcholine_receptor\" rel=\"noreferrer\">nicotinic acetylcholine receptors</a> (nAChR). These receptors are so-named because nicotine, found in cigarettes, is a strong agonist for them (although their typical endogenous agonist is acetylcholine).</p>\n\n<p>There is good evidence that nAChRs are involved in gut peristalsis. Antagonists of nAChRs reduce peristalsis <a href=\"http://ajpgi.physiology.org/content/271/5/G849.full.pdf+html\" rel=\"noreferrer\">Kadowaki et al. 1996</a> and agonists increase peristalsis <a href=\"http://ajpgi.physiology.org/content/257/4/G517.short\" rel=\"noreferrer\">Blank et al. 1999</a>.</p>\n\n<p>Therefore, you can expect that cigarettes, which contain nicotine, would increase gut motility and therefore make bowel movements more likely or more imminent. Of course, there can also be daily cycles of bowel function, so you cannot easily link smoking in the morning to a specific subsequent bowel movement.</p>\n\n<p>References</p>\n\n<hr>\n\n<p>Blank, E. L., Greenwood, B., &amp; Dodds, W. J. (1989). Cholinergic control of smooth muscle peristalsis in the cat esophagus. American Journal of Physiology-Gastrointestinal and Liver Physiology, 257(4), G517-G523.</p>\n\n<p>Kadowaki, M., Wade, P. R., &amp; Gershon, M. D. (1996). Participation of 5-HT3, 5-HT4, and nicotinic receptors in the peristaltic reflex of guinea pig distal colon. American Journal of Physiology-Gastrointestinal and Liver Physiology, 271(5), G849-G857.</p>\n", "score": 13 }, { "answer_id": 19414, "body": "<p><strong>FOOD</strong></p>\n\n<p>A simple way to stimulate the bowel movement in the morning is to <strong>eat or drink</strong> something - this is known as the <strong>gastrocolic reflex.</strong></p>\n\n<p><a href=\"https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/22%3A_Digestive_System/22.02%3A_Nervous_System_of_the_Digestive_System/22.2B%3A_Gastrointestinal_Reflex_Pathways\" rel=\"nofollow noreferrer\">Medical Libre Texts</a></p>\n\n<blockquote>\n <p>The gastrocolic reflex is the physiological reflex that controls the\n motility, or peristalsis, of the gastrointestinal tract. It involves\n an increase in motility of the colon in response to stretch in the\n stomach and the byproducts of digestion in the small intestine. Thus,\n this reflex is responsible for the urge to defecate following a meal.</p>\n</blockquote>\n\n<p><strong>COFFEE and NICOTINE</strong></p>\n\n<p>Coffee can stimulate the bowel movement but so can water. Nicotine does not - according to this study:</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16109656\" rel=\"nofollow noreferrer\">Stimulation of defecation: effects of coffee use and nicotine on rectal tone and visceral sensitivity (Scandinavian Journal of Gastroenterology, 2005)</a></p>\n\n<blockquote>\n <p>Rectal tone increased by 45% 30 min after coffee intake and by 30%\n after water intake, but the effects of coffee and water were not\n significantly different. Rectal tone did not change significantly\n after administration of nicotine (7%) or placebo (10%).</p>\n</blockquote>\n", "score": 0 } ]

[ "physiology" ]

[ { "answer_id": 18444, "body": "<p>All Anti-Depressants poop out equally for TR patients. Having just now signed up on this site, it seems a prerequisite to post is that you ought to have at least minimally researched the question, since the site compels ME not to ask for clarification. Either your or Kramer's interpretation (or both) of the phenomenon of tachyphylaxis, especially related to MAOIs is misfounded. Here is the quotation from your source [<em>emphasis mine</em>]: </p>\n\n<blockquote>\n <p>ADT tachyphylaxis (“poop-out”) was initially recognized in patients receiving monoamine oxidase inhibitors (MAOIs) before the advent of selective serotonin reuptake inhibitors (SSRIs) in the early 1980s.(1,4,5,7) Patients who lost their initial response to a MAOI responded poorly to subsequent treatment and revealed greater depressive severity after relapse than before the new treatment was initiated.(7,8) <strong><em>SSRIs were introduced in the United States in 1988 and ADT tachyphylaxis was subsequently identified with these drugs as well</em></strong>.(3,9,10) Fava et al found that 26 of 77 depressed patients (33.7%) who had achieved full remission of symptoms on fluoxetine 20mg daily experienced a recurrence of symptoms (ADT tachyphylaxis) between 14 and 54 weeks despite maintenance treatment.(10) In another small study, <strong><em>15 patients who had lost their response to antidepressants failed multiple treatment strategies including augmentation with mood stabilizers and, in some cases, electroconvulsive therapy</em></strong>.(11)</p>\n</blockquote>\n\n<p>In other words, ALL Anti-Depressants, as any above-his/her-weight-punching psychiatrist will tell you, will poop out, and often not just for 2-3 AD trials, but even 15 or more. This is called by any definition \"Treatment Resistant\".</p>\n\n<p>The difference between (I assume you mean) MAOIs that covalently bond versus those that do not (Non-selective versus RIMAs) is an important one, and points out why RIMAs like Moclobemide are no better than SSRIs, and why irreversible, non-selective MAOIs raise Serotonin levels > ~2000% over baseline, while SSRIs like Vortioxetine only raise it a few hundred percent. </p>\n\n<p>I hope a poster or referee will call me out on this, as I've got magazines of ammo on this. As the OP's thesis bears no relation to any of his references, I feel free for now, not to give any of my own. </p>\n\n<p>REFERENCES</p>\n\n<ol>\n<li>Cohen B, Baldessarini R. Tolerance to therapeutic effects of antidepressants. Am J Psychiatry. 1985;142:489–490. [PubMed]</li>\n<li>Frank E, Kupfer DJ, Perel JM, et al. Three-year outcomes for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1990;47:1093–1099. [PubMed]</li>\n<li>Byrne SE, Rothschild AJ. Loss of antidepressant efficacy during maintenance therapy: possible mechanisms and treatments. J Clin Psychiatry. 1998;59:279–288. [PubMed]</li>\n<li>Lieb J, Balter A. Antidepressant tachyphylaxis. Med Hypotheses. 1984;15:279–291. [PubMed]</li>\n<li>Lieb J. Antidepressant tachyphylaxis. J Clin Psychiatry. 1990;51:36. [PubMed]</li>\n<li>Nierenberg AA, Alpert JE. Depressive breakthrough. Psychiatr Clin North Am. 2000;23(4):731–742. [PubMed]</li>\n<li>Mann JJ. Loss of antidepressant effect with long-term monoamine oxidase inhibitor treatment without loss of monoamine oxidase inhibition. J Clin Psychopharmacol. 1983;3:363–366. [PubMed]</li>\n<li>Donaldson S. Tolerance to phenelzine and subsequent refractory depression: three cases. J Clin Psychiatry. 1989;50:33–35. [PubMed]</li>\n<li>Solomon D, Leon AC, Mueller TI, et al. Tachyphylaxis in unipolar major depressive disorder. J Clin Psychiatry. 2005;66:283–290. [PubMed]</li>\n<li>Fava M, Rappe SM, Pava JA, et al. Relapse in patients on long-term fluoxetine treatment respond to increased fluoxetine dose. J. Clin Psychiatry. 1995;56:52–55. [PubMed]</li>\n<li>Sharma V. Loss of response to antidepressants and subsequent refractoriness: diagnostic issues in a retrospective case series. J Affect Disord. 2001;64:99–106. [PubMed]</li>\n</ol>\n", "score": 2 } ]

[ "medications", "depression", "antidepressants", "maoi", "tachyphylaxis" ]

[ { "answer_id": 15583, "body": "<p>This is an old technique called desensitization, or, if you want to be fancy, <a href=\"https://www.allergy.org.au/patients/allergy-treatment/immunotherapy\" rel=\"nofollow noreferrer\">allergen immunotherapy</a>.</p>\n<p>Among other techniques, is this one</p>\n<blockquote>\n<p>Allergy injections start with a very low dose. A small needle is used which may be uncomfortable, but not very painful. The dose is gradually increased on a regular (usually weekly) basis, until an effective (maintenance) dose is reached. This usually takes three to six months. This dose may vary between patients, depending on the degree of sensitivity.</p>\n<p>Once the maintenance dose is reached, injections are administered less often, usually monthly, although still on a regular basis. Immunotherapy injections should always be administered in a medical facility under medical supervision. You should stay at the medical facility for the time recommended by the clinical immunology/allergy specialist (30-45 minutes) after the immunotherapy injection has been given.</p>\n</blockquote>\n<p>And here's a <a href=\"https://www.theguardian.com/australia-news/2017/aug/17/peanut-allergy-cured-in-majority-of-children-in-immunotherapy-trial\" rel=\"nofollow noreferrer\">oral trial</a> in children with peanut allergy</p>\n<blockquote>\n<p>Forty-eight children were enrolled in the PPOIT trial and were randomly given either a combination of the probiotic Lactobacillus rhamnosus with peanut protein in increasing amounts, or a placebo, once daily for 18 months.</p>\n<p>At the end of the original trial in 2013, 82% of children who received the immunotherapy treatment were deemed tolerant to peanuts compared with just 4% in the placebo group.</p>\n</blockquote>\n<p>Now the issue with doing this at home as you're asking is that you risk anaphylaxis and death if your allergy is severe.</p>\n", "score": 4 } ]

[ "home-remedies", "cure", "allergen-immunotherapy" ]

[ { "answer_id": 13975, "body": "<p>It depends on how long the patient has been on insulin, and whether \"pancreatic exhaustion\" has been reached.</p>\n\n<p>If the person has been on insulin only a few years when there is still endogenous insulin production ( check by doing a C-peptide test ), then yes, it's possible.</p>\n\n<p>See the work by Prof Taylor at Newcastle, England using extreme low calorie diets which rapidly reverse hepatic and pancreatic steatosis, restoring hepatic sensitivity to glucose levels.</p>\n\n<p>And for pathogenesis <a href=\"https://link.springer.com/article/10.1007%2Fs00125-008-1116-7\" rel=\"nofollow noreferrer\">https://link.springer.com/article/10.1007%2Fs00125-008-1116-7</a></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21656330\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/21656330</a></p>\n\n<p><strong>Update:</strong> The 12 month results from the DiRECT study show that 50% of the patients in the intervention arm ( The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825–853 kcal/day formula diet for 3–5 months), stepped food reintroduction (2–8 weeks), and structured support for long-term weight loss maintenance ) went into remission off all diabetic drugs. The greater the weight loss, the more likely remission was achieved.</p>\n\n<p><a href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext\" rel=\"nofollow noreferrer\">http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext</a></p>\n", "score": 11 }, { "answer_id": 13977, "body": "<p>As Neil Barnard <a href=\"https://www.youtube.com/watch?v=lLqINF26LSA\" rel=\"nofollow noreferrer\">explains in this video</a>, a low fat whole food plant based diet has yielded positive results. But note here that you don't need to go full vegan for this to work, the most important element is to drastically increase your whole grain carb intake, drastically reduce your fat intake, and increase your physical activity levels. This is best done under medial supervision because your medication will have to be adjusted to deal with the increased carb load.</p>\n\n<p>In contrast, the popular low carb, high fat ketogenic diet while having some benefits for diabetes patients, allowing people to reduce their medicine intake, is not usually not going to reverse diabetes, and this diet comes with serious adverse health risks. Anthony Lim explains <a href=\"https://www.youtube.com/watch?v=tbH6TIdtZ3Q\" rel=\"nofollow noreferrer\">in this video</a> that he used to recommend the low carb approach to his patients with some success, but how doing the opposite led to complete cures.</p>\n\n<p>An important factor that causes people to get type 2 diabetes and keep them diabetic is the indoctrination of the general public that eating large amounts of (unrefined) carbs is bad for health. I experience this almost every time when I'm ordering my diet in restaurants, particularly in North America. On one occasion a very obese waiter told me that the 1 kg of potatoes I ordered for dinner is bad for health. </p>\n", "score": 2 }, { "answer_id": 14058, "body": "<p>Yes. T2D is reversible, with some caveats.</p>\n\n<p>T2D is essentially a set of symptoms in a body that has ingested too much sugar, and has lost insulin sensitivity. \"Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.\" --wikipedia Diabetes_mellitus_type_2</p>\n\n<p>T2D is an arbitrary diagnosis based on the easily-measurable blood glucose level: wikipedia Diabetes_mellitus_type_2#Diagnosis</p>\n\n<p>Outside the arbitrary medical definition, which has a binary diagnosis, it's much more meaningful to talk about insulin sensitivity as a spectrum.</p>\n\n<p>Some people are insulin-sensitive superstars, far better at efficiently digesting sugars than \"normal\" people, and generally speaking T2 diabetics are less insulin-sensitive than normal people.</p>\n\n<p>A helpful analogy is IQ. The arbitrary definition of moron is a person with IQ between 50-69, an imbecile has an IQ from 20-49, and idiots have IQs below 20. That's pretty easy to measure, and also pretty meaningless. A much more useful application of IQ scores is to try to make ALL people improve their own individual IQ score over time through education.</p>\n\n<p>We don't focus enough on the fasting blood glucose level, or response of blood glucose level to ingested sugar <em>as a spectrum of insulin-sensitivity</em>. Instead, we just have 1 label, T2D. Kinda like if we ignored geniuses, morons, and regular people, and just had a single \"disease\", called \"dumb\", for people with an arbitrary IQ, let's say below 73.</p>\n\n<p>When you ask about reversing diabetes, what you're really asking is, can a person use diet to improve their insulin sensitivity, as measured by fasting blood glucose, and/or response of blood glucose to ingestion of sugar. The answer is <strong>yes</strong>!</p>\n\n<p><strong><em>Diet is the strongest factor in improving insulin sensitivity.</em></strong></p>\n\n<p>Carbs are just sugar chains consisting of 3 or more sugars, so it's useful to divide all nutrition into simply sugar, fat, and protein, and never use the word carbs again. Just call them long-chain or complex sugars, so you don't camouflage diabetes-inducing sugars as nutritive-sounding \"carbohydrates\".</p>\n\n<p>Eating very low-sugar diets (ketogenic, atkins, or even many low-calorie diets) improves insulin sensitivity. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313649/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313649/</a></p>\n\n<p>Here are some caveats:</p>\n\n<ol>\n<li><p>Most, if not all, T2Ds are terrible eaters who consume(d) loads of sugars, so dietary changes are difficult for many T2Ds.</p></li>\n<li><p>Some damage caused by eating sugar is irreversible. If you got your legs sawed off because you were extremely insulin-resistant for a long time, they won't grow back. Somewhere around 100,000 diabetes leg amputations happen every year in the US. This is a huge problem.</p></li>\n<li><p>Reversal is slow, unless the person commits to a very drastic change, like a ketogenic diet (for most people this means &lt;40g of sugar per day). Humans usually believe in lucky positive events, and expect to see immediate feedback from any changes, but most important achievements in life require small investments of energy and attention every day, over periods of months or years. This is why so few people are financially secure, physically fit, happily married, well-adjusted, and healthy. All of the important problems in life require consistent attention and near-daily investments of effort in PROCESSES over long investment horizons. The positive events, like winning Mr. Olympia, cover modelling on Forbes, and celebrating a happy 50th anniversary, aren't really \"events\", so much as results flowing naturally from slow, consistent processes. The behaviors that will reverse T2D are not comfortable, and your aunt will have to take those actions every day for months before seeing any positive results.</p></li>\n</ol>\n\n<p>If you can make your aunt see that sugar caused her T2D, and that not eating sugar will reverse it, and she carries a powerful enough \"WHY\", such as not getting her legs sawn off, being able to hike mountains with her nieces and nephews, living a long and happy life, then she will start substituting fat for sugar in her diet, and live happily ever after.</p>\n\n<p>Just be aware, it's a psychological battlefield, and the same thinking and actions that got her where she is will NOT get her out.</p>\n\n<p>Other Sources:</p>\n\n<ul>\n<li><a href=\"http://www.ncl.ac.uk/press/news/2017/09/type2diabetesisreversible/\" rel=\"nofollow noreferrer\">http://www.ncl.ac.uk/press/news/2017/09/type2diabetesisreversible/</a></li>\n<li><a href=\"https://en.wikipedia.org/wiki/Diabetes_mellitus_type_2#Diagnosis\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Diabetes_mellitus_type_2#Diagnosis</a></li>\n</ul>\n", "score": 2 } ]

[ "diabetes", "type-2-diabetes" ]

[ { "answer_id": 14120, "body": "<p>The Hepatitis B core antibody test is positive for IgG but negative for IgM indicating that you had the hepatitis B infection a while ago. The negative hepatitis B surface antigen test means that they are not detecting the hepatitis B in your blood when testing for the virus surface antigen. This means you've successfully cleared the infection to a very low level. You don't mention the hepatitis B surface antibody levels which are usually used to determine if you're now immune eg. after a series of hepatitis B vaccinations.</p>\n\n<p>This doesn't mean you don't have the virus in your system. Immunosuppressants such as methotrexate and TNF inhibitors could still potentially reactivate the hepatitis B infection. So, you'd want to measure the HBV DNA viral load and then track that serially to see if such treatment causes a reactivation.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24805974\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/24805974</a> </p>\n", "score": 7 } ]

[ "blood-tests", "liver", "virus", "infectious-diseases", "hepatitis" ]

[ { "answer_id": 15097, "body": "<p>While the blood pregnancy test is one option, urine pregnancy tests are still possible in an unconscious patient via a Foley catheter, which is a tube inserted up the urethra into the bladder. These catheters are commonly placed in trauma patients (2).</p>\n\n<p>There are several things that can be done during emergency management of a patient that can potentially cause harm to a fetus. One of these is imaging involving radiation, such as X-rays or CT scans. However, after 16 weeks of pregnancy imaging is unlikely to cause harm to a fetus (1). There are a number of drugs that can cause harm to a fetus (teratogenic drugs), however many safe alternatives exist, and emergency medical personnel are trained to treat you as though you are pregnant until proven otherwise (3,4)</p>\n\n<p>References:</p>\n\n<p><a href=\"https://emergency.cdc.gov/radiation/prenatalphysician.asp\" rel=\"noreferrer\">Effects of Radiation on Fetus</a></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889669/\" rel=\"noreferrer\">Indications for a Foley Catheter</a></p>\n\n<p><a href=\"https://www.cdc.gov/pregnancy/meds/index.html\" rel=\"noreferrer\">Teratogenic Medications in Pregnancy</a></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/26334607/\" rel=\"noreferrer\">Management of a Potentially Pregnant Trauma Patient</a></p>\n", "score": 6 } ]

[ "obstetrics", "emergency" ]

[ { "answer_id": 16502, "body": "<h2>Short Answer</h2>\n\n<p>HIV is a virus and when the HIV virus has invaded the body it becomes an infection (specifically an STI <strong>only if and when</strong> transmitted through sexual contact).</p>\n\n<p>Whilst the terms STI and STD are often used interchangeably, really and truthfully, they are different.</p>\n\n<p><strong>A sexually transmitted virus is an STI when inside the body, and an STI is <em>not necessarily</em> an STD</strong>.</p>\n\n<h2>Longer Answer</h2>\n\n<p>As an example of the confusion which can occur, there are articles that labeled herpes as a “sexually transmitted disease” (STD), while others favoured the term “sexually transmitted infection” (STI) (<a href=\"https://www.healthcentral.com/article/std-vs-sti-is-there-a-difference\" rel=\"noreferrer\">Depasse, 2017</a>). Even government health agencies like the National Institutes of Health (NIH) use the terms interchangeably (<a href=\"https://www.nichd.nih.gov/health/topics/stds/conditioninfo/types\" rel=\"noreferrer\">NIH, 2017</a>), often without explanation for doing so. With such ambiguity, it’s hard to discern fact from fiction.</p>\n\n<h2>Key Terms</h2>\n\n<p><strong>Pathogen</strong>: A pathogen is a microorganism that can cause disease. There are five major types of pathogens: bacteria, viruses, fungi, protozoa, and helminths (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NIH, 2007</a>).</p>\n\n<p><strong>Infection</strong>: An infection resulting from when a pathogen invades and begins growing within a host (e.g., a human) (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NIH, 2007</a>; <a href=\"https://c.merriam-webster.com/medlineplus/infection\" rel=\"noreferrer\">MedlinePlus, n.d.</a>).</p>\n\n<p><strong>Disease</strong>: A disease results <strong>only if and when</strong>, as a consequence of the invasion and growth of a pathogen, tissue function is impaired (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NIH, 2007</a>) it is when the body’s ability to perform normal functions is interrupted or changed, usually presenting with certain signs and symptoms. <a href=\"https://c.merriam-webster.com/medlineplus/disease\" rel=\"noreferrer\">MedlinePlus, n.d.(a)</a>).</p>\n\n<p>With these terms, the definitions of STI and STD in my question stands:</p>\n\n<blockquote>\n <h2>STI</h2>\n \n <p>Stands for Sexually Transmitted Infection — <strong>an infection</strong> caused by bacteria or virus which has been transmitted through sexual contact.</p>\n \n <h2>STD</h2>\n \n <p>Stands for Sexually Transmitted Disease — <strong>a disease</strong> caused by the infection of a bacteria or virus transmitted through sexual contact.</p>\n</blockquote>\n\n<p>Therefore, both Jan and I are correct with regard to HIV. HIV is a virus (a pathogen), and when the HIV virus has invaded the body it becomes an infection (specifically an STI <strong>only if and when</strong> transmitted through sexual contact). HIV by itself is not a disease (STD) but causes AIDS which is the STD (the symptom of advanced HIV infection). HIV is still present as an STI with AIDS being an STD.</p>\n\n<p>Whilst the terms STI and STD are often used interchangeably, really and truthfully, they are different.</p>\n\n<h2>References</h2>\n\n<p>Depasse, E. (2017). <em>STD vs. STI: Is There a Difference? And Why Does It Matter? - HealthCentral</em><br>Retreivable from: <a href=\"https://www.healthcentral.com/article/std-vs-sti-is-there-a-difference\" rel=\"noreferrer\">https://www.healthcentral.com/article/std-vs-sti-is-there-a-difference</a></p>\n\n<p>MedlinePlus. (n.d.). <em>Infection - Medical Dictionary</em><br>Retreivable from: <a href=\"https://c.merriam-webster.com/medlineplus/infection\" rel=\"noreferrer\">https://c.merriam-webster.com/medlineplus/infection</a></p>\n\n<p>MedlinePlus. (n.d.(a)) <em>Disease - Medical Dictionary</em><br>Retrievable from: <a href=\"https://c.merriam-webster.com/medlineplus/disease\" rel=\"noreferrer\">https://c.merriam-webster.com/medlineplus/disease</a></p>\n\n<p>NIH. (2007). Understanding emerging and re-emerging infectious diseases. Biological sciences curriculum study. <em>NIH Curriculum Supplement Series. National Institutes of Health, Bethesda, MD</em>.<br>NIH Bookshelf ID: <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NBK20370</a></p>\n\n<p>NIH. (2017). <em>What are some types of and treatments for sexually transmitted diseases (STDs) or sexually transmitted infections (STIs)?</em><br>Retreivable from: <a href=\"https://www.nichd.nih.gov/health/topics/stds/conditioninfo/types\" rel=\"noreferrer\">https://www.nichd.nih.gov/health/topics/stds/conditioninfo/types</a></p>\n", "score": 8 }, { "answer_id": 16501, "body": "<p>STI = sexually transmitted infection</p>\n\n<p>STD = sexually transmitted disease</p>\n\n<p>Strictly speaking, not all STIs are STDs. Infection merely means the presence of the microbes in the body and if it does not cause any symptoms, it is called asymptomatic infection, not a disease. Only when a HIV infection causes damage to the body, which usually comes with symptoms, it becomes a disease (STD), namely AIDS.</p>\n\n<p>HIV = human immunodeficiency virus. When someone catches HIV, he/she only catches a virus, which may or may not cause AIDS. The same way as you can catch some rhinoviruses and as a result you may or may not develop common cold. </p>\n\n<p><a href=\"https://www.medicalnewstoday.com/articles/316019.php\" rel=\"nofollow noreferrer\">MedicalNewsToday: HIV vs. AIDS: What is the difference?</a></p>\n\n<blockquote>\n <p>HIV infection and AIDS are not the same condition, and they are not\n the same diagnosis.</p>\n \n <p>HIV is a virus that attacks a type of white blood cell called a CD4\n cell in the body's immune system.</p>\n \n <p>AIDS is a syndrome, or range of symptoms, that may develop in time in\n a person with HIV who does not receive treatment. <strong>A person can have\n HIV without developing AIDS, but it is not possible to have AIDS\n without first having HIV.</strong></p>\n</blockquote>\n\n<hr>\n\n<p>Bottom line: HIV = an STI (infection), which may or may not become an STD (disease), called AIDS.</p>\n", "score": 4 } ]

[ "virus", "sti", "std" ]

[ { "answer_id": 17717, "body": "<p>To get even close to how much bacteria there are in vaginal discharge and penile discharge, we look at how are they diagnosed/detected laboratory wise.</p>\n\n<p><strong>Gonorrhea</strong> is caused by <em>Neisseria gonorrhea a gram-negative diplococcus</em> that is found in the discharge with pus seen in microscopy after gram staining. There are other microorganisms that are gram-negative diplococci; Examples of gram-negative diplococci are <em>Neisseria spp., Moraxella catarrhalis, and Acinetobacter spp</em>. Isolation of Neisseria is required by culturing it in a Thayer martin medium or by detecting its proteins by PCR. </p>\n\n<p>In short, we can't exactly count how much bacteria there are in a droplet or an mL of vaginal/penile discharge since all other bacteria in there look the same under the microscope.</p>\n\n<p>Another factor would be bacterial virulence and how competent an individual's immune system is. We cannot exactly determine at what rate the bacteria are reproducing and the competence of the immune system since both of these factors vary so much. </p>\n\n<p>I can't seem to find any experimental study on deliberately exposing test subjects to Neisseria and which dose can cause an infection.</p>\n\n<p>Source:\nJawetz, melnick, adelberg; medical microbiology 26th ed.\npage 73, 289</p>\n\n<p>The laboratory diagnosis of Neisseria gonorrhoeae\nLai-King Ng, PhD and Irene E Martin, BSc</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095009/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095009/</a></p>\n", "score": 9 } ]

[ "sex", "bacteria", "sti", "std" ]

[ { "answer_id": 18320, "body": "<p>This is an interesting question and I will take the bait. </p>\n\n<p>Using the definition from <a href=\"https://www.wordnik.com/words/calorie\" rel=\"nofollow noreferrer\">here</a>, and considering 2000 grams (2l) of water at about 0 degrees Celsius which the body must heat to about 37 degrees Celsius the lost heat effort is not that big: 37 deg * 2000 g = 74Kcal (out of about <a href=\"https://health.howstuffworks.com/wellness/food-nutrition/facts/question457.htm\" rel=\"nofollow noreferrer\">2000K</a> calorie per day)</p>\n\n<p>This <a href=\"https://www.theglobeandmail.com/life/health-and-fitness/fitness/a-hot-drink-cools-you-faster-than-a-cold-one-myth-or-reality/article4474567/\" rel=\"nofollow noreferrer\">article</a> dives into the results of a study that deals with this exact question:</p>\n\n<blockquote>\n <p>Sure enough, unlike previous studies, the new study found that\n drinking hot water triggered a sweat response that more than\n compensated for the heat of the drink. <strong>Cold drinks produced the\n opposite response, with a reduction in sweat cancelling out the\n cooling power of the drink.</strong></p>\n</blockquote>\n\n<p>So, sweat cancelling might be greater than the cooling effect of the drink.</p>\n\n<p>However, this happens only if sweat evaporated completely:</p>\n\n<blockquote>\n <p>The caveat is that your sweat must fully evaporate in order to produce\n the desired cooling effect. If you're exercising hard, or wearing too\n many clothes, or in a very humid environment, you may produce sweat\n more quickly than it can evaporate, in which case it's no longer\n desirable to ramp up your sweat rate further.</p>\n</blockquote>\n\n<p>This tackles the thermodynamic aspect of drinking cold water. However, efficiency might measured through hydration. <a href=\"https://www.livestrong.com/article/533835-which-is-better-drinking-ice-water-or-warm-water/\" rel=\"nofollow noreferrer\">This article</a> suggests that drinking cold water is more efficient than drinking warm water:</p>\n\n<blockquote>\n <p>(..) <strong>cold water is absorbed more quickly into your body than warm\n water,</strong> helping you rehydrate more quickly</p>\n</blockquote>\n\n<p>As a conclusion, taken into the account both thermodynamics and hydration, I would say drinking cold water is more effective. Of course, if you do not have some throat issues that might get worse when drinking cold liquids. </p>\n", "score": 2 } ]

[ "nutrition", "water", "body-temperature", "water-temperature" ]

[ { "answer_id": 17226, "body": "<p>Most blood donors are a bit weakened from giving blood, despite often feeling great. The amount of blood removed from circulation reduces your possible performance level and you might tire more easily as the reduced volume of blood also means a reduction in oxygen availability. This small measurable level of performance reduction can reach up to three weeks.<br />\n_{<a href=\"http://journals.lww.com/nsca-jscr/pages/articleviewer.aspx?year=2011&amp;issue=11000&amp;article=00014&amp;type=abstract\" rel=\"nofollow noreferrer\">Judd, TB., Cornish, S.M., Barss, T.S., Oroz, I., Chilibeck, P.D. (2011). Time course for recovery of peak aerobic power after blood donation. Journal of Strength &amp; Conditioning Research, 25(11)</a>. .}</p>\n<p>Apart from these slightly negative impact factors the <a href=\"http://www.redcrossblood.org/learn-about-blood/blood-facts-and-statistics\" rel=\"nofollow noreferrer\">American Red Cross</a> simply issues the recommendation:</p>\n<blockquote>\n<p>After you give blood:</p>\n<p>Take the following precautions:</p>\n<ul>\n<li>Drink an extra four glasses (eight ounces each) of non-alcoholic liquids.</li>\n<li>Keep your bandage on and dry for the next five hours, and do not do heavy exercising or lifting.</li>\n<li>Because you could experience dizziness or loss of strength, use caution if you plan to do anything that could put you or others at risk of harm. &gt; - For any hazardous occupation or hobby, follow applicable safety recommendations regarding your return to these activities following a blood donation.</li>\n<li>Eat healthy meals and consider adding iron-rich foods to your regular diet, or discuss taking an iron supplement with your health care provider, to replace the iron lost with blood donation.</li>\n<li>If you get dizzy or lightheaded: Stop what you are doing, lie down, and raise your feet until the feeling passes and you feel well enough to safely resume activities.</li>\n</ul>\n</blockquote>\n<p>The main reason being the possible risk of dehydration.</p>\n<blockquote>\n<p>Blood banks encourage the donation of whole blood by donors 50 weighing kg or who have a greater hemoglobin level of 125 g/L or greater. Following the donation of a 450-mL unit of whole blood, plasma volume, which is acutely reduced by 7% to 13%, recovers within 24 to 48 hours. This results in a decrease of the hemoglobin level of 10 to 20\ng/L. Recovery of the hemoglobin level to normal requires time and an adequate iron supply. Full recovery of the hemoglobin to baseline takes 3 to 4 weeks.</p>\n<p>It is theoretically possible that peak athletic performance may be affected during the 3 weeks it takes for hemoglobin recovery. Although there are compensatory mechanisms in anemia to improve oxygen delivery to tissues, it is not clear that they occur acutely or with such minor decreases in hemoglobin concentration.</p>\n<p>Athletes should wait 12 to 24 hours to resume strenuous exercise after blood donation and should be sure to stay well hydrated the day after a blood donation.</p>\n<p>_{<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8505821\" rel=\"nofollow noreferrer\">Ritchard G. Cable: &quot;Execise and Blood Donation&quot;, JAMA. 1993 Jun 23-30;269(24):3167.</a>}</p>\n</blockquote>\n<p>More information and a nice selection of links at\n<a href=\"https://blog.nasm.org/fitness/donating-blood-and-exercise-what-athletes-should-know/\" rel=\"nofollow noreferrer\">Jena Walther: &quot;Donating Blood and Exercise: What Athletes Should Know&quot; (National Academy of Sports Medicine) February 6, 2016.</a></p>\n", "score": 9 } ]

[ "exercise", "blood-donation" ]

[ { "answer_id": 18330, "body": "<p>While there is some evidence for what we call a <em>J-shaped curve</em> in the relationship between alcohol consumption and certain health outcomes, at best this evidence only suggests people who already drink modestly have better health outcomes than people who don't drink at all. There is <strong><em>no</strong> strong evidence that starting to drink a glass a day, if you do not drink already</em>, would improve your health outcomes. There is an important point here about study design. Evidence for the J-shaped curve is generally observational, often retrospective, and can only tell you about an association between some variable and a disease outcome. It may be an important association, e.g., a valuable marker for risk of disease, but it doesn't tell you what happens if you change the variable. To know what happens when you change the variable, you typically want a randomized controlled trial. </p>\n\n<p>Abstaining from alcohol (vs. moderate consumption) is likely what we call a confounding variable. It is associated with the variable of interest (some health outcome, e.g., mortality), but it is not on the causal pathway. That is to say, people who don't drink at all may be more likely to be ill (or become ill), but they didn't get that way because they don't drink. This is well explored in <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803651/\" rel=\"nofollow noreferrer\">this meta analysis</a>. A key part here is that former drinkers who currently don't drink any alcohol appear to be the major driver of the higher risk of mortality for individuals who don't drink at all. This suggests earlier heavy drinking or illness that causes someone to stop drinking. </p>\n", "score": 5 }, { "answer_id": 18371, "body": "<p>The reason you <em>may</em> want to be a moderate drinker is they're found to have lesser rates of death from heart disease and diabetes, which are dominant causes of death in a developed society.</p>\n\n<p>This is one study I'll be referring to, as it got a lot of press last summer,</p>\n\n<ul>\n<li><a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext#fig5\" rel=\"nofollow noreferrer\">Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016</a></li>\n</ul>\n\n<p>Below, if you’re above 1, that means you have greater risk of heart disease. Below 1, lesser risk. Drinkers have less risk, until they get to 6 (!) drinks per day.</p>\n\n<p><a href=\"https://i.stack.imgur.com/bRrAW.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/bRrAW.jpg\" alt=\"heart disease drinkers\"></a></p>\n\n<p>Heart disease deaths, up to a point, go <em>down</em> as people drink more. (Specific chart is for females but same trend happens for males; bottom ticks each represent one standard drink per day.)</p>\n\n<p>Note, you need to live long enough for heart disease or diabetes to potentially kill you in order to get this benefit. If you're in a low income country, alcohol only increases your risk of death:</p>\n\n<p><a href=\"https://i.stack.imgur.com/F7AWt.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/F7AWt.jpg\" alt=\"low socioeconomic country alcohol deaths\"></a>\n<a href=\"https://i.stack.imgur.com/5RcBk.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/5RcBk.jpg\" alt=\"alcohol types of deaths\"></a></p>\n\n<p>If you're in a rich country though, you get <strong>a lot</strong> of benefit from drinking alcohol, practically completely offsetting that initial negative we saw:</p>\n\n<p><a href=\"https://i.stack.imgur.com/YX2cp.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/YX2cp.jpg\" alt=\"alcohol rich country deaths\"></a></p>\n\n<p>If you examine the causes of death above more closely, you'll see ones like violence, cirrhosis, self-harm, etc. One could make an argument these don't apply to our moderate drinker, to where you could get rid of some of those deaths. That is, you're getting less negative and more positive.</p>\n\n<h2>Cancer</h2>\n\n<p>The heart disease connection is fairly well known. Cancer is not as appreciated. Yes, alcohol can increase the risk of cancer, but it can also decrease the risk!\n<a href=\"https://i.stack.imgur.com/SmjoL.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/SmjoL.jpg\" alt=\"cancer alcohol deaths\"></a></p>\n\n<p>From </p>\n\n<ul>\n<li><a href=\"https://academic.oup.com/jnci/article/101/5/296/913713#F1\" rel=\"nofollow noreferrer\">Moderate Alcohol Intake and Cancer Incidence in Women</a></li>\n</ul>\n\n<h2>Pinning down to specific people</h2>\n\n<p>The natural next question is some variety of \"why?\"</p>\n\n<p>People pretty much always go digging for biochemical answers, but as a personal trainer who has talked to many different personalities about alcohol through the years, a (I believe) very under appreciated element of alcohol is the kind of personality who swears it off.</p>\n\n<p>For instance, on one extreme, you have the person who is an alcoholic. Any alcohol turns into way too much. Obviously not healthy.</p>\n\n<p>You also have the person who is trying to be too strict about everything in their lives. Where they're inherently neurotic. Not a recipe for longterm health.</p>\n\n<p>There is research showing drinkers weigh <em>less</em> than non-drinkers. Personally, I've found with my clients some of them, if they have a drink after a rough day, that's the end of it. While others, if they don't drink, might eat a tub of ice cream. I've also seen other trainers / nutritionists tell their clients they can't drink at all anymore, only for the clients to be miserable. \"Going to my weekly date night with my spouse isn't as enjoyable.\"</p>\n\n<p>Alcohol can mean <strong>a lot</strong> to a lot of people's social lives. If swearing it off ends up making you more lonely or isolated, that's not good for the heart. (Seriously. There is literature out there talking about the dangers of loneliness.)</p>\n\n<p>With virtually any health question or topic, you're going to be hard pressed to acceptably paint a brush to how people should behave. (No smoking is probably the only one.) If you have a family history of breast cancer maybe you shouldn't drink; if you have one of thyroid, maybe you should?</p>\n", "score": 2 } ]

[ "diet", "alcohol" ]

[ { "answer_id": 19204, "body": "<p><em>DISCLAIMER: This answer is only about \"how to break fast\" and prevent refeeding syndrome in otherwise healthy adults, not in those who suffer from chronic alcoholism, eating disorders, cancer or other conditions.</em> </p>\n\n<p><strong>Refeeding syndrome</strong> can occur within few days of rapid feeding that follows prolonged starvation lasting for more than 5 days. Symptoms can include weakness, muscle cramps, tingling, seizures and, possibly, death.</p>\n\n<p>Refeeding syndrome occurs due to <strong>glucose</strong> that quickly enters the cells and drags phosphate, potassium, magnesium and vitamin B1 with it, resulting in hypophosphatemia and, less commonly, hypokalemia, hypomagnesemia and vitamin B1 deficiency. Sodium and water retention resulting in edema can also occur.</p>\n\n<p><strong>Prevention of refeeding syndrome:</strong></p>\n\n<ul>\n<li>Slow feeding in the first week:\n\n<ul>\n<li>after 5-10 day fasting: 20 Kcal/kg body weight/day</li>\n<li>after >10 day fasting: 10 Kcal/kg body weight/day </li>\n</ul></li>\n<li>Taking multivitamin supplements, including vitamin B1, daily for at least 10 days</li>\n<li>Eating usual foods, but taking care to get enough phosphates (meat, canned fish with bones, cheese, eggs) and potassium (potatoes, bananas)</li>\n<li>Avoiding foods high in sugars and other quickly-absorbable carbohydrates (fruit juice, soda, sweets, white bread, pasta cookies or rice) to prevent quick blood glucose shifts</li>\n<li>Drinking only as much water as necessary to maintain <a href=\"https://medlineplus.gov/ency/article/003281.htm\" rel=\"nofollow noreferrer\">normal skin turgor</a> and excretion of clear or straw-yellow urine, and avoiding excessive salt intake to prevent water retention (swollen ankles)</li>\n</ul>\n\n<p>Sources:</p>\n\n<ol>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/\" rel=\"nofollow noreferrer\">Refeeding syndrome: what it is, and how to prevent and treat it (PubMed, 2008)</a></li>\n<li><a href=\"https://www.hopkinsmedicine.org/gim/_pdf/consult/refeeding_syndrome.pdf\" rel=\"nofollow noreferrer\">The Importance of the Refeeding Syndrome (Hopkins Medicine, 2001)</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654033/\" rel=\"nofollow noreferrer\">Refeeding syndrome – awareness, prevention and management (PubMed, 2009)</a></li>\n<li><a href=\"https://jandonline.org/article/S0002-8223(08)01735-5/pdf\" rel=\"nofollow noreferrer\">Refeeding Syndrome: Recognition Is the Key to Prevention and Management\n(Journal of American Dietetic Association, 2008)</a></li>\n</ol>\n", "score": 5 } ]

[ "nutrition" ]

[ { "answer_id": 20102, "body": "<p>Screening tests are done across the population of asymptomatic people at risk of a disease (e.g. mammogram to look for breast cancer in all women with breasts) to try to catch disease early in its course.</p>\n<p>Diagnostic tests are done when a patient presents with symptoms.</p>\n<p>The <a href=\"https://www.sciencedirect.com/science/article/abs/pii/S0009898114005208\" rel=\"noreferrer\">ROMA test</a> is a diagnostic test done when a woman presents with an adnexal mass, and uses serum markers (CA125, HE4) to stratify the risk of the mass being cervical cancer in that individual. It is generally done after a pelvic ultrasound, and helps guide decisions regarding biopsy etc.</p>\n<p>Currently, most professional organizations including <a href=\"https://jamanetwork.com/journals/jama/fullarticle/2672638\" rel=\"noreferrer\">the USPSTF do NOT recommend screening for ovarian cancer</a>:</p>\n<blockquote>\n<p><strong>Rationale</strong></p>\n<p><strong>Importance</strong> - The age-adjusted incidence of ovarian cancer from\n2010 to 2014 was 11.4 cases per 100,000 women per year.1 Ovarian\ncancer is the fifth most common cause of cancer death among US women\nand the leading cause of death from gynecologic cancer, despite its\nlow incidence.1 Approximately 14,000 women die of ovarian cancer each\nyear in the United States. More than 95% of ovarian cancer deaths\noccur among women 45 years and older.2</p>\n<p><strong>Detection</strong> - The positive predictive value of screening tests for ovarian\ncancer is low, and most women with a positive screening test result do\nnot have ovarian cancer (ie, many women without ovarian cancer will\nhave a false-positive result on screening tests).</p>\n<p><strong>Benefits of Screening</strong> - The USPSTF found adequate evidence that\nscreening with transvaginal ultrasound, testing for the serum tumor\nmarker cancer antigen 125 (CA-125), or a combination of both does not\nreduce ovarian cancer mortality.</p>\n<p><strong>Harms of Screening</strong> - The USPSTF found adequate evidence that screening\nfor ovarian cancer can result in important harms, including many\nfalse-positive results, which can lead to unnecessary surgical\ninterventions in women who do not have cancer. Depending on the type\nof screening test used, the magnitude of harm ranges from moderate to\nsubstantial and reflects the risk for unnecessary diagnostic surgery.\nThe USPSTF found inadequate evidence on the psychological harms of\nscreening for ovarian cancer.</p>\n<p><strong>USPSTF Assessment</strong> - The USPSTF concludes that there is at least moderate\ncertainty that the harms of screening for ovarian cancer outweigh the\nbenefits.</p>\n</blockquote>\n<p>To summarize, screening tests are generally done population-wide when the population-wide benefits of catching early disease <em><strong>outweighs the harms</strong></em> of the testing/treatment done on the <em><strong>false positive cases</strong></em> of those screening tests. Testing and treating a false-positive can have serious or even fatal consequences. The benefits and risks are weighed carefully when deciding whether to screen population-wide.</p>\n<p>Screening for an individual based on their risks (e.g. first degree family members with ovarian cancer, environmental exposures or genetic mutations known to increase risk, etc) is NOT considered population-wide screening, it is something discussed with an individual's physician in their wellness visit, and is based on individual factors.</p>\n<p><strong>Once <em>any</em> test (whether screening or diagnostic) is performed, <em>any positive results ABSOLUTELY MUST be followed up by the physician</em> to discuss risks and benefits of the next steps in diagnosis and/or treatment.</strong> That is why the risks of diagnostics/treatments of false positive results (which occur at least a small % of the time in <em>any</em> test) have to be considered when deciding whether there is more harm or benefit to screening at a population level.</p>\n<p>Without giving an entire lecture on biostatistics... for example, if a screening test were to have a 5% false positive rate, and we screened a population of 1 million women, about 50,000 of those women screened would have a falsely positive result that would result in unnecessary additional tests/treatment. But when considering an individual, many other factors may change the balance of risks/benefits to favor doing testing, so that is why primary care providers are (usually) well trained in both doing and <em>discussing</em> screening tests with patients, to guide each individual in what is best for them.</p>\n", "score": 15 }, { "answer_id": 20107, "body": "<p>It's interesting that you picked this one specific example, because it happens to have been <a href=\"https://www.nature.com/articles/s41598-018-35585-z.pdf\" rel=\"nofollow noreferrer\">studied by Gigerenzer</a>, a prominent expert on risk perception. It also showcases that one shouldn't insist all the time of applying \"common sense\" to medicine, since facts show that, counterintuitive as it is to both patients and physicians, the screening does not have benefits. </p>\n\n<p>There is a nice citation in Gigerenzer's paper subsuming the facts: </p>\n\n<blockquote>\n <p>about 3 women in 1,000 in both the screening and the nonscreening group died of ovarian cancer within that time frame, and about 85 in 1,000 in each group of other causes. It further revealed substantial harms within the screening group: 96 women in every 1,000 screened had a false alarm, of whom 32 had their ovaries unnecessarily removed as part of further diagnostic work-up. </p>\n</blockquote>\n\n<p>So, screening for ovarian cancer does not reduce your chances of dying of ovarian cancer (or dying at all - that part is quite important, since one cannot rely on a death certificate correctly stating the reason for death). If you lost a relative to ovarian cancer, it is normal to have thoughts like \"if only she had been tested early enough\", but in reality, that would not have helped. </p>\n\n<p>The problem here is that the scenario of \"test -> detection -> help\" is so firmly rooted in people's ideas about medicine, that the idea of a test which does individually detect a malignancy but is unsuitable for screening just doesn't compute. I recommend reading the full paper (10.1038/s41598-018-35585-z), or try to get hold of some talks by Gigerenzer or his staff, highly interesting stuff. </p>\n\n<p>There are better way of representing this information, and one of them was tested in the paper I cite. I hope you can see easier from it why the screening is not recommended. </p>\n\n<p><a href=\"https://i.stack.imgur.com/Mb2Km.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Mb2Km.png\" alt=\"enter image description here\"></a></p>\n", "score": 6 } ]

[ "ovary", "cancer" ]

[ { "answer_id": 25639, "body": "<p>The short answer is: No.</p>\n<p>Your question is a good question, but I think, in this case, that you should focus on the nature of testing in general, rather than on the specifics of this test.</p>\n<p>Sensitivity and specificity of a test are an empiric result, with the test being held to some gold standard. Whether or not the false positives are false because of systematic error or random error doesn't matter when using the test in the sense you are using it here (generally and practically speaking).</p>\n<p>If you were trying to improve the test itself, then it would (e.g. you were an engineer designing a better test, or a researcher designing a better trial looking at the se/sp of the test). But at the point of care, think of it as a black box: your pre test probability &quot;multiplied by&quot; your test (usually the likelihood ratio) is your post test probability.</p>\n<p>To retest using the same test is nonsensical (though the explanation is beyond the scope of this question).</p>\n<p>Of note, in some settings (HIV: elisa/western blot) you run tests in series, but you don't retest twice (elisa/elisa).</p>\n", "score": 1 } ]

[ "covid-19", "statistics", "test", "antibodies" ]

[ { "answer_id": 25262, "body": "<p>This is probably as good as it gets for now, but experts <a href=\"https://apnews.com/article/fact-checking-afs:Content:9856420671\" rel=\"noreferrer\">quoted by AP</a> have dismissed the idea as highly improbable, basically on the argument that the common sequence is too short to be of concern and that other viral fusion proteins e.g. used in the flu vaccine haven't been observed to cause such an effect (on fertility):</p>\n<blockquote>\n<p>Experts say there is no evidence that the Pfizer vaccine would result in sterilization of women.</p>\n<p>Rebecca Dutch, chair of University of Kentucky’s department of molecular and cellular biochemistry, said in an email that while syncytin-1 and the spike protein broadly share some features, they are quite different in the details that antibodies recognize.</p>\n<p>Aside from the fact that COVID-19’s spike protein and syncytin-1 are viral fusion proteins that cause membrane fusion, they are not related at all, Dutch said.</p>\n<p>[...]</p>\n<p>Jacob Yount, an associate professor of the department of microbial infection and immunity at Ohio State University, College of Medicine, has studied the syncytin proteins as well as SARS-CoV-2. Yount said the COVID vaccines do not contain syncytin-1 protein or mRNA encoding syncytin-1, and thus there is no reason to think that an immune response against syncytin-1 would be developed.</p>\n<p>“We don’t see infertility with the flu vaccine and that is also targeting a viral fusion protein in a similar way that the spike is a viral fusion protein of the coronavirus,” he said.</p>\n<p>[...]</p>\n<p>Pfizer spokeswoman Jerica Pitts confirmed to The Associated Press that their vaccine candidate has not been found to cause infertility.</p>\n<p>“It has been incorrectly suggested that COVID-19 vaccines will cause infertility because of a shared amino acid sequence in the spike protein of SARS-CoV-2 and a placental protein,” she said in an email. “The sequence, however, is too short to plausibly give rise to autoimmunity.”</p>\n</blockquote>\n<p>N.B. some of this info (i.e. what Yount said) can be <a href=\"https://en.wikipedia.org/wiki/Membrane_fusion_protein\" rel=\"noreferrer\">gleaned from Wikipedia</a>:</p>\n<blockquote>\n<p>Class I fusion proteins resemble influenzavirus hemagluttinin in their structure.</p>\n</blockquote>\n<p>From a more detailed <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649671/\" rel=\"noreferrer\">paper</a> (see table 1 in there) the coronaviruses fusion proteins also belong to this class I.</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Syncytin-1#Structure\" rel=\"noreferrer\">Also</a> from Wikipedia:</p>\n<blockquote>\n<p>Syncytin-1 shares many structural elements with class I retroviral glycoproteins (such as, Murine Leukemia Virus gp, Ebolavirus gp, and HIV gp120, gp41).</p>\n</blockquote>\n<p>So it seems that viruses (or vaccines against them) from the filoviridae family would be even more likely (out of all in class I) to produce an effect like this on fertility. Alas these are more obscure in the sense that there haven't been many vaccines against filoviridae, nor were such vaccines in widespread use (compared to influenza), e.g. the ones <a href=\"https://en.wikipedia.org/wiki/Ebola_vaccine\" rel=\"noreferrer\">for Ebola</a> have seen some use, but in more limited areas. The Wikipedia page doesn't mention any effects on fertility or pregnancy from these.</p>\n<p>... but (for what's worth it) there is actually a <a href=\"https://wwwnc.cdc.gov/eid/article/26/3/19-1018_article\" rel=\"noreferrer\">March 2020 CDC paper</a> on &quot;Pregnancy Outcomes among Women Receiving rVSV?-ZEBOV-GP Ebola Vaccine during the Sierra Leone Trial to Introduce a Vaccine against Ebola&quot;</p>\n<blockquote>\n<p>Among immediate vaccinated women, 45% (14/31) reported pregnancy loss, compared with 33% (11/33) of unvaccinated women with contemporaneous pregnancies (relative risk 1.35, 95% CI 0.73–2.52). Pregnancy loss was similar among women with higher risk for vaccine viremia (conception before or &lt;14 days after vaccination) (44% [4/9]) and women with lower risk (conception &gt;15 days after vaccination) (45% [10/22]). No congenital anomalies were detected among 44 live-born infants examined. These data highlight the need for Ebola vaccination decisions to balance the possible risk for an adverse pregnancy outcome with the risk for Ebola exposure.</p>\n</blockquote>\n<p>Alas because of were the study was conducted it</p>\n<blockquote>\n<p>had several limitations, however, beyond the small sample size and inability to adjust for confounding factors. In cases of pregnancy loss, information on the timing of the loss was often lacking, limiting our ability to differentiate between early and late pregnancy loss.</p>\n</blockquote>\n<p>Regarding influenza vaccination and fertility, I also found a recent study <a href=\"https://pubmed.ncbi.nlm.nih.gov/32409134/\" rel=\"noreferrer\">Jun 2020</a> on a fairly large US sample (thousands), with the conclusion:</p>\n<blockquote>\n<p>Compared with couples in which neither participant was vaccinated, FRs [fecundability ratios] were 1.13 for female-only vaccination (95% CI: 0.99-1.29), 0.94 for male-only vaccination (95% CI: 0.78-1.12), and 1.07 when both partners were vaccinated (95% CI: 0.94-1.21). When restricted to recent vaccination before peak influenza season, results were similar.</p>\n<p>Conclusions: Our data indicate no adverse effect of influenza vaccination on fecundability</p>\n</blockquote>\n", "score": 9 } ]

[ "covid-19", "vaccination", "sars-cov-2", "fertility" ]

[ { "answer_id": 25393, "body": "<p>Roman Zieliński seems to be intentionally misleading you by making an implausible circumstance that is technically possible sound like a likely outcome. This strategy is not unusual among people who argue against vaccination, because they have very little actual science to argue based on.</p>\n<p>The Central Dogma as stated by Crick says nothing about RNA vs DNA. It does not say that RNA must enter DNA, or anything like that. It only says that information in protein sequence does not become information in nucleic acid sequence, and that information in nucleic acid sequence <em>does</em> become information in protein sequence. The historical basis of this is that there was a time in which people thought protein might be the hereditary material. We know now this is not the case, and Crick was trying to make a special point of it by giving it this &quot;central dogma&quot; name.</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Telomerase\" rel=\"noreferrer\">Telomerase</a> is a special reverse transcriptase that adds a &quot;cap&quot; to human chromosomes by replicating a specific RNA it holds. It does not copy random sequences of RNA to DNA or put DNA anywhere else.</p>\n<p>Reverse transcriptase of viral origin comes from <a href=\"https://en.wikipedia.org/wiki/Retrovirus\" rel=\"noreferrer\">retroviruses</a>. You don't have these reverse transcriptases present unless you are infected with such a virus, like HIV. These viruses do not insert all RNA into the genome, they use another protein called <a href=\"https://en.wikipedia.org/wiki/Integrase#In_HIV\" rel=\"noreferrer\">integrase</a> that specifically inserts virus-derived double-stranded DNA copies into the genome. Even if this process were less specific, the only affected cells would be those already infected with HIV.</p>\n<p>Similarly, he might be making reference to <a href=\"https://en.wikipedia.org/wiki/Endogenous_retrovirus\" rel=\"noreferrer\">endogenous retroviruses</a> but these do not incorporate random RNA into the genome as he implies.</p>\n<p>If random RNA present in cells regularly inserted itself into the genome, we would have a huge huge problem <strong>all the time</strong>, not just when adding some exogenous RNA. Human cells are full of all sorts of mRNA, and if it was inserted back into the DNA genome we'd have multiple extra copies of all sorts of genes. They'd be in the wrong places, getting transcribed under the wrong promoters, ending up in the middle of other genes, etc.</p>\n", "score": 9 }, { "answer_id": 25397, "body": "<p>To supplement Bryan's answer (although I'm not going to say anything fundamentally different here), according to their proponents, mRNA vaccines are considered the safest genetic vaccines (in this integration regard) because mRNA transcription (&quot;<a href=\"https://en.wikipedia.org/wiki/Transfection\" rel=\"noreferrer\">transfection</a>&quot;) to proteins happens outside the nucleus. Quoting from a <a href=\"https://www.frontiersin.org/articles/10.3389/fimmu.2018.01963/full\" rel=\"noreferrer\">review</a></p>\n<blockquote>\n<p>mRNA vaccines do not interact with the host-cell DNA, they avoid the potential risk of genomic integration posed by DNA-based vaccines.</p>\n</blockquote>\n<p>On other hand, if you're really curious about this, DNA vaccines have also been proposed and even tried in clinical studies, and regulators are a bit more concerned about integration effects with these, even just at the local, administration-site level.</p>\n<blockquote>\n<p>employing DNA as a basis for vaccination also implicates some disadvantages. A concern in this context is the long-term persistence of DNA plasmids upon injection. Indeed, DNA persistence was shown in various preclinical studies that demonstrated the presence of plasmid DNA for up to 2 years upon IM injection with low but detectable expression and immunogenicity in a mouse model. According to the FDA, DNA persistence is not generally evident at ectopic sites in biodistribution and persistence studies, but remains detectable at the injection sites for periods exceeding 60 days. Especially in the context of this long-term persistence, the presence of foreign genetic information in the nucleus of transfected cells poses the additional risk of genomic integration into the host's chromosomes and the resulting threat of mutagenesis and oncogenesis. Despite negative results in several studies focusing on detection of DNA integration events upon IM injection in small animal models, genomic integration events were detectable following electroporation in mice demonstrating that integration represents a small risk that nevertheless needs to be considered in systems with enhanced DNA uptake. The FDA recommends integration studies to be included whenever plasmid DNA exceeding 30,000 copies per μg of host DNA persists in any tissue by study termination. The WHO advises integration studies as part of the preclinical safety program of DNA vaccines.</p>\n</blockquote>\n<p>If you read that carefully, the regulators are concerned about DNA vaccines giving the patient some form of cancer, and so they require tests showing low integration effects, however this [integration] is generally regarded as a remote risk. Note that this kind of concern didn't stop DNA vaccine from proceeding to clinical trials, e.g.</p>\n<blockquote>\n<p>DNA based vaccines were among the first to proceed to clinical trials upon the Zika crisis in 2016.</p>\n</blockquote>\n<p>In general, DNA vaccines have proven to be less effective in clinical trials in part because they need to cross two membranes (cell and then nucleus) to actually have their desired transfection effect. mRNA vaccines have required quite a bit of engineering just to achieve the former (i.e. cell entry) well enough--the whole liquid nanoparticles thing is about that.</p>\n<blockquote>\n<p>vaccination with a DNA vector alone generally leads to relatively low immunogenicity, especially in large animal models and humans. A factor that may play a role is the need for DNA vaccines to cross two cellular membranes, i.e., the plasma, as well as the nuclear membrane, in order to achieve protein expression. Of note, this does not hold true for RNA vaccines, which are translated upon crossing the plasma or endosomal membrane, respectively.</p>\n</blockquote>\n<p>On the other hand, DNA vaccine proponents <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631684/\" rel=\"noreferrer\">point out</a> that even for these the risk of integration has been overblown, and that even DNA vaccines are <em>not</em> considered <a href=\"https://en.wikipedia.org/wiki/Gene_therapy\" rel=\"noreferrer\">gene therapy</a> (i.e. host-DNA modification):</p>\n<blockquote>\n<p>DNA vaccines did not need to be evaluated by the US National Institutes of Health (NIH) Recombinant Advisory Committee prior to human clinical trials, unlike viral vectors for gene therapy. Nevertheless, significant safety studies were initially required to evaluate the possibility of integration of the plasmid DNA into the host genome. As a result of these studies for both human vaccines and for the licensed DNA vaccines for fish, as well as the many human studies with DNA vaccines that have demonstrated safety, little concern now exists regarding integration. Comparisons have stated that mRNA offers an advantage because RNA itself cannot integrate into genomic DNA without the presence of the viral elements in a retrovirus that enable such integration (reverse transcriptase and integrase). However, HERVs (human endogenous retroviruses) whose remnants are now permanent parts of human genomes as retrovirus-like sequences comprise up to 8% of the human genome. In addition, some recipients of mRNA drugs or vaccines may be already infected with a retrovirus (e.g., HIV), thus providing a theoretical means for provision of the proteins needed for integration. Nevertheless, the risk of integration remains, at this point, extremely unlikely for mRNA, even from a theoretical standpoint, nor is it any longer a significant concern for plasmid DNA. This means that mRNA does not offer any clear advantage compared to plasmid DNA in this regard. From a regulatory perspective, mRNA prophylactic vaccines appear to not be considered gene therapy products, similar to DNA vaccines before them.</p>\n</blockquote>\n<p>In other words (as Bryan said and you can see reflected in the quote above), the only (theoretically) known means by which such integration of mRNA into cell-host DNA could happen is co-infection with a retrovirus, which is regarded as an unlikely coincidence/risk. There don't seem to be any experiments that have actually tried to even demonstrate this risk, i.e. that mRNA (particularly one from a vaccine) could be integrated in the host in the presence of e.g. HIV.</p>\n", "score": 7 } ]

[ "vaccination", "side-effects", "coronavirus", "genetics", "dna" ]

[ { "answer_id": 28956, "body": "<p>The <a href=\"https://en.wikipedia.org/wiki/T_helper_cell#Th1/Th2_model\" rel=\"noreferrer\">TH1/TH2 model of T-cell responsiveness</a> can be summarized as TH1 being the &quot;antiviral/antibacterial&quot; immune response and TH2 is the &quot;antiparasite&quot; immune response against worms and other multicellular parasites (though, as with most biology, lines drawn like this are always subject to exceptions). These separate pathways counteract each other to some extent, such that you can expect a TH1 suppression when TH2 is activated, and vice-versa.</p>\n<p>The TH2 pathway is the one associated with <a href=\"https://en.wikipedia.org/wiki/Histamine\" rel=\"noreferrer\">histamine</a> release, which is important in the pathophysiology of anaphylaxis. It's also why people can typically take antihistamines, which suppress this part of the immune response, to suppress their environmental allergy symptoms without making them susceptible to viral and bacterial illness.</p>\n<p>Allergic reactions including anaphylaxis tend to be more associated with the TH2 side of things: the responses against multicellular pathogens. However, that doesn't mean it's impossible for viruses to also cause anaphylactic responses:</p>\n<p><em>Grunewald, S. M., Hahn, C., Teufel, M., Bröcker, E. B., Wohlleben, G., Major, T., ... &amp; Erb, K. J. (2002). Infection with influenza A virus leads to flu antigen-induced cutaneous anaphylaxis in mice. Journal of investigative dermatology, 118(4), 645-651.</em></p>\n<p><em>Bach, M., Lim, P. P., Azok, J., Ruda Wessell, K., Desai, A. P., &amp; Dirajlal-Fargo, S. (2021). Anaphylaxis and rhabdomyolysis: a presentation of a pediatric patient with COVID-19. Clinical Pediatrics, 60(4-5), 202-204.</em></p>\n<p>I think it's also worth considering the time course of exposure to an antigen. During an infection, antigens build over time. The initial exposure dose is potentially quite small, down to a single active viral particle, but antigens accumulate over time as the virus replicates/bacteria multiply. In the lungs the immune response can contribute to <a href=\"https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome\" rel=\"noreferrer\">ARDS</a>. When exposed even to a very small amount of, say, peanut dust, the antigen is still presented &quot;all at once&quot;, hence the rapid response. No matter how small the exposure, it's going to be largest at the initial exposure and not build past that.</p>\n<p>Anaphylactic reactions <em>do</em> occur in response to vaccination, though they are typically rare and associated with vaccine ingredients besides the intended &quot;active&quot; ingredient antigen, such as eggs for influenza vaccines. The observation period after influenza or COVID-19 vaccinations, for example, are primarily to allow nurses to be present in case of one of these rare reactions.</p>\n", "score": 9 } ]

[ "virus", "immune-system", "allergy" ]

[ { "answer_id": 29183, "body": "<p><a href=\"https://vaers.hhs.gov/data/dataguide.html\" rel=\"noreferrer\">https://vaers.hhs.gov/data/dataguide.html</a> provides a useful guide for interpreting these data.</p>\n<p>VAERS deaths are not causal reports, they're just a report where someone (doctor, family member) decided to fill in a form. Most are likely to be coincidences. These links are posing the question &quot;well if these are just coincidences, why are so many the day after vaccination and so few weeks later?&quot;</p>\n<p>If someone dies of heart failure the day they get a vaccine, after struggling with heart failure for months, how likely do you think it is that someone would report to the vaccine surveillance database? After all, they just got the vaccine the day they died!</p>\n<p>Now imagine the same person dies 3 weeks after the vaccine. Who is going to think to report that as a vaccine-related death? They were probably very ill before the vaccine, very ill after, and very ill for the weeks until they eventually died.</p>\n<p>Same things go for old, boring, annual flu vaccine vs new, exciting COVID vaccines. Docs are instructed not to report deaths after a flu vaccine that are unlikely to be vaccine related since those vaccines have been given over many years without problem; the newer COVID vaccines don't come with this same guideline, so docs are likely to report deaths after the new vaccines, even if they have no reason to think they are related. They are reporting just to be safe, and it's silly to compare two vaccines reported under very different guidelines.</p>\n<p>These data are very hard to understand for these reasons, but certainly the interpretations given in those links seem very misinformed. It's crucial to know and understand where your data are coming from before reporting them. Since they clearly do not (or know and choose to mislead anyways), I don't think it's even worth investigating further. There are similar questions on Skeptics.SE if you want to find more misuse of VAERS data, just search VAERS there.</p>\n", "score": 46 }, { "answer_id": 29202, "body": "<p>VAERS has a useful purpose, but in high profile situations such as this the data is often more reflective of data collection issues rather than actual effects of vaccination.</p>\n<p>In addition to the reasons mentioned in another answer (people are more diligent about reporting incidents after the COVID vaccines because they are new and notable), note that VAERS has a literal form on a webpage where any member of the public can submit a report with no real verification/validation. This form has a notice that it is <em>illegal</em> to deliberately submit false reports, but since it is a form on the internet of course people do anyway. (As well as probably a number of people who intend to submit a correct report but have accidentally entered something incorrectly, etc.)</p>\n<p>Looking at your source of OpenVaers, there is an item in their FAQ:</p>\n<blockquote>\n<p>We do not change, modify or vet data. We take the downloads, upload them to our server and put a different face on them so they are easier to browse and get quick accurate info from. There are mistakes in the data (impossible dates are usually the most obvious), clearly, but we leave it as we get it.</p>\n</blockquote>\n<p>And a very, very quick glance at their data confirms this: from an eyeball estimate, more than 7,500 people were reported as dying from the COVID vaccine between 1990 and 2019. Since the COVID vaccine didn't exist until 2020, this is a very easy example of the data quality and reliability of reporting here.</p>\n<p>Additionally, the actual VAERS has a disclaimer that you have to click &quot;I agree&quot; to in order to access the data which elaborates on this. It reads as follows (reproducing in entirety because it's important, also as it's US gov't work it is not copyrighted):</p>\n<blockquote>\n<p>VAERS accepts reports of adverse events and reactions that occur following vaccination. Healthcare providers, vaccine manufacturers, and the public can submit reports to VAERS. While very important in monitoring vaccine safety, VAERS reports alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness. The reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable. Most reports to VAERS are voluntary, which means they are subject to biases. This creates specific limitations on how the data can be used scientifically. Data from VAERS reports should always be interpreted with these limitations in mind.</p>\n<p>The strengths of VAERS are that it is national in scope and can quickly provide an early warning of a safety problem with a vaccine.\nAs part of CDC and FDA's multi-system approach to post-licensure vaccine safety monitoring, VAERS is designed to rapidly detect unusual or unexpected patterns of adverse events, also known as &quot;safety signals.&quot; If a safety signal is found in VAERS, further studies can be done in safety systems such as the CDC's Vaccine Safety Datalink (VSD) or the Clinical Immunization Safety Assessment (CISA) project. These systems do not have the same limitations as VAERS, and can better assess health risks and possible connections between adverse events and a vaccine.</p>\n<p>Key considerations and limitations of VAERS data:</p>\n<ul>\n<li>Vaccine providers are encouraged to report any clinically significant health problem following vaccination to VAERS, whether or not they believe the vaccine was the cause.</li>\n<li>Reports may include incomplete, inaccurate, coincidental and unverified information.</li>\n<li>The number of reports alone cannot be interpreted or used to reach conclusions about the existence, severity, frequency, or rates of problems associated with vaccines.</li>\n<li>VAERS data are limited to vaccine adverse event reports received between 1990 and the most recent date for which data are available.</li>\n<li>VAERS data do not represent all known safety information for a vaccine and should be interpreted in the context of other scientific information.</li>\n</ul>\n<p>VAERS data available to the public include only the initial report data to VAERS. Updated data which contains data from medical records and corrections reported during follow up are used by the government for analysis. However, for numerous reasons including data consistency, these amended data are not available to the public.</p>\n</blockquote>\n", "score": 8 } ]

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

[ { "answer_id": 257, "body": "<p>There are the following newer studies which are related to that one from <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/2229769\" rel=\"noreferrer\">1990</a>:</p>\n<ul>\n<li><p>1992: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/1550021\" rel=\"noreferrer\">Usefulness of predischarge electrophysiologic study in predicting late outcome after surgical ablation of the accessory pathway in the Wolff-Parkinson-White syndrome</a>,</p>\n</li>\n<li><p>1992: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/1382283\" rel=\"noreferrer\">Diagnosis and localization of accessory pathways.</a></p>\n<blockquote>\n<p>The WPW syndrome is a curable disease. The evolution of nonpharmacological methods of accessory pathway ablation has had a significant impact on management strategies in patients with arrhythmias mediated by accessory pathways. Despite an incidence of preexcitation in the general population of 0.1% to 0.3%, curative therapy is underutilized. This review has highlighted the traditional and newer methods of diagnosing and localizing accessory pathways.</p>\n</blockquote>\n</li>\n<li><p><strong>1992: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/1416552\" rel=\"noreferrer\">Wolff-Parkinson-White disease in childhood: follow up of 36 cases</a></strong></p>\n<blockquote>\n<p>We have studied 36 patients (19 females and 17 males), controlled between 1973 and 1989, who suffered Wolff-Parkinson-White (WPW) pattern in their electrocardiogram. Epidemiological, clinical, diagnostic, therapeutic and evolutional data were reviewed. The mean age at the time of diagnosis was 4 years and 3 months, with 48% younger than six months of age. The average time for the follow-up period was 4 years and 2 months. There was not familiar occurrence. Six (16%) of the patients had associated heart disease. Seventeen (47%) had type A of WPW, 12 (33%) type B and 7 (20%) were not defined. An echocardiographic study was done in 20 patients (61%). Twenty-seven patients (75%) showed supraventricular tachycardia (SVT), which in 22 of these cases was the reason for seeking consultation. Children without SVT, 9 (25%), did not need any form of treatment. Twenty-four (889) of the patients with SVT required treatment to prevent recurrence. In the 27 studied episodes of SVT, Verapamil IV (55%) and vagal manoeuvres were the most efficient treatments. Seventeen (47%) of the patients presented a persistent WPW pattern and 11 (31%) experienced a normalization of their electrocardiogram with a mean time of 2 years-2 months.</p>\n</blockquote>\n</li>\n<li><p>1994: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8037505\" rel=\"noreferrer\">Surgical treatment of Wolff-Parkinson-White syndrome in infants and children.</a></p>\n</li>\n<li><p>1998: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/9579160\" rel=\"noreferrer\">Tuberous sclerosis complex and Wolff-Parkinson-White syndrome.</a></p>\n<blockquote>\n<p>Ten patients with concurrent diagnoses of Wolff-Parkinson-White syndrome and tuberous sclerosis were identified. Wolff-Parkinson-White syndrome presented early in life, nine cases being diagnosed in the first year. Eight of the 10 cases were male. In eight cases, the syndrome was associated with supraventricular tachycardias, and in nine with cardiac rhabdomyomata. One child died from cardiac failure secondary to obstruction of the left ventricular outflow tract by a rhabdomyoma. Five of nine survivors showed resolution of Wolff-Parkinson-White syndrome on follow up.</p>\n</blockquote>\n</li>\n<li><p>2007: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17972375\" rel=\"noreferrer\">Wolff-Parkinson-White syndrome in Ebstein's anomaly</a></p>\n</li>\n</ul>\n<p>There are no specific newer studies which relates to recurrence for patients given drugs compares to those without drugs, however study from 1992 has some follow-up of 36 cases of patients from 1973-1989 who suffered WPW which could be some interest for you.</p>\n", "score": 5 } ]

[ "clinical-study" ]

[ { "answer_id": 44, "body": "<p>The <a href=\"http://www.webmd.com/diabetes/guide/type-1-diabetes-cause\" rel=\"nofollow noreferrer\">short answer</a> is that Type 1 diabetes is an <a href=\"http://en.wikipedia.org/wiki/Autoimmune_disease\" rel=\"nofollow noreferrer\">autoimmune disease</a>, a disease that is caused by the body's own immune system attacking and destroying insulin-producing cells, called <a href=\"http://en.wikipedia.org/wiki/Beta_cell\" rel=\"nofollow noreferrer\">beta cells</a> (which are located in the <a href=\"http://en.wikipedia.org/wiki/Islets_of_Langerhans\" rel=\"nofollow noreferrer\">islets of Langerhans</a>).1</p>\n\n<p>What, exactly, kicks off this autoimmune response <a href=\"http://en.wikipedia.org/wiki/Diabetes_mellitus_type_1#Cause\" rel=\"nofollow noreferrer\">is as yet unclear</a>. Some options are <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20432533\" rel=\"nofollow noreferrer\">genes</a>, and different components of the environment, like <a href=\"http://www.nature.com/ni/journal/v3/n4/full/ni0402-338.html\" rel=\"nofollow noreferrer\">viruses</a>, and certain <a href=\"http://hazmap.nlm.nih.gov/category-details?id=6918&amp;table=copytblagents\" rel=\"nofollow noreferrer\">chemicals</a> and <a href=\"http://en.wikipedia.org/wiki/Streptozotocin\" rel=\"nofollow noreferrer\">drugs</a>.</p>\n\n<hr>\n\n<p>According to diabetes professional <a href=\"https://twitter.com/darthskeptic\" rel=\"nofollow noreferrer\">@darthskeptic</a>:</p>\n\n<blockquote>\n <p>That candy won't give you diabetes.</p>\n \n <p>Unless it's molded into a blade, hardened, sharpened, then used to\n remove your pancreas.</p>\n</blockquote>\n\n<p>(<em><a href=\"https://twitter.com/darthskeptic/status/508508744100347904\" rel=\"nofollow noreferrer\">6 Sep 2014</a></em>)</p>\n\n<p>See <a href=\"https://health.stackexchange.com/q/51/49\">Is there evidence that eating too much sugar can increase the risk of diabetes?</a> for info on Type 2 Diabetes.</p>\n\n<hr>\n\n<p>1 Funny what I could have told you as a five-year-old</p>\n", "score": 8 }, { "answer_id": 542, "body": "<h3>Introduction</h3>\n\n<p>Diabetes is a lifelong condition that causes a person's blood sugar (glucose) level to become too high.</p>\n\n<p>There are two types of diabetes:</p>\n\n<ul>\n<li><strong>Type 1</strong> (previously known as insulin-dependent, juvenile or childhood-onset) – where the pancreas doesn't produce any insulin (10% of all diabetes, often inherited/genetic)</li>\n<li><strong>Type 2</strong> – where the pancreas doesn't produce enough insulin or the body’s cells don't react to insulin</li>\n</ul>\n\n<p>It's very important to be diagnosed as soon as possible, as it can get progressively worse if left untreated.</p>\n\n<p>Type 1 diabetes can develop at any age (usually before age of 40), particularly in childhood (that's why it's called juvenile).</p>\n\n<h3>Causes of type 1 diabetes</h3>\n\n<p>Type 1 diabetes is an <a href=\"https://en.wikipedia.org/wiki/Autoimmune_disease\" rel=\"noreferrer\">autoimmune condition</a> which arise from an autoimmune disease or virus infection<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11919574\" rel=\"noreferrer\">2002</a> and as a result of the body's pancreas is unable to produce insulin to be converted into energy and without insulin your body will break down its own fat and muscle, resulting in weight loss. In other words glucose can't be moved out of your bloodstream into your cells.</p>\n\n<p>The main cause of type 1 diabetes is unknown<a href=\"http://www.who.int/mediacentre/factsheets/fs312/en/\" rel=\"noreferrer\">WHO</a>. However a number of theories explains that cause may be one of the following:</p>\n\n<ul>\n<li><p>genetic susceptibility,</p>\n\n<blockquote>\n <p>Balance between regulatory and effector T cells determines disease risk, timing of disease activation, and disease tempo<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20432533\" rel=\"noreferrer\">2010</a>.</p>\n</blockquote></li>\n<li><p>a diabetogenic trigger (such as virus infection<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11919574\" rel=\"noreferrer\">2002</a>),</p>\n\n<blockquote>\n <p>Evidence is emerging that insulin-producing beta cells are highly susceptible to acute infection by <a href=\"https://en.wikipedia.org/wiki/Coxsackievirus\" rel=\"noreferrer\">Coxsackie virus</a> if their production of interferon is inhibited, resulting in diabetes. Coxsackie B viruses (CVBs) have been implicated in human diabetes and can induce diabetes in animal models, which provides a strong basis for virus involvement<a href=\"http://www.nature.com/ni/journal/v3/n4/full/ni0402-338.html\" rel=\"noreferrer\">Nature</a></p>\n</blockquote>\n\n<p>This relationship is currently being studied further.</p></li>\n<li><p>environmental<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17941471\" rel=\"noreferrer\">2007</a> (such as exposure to an antigen<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16306330\" rel=\"noreferrer\">2005</a>).</p>\n\n<blockquote>\n <p>Other factors possibly playing a role in modifying the development of the disease are vaccinations, psychological stress and climatological factors.</p>\n \n <p>It may partly explain why the disease incidence increased has so much in the last three decades despite markedly improved hygiene and health care standards.<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17941471\" rel=\"noreferrer\">2007</a></p>\n</blockquote></li>\n</ul>\n\n<p>Read more:</p>\n\n<ul>\n<li><a href=\"http://www.nhs.uk/conditions/Diabetes-type1/Pages/Introduction.aspx\" rel=\"noreferrer\">Introduction</a> &amp; <a href=\"http://www.nhs.uk/Conditions/Diabetes-type1/Pages/Causes.aspx\" rel=\"noreferrer\">Causes of type 1 diabetes</a> at NHS</li>\n<li><a href=\"https://en.wikipedia.org/wiki/Diabetes_mellitus_type_1\" rel=\"noreferrer\">Diabetes mellitus type 1</a> at Wikipedia</li>\n</ul>\n", "score": 4 } ]

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

[ { "answer_id": 333, "body": "<p>Two important questions:</p>\n\n<ul>\n<li>Has AST/ALT elevation been present only once in blood sample?</li>\n<li>Is the elevation more than 3x the upper limit?</li>\n</ul>\n\n<p>Basis for \"normal\" values should be understood. \"Normal\" values indicate confidence interval which includes 95% of healthy individuals. As so, any blood test with slightly elevated value may be normal, since all healthy individuals does not belong to the 95% confidence interval on which the \"normal\" values are based. As so you should not be automatically concerned if your blood level is above \"normal\". Of course this does not imply that fact that you should refer to your GP for more information and further investigation.</p>\n", "score": 4 } ]

[ "blood-tests", "liver" ]

[ { "answer_id": 280, "body": "<p>Probably some of the more common causes would be poor diet and lack exercise. Not everyone who eats poorly and doesn't exercise will be over weight since genetics plays a role. That is, a young adult can appear to be healthy but be internally suffering. Another question would be is this otherwise health individual a smoker?</p>\n<blockquote>\n<p>Two recent studies confirm the blood pressure benefits of maintaining a healthy diet. First is the Dietary Approaches to Stop Hypertension (DASH) clinical study, which tested the effects of food nutrients on blood pressure. It emphasizes consumption of fruits, vegetables, and lowfat dairy foods, whole grains, poultry, fish, and nuts, and stresses reduction of fats, red meats, sweets, and sugared beverages.</p>\n<p>Second is the DASH-sodium study, which demonstrates the importance of lowering sodium (salt) intake. Most Americans consume far more than the current, daily recommendation of 2,400 milligrams (mg) of sodium—about a teaspoon of table salt—or less. This includes all salt and sodium consumed, not just at the table, but also in cooking. For those with high blood pressure, consuming even less may be advisable, since the DASH-sodium study revealed that diets containing no more than 1,500 mg of sodium per day had still greater pressure-lowering effects.</p>\n<p>Regular physical activity is another good step toward controlling or even preventing high blood pressure. Start with 30 minutes of moderate-level activity, such as brisk walking, bicycling or gardening on most—preferably all—days of the week. The activity even may be divided into three, 10-minute periods each. For added benefit, these moderate half-hours may be increased or supplanted by regular, vigorous exercise. Of course, prior to upping the activity level, people should check with their physicians, especially if they have had heart trouble or a previous heart attack, a family history of heart disease at an early age, or other serious health problems.</p>\n<p>Another healthy move is to limit alcohol intake. Excess alcohol can raise blood pressure as well as damage the liver, heart, and brain. Drinks should be kept to a maximum of one per day for women, and two for men. (One drink equals 12 ounces of beer or five ounces of wine.)</p>\n<p>Finally, quit smoking. Among other things, smoking damages blood vessel walls and speeds hardening of the arteries. Ceasing smoking reduces the risk of heart attack in just one year <a href=\"http://www.nlm.nih.gov/medlineplus/magazine/issues/fall11/articles/fall11pg10-11.html\" rel=\"noreferrer\">[1]</a>.</p>\n</blockquote>\n<p>I would say this would probably be the most common causes of a young, health adult presenting with asymptomatic hypertension; however, there can be other reasons as well. For instance, another cause could be <a href=\"http://en.wikipedia.org/wiki/Paraganglioma\" rel=\"noreferrer\">paraganglioma</a>. The NIH presented a case of a 19 year old female with asymptomatic severe hypertension in 2010. The woman had a BP of 220/140 mmHg. Her lab results showed elevated plasma norepinephrine, 1807 pg/ml, and 24h urinary free catecholamines, 483 ug/24h. After resection of the tumor, the patients BP was normal during followup. You can read the entire article <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031332/\" rel=\"noreferrer\">here</a> which is rather interesting.</p>\n<ul>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031332/\" rel=\"noreferrer\">Paraganglioma in a young patient with asymptomatic severe hypertension: a case report and review of the literature</a></li>\n</ul>\n<p>Whoever is experience high blood pressure should definitely consult a physician since untreated high blood pressure can result in organ damage <a href=\"http://www.aafp.org/afp/2010/0215/p470.html\" rel=\"noreferrer\">[2]</a>, <a href=\"http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868\" rel=\"noreferrer\">[3]</a></p>\n<p>Additionally reading on paraganalioma.</p>\n<ul>\n<li><a href=\"http://www.cancer.gov/cancertopics/pdq/treatment/pheochromocytoma/Patient/page1\" rel=\"noreferrer\">http://www.cancer.gov/cancertopics/pdq/treatment/pheochromocytoma/Patient/page1</a></li>\n<li><a href=\"http://ghr.nlm.nih.gov/condition/nonsyndromic-paraganglioma\" rel=\"noreferrer\">http://ghr.nlm.nih.gov/condition/nonsyndromic-paraganglioma</a></li>\n<li><a href=\"http://ghr.nlm.nih.gov/condition/hereditary-paraganglioma-pheochromocytoma\" rel=\"noreferrer\">http://ghr.nlm.nih.gov/condition/hereditary-paraganglioma-pheochromocytoma</a></li>\n</ul>\n", "score": 6 } ]

[ "hypertension" ]

[ { "answer_id": 261, "body": "<p>Paresthesia can be caused by inactivity, sustained pressure on the nerve, neurological disorder, or nerve damage. </p>\n\n<p>If the causes is from pressure, the user <a href=\"https://biology.stackexchange.com/users/5694/v-ix\">V_ix</a> on Biology gave the following answer <a href=\"https://biology.stackexchange.com/a/16082/12909\">here</a> which I have quoted:</p>\n\n<blockquote>\n <p>Underneath the superficial layers of your skin there are receptors which sense pressure, temperature and pain. These receptors are part of the peripheral nervous system which senses stimuli and they take the message conveying details about the stimulus to the somatosensory cortex of the brain. Here is where the perception of pain, burning, pressure etc is ultimately made. To take the simplest example, if you stop blood flow for a short amount of time in a limb, these receptors are activated, and will send signals to the brain that are interpreted as tingling or numbness. With more severe pain, different receptors are activated which , again, project to the same brain area but a different message is read out. If the pressure from one limb is removed, the receptors will go back to normal function as blood flow is restored.</p>\n</blockquote>\n\n<p>If what you experience is chronic, you may need to see your healthcare provider in order to rule out a neurological disorder or nerve damage. You can find more information on paresthesia from the National Institute of Neurological Disorders and Stroke as well as clinical trials if you are really concerned about this on their site:</p>\n\n<ul>\n<li><a href=\"http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm\" rel=\"nofollow noreferrer\">http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm</a></li>\n</ul>\n", "score": 10 } ]

[ "feet", "nerves" ]

[ { "answer_id": 294, "body": "<p>In this case 8400 kJ or 2000 kcal indicates the amount energy what an AVERAGE weighing human doing AVERAGE amount of work per day needs to meet his/her <em>basal metabolic rate</em>. As so when daily input of energy is 8400 kJ / 2000 kcal this AVERAGE (wo)man neither gains or loses weight.</p>\n\n<p>There are so many factors influencing this basal metabolic rate that I wont dig in to those. Basically these reference values are VERY vague, since same reference dont apply to man weighing 200kg, doing hard manual labor compared to 45kg weighing woman doing nothing demanding work. But naturally byrocrats need some reference values to be able give some guidelines what food should be offered to students in schools and old people in retirement homes.</p>\n\n<p>Each domain of this reference intake is then calculated or defined against current evidence in literature. Humans need salt, but salt intake of >6g is known to cause CV diseases and hypertension <a href=\"http://www.who.int/elena/titles/sodium_cvd_adults/en/\" rel=\"noreferrer\">(Evidence for Nutrition Actions)</a>. Human needs fat but excessive amount of especially saturated fats leads to heart disease and high cholesterol <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002137.pub3/abstract;jsessionid=08A1F0F5920E6521FD39681C07A5B68A.f01t01\" rel=\"noreferrer\">(Cochrane Heart Group) </a>. Too much protein can affect kidney function in population level <a href=\"http://www.efsa.europa.eu/en/efsajournal/pub/2557.htm\" rel=\"noreferrer\">(EFSA Panel on Dietetic Products, Nutrition and Allergies)</a>. Then the remaining energy intake should come from carbohydrates, maily food substances with low glygemic index <a href=\"http://jaha.ahajournals.org/content/1/5/e000752.full\" rel=\"noreferrer\">(J Am Heart Assoc.\n2012,</a><a href=\"http://care.diabetesjournals.org/content/27/11/2701.full\" rel=\"noreferrer\">Diabetes Care November 2004) </a>. </p>\n\n<p>So these values are not maximum, they are not minimum but they give the RATIO how you should eat carbohydrates, fat and protein in order to avoid life-style related diseases. The more you weigh, the more you need energy. The harder you work the more you need energy. The more you do strength trainig the more you need proteins. The more you do long duration exercises the more you need carbohydrates.</p>\n", "score": 5 } ]

[ "nutrition", "labeling" ]

[ { "answer_id": 518, "body": "<p>If you look at the factors that cause an <a href=\"http://en.wikipedia.org/wiki/Acute_exacerbation_of_chronic_obstructive_pulmonary_disease\">acute exacerbation of Chronic Obstructive Pulmonary Disease</a> (such as bronchitis), you will find that</p>\n\n<ol>\n<li><p>The cause can not be identified in one third of the cases. In the ones with identifiable causes, they may be</p></li>\n<li><p>Respiratory infections (bacterial and viral)</p></li>\n<li><p>Allergy</p></li>\n<li><p>Toxins</p></li>\n<li><p>Non adherenace to medications. </p></li>\n</ol>\n\n<p>When I read through the technique you were talking about, I found that there is no such risk factors in that technique. However, you should take the following precautions:</p>\n\n<ol>\n<li><p>Avoid this exercise when you have an active acute exacerbation of the disease. Fast breathing causes <a href=\"http://en.wikipedia.org/wiki/Airway_resistance\">airways to collapse</a> by Bernoulli's principle, and hence you will have more difficulty breathing. Even though it can potentially clear your airway, it is better avoided at that times.</p></li>\n<li><p>Make sure that you sit in a place with clean air when you do this exercise. You don't want allergens, toxins or even pathogens in the air entering your lungs when you are breathing like that.</p></li>\n<li><p>No cold exposure. Cold exposure can trigger a vasovagal attack and can cause constriction of airways. This can even precipitate an acute attack. So a big no no to that. </p></li>\n<li><p>Even though it is a no brainer, it is important that you monitor yourself all the time. If you feel not so good, stop immediately. </p></li>\n</ol>\n\n<p>Other than that, it is generally considered a safe practice to do breathing exercises, and are sometimes adviced to patients of bronchitis. If you follow these precautions, you should be fine. </p>\n", "score": 8 } ]

[ "breathing", "lungs" ]

[ { "answer_id": 353, "body": "<p>Your nose is impressively compressible! However, if you don't have any other problems, there's nothing wrong with that.</p>\n\n<p>You're young, and have less bone and more cartilage in your nose relative to it's size than adults have. If you find and press the noses of other kids your age, then do so with adults, you'll notice a significant difference between the adults and the kids, though not all of the kids' noses will flatten as much as yours.</p>\n\n<p>Though noses are different, in this picture you can see a woman and a young child. Their noses are quite different in length. The baby's would be very compressible. The woman, not so much. </p>\n\n<p><img src=\"https://i.stack.imgur.com/v3L7S.jpg\" alt=\"enter image description here\"></p>\n\n<p>This is a young woman's nose with the underlying structures labeled. The septal cartilage, from the top almost to the bottom between the nostrils and the two upper lateral nasal cartilages fuse together and to the nasal bone. (The lower nasal cartilages don't fuse, so the tip of the nose always stays very flexible. Your lower nasal cartilages make up more of your nose than hers, so more of your nose is flexible.) </p>\n\n<p>Your nose will be bendable depending on how long your nasal bone is - it's longer in some than in others, and it's longer in adults than kids. Your nasal bone - the really hard part that projects down from between your eyebrows - may be short, making your nose more compressible.</p>\n\n<p><img src=\"https://i.stack.imgur.com/SSuyk.jpg\" alt=\"enter image description here\"></p>\n\n<p>I said in the beginning \"if you don't have any other problems\". Place your index finger on your upper lip and press hard enough that you can feel your teeth and gums. Now move your whole finger up toward the columulla (it separates the two nostrils on the outside.) Did you feel a hard bone above your lip (it's kind of triangle shaped with the base - against your lip - wider than the tip (which fuses with the septal cartilage.) If you don't have a bone there, you should ask your doctor to check your nose just in case.</p>\n\n<p>Congenital anomalies of the nose are very rare and occur in 1/20,000\nto 1/40,000 newborns, so it's highly unlikely you have one. Most of the time they are associated with other facial problems, for example a small chin (I can see yours, and it's fine). If you can breathe normally through your nose, and the only trick you can do with your body is to flatten your nose (great party trick!) you are just fine.</p>\n\n<p>_{<a href=\"http://www.researchgate.net/publication/51141251_Isolated_congenital_partial_absence_of_the_left_lower_lateral_nasal_cartilage_case_report\" rel=\"noreferrer\">Isolated congenital partial absence of the left lower lateral nasal cartilage: case report</a>}<br>\n_{<a href=\"http://emedicine.medscape.com/article/837236-overview\" rel=\"noreferrer\">Congenital Malformations of the Nose</a>}</p>\n", "score": 14 } ]

[ "nose" ]

[ { "answer_id": 398, "body": "<h2>Get to a doctor or dermatologist straight away</h2>\n<p>A changing mole is an indicator of possible melanoma. Melanoma spreads very quickly, and mortality rates rise fast if it is left to grow.</p>\n<p><a href=\"http://www.nhs.uk/Conditions/Moles/Pages/Introduction.aspx\" rel=\"noreferrer\">Here is some information on what to look for, and potential indicators of melanoma</a> (UK NHS).</p>\n<blockquote>\n<p>Melanomas usually appear as a dark, fast-growing spot where there was not one before, or a pre-existing mole that changes size, shape or colour and bleeds, itches or reddens.</p>\n</blockquote>\n<p>A specialist will be able to do a diagnosis, and advise you on future checks. If they think it could be a melanoma, they will remove the mole and perform a biopsy.</p>\n", "score": 7 } ]

[ "dermatology" ]

[ { "answer_id": 421, "body": "<p>First, what is radiation?</p>\n\n<p><a href=\"http://www.oxforddictionaries.com/definition/english/radiation\" rel=\"nofollow\">Oxford Dictionaries</a></p>\n\n<blockquote>\n <p>the emission of energy as electromagnetic waves or as moving subatomic particles, especially high-energy particles which cause ionization.</p>\n</blockquote>\n\n<p>okay, so do mobile phone towers use this?</p>\n\n<p><a href=\"http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/cellular-phone-towers\" rel=\"nofollow\">American Cancer Society</a></p>\n\n<blockquote>\n <p>Cell phones communicate with wave in the electromagnetic spectrum, with a slightly higher wavelength than, but less than microwaves.</p>\n</blockquote>\n\n<p>So they do, but...</p>\n\n<blockquote>\n <p>Like FM radio waves, they are forms of non-ionizing radiation. This means <strong>they cannot cause cancer by directly damaging DNA</strong>.</p>\n</blockquote>\n\n<p>Hmm, so they don't cause cancer. What other health issues?</p>\n\n<blockquote>\n <p>At ground level near typical cellular base stations, the amount of energy is thousands of times less than the limits for safe exposure set by the regulatory authorities. It is very unlikely that a person could be exposed to RF levels in excess of these limits just by being near a cell phone tower.</p>\n</blockquote>\n\n<p>So not only is it not a huge amount (most goes over your head), the radiation is pretty safe.</p>\n", "score": 3 }, { "answer_id": 779, "body": "<p>Many countries have done studies that seem to indicate short-term exposure to the radiation does not increase risk of cancer.</p>\n\n<ul>\n<li>(German) <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16443797\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/16443797</a></li>\n<li>(Danish) <a href=\"http://jnci.oxfordjournals.org/content/98/23/1707.abstract\" rel=\"nofollow\">http://jnci.oxfordjournals.org/content/98/23/1707.abstract</a></li>\n<li>(Swedish) <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15746469\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/15746469</a></li>\n<li>(US) <a href=\"http://www.cancer.gov/newscenter/newsfromnci/2012/GliomaCellPhoneUse\" rel=\"nofollow\">http://www.cancer.gov/newscenter/newsfromnci/2012/GliomaCellPhoneUse</a></li>\n</ul>\n\n<p>However, some countries are still uncertain about this, and have requested companies move their towers away from people by at least 100 meters.</p>\n\n<p>An Italian court even acknowledged a \"causal\" link:\n<a href=\"http://www.prlog.org/12004383-italian-supreme-court-rules-cell-phones-can-cause-cancer.html\" rel=\"nofollow\">http://www.prlog.org/12004383-italian-supreme-court-rules-cell-phones-can-cause-cancer.html</a>\nbut this has been deeply criticized by public health leaders in places like the US.</p>\n\n<p>For the most part, there hasn't been substantial evidence to say that the towers cause harm to humans more than 100 meters away. Particularly in the case of short-distance exposure, there hasn't been much data because many times base stations are not turned off during maintenance, but the power being sent through to the antennas is cut off, so that the workers do not have to work near live antennas, but a study over around 50 years of people exposed to Radio Frequency (RF) waves indicates no significant negative consequences. In the conclusion the author notes a well-worded disclaimer:</p>\n\n<blockquote>\n <p>The controversy about cell phones and cancer is likely to\n continue either until clear-cut evidence of a hazard is established or\n until the public (including politicians, businessmen, lawyers and\n journalists) concludes that there is little likelihood of a real and\n significant hazard. Perhaps the greatest contribution that scientists\n can make to this debate is to help educate the public (and other\n scientists) about the uncertain nature of risk assessment, and about the\n breadth of disciplines and rigor of analysis that must be brought to\n bear if high-quality risk assessment is to be accomplished.</p>\n</blockquote>\n\n<p>Comes from the following article (same one, two different links):\n<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10319725?dopt=AbstractPlus\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/10319725?dopt=AbstractPlus</a>\n<a href=\"http://www.jstor.org/stable/3580028?origin=crossref&amp;seq=1#page_scan_tab_contents\" rel=\"nofollow\">http://www.jstor.org/stable/3580028?origin=crossref&amp;seq=1#page_scan_tab_contents</a></p>\n\n<p>There have been studies done on animals with respect to RF exposure with possible consequences that you can read about on wikipedia:\n<a href=\"http://en.wikipedia.org/wiki/Mobile_phone_radiation_and_health#cite_note-95\" rel=\"nofollow\">http://en.wikipedia.org/wiki/Mobile_phone_radiation_and_health#cite_note-95</a></p>\n\n<p>but when we're talking about these levels of radiation, you would have to be extremely close for an extended period of time, which is why we haven't yet found results in humans. For the most part, we don't stay close enough to have measurable results and those who do take precautions and avoid long-term exposure.</p>\n", "score": 2 } ]

[ "side-effects", "bioelectromagnetics" ]

[ { "answer_id": 451, "body": "<p>If you must use both to maximally remove infectious organisms from the hands, it's best to wash hands with soap and water, dry, then apply hand sanitizer and allow to air-dry on the skin. </p>\n\n<p>This is because dirt, food, oils, etc. on your hands can make the sanitizers less effective. If you first wash your hands to remove barriers to their effectiveness, the sanitizer will be more useful.</p>\n\n<p>In a non-hospital setting, though, it's unnecessary to wash with soap and water <strong>and</strong> use a hand sanitizer. For the most part, proper hand washing is as good or better than using hand sanitizers at removing bacteria and viruses from your hands.¹ </p>\n\n<blockquote>\n <p>Research has shown that hand sanitizers can be as effective as hand washing only in certain situations.</p>\n</blockquote>\n\n<p>The major problem is that many people don't take the time to thoroughly wash their hands.</p>\n\n<p>Reasons to use both include:</p>\n\n<blockquote>\n <ul>\n <li>coming in close physical contact with persons at high risk for infection (such as newborns, the very old, the ill, or the immunosuppressed)</li>\n <li>having direct physical contact with someone with an upper respiratory infection, skin infection or diarrhea,</li>\n <li>working in settings where infectious diseases are commonly transmitted, such as food preparation, and/or crowded living areas (child-care centers, preschools, prisons, or chronic-care residences), or</li>\n <li>when you're uncertain if the water you're using to wash your hands is drinking-water clean (e.g. after a flood or when you have a \"boil water\" advisory.</li>\n </ul>\n</blockquote>\n\n<p>^{How to wash hands properly: 1. Wet hands with clean, running water (warm or cold), turn off the tap, and apply soap. 2. Lather your hands by rubbing them together with the soap. <strong>Be sure to lather the backs of your hands, between your fingers, and under your nails.</strong> 3. Scrub your hands for at least 20 seconds. Need a timer? Hum the \"Happy Birthday\" song from beginning to end twice. 4. Rinse your hands well under clean, running water. 5. If you're using a tap, turn water off with a paper towel. 6. Dry your hands using a clean (new) towel or air dry them.}</p>\n\n<p>_{<a href=\"http://edis.ifas.ufl.edu/fy732\">1 Hand Hygiene and Hand Sanitizers</a>}<br>\n_{<a href=\"http://www.cdc.gov/features/handwashing/\">Wash Your Hands - CDC</a>}</p>\n", "score": 13 } ]

[ "sanitation", "disinfection" ]

[ { "answer_id": 1519, "body": "<p>The most clearly effective stimulating (energizing) herbs have run into legal restrictions, at least in the United States. The most notorious is the leaf of the E. coca tree, which contains cocaine. Another stimulating herb more recently banned is Catha edulis (Khat) which contains cathinone. The chemically similar stimulant ephedrine is the active constituent of Ephedra sinica (Mormon Tea), which has had sales restricted in recent years. Ephedra is used instead of black tea (Camellia sinensis) by Mormons because of their restriction against consuming caffeine. Psychedelics like mecsaline found in the common San Pedro cactus (Trichocereus pachanoi), or ibogaine in Tabernanthe iboga, tend to be stimulating at doses below the psychedelic dose but are technically illegal to make tea from.</p>\n\n<p>Stimulating herbs which have been legally ignored tend to have unwanted side effects, at least in comparison with caffeine. The bark of Pausinystalia yohimbe contains the adrenergic stimulant yohimbine, commonly marketed as a sex enhancer. Herbs like Nux vomica, which contains the convulsive stimulant strychnine, is certainly available, especially as rat poison. Species containing ketones like camphor (Cinnamomum camphora) and thujone (Artemisia absinthium - the key ingredient wormwood used in absinthe) are said to be toxic but stimulating.</p>\n\n<p>Many other herbs have been promoted as stimulating, sedating, etc., without there being clear proof that they are more than placebos. I believe I have tried all the herbs in your list of suggestions but didn't notice any stimulating or other effects from them. Ginseng is commonly claimed to be stimulating but I haven't noticed any effect.</p>\n", "score": 3 }, { "answer_id": 18753, "body": "<p>According to this paper by Moss et al. (2016) <a href=\"http://nrl.northumbria.ac.uk/35632/1/Moss%20et%20al%20-%20Peppermint%20and%20Chamomile%20teas%20OA.pdf\" rel=\"nofollow noreferrer\">1</a> peppermint tea has energizing properties. The molecular mechanism by which this effect is exerted is summarized in its discussion part:</p>\n\n<blockquote>\n <p>Active compounds identified in Peppermint include menthol, menthone, 1,8 – cineole and rosmarinic acid, the latter two of which have been shown to possess cholinergic agonist properties via the inhibition of acetylcholine esterase activity (Perryet al., 2003; Orhan et al., 2008). Such a mechanism could underpin the cognitive effects observed here and elsewhere as acetylcholine is the fundamental memory neurotransmitter, whilst the dopaminergic influence of menthol and menthone might be independently reflected in the subjective ratings of alertness.</p>\n</blockquote>\n\n<p>Another paper by Kennedy et al. (2011) <a href=\"https://www.researchgate.net/profile/Andrew_Scholey/publication/5502737_An_extract_of_Salvia_sage_with_anticholinesterase_properties_improves_memory_and_attention_in_healthy_older_volunteers/links/0fcfd50db9948809e5000000.pdf\" rel=\"nofollow noreferrer\">2</a> suggests the same for Salvia officinalis, commonly known as sage. They state that: </p>\n\n<blockquote>\n <p>The current study combined an in vitro investigation of the cholinesterase inhibitory properties and phytochemical constituents of a S. lavandulaefolia essential oil, with a double-blind, placebo-controlled, balanced crossover study assessing the effects of a single dose on cognitive performance and mood. In this latter investigation 36 healthy participants received capsules containing either 50mL of the essential oil or placebo on separate occasions, 7 days apart. Cognitive function was assessed using a selection of computerized memory and attention tasks and the Cognitive Demand Battery before the treatment and 1-h and 4-h post-dose. The essential oil was a potent inhibitor of human acetylcholinesterase (AChE) and consisted almost exclusively of monoterpenoids. Oral consumption lead to improved performance of secondary memory and attention tasks, most notably at the 1-h post-dose testing session, and reduced mental fatigue and increased alertness which were more pronounced 4-h post-dose. These results extend previous observations of improved cognitive performance and mood following AChE inhibitory sage extracts and suggest that the ability of well-tolerated terpenoid-containing extracts to beneficially modulate cholinergic function and cognitive performance deserves further attention</p>\n</blockquote>\n", "score": 3 } ]

[ "nutrition", "tea" ]

[ { "answer_id": 824, "body": "<p>In March, journal \"Molecular and Cellular Neuroscience\" published three reviews in Article in Press -section related directly to this topic <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25770439\" rel=\"nofollow\">(Ling et al. 2015, </a><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25758552\" rel=\"nofollow\">Daneshvar et al. 2015, </a><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25748121\" rel=\"nofollow\">Gardner and Yaffe 2015)</a>.</p>\n\n<p>There is major epidemiological evidence stating the association between moderate or traumatic brain injury (TBI) and neurogenerative diseases such as Alzheimers (AD) and Parkinsons disease (PD) (Gardner and Yaffe 2015). </p>\n\n<p>There are several studies investigating association between one time MTBI and dementia. Schofield and co-coworkers stated \"Incident Alzheimer's disease was significantly associated with head injury which occurred within the preceding 30 years\" <a href=\"http://jnnp.bmj.com/content/62/2/119.long\" rel=\"nofollow\">(Schofield et al. 1997)</a>. There have been many recent studies in this topic. Lee et al. stated \"TBI is an independent significant risk factor of developing dementia even in the mild type\" <a href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062422\" rel=\"nofollow\">(Lee al al. 2013)</a>. Nordströn et al. stated \"In the present study, we found strong associations between YOD (young onset dementia) of non-AD forms and TBIs of different severity\" <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24812697\" rel=\"nofollow\">(Nordström et al. 2014)</a>.</p>\n\n<p>All these studies are cited in recent literature review in which authors state \"Taken together, these studies suggest that there is likely a small, but significant, risk of dementia following a single MTBI that is not solely due to reverse-causation or confounding. It is likely, however, that younger adults may be more resilient or may take longer to develop dementia than older adults who sustain a MTBI\" (Gardner and Yaffe 2015). </p>\n\n<p>CTE (Chronic traumatic encephalopathy) is a neurogenerative disease linked to exposure to repetitive MTBI <a href=\"http://en.wikipedia.org/wiki/Chronic_traumatic_encephalopathy\" rel=\"nofollow\">(Wikipedia)</a>. CTE has been associated with mood, behavior, cognitive, and/or motor symptoms (including parkinsonism and/or motor neuron disease). CTE is officially <em>a postmortem</em> diagnosis. Prevalance of CTE among former professional American football players have ranged from 50% to 97%. In one study stage of CTE was associated to years of football exposure, \"lending weight to a true causal association\" (Gardner and Yaffe 2015). </p>\n\n<p>As so there is mounting evidence of the association between (repetitive) MTBI and neurogenerative diseases but there are many epidemiological (\"secular trends\",\"reverse-causation\") and study protocol related (clinical criteria for CTE, quantification of MTBI) issues which warrant further research in this topic. Authors of the recent review state \"Recently, large epidemiological studies have reported that MTBI and repetitive MTBI are also significant risk factors for neurodegenerative diseases, but these associations are not yet aswell established and require further replication\" (Gardner and Yaffe 2015). </p>\n", "score": 4 } ]

[ "head-trauma" ]

[ { "answer_id": 664, "body": "<p>What you have is called a subungual hematoma; that's just a fancy way of saying <em>a collection of blood under the nail</em>. It may happen with any kind of direct trauma, including (perhaps the worst?) a broken toe. It is similar to any other injury causing bleeding; the major difference is you can actually see the dark blood because the nail is transparent.</p>\n\n<p>Yes, it will disappear by itself, but as already noted by @JohnP, it will take a long time, as the clotted, thickened blood residue will be pulled towards the tip of the toe at the same rate that your toenail grows. </p>\n\n<p>This is a picture of a subungual hematoma (SUH) after six months of growth:</p>\n\n<p><img src=\"https://i.stack.imgur.com/qacCU.jpg\" alt=\"enter image description here\"> </p>\n\n<p>As you can see, there is a nice, normal nail growing out. I will hazard a guess that this particular injury was a lot like yours by the ridge formed across the top of the new nail. This indicates that the nail was lifted slightly off the nail plate. Also, this is a <em>very</em> slow growing nail.</p>\n\n<p>Your SUH needs no treatment this far out. </p>\n\n<p>As @JohnP noted, if there was significant injury to the growth plate, your nail may be permanently changed: it may be thicker, ridged, shorter, etc. But often this grows out without any problem.</p>\n\n<p>Acute care includes ice and elevation. If very painful, most doctors are capable of trephining the SH under sterile conditions (burning a small hole in the nail through which the blood may escape.) This sounds much worse than it is; in actuality, it provides immediate relief.</p>\n\n<p>_{Because this was associated with trauma, it is a SUH. However, if it was not associated with trauma, one would need to consider a subungual melanoma, meaning a skin cancer under the nail. These can spread into adjacent soft tissue. Keep it in mind as it grows out; it should be replaced by fresh, unaffected nail.} </p>\n\n<p>_{<a href=\"https://www.flickr.com/photos/poslfit/14094821/\" rel=\"nofollow noreferrer\">Photo courtesy of John Chew via Flikr</a>}<br>\n_{<a href=\"http://emedicine.medscape.com/article/82926-overview\" rel=\"nofollow noreferrer\">Subungual Hematoma Drainage</a>}<br>\n_{<a href=\"http://journals.lww.com/em-news/Fulltext/2003/08000/Evaluation_and_Treatment_of_Subungual_Hematoma.12.aspx\" rel=\"nofollow noreferrer\">Evaluation and Treatment of Subungual Hematoma</a>} </p>\n", "score": 7 }, { "answer_id": 653, "body": "<p>It's much the same as any other traumatic impact, it's a collection of blood from ruptured vessels. In the skin, it appears as a bruise. When under the nail, it appears as a black shape, usually a crescent.</p>\n\n<p>If the amount of blood is significant, or if the pressure of it causes pain, you should have it checked out by a podiatrist. It is also possible that if the trauma was severe, that there can be a risk of infection.</p>\n\n<p>It will last quite a long time, as the nails (both fingers and toes) are relatively slow growing (average 3mm/month). It is possible that you will lose the nail, although after a month that is less likely. It is also possible that the nail will not grow back in a normal shape, as you may have caused trauma to the nail bed. The black shape (old, clotted blood, actually) will move out with the growth, and may possibly cause nail splitting and separation from the bed in the affected area. Eventually it will reach the end of the nail and can be removed.</p>\n\n<p>While not urgent after a month, there are possibilities of complications, so if you notice any pain, further discolorations or odors, have it checked by a professional.</p>\n", "score": 5 } ]

[ "hematology", "injury" ]

[ { "answer_id": 707, "body": "<p>The recommended daily intake of salt varies, but Nutrition Australia recommends 1.15-2.00 grams per day. </p>\n\n<p>When you consume more salt than this, your blood pressure increases as a result of the body's compensatory mechanism for controlling the increase in plasma sodium. The body prefers to have higher blood pressure than to have a higher sodium concentration, as a high sodium concentration can be catastrophic and can lead to seizures and coma.</p>\n\n<p>The mechanism behind the increase in blood pressure in order to control sodium concentration is as follows:</p>\n\n<ol>\n<li><p>The increase in plasma osmolarity due to the increased plasma sodium causes the osmoreceptor cells located in the anterior hypothalamus near the supra-optic nuclei to shrink. This shrinkage of the osmoreceptor cells causes them to fire, sending nerve signals to nerve cells in the supra-optic nuclei, which eventually transmit signals to the posterior pituitary.</p></li>\n<li><p>This results in increased release of the hormone ADH (anti-diuretic hormone) from the posterior pituitary. This ADH hormone then enters the blood stream, moves to the kidneys and increases the permeability of the collecting tubules to water, resulting in increased water resorption in the kidneys, leading to urine being more concentrated.</p></li>\n<li><p>The net result is an increase in water resorption and an increase in blood volume and blood pressure.</p></li>\n</ol>\n\n<p>High blood pressure is associated with many adverse health effects, particularly cardiovascular disease, including stroke and myocardial infarction.</p>\n", "score": 2 } ]

[ "nutrition", "salt" ]

[ { "answer_id": 680, "body": "<p>Smoking and drinking both put the recipient of the blood donation at risk or possible risk.</p>\n\n<p>Smoking causes nicotine to enter your bloodstream and usually breaks down into cotinine. Both of these are connected with increasing plasma Vascular Endothelial Growth Factor (VEGF) levels, which <strong>may</strong> be involved in the progression of both vascular disease and cancer. The researchers note: </p>\n\n<blockquote>\n <p>\"These findings may give a clue as to the mechanisms by which nicotine\n and cotinine from cigarette smoking increase vascular disease\n progression and tumor growth and metastasis.\"</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1850669/\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1850669/</a></p>\n\n<p>Alcohol will immediately be absorbed through the lining of your stomach and small intestine into the bloodstream, meaning it will also be in the blood that you try to donate! <a href=\"http://pubs.niaaa.nih.gov/publications/AA67/AA67.htm\" rel=\"nofollow\">{2}</a> If your recipient happen to be a child, that alcohol can damage the developing brain and liver. <a href=\"http://www.princeton.edu/uhs/healthy-living/hot-topics/alcohol/\" rel=\"nofollow\">{3}</a></p>\n", "score": 5 } ]

[ "alcohol", "blood", "donor", "smoking" ]

[ { "answer_id": 717, "body": "<p>If your abdomen pain in the upper right quadrant have been diagnosed as gall bladder stones and you are awaiting for surgery, I am very puzzled that you have not received a prescription for appropriate pain relief medication.</p>\n\n<p>In Finland the drug of choice is Litalgin, which contains metamizole and pitophenone. The former is a pain killer and the latter is muscle relaxant which affects directly to smooth muscle tissues located in GI and urinary tract. It is also very good medication for kidney stones.</p>\n\n<p>Another good medication for gallbladder stones is any fast acting NSAID.</p>\n\n<p>You should contact your GP or treating surgeon for appropriate medication.</p>\n", "score": 3 } ]

[ "pain", "gallbladder", "gastroenterology" ]

[ { "answer_id": 993, "body": "<p>I seem to perceive some confusion in your question, and I'll try to clarify all doubts as much as I can. Olive oil is one of the best oils you can use to cook. It is mainly composed by <strong>monounsaturated fatty acids</strong> (<a href=\"http://www.chempro.in/fattyacid.htm\" rel=\"noreferrer\">1</a>), that are neutral to <strong>cardiovascular risk and blood cholesterol</strong>. There are some oils that are better, by this point of view, like canola oil, that has a higher proportion of polyunsaturated fatty acids, that are beneficial to cardiovascular risk. Some oils are worse, like palm oil, because of the higher proportion of saturated fatty acids, that are detrimental to cardiovascular risk. For the same reason you should also avoid margarines and butter.</p>\n\n<p>Olive oil has also a <strong>high smoke point</strong> (<a href=\"https://en.wikipedia.org/wiki/Smoke_point\" rel=\"noreferrer\">2</a>), that makes it suitable for frying. Smoke point is the temperature at which toxic compounds are formed; it means that you should never heat beyond smoke point of <strong>any</strong> oil. This is the reason why the dangerousness of very hot olive oil is not something specific of olive oil, but of any oil that is heated beyond its smoke point.</p>\n\n<p>Finally, something that you should also be aware is that most of cooking oils are extracted with the use of <strong>hexane</strong> (<a href=\"https://en.wikipedia.org/wiki/Hexane#Uses\" rel=\"noreferrer\">3</a>), a chemical solvent. Although the oil is subsequently refined, \"cleaned\", and the industry claims it's safe enough to be consumed, this procedure has risen a lot of concern. <strong>\"Virgin\" and \"extra virgin\" olive oil</strong> do not involve the use of any solvent during the production; this characteristic is shared with other oils that are cold pressed. Cold pressing is an extraction technique that, additionally, preserves the chemical content of the polyphenols, antioxidants, and vitamins present in the oil, that are reduced by high temperatures. The regulation of the definition of \"virgin\" oils and cold pressing is different between countries.</p>\n\n<p>I apologize for my english, it is not my mother language. Here in Italy we speak a different language, and we know about oil.</p>\n", "score": 6 } ]

[ "diet", "cooking" ]

[ { "answer_id": 733, "body": "<p>Many patients who have been diagnosed with breast cancer have their axillary lymph nodes removed. </p>\n\n<p>One of the main roles of the lymphatic system is to assist in draining extra-cellular fluid to the thoracic duct and ultimately back into the blood stream. Therefore, when axillary lymph nodes are removed, there is risk of developing lymphodema (swelling) in the corresponding arm. This puts the arm at a greater risk of infection.</p>\n\n<p>When a blood pressure cuff is applied to the arm, the pressure of the cuff may further inhibit the drainage of the extra-cellular fluid in the arm, further enhancing the risk of the patient developing lymphodema.</p>\n\n<p>Therefore as a precuationary measure, it is not recommended to use a blood pressure cuff on the arm of the side effected by breast cancer.</p>\n\n<p>It is also recommended that injections are not given, and blood not taken from the affected arm. This is because the removal of axillary lymph nodes results in a higher risk of infection in that arm.</p>\n\n<p>References:</p>\n\n<ol>\n<li><p>Petrek JA, Pressman PI, Smith RA. Lymphedema: current issues in research and management. CA Cancer J Clin. 2000 Sep-Oct;50(5):292–307. quiz 308-211.</p></li>\n<li><p>Loudon L, Petrek J. Lymphedema in women treated for breast cancer. Cancer Pract. 2000 Mar-Apr;8(2):65–71.</p></li>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652571/\" rel=\"nofollow\">Preventative measures for lymphedema: Separating fact from fiction</a></p></li>\n</ol>\n", "score": 8 } ]

[ "first-aid", "biological-parameter" ]

[ { "answer_id": 810, "body": "<p>Many of the active ingredients in flea and tick powders are harmful to humans, or suspected of being carcinogenic, or have effects on the nervous system.</p>\n<p>The <a href=\"http://www.humanesociety.org/animals/resources/tips/flea_tick_OTC_pet_products.html\" rel=\"nofollow noreferrer\">Humane Society</a> has a page on OTC flea and tick products, one of the sections details a couple of these effects:</p>\n<blockquote>\n<p>Besides pyrethroid-based products, ingredients to be wary of are organophosphate insecticides (OPs) and carbamates, both of which are found in various flea and tick products. The only OP currently found in flea and tick products in the U.S. is tetrachlorvinphos. This chemical is classified by the EPA as being &quot;likely to be carcinogenic to humans.&quot; There are questions about the effects of long-term, cumulative exposures as well as combined exposures from the use of other products containing OPs and carbamates. Permethrin is another chemical that the EPA has classified as &quot;likely to be carcinogenic to humans&quot; if ingested orally.</p>\n<p>If the ingredient list includes carbaryl or propoxur, the product contains a carbamate. According to the NRDC, the potential dangers posed by thee products are greatest for children and pets. Propoxur is considered to be a &quot;probable human carcinogen&quot; by the EPA. As of September 2010, Carbaryl will no longer be permitted for use in new pet products. However, existing stock of flea/tick products containing carbaryl can still be sold. The HSUS recommends that pet products containing carbaryl should be disposed of and not used on pets.</p>\n</blockquote>\n<p>Additionally, one of the current varieties of powder (<a href=\"http://www.petco.com/product/12687/K9-Advantix-II-Dog-Flea-And-Tick-Drops.aspx#\" rel=\"nofollow noreferrer\">K9 Advantix II</a>) has the following warning on it's website for the product:</p>\n<blockquote>\n<p>Hazards to Humans: Warning. Causes substantial but temporary eye injury. Do not get in eyes or on clothing. Harmful if swallowed. Harmful if absorbed through skin. Avoid contact with skin. Wash thoroughly with soap and water after handling and before eating, drinking, chewing gum, using tobacco or using the toilet. Remove and wash contaminated clothing before reuse.</p>\n</blockquote>\n<p>So there are a host of possible side effects, from possible nerve damage up through it being a possible carcinogen. I would not advise using them on yourself.</p>\n", "score": 5 } ]

[ "prevention", "fleas", "insecticides", "insect-repellents", "lyme-disease" ]

[ { "answer_id": 1650, "body": "<p>There are actually studies about sitting in a regular chair vs. an <a href=\"https://en.wikipedia.org/wiki/Exercise_ball\" rel=\"nofollow\">exercise ball</a>. <a href=\"http://www.sciencedirect.com/science/article/pii/S0003687008000690\" rel=\"nofollow\">Here</a> and <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16696264\" rel=\"nofollow\">here</a> for example. Neither seems to show <em>net</em> benefits. The limitations of both studies are small sample size and short time period of observation.</p>\n\n<p>Anecdotally, I know at least two people who both have done it and they seem happy with it (but this is recent, so I can't speak for long term use).</p>\n\n<p>A few considerations:</p>\n\n<p>Height - With an exercise ball, you will not be able to vary its height. So if it's fairly low relative to your desk, you might be forced to straighten your back. If it's too high you might end up curving your spine.</p>\n\n<p>Arm rests - Just from experience, I find that in chairs without arm rests, my shoulders are less slouchy, and my back is a bit straighter. I don't know to what extent this makes a difference for you or others, but keep it in mind.</p>\n\n<p>Soft vs. hard seat - I wonder how this influences blood flow to your legs, other parts of the body, and if it also affects posture.</p>\n", "score": 2 } ]

[ "ergonomics", "posture", "office", "exercise-ball" ]

[ { "answer_id": 3938, "body": "<p>I'll start off by highlighting a couple of more general studies:</p>\n\n<ul>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15712981\" rel=\"nofollow\">Cole &amp; Schumacher (2005)</a>: A general study of corticosteroids, this found that some corticosteroids may be free of side effects (specifically, intraarticular corticosteroids) for a series of short-term injections for a short amount of time (one injection every three months for two years). However, other corticosteroids can cause tissue atrophy, if used for long periods of time - even for periods as short as two years. That said, the authors believe that more general research is needed to draw definitive conclusions. A full pdf of the study is available <a href=\"http://www.pacificaorthopedics.org/downloads/sek/Steroid_Injections_Clinical_Practice.pdf\" rel=\"nofollow\">here</a>.</li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12571845\" rel=\"nofollow\">Raynauld et al. (2003)</a>: This is a study on general intraarticular steroids, as applied to osteoarthritis, which also found that there were no effects from the injections. Over two years, minimal side effects were noted. This used the same intervals as in Cole &amp; Schumacher: One injection every three months for about two years.</li>\n</ul>\n\n<p>These studies did not specifically address the cortisone shots you're concerned with; instead, they dealt with the more broader class of drugs called <a href=\"https://en.wikipedia.org/wiki/Corticosteroid\" rel=\"nofollow\">corticosteroids</a>. I find the results of these studies interesting, because there are a lot of websites out there that say the exact opposite: That a range of side effects are possible if used long-term, and may very well occur. I highlighted these studies in part to show that more research may well be needed, and that different drugs may work better for different people.</p>\n\n<p>The CDC has <a href=\"http://www.cdc.gov/ncbddd/dba/corticosteroid.html\" rel=\"nofollow\">a list of potential side effects from the use of corticosteroids</a>. The potential short-term side effects are too many to list, but I'll cover the long-term ones:</p>\n\n<ul>\n<li>Growth problems in children</li>\n<li>Brittle bones</li>\n<li>Muscle weakness (see the tissue atrophy mentioned in Cole &amp; Schumacher)</li>\n<li>Diabetes</li>\n<li>Eye issues</li>\n</ul>\n\n<p><em>However</em> - and this is an enormous \"however\" - this appears to be focused mainly on doses taken orally, and perhaps daily. In other words, side effects might change based on the method of intake, although this might be only a minor difference. Additionally, these are the effects of using corticosteroids on a much more frequent basis than you would be having them - and even then, these effects are only possibilities.</p>\n\n<p>These studies are the closest approximations I can combine to address your specific case. It seems that three-month intervals are the longest period of time that has been studied in any depth. In other words, your regimen seems to be a rare one - and a safer one.</p>\n\n<p>Every cortisone shot has the potential for side effects. But the combined effect of these multiple shots would most likely be have been diluted substantially. Studies with intervals of three months brought no side effects (and the risks given by the CDC appear to be due to repeated, short-term doses), and so it seems highly unlikely that your case will be any severer.</p>\n", "score": 3 } ]

[ "steroids", "injections", "orthopedics", "broken-bones" ]

[ { "answer_id": 888, "body": "<p>According to <a href=\"http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm274593.htm\" rel=\"nofollow noreferrer\">the FDA website</a>, no daily reference value has been established for sugars because no recommendations have been made for the total amount of sugar to eat in a day. </p>\n\n<p>Keep in mind that the sugar values listed do not distinguish between naturally occurring and added sugars because it is not a chemically meaningful distinction. So unlike nutritional information about vitamins, proteins, fats, etc, there really is no level of \"recommended sugar\" that would make a good blanket statement for everyone. </p>\n\n<p>Claims that high consumption of added sugars harmful to your health is an extremely complicated subject. It's not that the sugar itself is inherently harmful due to any of its chemical properties, it's just that added sugar tends to be in products that have extremely high fat and high calorie content and are easy to consume in large quantities.</p>\n\n<p>So saying to avoid foods high in added sugars is good general advice, but labeling products to indicate that you should consume {x} amount of sugar per day was <strong><em>not</em></strong> a piece of nutritional guidance the FDA was prepared to make in that labeling.</p>\n", "score": 9 }, { "answer_id": 25223, "body": "<p>It seems that the US Food and Drug Administration (FDA) <a href=\"https://www.fda.gov/food/new-nutrition-facts-label/added-sugars-new-nutrition-facts-label\" rel=\"nofollow noreferrer\">has recently added guidance for &quot;added sugars&quot; as a part of enhancing the existing nutrition facts label</a>.</p>\n<p>They differentiate between &quot;total sugars&quot; and &quot;added sugars&quot; and provide the following regarding %DV for total sugars:</p>\n<blockquote>\n<p>&quot;There is no Daily Value* for total sugars because no recommendation\nhas been made for the total amount to eat in a day.&quot;</p>\n</blockquote>\n<p>As for %DV of added sugars, <a href=\"https://www.fda.gov/media/99059/download\" rel=\"nofollow noreferrer\">they also appear to have a PDF</a> of daily recommended values for food components which suggests for adults and 4 years and older that the daily recommended value is 50g:</p>\n<p><a href=\"https://i.stack.imgur.com/kiHYn.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/kiHYn.png\" alt=\"chart showing daily recommended values for food components\" /></a></p>\n", "score": 2 } ]

[ "nutrition", "sugar" ]

[ { "answer_id": 931, "body": "<p>There are several investigations assessing this issue. In several clinical trials (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16873779\">1</a>, <a href=\"http://ajcn.nutrition.org/content/early/2009/04/01/ajcn.2009.26736H.short\">2</a>) Dr. Barnard has prooved that a low-fat vegan diet can improve serum values of <strong>HbA1c</strong> and requirements for medication of patients affected by type 2 diabetes. The same studies found significant improvements in <strong>plasma lipids</strong> (LDL and total cholesterols), that show decrease of risk factors for cardiovascular disease, often a complication of diabetes and metabolic disorders.</p>\n\n<p>Additionally, clinical trials show that vegan and vegetarian diets promote <strong>weight loss</strong> (<a href=\"http://europepmc.org/abstract/med/9863851\">3</a>, <a href=\"http://www.sciencedirect.com/science/article/pii/S0002934305002792\">4</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19506174\">5</a>) and improved <strong>insulin sensitivity</strong>(<a href=\"http://www.sciencedirect.com/science/article/pii/S0002934305002792\">4</a>, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19506174\">5</a>) being these two important risk factors for type 2 diabetes (<a href=\"http://www.webmd.com/diabetes/risk-factors-for-diabetes\">6</a>).</p>\n\n<p>The reasons of the effectiveness must be found in the fact -among others- that vegetarians and vegans eat less quantities of <strong>total fats</strong>, <strong>saturated fats</strong> and highers amounts of <strong>fiber</strong> and show lower <strong>BMI</strong> (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19562864\">7</a>).</p>\n", "score": 5 }, { "answer_id": 16402, "body": "<p>Not only has it been proven that a whole food plant-based diet can reverse diabetes type 2 in many cases, but that it can completely reverse diabetes type 2 in two weeks in some people who've been injecting themselves with insulin for 20 years on a daily basis. Studies where this has been achieved can be found at the following link: <a href=\"https://nutritionfacts.org/video/how-not-to-die-from-diabetes/\" rel=\"nofollow noreferrer\">NutritionFacts</a></p>\n", "score": 0 } ]

[ "nutrition", "diabetes", "vegetarianism" ]

[ { "answer_id": 917, "body": "<p>Blood pressure of a person varies throughout the day. This is attributed to numerous factors including stimuli from your sorroundings. As an innate tendency of the body. blood pressure is lower at night when you sleep, and is higher when you wake up in the morning. It continuously increases(roughly) as the day progresses. </p>\n\n<p>So there is no one best time to measure your blood pressure. If what you are looking to do is to monitor your blood pressure, then it is important that you measure it at the same time everyday - at whatever time of the day it is. If what you are trying to get is an accurate measurement, then you are better of measuring it at two different times of the day(in the morning and in the evening) and taking an average, or measure it at two different times and report the readings along with the time of the day the measurement was taken. If you are on any medication to control your blood pressure, then you should measure your blood pressure once in the morning before taking any medications and once in the evening (assuming that you take medication in the morning). However, your doctor may specifically ask you to measure your blood pressure at a particular time of the day. That is because he is interested in that particular value for some reason. </p>\n\n<p>References : </p>\n\n<ol>\n<li><p><a href=\"http://hyper.ahajournals.org/content/60/2/512.full.pdf\" rel=\"nofollow\">Short- and Long-Term Blood Pressure Variability</a></p></li>\n<li><p><a href=\"http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20047889?pg=2\" rel=\"nofollow\">High blood pressure (hypertension)</a></p></li>\n</ol>\n", "score": 4 } ]

[ "blood-pressure" ]

[ { "answer_id": 1007, "body": "<p>The causes of such pains are called back strains, and may be muscular or ligamentous in origin.</p>\n\n<p>It may be caused by:</p>\n\n<ol>\n<li>Physical exertion</li>\n<li>Fall</li>\n<li>Bending repeatedly</li>\n<li>Lifting heavy objects</li>\n<li>Emotional Stress</li>\n<li>Sitting in improper postures for long periods of time</li>\n</ol>\n\n<p>This happens when a muscle/ligament is overstretched, resulting in the injury of the same. Since spine is essentially supported by a large number of muscles and ligaments, this can happen very easily. If there is an injury, the area around it gets inflamed, and these will lead to spasm of the muscles. Hence the movement of the spine in such conditions will be extremely painful.</p>\n\n<p>The treatment modalities are usually conservative, including rest, NSAIDs, muscle relaxants, and physiotherapy when needed.</p>\n\n<p>References:</p>\n\n<ol>\n<li><p><a href=\"http://www.aafp.org/afp/2000/0315/p1779.html\">Diagnosis and Management of Acute Low Back Pain</a></p></li>\n<li><p><a href=\"http://www.webmd.com/back-pain/guide/low-back-strain\">Low Back Strain - WEBMD</a></p></li>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25314730\">What's causing your lower back pain? The top three causes are sprains and strains, herniated discs, and stenosis</a> (Full text may not be accessible). </p></li>\n</ol>\n", "score": 7 }, { "answer_id": 10414, "body": "<p>According to my understanding and experience sudden back pain can be considered as a sort of <a href=\"https://en.wikipedia.org/wiki/Spasm\" rel=\"nofollow noreferrer\">spasm</a>. As such it cannot be controlled or relaxed intentionally. The patient is also not even aware of the spasm but only of the pain.</p>\n\n<p>However, recent studies have found that an increased intake of magnesium can reduce the back pain. See for example</p>\n\n<p><a href=\"http://onlinelibrary.wiley.com/doi/10.1111/anae.12107/abstract\" rel=\"nofollow noreferrer\">A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component</a>.</p>\n\n<p>Magnesium plays an important role in the communication of nerves and the prevention of spasm. Moreover many people need more magnesium than suggested by the recommended daily allowances for various reasons.</p>\n\n<p>This way I understand the result of this study.</p>\n", "score": 1 } ]

[ "pain", "back" ]

[ { "answer_id": 985, "body": "<p>You picked an interesting virus (and illness) to ask about. There are still a lot of studies being conducted and many of the answers aren't in. </p>\n\n<p>A bit of background. Epstein-Barr virus (EBV - the virus that causes infectious mononucleosis) is a member of the herpesvirus family, very \"successful\" viruses in that most of the world's population are infected (90% of the world's population has been infected with EBV), and the viruses are known to remain in the host's body throughout their lifetimes (that is, the host doesn't usually die from the disease, instead living to pass it on to others). With Herpes Simplex, reactivation is in the form of cold sores. With varicella-zoster virus - the cause of chickenpox - reactivation takes the form of \"shingles\". So, to expect EBV of periodic reactivation isn't very far fetched.</p>\n\n<p>In the US, ~50% of the population seroconverts (becomes infected as manifested by antibodies to the virus) before 5 years of age. This population has not been extensively studied for asymptomatic viral shedding. In the rest of the population, most cases of EBV infection are still subclinical, but some adolescents and young adults - about 25% of those newly infected - get the illness known as infectious mononucleosis (IM). This has been the group most studied group in terms of who is shedding virus and who isn't.</p>\n\n<p>Once infected, humans carry the virus for life in a small number of white blood cells called \"memory B lymphocytes\". Immediately following infection, the cells shedding the most virus are pharyngeal epithelial cells (though this has been challenged), so virus is present in the saliva, but has also been found in other bodily fluids.</p>\n\n<p><img src=\"https://i.stack.imgur.com/v8u7F.jpg\" alt=\"enter image description here\"></p>\n\n<p>One study in France followed 30 patients for 6 months: 20 after diagnosis of IM, and 10 healthy EBV carriers (determined by the presence of IgG antibodies against EBV and the absence of IgM) as controls. Blood and saliva samples were collected at day 0 [D0]), D3, D7, D15, D30, D60, D90, and D180 on all subjects.</p>\n\n<p>Infectivity of saliva was determined by lymphocyte transformation in cell cultures of fresh cord-blood lymphocytes.</p>\n\n<p>All newly infected patients had sustained viral shedding in the saliva, and all still had infectious saliva at day 180, 16 patients maintaining a <em>high</em> EBV load during the 6 months of follow-up, and 4 showing a <em>low</em> level of virus, though viral load was significantly lower at D180 than at D90 in all patients. Of the <em>controls</em> (healthy people who had positive antibodies), 8 subjects had 2–4 episodes of detectable EBV in their saliva, with the remaining 2 having no EBV in their saliva during the follow-up period. </p>\n\n<p>In the patient blood samples, EBV-infected B cells decreased significantly from day 0 to day 180, with 18 showing a viral rebound between D30 and D90. Among these 18, 4 patients had tonsillitis and lymphadenopathy (!) which indicates a recurrence. Only one of the control subjects showed no detectable EBV in their Memory B Cells during the entire follow-up period. This shows that patients with IM remain highly infectious during convalescence.</p>\n\n<p>A Japanese study analyzed the prevalence of EBV in saliva and throat washings from healthy people. EBV DNA was detected in 43 of 48 throat washings from healthy adults aged 21 to 57 years of age, and in 35 of 93 salivas from healthy children 0 to 6 years old. Umbilical cord lymphocytes were transformed by some throat washings from EBV seropositive donors, indicating infectivity of the virus. Furthermore, EBV DNA was detected in throat washings from 2 healthy adults whose <em>EBV antibody was not detected</em>. </p>\n\n<p>In a study of 22 healthy EBV-seropositive blood donors over a period of 15 months, serology suggested reactivation (significant changes in viral load plus a serological response) in eight donors. Another five individuals also exhibited significant changes in viral load but no serologic response. Of the 13 volunteers with significant increases in viral load, 6 had a period of viremia accompanying the rise in viral load, that is, <em>they had a viral infection clinically.</em> </p>\n\n<p>What triggers reactivation in healthy subjects is not known precisely. The presumption is that it occurs when latently infected B cells respond to unrelated infections, because B-cell receptor stimulation triggers reactivation in B-cell lines. </p>\n\n<p>So, whatever you have read, there is probably proof for it, as well as much else that wasn't read! It appears that healthy adults and children shed virus intermittently for an unknown number of years.</p>\n\n<p>_{Image from <em>On the dynamics of acute EBV infection and the pathogenesis of infectious mononucleosis</em>, Hadinoto et al, Blood. 2008 Feb 1; 111(3): 1420–1427.}</p>\n\n<p>_{<a href=\"http://emedicine.medscape.com/article/222040-overview#showall\" rel=\"nofollow noreferrer\">Infectious Mononucleosis</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021204/\" rel=\"nofollow noreferrer\">Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections</a>}<br>\n_{<a href=\"http://jid.oxfordjournals.org/content/191/6/985.full.pdf+html\" rel=\"nofollow noreferrer\">Long-Term Shedding of Infectious Epstein-Barr Virus after Infectious\nMononucleosis</a>}<br>\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S128645790000277X\" rel=\"nofollow noreferrer\">Detection of Epstein-Barr virus in salivas and throat washings in healthy adults and children</a>}<br>\n_{<a href=\"http://jcm.asm.org/content/41/12/5419.short\" rel=\"nofollow noreferrer\">Molecular Parameters for Precise Diagnosis of Asymptomatic Epstein-Barr Virus Reactivation in Healthy Carriers</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214734/\" rel=\"nofollow noreferrer\">On the dynamics of acute EBV infection and the pathogenesis of infectious mononucleosis</a>}</p>\n", "score": 6 } ]

[ "disease", "disease-transmission" ]

[ { "answer_id": 978, "body": "<p>This is a very good question. The answer: <strong>because your head was meant to be above your body!</strong></p>\n\n<p>Your body has very specific mechanisms for maintaining a constant blood flow in the cerebral circulation despite shifts in blood pressure, either due to changing blood pressure in the rest of the circulation or due to a different 'local' pressure because of position . This is termed <em>autoregulation</em>.</p>\n\n<p>The blood pressure that the brain 'sees' is called 'cerebral perfusion pressure' (CPP). Technically CPP is the difference between intra-arterial pressure and the pressure in the veins, but venous pressure is very low (2-5 mm Hg), so we can estimate it as the arterial blood pressure (here, a weighted average of systolic and diastolic pressures). In a normal person accustomed to normal blood pressures, the body can maintain a constant blood flow of ~50 mL per 100 g of brain tissue per minute with a CPP range of ~60 to 160 mmHg. That’s a big range!</p>\n\n<p>The mechanisms of autoregulation are incompletely understood. Most likely reductions in CPP stimulate the release of substances that cause vasodilation (candidates include H⁺, K⁺, O₂, adenosine), thereby increasing flow. On the other side, high pressures stimulate constriction of the myocites in cerebral vessels, reducing flow. </p>\n\n<p>The end result is that your brain ‘sees’ a relatively constant pressure regardless of what position you’re in or other factors that may change blood pressure. That having been said, if blood pressure fluctuates outside the range for which auto regulation can accommodate, position does indeed matter for blood pressure. If a patient is markedly hypotensive, for instance, it is traditional to tilt the bed so that their head is below their body.¹ At the extremes, this manipulation can indeed affect blood flow to the brain. </p>\n\n<hr>\n\n<p>_{\n1. This is termed the Trendelenberg position, although <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16120887\">recent evidence indicates that this is not a good idea</a> for hypotensive shock due to more complex cardiovascular considerations.\n} </p>\n\n<p>_{\nAll of this material is summarized nicely in this publicly available textbook:<br> <a href=\"http://www.ncbi.nlm.nih.gov/books/NBK53082/\">Cipolla MJ. The Cerebral Circulation. San Rafael (CA): Morgan &amp; Claypool Life Sciences; 2009. Chapter 5, Control of Cerebral Blood Flow.</a>\n} </p>\n", "score": 8 } ]

[ "blood-pressure", "blood" ]

[ { "answer_id": 1001, "body": "<p>Short answer: <a href=\"http://www.sciencedirect.com/science/article/pii/S0960076005002220\">No.</a></p>\n\n<p>Longer answer: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25754279\">UVB rays are essential for Vitamin D synthesis</a>. According to some studies, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23441390\">1 hour of sunshine</a> is needed even in sunny climates - but only in average, still depending on latitude, skin color and other factors - to prevent Vitamin D deficiency. Still, even the average sun exposure in mid-latitude regions summers <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25754279\">might not fulfill your body's needs for UV radation</a> to supply itself with Vitamin D, but opinions on this differ (as can be seen in comparison with the first link of this paragraph). </p>\n\n<p>But when comparing it to 1 hour of full sun exposure in mild climates, it is safe to conclude that the UVB levels behind glass windows, as measured in the first overall link above, are so low that it is highly improbable to reach sufficient Vitamin D levels behind them.</p>\n", "score": 10 } ]

[ "dermatology", "micronutrients" ]

[ { "answer_id": 13025, "body": "<p>If a person's body is in a low-metabolism state induced by starvation or restricted calorie intake, then an increase in the calorie intake will allow a raised metabolism. The natural lower limit to metabolism is death: if a person restricts calories too much, their metabolism drops lower and lower, until they develop various complications and then die. The natural upper limit to metabolism is, in my view, heat: a person's metabolism is only going to increase naturally to a certain point, based on their BMI, body composition, genetics, lifestyle, etc., and after that point the metabolism will not increase any more otherwise excessive heat would be generated (also leading to death.) A example of dysfunctional metabolism where people just burn more and more energy is the misuse of the now-unavailable drug mimicking \"uncoupling protein\" (<a href=\"http://www.independent.co.uk/news/uk/home-news/death-of-medical-student-sarah-houston-after-taking-banned-slimming-drug-dinitrophenol-highlights-8584597.html\" rel=\"nofollow noreferrer\">http://www.independent.co.uk/news/uk/home-news/death-of-medical-student-sarah-houston-after-taking-banned-slimming-drug-dinitrophenol-highlights-8584597.html</a>). BUT this is an example where a drug was taken that dysregulated metabolism. Normally the body will not allow the metabolism to increase like that. What happens instead in the natural world is obesity. If you increase calories too much, past the point of metabolic increase, then extra calories are stored as fat and you become obese.</p>\n", "score": 3 } ]

[ "nutrition", "digestion", "calories", "metabolism" ]

[ { "answer_id": 1066, "body": "<p>This rumor is common enough that there is even a <a href=\"http://www.snopes.com/food/warnings/fruit.asp\">Snopes article</a> about it.</p>\n\n<p>In essence no, this doesn't help, and is in fact closer to the opposite of the truth. When eating a meal many more digestive enzymes and processes are started up then when only eating a small amount or say a pill. This is one of the reason you should always take your multivitamin with or immediately after a meal. The key factor here is known as gastric emptying, or how quickly the food is going through you. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18577009\">When it happens quickly</a>, only the nutrients that are easy to absorb (like fats) are obtained. Eating more food at once (to a point) slows gastric emptying allowing for more complete digestion.</p>\n\n<p>There are two key aspects when looking at the digestion of fruit. The first, and perhaps obvious, benefit is the absorption of nutrients. All of the calories, vitamins, etc that one can get out of fruit falls into this category. The second benefit is that of fiber which can help clear the gut of waste, bowel motility, maintenance of gut flora, and other uses that call for both soluble and non-soluble fibers which fruits are rich in. A very good review on their benefit can be found <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649719/\">here</a>.</p>\n\n<p>But what about when they are mixed together with other things? <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23944181\">When compared</a> to milk and oatmeal, blue berries were found to have a synergistic effect with oatmeal, but milk was found to be inhibitory to both. If you are willing to take <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25029433\">an example with pigs</a>, fruits and vegetables protected against some of the more harmful effects of a high fat and protein diet when eaten at the same time (though this could be because of simple decreases in the fat intake).</p>\n", "score": 6 } ]

[ "nutrition", "fruits" ]

[ { "answer_id": 1453, "body": "<p>You are correct to be worried about the effect of sleep on your physical health, especially because you seem to have bad luck (or bad genes) when it comes to serious infectious disease. </p>\n\n<p>Anyway, back to the issue of sleep as it relates to infectious disease:</p>\n\n<pre><code> Sleep deprivation attenuates antibody responses to vaccine,\n whereas good sleep imparts long-lasting immunoenhancing effects.\n Furthermore, sleep is a profound regulator of cellular immunity\n and formation of immunological memory critical for adaptive\n responses to immune challenges.\n -- from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3695049/\n</code></pre>\n\n<p>So it's safe to presume that your lack of sleep is impairing your health. No one can guarantee that good sleep will restore you to good health, but it can't hurt. </p>\n", "score": 2 } ]

[ "sleep", "lymph-nodes" ]

[ { "answer_id": 5224, "body": "<p><em>Waiting period</em></p>\n\n<p>It's hard to prove some information doesn't exist, but maybe I'll get points for effort ;)</p>\n\n<p>There is a section on \"Post exposure vaccination\" in the (long) World Health Organization <a href=\"http://www.who.int/immunization/sage/6_TBE_backgr_18_Mar_net_apr_2011.pdf\" rel=\"nofollow\">Background Document on Vaccines and Vaccination\nagainst Tick-borne Encephalitis (TBE)</a>. They mention the concern you also cite in your question, but go on to say that there is no evidence for it:</p>\n\n<blockquote>\n <p>Of special concern is the theoretical possibility that post-exposure\n prophylaxis could result in antibody-dependent enhancement of the infection and exacerbation of the disease. Such phenomena have been reported for other flavivirus infections, but not for TBEV.</p>\n</blockquote>\n\n<p>At least, vaccination after exposure will probably not fast enough to prevent an infection (vaccinating after exposure is, for example, <a href=\"http://www.who.int/ith/vaccines/rabies/en/\" rel=\"nofollow\">done for rabies</a>):</p>\n\n<blockquote>\n <p>Since TBE has a relatively short incubation period, even an anamnestic response may not be fast enough to protect the individual following exposure.</p>\n</blockquote>\n\n<p>This information all seems to come from the review <a href=\"http://www.sciencedirect.com/science/article/pii/S0264410X07013497\" rel=\"nofollow\">After a tick bite in a tick-borne encephalitis virus endemic area: Current positions about post-exposure treatment</a>. It is also repeated in the WHO position paper <a href=\"http://www.who.int/immunization/sage/1_TBE_PP_Draft_13_Mar_2011_SAGE_apr_2011.pdf\" rel=\"nofollow\">Vaccines against tick-borne encephalitis</a>. </p>\n\n<p>Neither those studies nor the manufacturer information for <a href=\"https://www.pfizer.de/fileadmin/produktdatenbank/pdf/FSME-IMMUN_Erwachsene_FI_01.pdf\" rel=\"nofollow\">FSME Immun</a> (which might be what you would receive - warning for others: that information is in German) state a waiting period. A good guess would probably be the incubation period for TBE (<a href=\"http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/tickborne-encephalitis\" rel=\"nofollow\">median 8 days</a>).</p>\n\n<p><em>Subsequent vaccinations</em></p>\n\n<p>That part is easier. For the two vaccines usually used in Western Europe, the WHO writes</p>\n\n<blockquote>\n <p>With both vaccines the manufacturers recommend a booster 3 years after completion of the primary series and subsequent boosters at intervals of 5 years (3 year intervals for individuals aged >60 years)</p>\n</blockquote>\n\n<p>See table 6 on page 43 of the <a href=\"http://www.who.int/immunization/sage/6_TBE_backgr_18_Mar_net_apr_2011.pdf\" rel=\"nofollow\">Background Document on Vaccines and Vaccination against Tick-borne Encephalitis (TBE)</a></p>\n\n<p>As for scheduling, even after those 3 or 5 years, <a href=\"http://www.who.int/immunization/TBE_duration_protection.pdf?ua=1\" rel=\"nofollow\">protection is still really good</a> (after 8 years, 90% were still protected), so there's probably no rush and the booster can be taken when convenient.</p>\n", "score": 4 }, { "answer_id": 1132, "body": "<p>The U.S. recommended primary immunization schedule for <strong>Ixiaro</strong>, the Japanese Encephalitis (JE) Virus Vaccine (Inactivated) is one week <strong>prior</strong> to exposure [1]. An adult patient (17 years old or older) may receive a booster after one year of completing the primary series; adolescents and children (less than 17) has not been studied [1].</p>\n\n<p>Treatment for JE involves supportive care only [2]. There is no specific antiviral treatment for JE; ribavirin, interferon alpha-2a was trialed with no success [2].</p>\n\n<p>Nonspecific symptoms appear after a 5 to 15 day incubation period followed by the specific mental status change manifestations [2]. The seasonality of the disease depends on the local area [2].</p>\n\n<p>References:</p>\n\n<ol>\n<li><p>Ixiaro Package Insert. FDA Approved Biologic Products. <a href=\"http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM142569.pdf\" rel=\"nofollow\">http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM142569.pdf</a> [accessed 6/3/2015.]</p></li>\n<li><p>Japanese encephalitis: Epidemiology, diagnosis, treatment and prevention. UpToDate.com [accessed 6/3/2015.]</p></li>\n</ol>\n", "score": 1 } ]

[ "infection", "vaccination", "virus" ]

[ { "answer_id": 1181, "body": "<p>Many primary care practitioners have not received training in the evaluation and treatment of patients who are transitioning.</p>\n\n<blockquote>\n <p>I went to my doctor's office to be prescribed to HRT medications, but my doctor said he's not qualified to prescribe it. Is that possible? </p>\n</blockquote>\n\n<p>Yes, it's possible in that he may not <em>believe he's qualified</em> to prescribe HRT for a transitioning female. Treating transitioning females hormonally is not a common occurrence, and doctors are allowed to refuse to treat conditions they're unfamiliar or (medically) uncomfortable with.</p>\n\n<blockquote>\n <p>Transsexual patients often have difficulty finding care because many physicians are not comfortable prescribing appropriate hormone regimens. Management of hormones for transsexual patients is not difficult, and these medications are safer than many therapies routinely prescribed by the primary care physician. <em>The diagnosis of gender identity disorder (GID) must be established by an experienced mental health professional prior to consideration for hormonal management.</em></p>\n</blockquote>\n\n<p>Once this has been done, a specialist can easily communicate the treatment regimen to be followed, but it's really up to the individual physician to do so. Most will. Some won't. In that case, a reasonable physician will refer to a colleague who does do so.</p>\n\n<p>There should not be any financial repercussions for you. </p>\n\n<p>_{<a href=\"http://link.springer.com/article/10.1023/A:1026563806480\">Clinical Update: Medical Care of Transsexual Patients</a>}</p>\n", "score": 7 } ]

[ "prescription" ]

[ { "answer_id": 1721, "body": "<p><strong><a href=\"http://www.aafp.org/afp/2006/0801/p449.html\">Antidepressant Discontinuation Syndrome</a></strong></p>\n\n<p>Affects approximately 20% of patients who experience abrupt discontinuation of an antidepressant that has been taken for at least 6 weeks. There are a myriad of symptoms including flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal.</p>\n\n<p>The definitive cause of antidepressant discontinuation syndrome is currently unknown. However, there is speculation of temporary deficiencies in synaptic serotonin which is compounded by hypoactive receptors remaining in that state for days to weeks. This is thought to be the direct cause or indirect cause (due to downstream effects on other neurotransmitter systems) for antidepressant discontinuation syndrome.</p>\n\n<p>So far not enough quality <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627130/#__sec5title\">studies</a> have been done to fully understand the causes for antidepressant discontinuation syndrome.</p>\n", "score": 8 }, { "answer_id": 11537, "body": "<p>Short answer: No. There is no technical term for \"brain zaps.\"</p>\n\n<p>\"Antidepressant discontinuation syndrome\" accurately names the <em>cause</em> of brain zaps, but brain zaps are only one of many symptoms of antidepressant discontinuation syndrome.</p>\n\n<p>WebMD calls them \"electric shock sensations,\" psychopharmacologyinstitute.com calls them \"electric shock-like sensations\" and (possibly, assuming they're referring to the same thing) \"rushing sensations in the head.\"</p>\n\n<p><a href=\"https://www.psychologytoday.com/blog/creativity-way-life/201107/fireworks-or-brain-zaps\" rel=\"nofollow noreferrer\">Psychology Today</a> refers to them as \"Brain zaps, brain shivers, brain shocks, head shocks or electrical shocks\" and describes them as \"brief but repeated electric shock-like sensations in the brain and head, or originating in the brain but extending to other parts of the body.\"</p>\n\n<p>Medhealthdaily.com says some folks refer to them as \"cranial shivers.\"</p>\n\n<p>A variety of sources are proposing \"myalotinasis\" from the Greek for \"brain\" and \"jolt,\" but although it certainly sounds much more medical, it doesn't seem to be catching on.</p>\n", "score": 3 } ]

[ "medications", "neurology", "symptoms", "mental-health" ]

[ { "answer_id": 1365, "body": "<p>The difference between systolic and diastolic pressures is known as the <em>pulse pressure</em>. (If this doesn't make sense, please see <a href=\"https://health.stackexchange.com/a/849/165\">another answer of mine</a> where I explained the meanings of the different components of blood pressure.) There is no \"normal\" or \"should\" that are well defined here. Despite that, there is quite a bit that can be said.</p>\n\n<p><strong>What causes them to be ... far apart?</strong> * </p>\n\n<ol>\n<li><p><strong>Age</strong><br>\nOn a population level, the biggest factor is age. With increasing age, pulse pressure increases, sometimes dramatically. </p>\n\n<ul>\n<li><p>Arithmetically, this is because diastolic pressure peaks at about age 55 and delines thereafter, whereas systolic pressure continues to increase throughout life (see Franklin, 1997). </p></li>\n<li><p>Physiologically, this is because the large vessels tend to \"stiffen\" with age to calcification. As such, when the heart pumps blood into them (systole), they aren't especially elastic, so the diameter doesn't increase much. The result is higher systolic pressure. Similarly, in the period of diastole when flow is lower, the arteries don't rebound to a smaller diameter as robustly as young vessels, so the pressure falls. It is common in 80+ year-olds to see blood pressures like 180/60. I've never seen such a pressure in a young person. </p></li>\n</ul></li>\n<li><p><strong>Valvular disease</strong><br>\nThis is the part with an obvious physiologic correlate that medical schools and board exams like to hammer on. <a href=\"http://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/basics/definition/CON-20022523\" rel=\"nofollow noreferrer\">Aortic regurgitation</a> (a.k.a. aortic insufficiency) is the primary valvular disease associated with increased pulse pressure. That's because the incompetent aortic valve allows part of the blood to flow back into the left ventricle during diastole. If the aorta has access to the ventricle as it relaxes during diastole, the ventricle acts as a pressure sink, resulting in lower systemic pressures during that phase, increasing pulse pressure.</p>\n\n<p>The converse of this is <a href=\"http://www.mayoclinic.org/diseases-conditions/aortic-stenosis/basics/definition/CON-20026329\" rel=\"nofollow noreferrer\">aortic stenosis</a>, which is a valve that doesn't let adequate blood through during systole. Because the flow is less, the pumping ventricle does not change the pressure in the systemic circulation as much as it normally would.</p>\n\n<p><a href=\"http://www.cvphysiology.com/Heart%20Disease/HD004.htm\" rel=\"nofollow noreferrer\">This physiology text</a> does a pretty good job explaining the valvular pathology in more detail.</p></li>\n</ol>\n\n<p><strong>Pulse pressure as a predictor of cardiovascular disease</strong> </p>\n\n<p>There is extensive literature addressing the question of whether pulse pressure is a (semi-) independent risk factor for cardiovascular disease, beyond that provided by systolic or diastolic pressure alone. I provide a few references below. The upshot is that the relationship between pulse pressure and risk is complicated and highly age-dependent. A high pulse pressure may be a better predictor of cardiovascular events than systolic pressure itself among the elderly.</p>\n\n<p>_{\n*Removed \"too\" because this just isn't well defined.\n}</p>\n\n<hr>\n\n<ol>\n<li><p>Franklin SS, Gustin W 4th, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=10421594\" rel=\"nofollow noreferrer\">Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study.</a> Circulation. 1997 Jul 1;96(1):308-15.</p></li>\n<li><p>Vaccarino V, Berger AK, Abramson J, Black HR, Setaro JF, Davey JA, Krumholz HM. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=11703993\" rel=\"nofollow noreferrer\">Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program.</a> Am J Cardiol. 2001 Nov 1;88(9):980-6.</p></li>\n<li><p>Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Circulation. 1999 Jul 27;100(4):354-60. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=10421594\" rel=\"nofollow noreferrer\">Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study.</a></p></li>\n<li><p>Pastor-Barriuso R, Banegas JR, Damián J, Appel LJ, Guallar E. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=14597457\" rel=\"nofollow noreferrer\">Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality.</a> Ann Intern Med. 2003 Nov 4;139(9):731-9.</p></li>\n</ol>\n", "score": 5 } ]

[ "blood-pressure", "cardiology" ]

[ { "answer_id": 1750, "body": "<p>It has been long known that use of NSAID have an effect for bone healing after fractures <a href=\"http://www.bjj.boneandjoint.org.uk/content/85-B/5/700.long\">(1)</a>. Therefore the use of NSAIDs is recommended only for certain period after fracture and long-term use should be avoided.</p>\n\n<p>NSAIDs are either non-selective COX1 and COX2 inhibitors (ibuprofen, diclofenac, naproxen) or modern selective COX2 inhibitors (selecoxib, parecoxib). There is some evidence that non-selective COX1&amp;2 inhibitors such as ibuprofen have a positive effect for the healing of tendons <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3239621\">(2)</a><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/142610\">(3)</a>. In general the use of NSAIDs are useful in the treatment of ligament injuries but whether the advantage of NSAIDs is due to the matter that reduction in pain results to early mobilization and thus earlier recovery is still controversial <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11734496/\">(4)</a>.</p>\n\n<p>However, the use of selective COX-2 inhibitors is shown to have adverse effect on the tissue healing <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11734496/\">(4)</a><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15494342/\">(5)</a>.</p>\n\n<p><em>As so, the use of ibuprofen does not look like disadvantageous with regard to tissue healing unless where are dealing with bone fracture.</em></p>\n\n<p>Of course, whether there is really an objective soft tissue damage present after a whiplash is a whole another matter....</p>\n", "score": 5 } ]

[ "medications", "pain" ]

[ { "answer_id": 1448, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Laxative\" rel=\"nofollow\">Laxatives</a> can be of multiple types - from simple dietary roughage to some OTC mineral oils to prescription intestinal stimulants, there are simply a wide range of substances that can loosen stools and increase bowel movements. </p>\n\n<p>When should one take a laxative? I would say everyday. Dietary fibres are very good laxatives in normal individuals. Any diet should include plenty of dietary fibres. They also reduce the <a href=\"http://www.wjgnet.com/1007-9327/14/6453.pdf\" rel=\"nofollow\">risk of colorectal carcinomas</a> and <a href=\"http://nutritionreviews.oxfordjournals.org/content/67/4/188\" rel=\"nofollow\">reduce cholesterol</a> and are all the more reasons to include in the diet - especially in the western population. For someone who follows a regular food habit and is generally healthy there won't be any reason to take anything else to increase bowel movements. So in short, dietary fibres(roughage) should be your everyday laxative. </p>\n\n<p>If you are acutely constipated for some reason, and is making you miserable, and do not have any other symptoms(such as vomiting, abdominal pain, blood in stool, etc) then you can take an over the counter laxative for one day and see if it resolves the issue. That can be simple mineral oil, castor oil, Isapghula, etc. If a single dose of any of those does not improve your costipation, then you should consult a doctor. The doctor can look at the cause of constipation and prescribe a medicine for you appropriately for a short duration of time. Some people who take certain pills (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/26126675\" rel=\"nofollow\">opiod narcotics for example</a>) are likely to be chronically constipated. In that case one may have to use laxatives for a long duration of time, but that decision is taken by a doctor. </p>\n\n<p>The reason why it is not recommended to take a laxative for a long duration of time without a good reason is that some laxatives reduce cause colonic tissues to wear out over time and make the patient permanently consipated(<a href=\"https://en.wikipedia.org/wiki/Laxative#Laxative_gut\" rel=\"nofollow\">laxative gut</a>) There is also the risk of <a href=\"https://en.wikipedia.org/wiki/Laxative#Laxative_abuse\" rel=\"nofollow\">reduced nutrient absorption, fluid and electrolyte imbalance, intestinal paralysis, irritable bowel syndrome, factitious diarrhea, etc</a>. So chronic use of stimulant laxatives should be avoided whenever possible. </p>\n", "score": 3 } ]

[ "digestion" ]

[ { "answer_id": 1531, "body": "<p>I don't wear glasses much (only to read) and I feel that same groove. I also feel other grooves on my head, for example I can feel a groove over either temple going somewhat vertically for quite a distance - all the way to the top of my head, actually.</p>\n<p>I think what you (and I) are feeling is a <em>suture</em>.</p>\n<p><img src=\"https://i.stack.imgur.com/zPqfu.jpg\" alt=\"enter image description here\" /></p>\n<p>Between the plates or bones in our heads (separate in utero and infancy) are sutures which form slight depressions in our skulls which we can feel with our fingertips. Although they are similarly located on everyone, there is a degree of variation (on some skulls, for example, the squamous suture (between the pink parietal bone and the mauve temporal bone, the one I think we are feeling) is <a href=\"https://www.google.com/search?hl=en&amp;authuser=0&amp;site=imghp&amp;tbm=isch&amp;source=hp&amp;biw=1274&amp;bih=761&amp;q=skull+anatomy+with+sutures&amp;oq=skull+anatomy+with+sutures&amp;gs_l=img.3...2045.26194.0.26670.28.14.0.14.4.0.127.1552.0j14.14.0....0...1ac.1.64.img..11.17.1455.rExtjoTtRXM#hl=en&amp;authuser=0&amp;tbm=isch&amp;q=human+skull+anatomy+sutures\" rel=\"noreferrer\">less curved</a> posterior to the eye. I can clearly feel my lambdoid, coronal, and sagittal sutures (not shown) as well. So, I think this is what you're feeling and seeing.*</p>\n<p>This is, I would guess, why the people you explain this to don't say much. That dent is pretty much there on everyone (note, I'm not saying a lifetime of tight glasses don't make their mark. I just don't think that dent is unique to people who wear glasses.</p>\n<p>The question about headaches from tight glasses is therefore separate.</p>\n<p>The problem with that question is that both headaches and refractive errors requiring glasses are very common conditions in the general population. People often associate glasses and headaches.</p>\n<p>However, there isn't a very strong correlation between refractive errors and headaches.</p>\n<blockquote>\n<p>Is this perhaps a psychological effect or my tight glasses be causing headaches?</p>\n</blockquote>\n<p>I think it's safe to say that you might be projecting <em>the cause of your headaches</em> onto your glasses. The only way to tell for sure is to switch to contacts and see if this relieves your activity-associated headaches.</p>\n<p>Headaches are very common and very often benign. However, if you're concerned, or perceive a change in the frequency or severity of your headaches, or they are associated with other symptoms, you should seek medical attention.</p>\n<p>_{<a href=\"http://onlinelibrary.wiley.com/doi/10.1046/j.1526-4610.2002.02077.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+12th+July+2015+at+10%3A00-16%3A00+BST+%2F+05%3A00-11%3A00+EDT+%2F+17%3A00-23%3A00+SGT+for+essential+maintenance.++Apologies+for+the+inconvenience.&amp;userIsAuthenticated=false&amp;deniedAccessCustomisedMessage=\" rel=\"noreferrer\">Headaches Associated With Refractive Errors: Myth or Reality?</a>}<br />\n_{<a href=\"http://onlinelibrary.wiley.com/doi/10.1046/j.1475-1313.2001.00571.x/abstract\" rel=\"noreferrer\">Why do we still not know whether refractive error causes headaches? Towards a framework for evidence based practice</a>}</p>\n<p>*_{Now I just woke up my dog by poking around on her skull. I can feel her sagittal suture really well, the others not so much, probably because of the muscles she uses to orient her ears. I should know better, but she's very gracious and went right back to sleep.}</p>\n", "score": 5 }, { "answer_id": 7013, "body": "<p>I had fun reading all the above reponses regarding this inquiry of having tight frames possibly leading to headaches... I also have tight frames and I tend to rest them on top of my ears to relieve the pressure it has on the temporals...i do believe like anywhere in the body, prolonged pressure leads to decrease in circulation and if left for a while it can lead to ulcerations and necrosis. This is why health care providers advise patients to move every 15 mins in chair and every 2 hours in bed. I highly disagree with the palpable suture hypothesis one person mentioned above and fluid shifting made by whom I think is a practicing nurse... Fluid shifting is seen when there's a shift or change in osmotic pressure of intravascular osmolality that causes a shift in fluid from one compartment to another. So on conclusion, to alleviate the headache I would either take them off intermittently or buy frames that fit your facial structure. Oh and if this headache is relate to something that you think isn't from the pressure of the glasses, I would have ur health care provider examine it. </p>\n", "score": 1 }, { "answer_id": 7592, "body": "<p>You are probably aware of this already, but there are frames with earpieces that not only fold in, but are on hinges with a spring and can be moved out. This might alleviate the pressure a bit. </p>\n\n<p>Also, I had wire frames which left the indentation on the skin at the temples, which I think is what you are describing. When I chose frames on hinges as mentioned above, made out of plastic, the indentations were no more. I think it also helps that the plastic earpieces are thicker which distributes the pressure a bit more than concentrating it on a smaller area. </p>\n", "score": 1 }, { "answer_id": 11142, "body": "<p>I've been wearing glasses since 1980. I too get those depressions in the side of my head just above my ears. These don't give me headaches, but the frames do cause great tension in my scalp and eyes.</p>\n\n<p>If I lightly pull the frames that go over my ears outward and away from my scalp, all the tension melts away instantly. </p>\n\n<p>Contacts would probably relieve this. I haven't tried them since 1980 - - they didn't work well for astigmatism at the time. I never tried them again.</p>\n", "score": 1 }, { "answer_id": 9337, "body": "<p>Just my personal experience, but I feel my head to be extremely sensitive to glasses. I've been wearing glasses since childhood, but I finally changed to contact lenses about two years ago. Since then the discomfort on my head largely stopped and I feel much more natural now in various activities. I guess people feeling the same can definitely try it out and see if that makes them feel better.</p>\n", "score": 0 } ]

[ "headache", "glasses" ]

[ { "answer_id": 5269, "body": "<p><a href=\"http://www.webmd.com/diet/guide/vitamin-d-deficiency\" rel=\"nofollow\">WebMD</a></p>\n\n<p>Signs and Symptoms of Vitamin D deficiency can be subtle, but can manifest as bone pain and muscle weakness. Also, <a href=\"http://www.prevention.com/health/symptoms-vitamin-d-deficiency\" rel=\"nofollow\">excessive sweating</a>(when not indicated due to exercise level and heat).</p>\n\n<p>Because of the sometimes subtle symptoms, getting appropiate screening based on risk factors and regular physician exams is important to discovering and managing deficiency.</p>\n\n<p><a href=\"http://www.webmd.com/diet/guide/vitamin-d-deficiency?page=2\" rel=\"nofollow\">Tests for Vitamin D Deficiency</a></p>\n\n<blockquote>\n <p>The most accurate way to measure how much vitamin D is in your body is\n the 25-hydroxy vitamin D blood test. A level of 20\n nanograms/milliliter to 50 ng/mL is considered adequate for healthy\n people. A level less than 12 ng/mL indicates vitamin D deficiency.</p>\n</blockquote>\n\n<p><a href=\"http://articles.mercola.com/sites/articles/archive/2014/05/28/vitamin-d-deficiency-signs-symptoms.aspx\" rel=\"nofollow\">7 Signs You May Have a Vitamin D Deficiency</a> can help in the you understand risk factors, because knowing risk factors can mean better understanding to what symptoms may mean. </p>\n\n<p>Treatment is diet with adequate Vitamin D and supplements. While treatment may be simple, prolonged deficiency can manifest as very serious manifestations so if worried about deficiency a Vitamin D test and Physician Workup is indicated. </p>\n\n<hr>\n\n<p>Risk Factors:</p>\n\n<p><a href=\"http://www.webmd.com/diet/guide/vitamin-d-deficiency\" rel=\"nofollow\">Include:</a> Allegy to milk, vegan diets, darker skin and amount of sun you recieve. </p>\n", "score": 3 }, { "answer_id": 5360, "body": "<p>Vitamin D deficiency can actually cause or exacerbate depression, and it can manifest itself in feelings of tiredness, persistent sadness, weakness, etc... It also prevents your bones from mineralizing so your bone density may decline and cause bone pain (as stated by WebMD). I've experienced this, and it feels like an ache deep inside your limbs. I also had pretty strong dairy cravings, which I think may have been However, sometimes these symptoms are slight and you may not even know you have a deficiency. I came to the doctor once with complaints of depression and tiredness. She ordered a blood test for a bunch of things, including blood iron levels and vitamin D levels. My iron levels were good but my vit D was low, and I never would have guessed; I thought I was depressed and just needed antidepressants. </p>\n\n<p>Definitely get a blood test for it if you're concerned because the symptoms of vitamin D deficiency can be attributed to so many different causes, and you may feel pretty \"ok\" when you could be feeling much better.</p>\n", "score": 1 } ]

[ "micronutrients", "milk", "deficiency", "melanin", "vitamin-d" ]

[ { "answer_id": 1553, "body": "<p>More vacation time will come at the expense of a higher daily workload, which can cause even more stress, <a href=\"http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.461.7005&amp;rep=rep1&amp;type=pdf\" rel=\"nofollow\">see e.g. here</a>. If you can work 8 hours a day, exercise, eat dinner and go to bed on time, there should be no need to go on vacation just to wind down. So,on the long term, you'll be better off having a bit more free time every day and using that extra time to get some quality relax and exercise time. You'll become physically and mentally a lot stronger, which will allow you to enjoy the few weeks vacation per year a lot more.</p>\n", "score": 2 } ]

[ "depression", "mental-health" ]

[ { "answer_id": 1568, "body": "<p>This so-called sixth sense is called <em>kinesthesia</em> or <em>proprioception</em>. There are some slight differences between the two, in that kinesthesia only refers to moving parts, whereas your proprioceptive sense can identify the position of your body even when still.</p>\n\n<p><strong>kin·es·the·sia</strong></p>\n\n<p>awareness of the position and movement of the parts of the body by means of sensory organs (proprioceptors) in the muscles and joints.</p>\n\n<p><strong>pro·pri·o·cep·tion</strong> </p>\n\n<p>the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement.</p>\n", "score": 11 } ]

[ "neurology", "brain", "senses" ]

[ { "answer_id": 7394, "body": "<p>Prolactin is a peptide hormone that, in addition to modulating the hypothalamic–pituitary–gonadal axis, functions as a cytokine in the immune system and as a growth factor in the vascular system amongst many other functions.</p>\n\n<p>According to Wikipedia:</p>\n\n<blockquote>\n <p>Prolactin receptors are present in the mammillary glands, ovaries, pituitary glands, heart, lung, thymus, spleen, liver, pancreas, kidney, adrenal gland, uterus, skeletal muscle, skin and areas of the central nervous system.^{<a href=\"https://en.wikipedia.org/wiki/Prolactin#cite_note-Mancini2008-31\" rel=\"nofollow\">[31]</a>}</p>\n</blockquote>\n\n<p>How prolactin suppresses GnRH, the mechanism through which hyperprolactinemia causes hypogonadism, is unknown. Many of prolactin's other functions may not necessarily be influenced by blood serum levels, as prolactin acts in a paracrine and autocrine, in addition to an endocrine, manner.</p>\n\n<p>The positive outcomes from normalizing hypogonadism should outweigh any negative effects of reducing prolactin levels. Androgen deficiency in males can cause osteoporosis, a series weakening of the bones. Of course, as more is known about the function of elevated prolactin levels, this opinion may change.</p>\n\n<p>Surprisingly, serum prolactin below physiological levels can cause many of the symptoms that high levels can. Prolactin acts as a weak gonadotropin by itself, and enhances the effect of leuteinizing hormone at testosterone-producing cells in males.</p>\n\n<p>Hypoprolactinemia can lead to hypogonadism and osteoporosis, just like in hyperprolactinemia. However, in cases of hyperprolactinemia, cabergoline often does not completely reduce prolactin to normal levels, anyway.</p>\n\n<p>The side effects of cabergoline itself are probably more important. as there are known cases of valvular heart disease in doses used to treat Parkinson's. Inflammation and fibrosis of various tissues can also occur.</p>\n", "score": 2 } ]

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

[ { "answer_id": 1816, "body": "<p>There are three types of heart attacks: unstable angina pectoris, non-ST-elevation myocardial infarct (NSTEMI) and ST-elevation myocardial infarct (STEMI). Choosing between thrombolysis and angioplasty matters only in the STEMI.</p>\n\n<blockquote>\n <p>Which is better: thrombolysis (treatment with clot busting medication) or primary angioplasty (an invasive procedure for mechanical opening of the blocked artery)?</p>\n</blockquote>\n\n<p>If the patient arrives within 2-3 hours to the hospital from the onset of the pain, \"drug of choise\" is angioplasty. The evidence is overwhelming. <a href=\"http://www.nejm.org/doi/pdf/10.1056/NEJMoa025142\" rel=\"nofollow\">The largest study</a> on this topic involves 1572 randomized to either thrombolysis or primary angioplasty. The latter was superior. Footnote includes other smaller studies on this topic.</p>\n\n<p>The primary angioplasty is best to be performed in less than 120 minutes from the pain. After that, superiority over thrombolysis is not clear, as stated in <a href=\"http://eurheartj.oxfordjournals.org/content/ehj/27/7/779.full.pdf\" rel=\"nofollow\">this high quality meta-analysis</a>.</p>\n\n<blockquote>\n <p>Does it matter if the patient reaches very early to hospital (within 2-3 hours) or reaches late after onset of chest pain?</p>\n</blockquote>\n\n<p>If paramedics reaches the patient rapidly after the onset of pain and the patient cannot be moved to a hospital capable performing angioplasty in less than 2-3 hours, it is preferable to perform thrombolysis <strong>on-site.</strong> This has been showed in many studies <a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199308053290602\" rel=\"nofollow\">(1)</a><a href=\"http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673696025147.pdf\" rel=\"nofollow\">(2)</a>. What is the optimal time cut-off remains to be shown.</p>\n\n<hr>\n\n<p><strong>References:</strong></p>\n\n<p>Busk M, Maeng M, Rasmussen K ym. The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up. Eur Heart J 2008;29(10):1259-66. </p>\n\n<p>Widimsky P, Bilkova D, Penicka M ym. Long-term outcomes of patients with acute myocardial infarction presenting to hospitals without catheterization laboratory and randomized to immediate thrombolysis or interhospital transport for primary percutaneous coronary intervention. Five years' follow-up of the PRAGUE-2 Trial. Eur Heart J 2007;28(6):679-84. </p>\n\n<p>Nunn CM, O'Neill WW, Rothbaum D ym. Long-term outcome after primary angioplasty: report from the primary angioplasty in myocardial infarction (PAMI-I) trial. J Am Coll Cardiol 1999;33(3):640-6. </p>\n\n<p>Zijlstra F, Hoorntje JC, de Boer MJ ym. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999;341(19):1413-9. </p>\n\n<p>Bonnefoy E, Lapostolle F, Leizorovicz A ym. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet 2002;360(9336):825-9. </p>\n\n<p>Bonnefoy E, Steg PG, Boutitie F ym. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J 2009;30(13):1598-606. </p>\n\n<p>Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003;361(9351):13-20. </p>\n\n<p>Svensson L, Aasa M, Dellborg M ym. Comparison of very early treatment with either fibrinolysis or percutaneous coronary intervention facilitated with abciximab with respect to ST recovery and infarct-related artery epicardial flow in patients with acute ST-segment elevation myocardial infarction: the Swedish Early Decision (SWEDES) reperfusion trial. Am Heart J 2006;151(4):798.e1-7. </p>\n", "score": 3 }, { "answer_id": 3363, "body": "<p>A number of studies have shown that in early period (within 2-3 hours of onset of chest pain), thrombolysis is as good or even better than primary angioplasty: </p>\n\n<ul>\n<li><a href=\"http://www.tctmd.com/show.aspx?id=123817\" rel=\"nofollow\">FAST-MI study</a></li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768566/\" rel=\"nofollow\">USIC 2000 registry</a></li>\n<li><a href=\"http://circ.ahajournals.org/content/108/23/2851.full\" rel=\"nofollow\">CAPTIM trial</a> and <a href=\"http://eurheartj.oxfordjournals.org/content/ehj/30/13/1598.full.pdf\" rel=\"nofollow\">its 5 year results</a></li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/26162464\" rel=\"nofollow\">Vienna registry</a></li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12559941\" rel=\"nofollow\">PRAGUE-2 study</a></li>\n<li><a href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1301092?viewType=Print&amp;viewClass=Print\" rel=\"nofollow\">STREAM trial</a></li>\n<li><a href=\"http://www.nejm.org/doi/pdf/10.1056/NEJMoa025142\" rel=\"nofollow\">DANAMI-2 study</a> Subgroup analysis of this study quoted by arkiaamu also showed clear benefit only in patients who had duration of chest pain > 4 hours. </li>\n</ul>\n\n<p>Thrombolytic therapy (clot busting medicines e.g. tPA, also called fibrinolytics since they lyse fibrin strands of thrombi or clots) has major advantage in ease of administration. They are administered via intravenous route and hence can be give by nurses or paramedical personnel. The drug travels in the blood stream to reach arteries of the heart and lyses the thrombus (clot) there. Thrombolysis treatement can be given in ambulance while patients are being transported to hospitals or even at patient's home to save time. Tenecteplase, a type of thrombolytic therapy, can be given just as a bolus injection and does not even need infusion. Early after onset of heart attack, the thrombus is soft and possibly smaller in size and hence is more easily lysed by thrombolytic agents.</p>\n\n<p>On the other hand, primary angioplasty needs a fully functioning cardiac catheterization laboratory which costs a lot and are available only in tertiary centers. Trained cardiologists and cath lab technician/nursing staff are needed to perform primary angioplasty. The access has to be through high pressure artery rather than simple vein for thrombolysis. The procedure itself is very complex since the coronary arteries of the heart have to be hooked, wires, balloon catheters, thrombo-suction devices and stents have to be passed into them to open the block caused by thrombus. The logistics of availablity are difficult, especially at nights and on weekends. Hence, the costs are also much more with primary angioplasty. </p>\n\n<p>Because of all these reasons, we should not ignore the role of thrombolytic therapy in patients presenting early after onset of chest pain in acute heart attack. For patients presenting late, primary angioplasty has been shown to be more beneficial than thrombolytic treatment, presumably because the thrombus become more extensive and firm with time and is not easily lysed wih thrombolytic agents (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12517460\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/12517460</a>).</p>\n", "score": 2 }, { "answer_id": 1817, "body": "<p>Many studie claim that primary angioplasty is better than thrombolyis, as short-time mortality and morbidity of angioplasty is significantly lower than with thrombolysis treatment. (1,3) Reaching late after onset of pain generally reduces effectiveness of any treatment. (2)</p>\n\n<p>You may see this table : <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377579/table/A01tab02/\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377579/table/A01tab02/</a></p>\n\n<p>[1] Primary angioplasty versus intravenous thrombolysis for acute myocardial infarction. - <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12917910\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/12917910</a></p>\n\n<p>[2] Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17277350\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pubmed/17277350</a></p>\n\n<p>[3] Primary Angioplasty and Thrombolysis for the Treatment of Acute ST-Segment Elevated Myocardial Infarction <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377579/\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377579/</a></p>\n", "score": 0 } ]

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

[ { "answer_id": 20612, "body": "<p>In short, there seems to be no evidence that acute caffeine overdose by drinking a great amount of energy drink would result in heart enlargement (hypertrophic or dilated cardiomyopathy). It could cause severe caffeine overdose, though.</p>\n\n<p>8 oz (237 ml) of an energy drink can contain 150 mg of caffeine (<a href=\"https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/caffeine/art-20049372\" rel=\"nofollow noreferrer\">Mayo Clinic</a>).</p>\n\n<p>20 such drinks would give you 3,000 mg (3 g) of caffeine and 4.7 liters of water.</p>\n\n<p><strong>3 g of caffeine,</strong> does not seem to be lethal:</p>\n\n<blockquote>\n <p>Lethal doses of caffeine have been reported at blood concentrations of\n 80 to 100 micrograms/ml which can be reached with ingestion of\n approximately 10 grams or greater. (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK532910/\" rel=\"nofollow noreferrer\">Stat Pearls, 2019</a>)</p>\n</blockquote>\n\n<p><strong>4.7 liters of water</strong> drunk in a short time can result in fatal water intoxication. There is a report of a woman dying after drinking <a href=\"http://news.bbc.co.uk/2/hi/uk_news/england/bradford/7779079.stm\" rel=\"nofollow noreferrer\">4 liters of water in 2 hours</a>.</p>\n\n<p>Symptoms of caffeine overdose: <a href=\"https://journals.lww.com/nursing/Fulltext/2019/04000/How_to_recognize_caffeine_overdose.15.aspx\" rel=\"nofollow noreferrer\">How to recognize caffeine overdose (Nursing, 2019)</a>:</p>\n\n<blockquote>\n <p>Moderate toxicity can cause restlessness, tremors, anxiety, mood\n changes, and gastrointestinal discomfort (such as vomiting). Very high\n doses of ingested caffeine (more than 6 mg/kg) can decrease both\n physical and cognitive performance and induce severe gastrointestinal\n distress. Extremely high blood levels (up to 150mg/kg) of caffeine\n can cause changes including hypokalemia, ventricular dysrhythmias,\n hypotension, rhabdomyolysis, and death. Blood caffeine concentrations\n around 150 mg/kg of body weight can be fatal.</p>\n</blockquote>\n", "score": 1 } ]

[ "diet", "cardiology", "heart" ]

[ { "answer_id": 1608, "body": "<p>This is an excellent question. </p>\n\n<p>Let us give an example of a procedure that some humans really need to be exposed to - and that is <a href=\"http://www.oncolink.org/treatment/article.cfm?id=35\" rel=\"nofollow\">Radiation Therapy</a>. </p>\n\n<p>Radiation therapy is usually given to cancer patients to destroy a tumor. Technically, there are two methods of giving radiation to a patient for therapeutic purposes - <a href=\"http://www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/what-radiation-therapy\" rel=\"nofollow\">External and Internal radiation therapy</a>. </p>\n\n<p>When we talk about <strong>External Radiation therapy</strong>, we are talking about radiation administered through a beam to a specific region of the body. Basically, it is non-invasive because it uses only a machine with a beam that directs radiation to the specific body part containing the tumor. </p>\n\n<blockquote>\n <p>Since the radiation is given in relatively\n small doses, patients who receive external radiation therapy are not\n considered radioactive and do not need to take any special precautions\n during the time they are being treated. It is safe for friends,\n family, and children to be around them - <a href=\"http://www.oncolink.org/treatment/article.cfm?id=35\" rel=\"nofollow\">OncoLink</a>. </p>\n</blockquote>\n\n<p>On the other hand, patients undergoing <strong>internal radiation therapy</strong> (<a href=\"http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/radiation-therapy/brachytherapy/?region=on\" rel=\"nofollow\">brachytherapy</a>) get radioactive implants to destroy the tumor. This procedure is considered invasive because doctors need to put the radioactive implants inside the body where the tumor is located. Commonly used radioactive substance in implants are <em>cesium, gold, iodine, iridium, and palladium</em>.</p>\n\n<blockquote>\n <p>Different radioactive materials have different half-lives. This\n information helps the radiation therapy team to choose the type of\n material to use and plan the treatment regimen. It also determines how\n long radiation safety precautions must be taken following treatment - <a href=\"http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/radiation-therapy/brachytherapy/?region=on\" rel=\"nofollow\">Canadian Cancer Society</a>. </p>\n</blockquote>\n\n<p>Furthermore, if high dosage is being used in the therapy, expect that a small amount of radiation will be left in the patient's body after the implants removal. As the <a href=\"http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/radiation/understandingradiationtherapyaguideforpatientsandfamilies/understanding-radiation-therapy-internal-radiation-therapy\" rel=\"nofollow\">American Cancer Society</a> states that, </p>\n\n<blockquote>\n <p>With internal radiation therapy, your body may give off a small amount\n of radiation for a short time.</p>\n \n <p>If the radiation is contained in a temporary implant, you will be\n asked to stay in the hospital and may have to limit visitors during\n treatment. You also may be asked to stay a certain distance away from\n them. Pregnant women and children may not be allowed to visit you.\n Your body fluids are not radioactive. Once the implant is removed,\n your body will no longer give off radiation.</p>\n \n <p>Permanent implants give off small doses of radiation over a few weeks\n to months as they slowly stop giving off radiation. The radiation\n usually doesn’t travel much farther than the area being treated, so\n the chances that others could be exposed to radiation is very small.\n Still, your health care team may ask you to take certain precautions\n such as staying away from small children and pregnant women,\n especially right after you get the implants. Again, body fluids and\n the things you use will not be radioactive.</p>\n</blockquote>\n", "score": 7 } ]

[ "disease-transmission", "radioactivity" ]

[ { "answer_id": 18437, "body": "<h2>What is anodized aluminum?</h2>\n\n<blockquote>\n <p>Anodizing is an electrolytic passivation process used to increase the\n thickness of the natural oxide layer on the surface of metal parts.\n - <a href=\"https://en.wikipedia.org/wiki/Anodizing\" rel=\"nofollow noreferrer\">Wikipedia</a></p>\n</blockquote>\n\n<p>So, it's a layer of aluminum oxide. But since pure aluminum is soft, your watch would most likely be made of an alloy. Some of the most common metal added to aluminum alloys are <a href=\"https://en.wikipedia.org/wiki/Aluminium_alloy\" rel=\"nofollow noreferrer\">Si, Fe, Cu, Mn, Mg, Cr, Zn, V, Ti, Bi, Ga, Pb, and Zr</a>. But since the concentrations of these metals are minuscule, we won't account for their presence in the alloy.</p>\n\n<hr>\n\n<h2>Absorbability?</h2>\n\n<p>Aluminum oral intake from dietary sources is usually greater than aluminum absorbed in the skin</p>\n\n<blockquote>\n <p>...about 2.5% of the aluminum typically absorbed by the gut from food over the same time period.\n - <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11267710\" rel=\"nofollow noreferrer\">A preliminary study of the dermal absorption of aluminum from antiperspirants using aluminium-26.</a> </p>\n</blockquote>\n\n<hr>\n\n<h2>Topical Toxicity?</h2>\n\n<blockquote>\n <p>ALUMINIUM OXIDE</p>\n\n<pre><code>Used as a component of paints and varnishes and in the manufacture of\nalloys, ceramics, glass, electrical insulators and resistors.\n\n**Toxicity**\n\nSignificant toxicity has been reported only following **chronic occupational inhalation**.\n\nTopical - Aluminium contact sensitivity has been described but is extremely rare\n</code></pre>\n \n <p><a href=\"http://www.inchem.org/documents/ukpids/ukpids/ukpid33.htm\" rel=\"nofollow noreferrer\">InChem - Chemical Safety Information from Intergovernmental Organizations</a></p>\n</blockquote>\n\n<hr>\n\n<h2>Inhalational and Oral Toxicity?</h2>\n\n<blockquote>\n <p>Aluminium bioavailability from occupational inhalation exposure is ~\n 2% whereas oral aluminium bioavailability from water has been reported\n to be 0.1 to 0.4%</p>\n \n <p>Increased oral aluminium absorption has been suggested in Alzheimer’s disease (AD) and Down’s subjects. Oral aluminium bioavailability from the diet has been estimated to be ~ 0.1 to 0.3%, based on daily aluminium intake and urinary elimination.</p>\n \n <p>-<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782734/\" rel=\"nofollow noreferrer\">HUMAN HEALTH RISK ASSESSMENT FOR ALUMINIUM, ALUMINIUM OXIDE, AND ALUMINIUM HYDROXIDE</a></p>\n</blockquote>\n\n<hr>\n\n<h2>Summary</h2>\n\n<p><a href=\"https://i.stack.imgur.com/Kmyom.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Kmyom.jpg\" alt=\"table of aluminum toxicity\"></a>\n-<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782734/\" rel=\"nofollow noreferrer\">HUMAN HEALTH RISK ASSESSMENT FOR ALUMINIUM, ALUMINIUM OXIDE, AND ALUMINIUM HYDROXIDE</a></p>\n\n<hr>\n\n<h2>Answer?</h2>\n\n<p>Your anodized aluminum watch is safe to wear. Not unless you have a rare allergy to aluminum.</p>\n\n<hr>\n\n<h2>P.S.</h2>\n\n<p>Read the <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782734/\" rel=\"nofollow noreferrer\">HUMAN HEALTH RISK ASSESSMENT FOR ALUMINIUM, ALUMINIUM OXIDE, AND ALUMINIUM HYDROXIDE</a>. It's all there.</p>\n", "score": 2 } ]

[ "dermatology", "risks", "skin-absorption" ]

[ { "answer_id": 12845, "body": "<p>Have you had a read through the \"What counts as your 5 A Day\" link, at the top of the NHS page you linked to?</p>\n\n<p><a href=\"http://www.nhs.uk/Livewell/5ADAY/Pages/Whatcounts.aspx\" rel=\"nofollow noreferrer\">http://www.nhs.uk/Livewell/5ADAY/Pages/Whatcounts.aspx</a></p>\n\n<p>It seems to answer most of the questions you've raised. Keep in mind that the point of these programs is to increase the variety of fresh fruit and veg - not to give you a list of foods you should eat, but to push towards better eating habits involving a wider variety of fresh foods (which, as the site says, are known to be healthier than processed foods).</p>\n\n<p>According to that NHS page, potatoes don't seem to count because they're already consumed ubiquitously and often unhealthily. Wine wouldn't count because a) it's not fresh, and b) there are other health concerns involved.</p>\n", "score": 4 } ]

[ "nutrition" ]

[ { "answer_id": 1675, "body": "<p>You should not skip any pills when taking oral contracptives. Breakthrough bleeding is not uncommon, especially early on, and the pill is still effective at preventing pregnancy. You should, however, report breakthrough bleeding; your doctor may want to change your pill.</p>\n<p>Breakthrough Bleeding is one of the most common reasons for women to stop taking their pill. However, it is still an effective contraceptive when taken regularly. An adjustment of one of the components of your pill can stop breakthrough bleeding.</p>\n<blockquote>\n<p>[B]reakthrough bleeding... is vaginal bleeding that occurs during your active pills. This is a common side effect during the first 3 months of birth control pills use and up to 50% of users may experience this. By the third pack of pills, 90% of users are no longer experiencing spotting. Some may notice some mild menstrual cramping with the spotting but this should resolve for most by the third pack of pills as well. Contraceptive effectiveness is present even with spotting, as long as no pills have been missed. If you are experiencing light bleeding on your active pills that lasts longer than 5 days, or heavier bleeding lasting more than 3 days, contact your provider.</p>\n</blockquote>\n<p><em><strong>Evidence on the association between antibiotic use and combination oral contraceptive (COC) failure remains controversial, with recent studies reporting no evidence to support decreased effectiveness of birth control with the use of antibiotics except rifampin and rifabutin.</strong></em></p>\n<p>However, some doctors will ask an oral contraceptive user to use additional protection while using an antibiotic.</p>\n<p>The reasoning that antibiotics might interfere with the effectiveness of COCs revolves around the antibiotic decreasing steroid hormone’s plasma concentrations by hepatic microsomal enzyme induction or inhibition, interference with enterohepatic circulation of COC metabolites, interference with absorption from the GI tract, competition between two drugs for the same metabolizing enzyme, alterations in plasma protein binding, induction of an opposite physiologic effect, or increased urinary or fecal excretion of the contraceptive.</p>\n<p>The strongest evidence is for rifabutin and rifampin: a significant decrease in the hormonal levels was noted in women taking rifampin even after <em>a single dose.</em> Dirithromycin slightly decreased plasma ethinyl estradiol levels, with questionable clinical importance. A recent study in the Netherlands <em>did</em> find a relationship between the use of antibiotics and breakthrough pregnancy in a population-based <em>prescription</em> database; also, individual patients do show large decreases in the plasma concentrations of ethinyl estradiol when they take certain antibiotics, notably tetracycline and penicillin derivatives.</p>\n<p>Because of earlier studies, anecdotal reports, and the above (it's not possible to identify whose levels will drop with antibiotic use), a cautious approach is advised. Physicians and pharmacists (80-90% of both) still lean towards believing that broad-spectrum antibiotics decrease the effectiveness of COCs, and continue to advise the use of back-up contraception.</p>\n<p>The tide is shifting, however, as new studies come out. Here are a few excerpts of recent studies:</p>\n<blockquote>\n<p>Available scientific and pharmacokinetic data do not support the hypothesis that antibiotics (with the exception of rifampin) lower the contraceptive efficacy of oral contraceptives. (J Am Acad Dermatol 2002;46:917-23.)</p>\n</blockquote>\n<p>Since dermatologists treat acne with antibiotics, and a significant percentage of these patients are young women of child-bearing age, they certainly have a vested interest in knowing if this is true.</p>\n<blockquote>\n<p>Rifampicin and griseofulvin induce hepatic enzymes and do appear to have a genuine interaction with the COCP, leading to reduced efficacy. The situation with the broad-spectrum antibiotics is less clear. There are relatively few prospective studies of the pharmacokinetics of concurrent COCP and antibiotic use and few, if any, demonstrate a convincing basis for any reduced contraceptive efficacy.</p>\n<p>We did not find an association between concomitant antibiotic use and the risk of breakthrough pregnancy among COC users. However, due to limited power and potential carryover effects, findings from this study cannot rule out an elevated risk of COC failure among antibiotic users. (2011)</p>\n</blockquote>\n<p>So, the answer is (except with your noted exceptions) the penicillin-class antibiotics <em>probably do not interfere with effectiveness of COCs.</em> However, one unwanted pregnancy is one pregnancy too many, and the use of a back-up method is not a huge deal (just ~14 days).</p>\n<p>Until more and larger studies demonstrate a lack of interaction between most antibiotics and COCs, this will likely be the advice people continue to receive. When you look at the risk to benefit ratio of back-up, it's probably the wisest course for people prescribed a short course of antibiotics. It is more significantly problematic for people prescribed continuous antibiotic use for acne, Crohn's and other conditions/illnesses.</p>\n<p>_{<a href=\"http://www.brown.edu/Student_Services/Health_Services/Health_Education/sexual_health/safer_sex_and_contraceptives/birth_control_pills.php\" rel=\"noreferrer\">Birth Control Pills (BCPs)</a>}\n_{<a href=\"https://www.rochester.edu/uhs/healthtopics/SexualHealth/contraception/files/BirthControlPills.pdf\" rel=\"noreferrer\">Birth Control Pills\n(Oral Contraceptives)</a>}<br />\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0190962202000373\" rel=\"noreferrer\">Oral contraceptive efficacy and antibiotic interaction: A myth debunked</a>}<br />\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0010782499000098\" rel=\"noreferrer\">Interaction between broad-spectrum antibiotics and the combined oral contraceptive pill: A literature review</a>}<br />\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0010782410005172\" rel=\"noreferrer\">Antibiotics and oral contraceptive failure — a case-crossover study</a>}<br />\n_{<a href=\"http://onlinelibrary.wiley.com/doi/10.1002/pds.3267/abstract?deniedAccessCustomisedMessage=&amp;userIsAuthenticated=false\" rel=\"noreferrer\">Are antibiotics related to oral combination contraceptive failures in the Netherlands? A case-crossover study</a>}<br />\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11704183/\" rel=\"noreferrer\">Drug interactions between oral contraceptives and antibiotics.</a>}<br />\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25143790\" rel=\"noreferrer\">Survey of pharmacists and physicians on drug interactions between combined oral contraceptives and broad-spectrum antibiotics.</a>}</p>\n", "score": 5 } ]

[ "contraception", "antibiotics", "menstrual-cycle" ]

[ { "answer_id": 1797, "body": "<h3>Is tinnitus curable?</h3>\n<p>No, there is no cure for tinnitus. It is connected to a malfunction in the neurons which turn the signals from the ear into the perception of hearing. The usual cause is that the inner ear is damaged, and nobody knows how to repair this organ. You have to accept the idea that it will almost certainly stay with you for the rest of your life.</p>\n<h3>What can you do about tinnitus?</h3>\n<p>The German association for ENT, Head and Neck surgery <a href=\"http://www.awmf.org/leitlinien/detail/ll/017-064.html\" rel=\"nofollow noreferrer\">classifies tinnitus</a> as:</p>\n<blockquote>\n<p>grade I: Does not cause suffering</p>\n<p>grade II: Noticed primary during silence, only interferes during stressful moments and psychic load</p>\n<p>grade III: Causes persistent impairment in the private or professional life, with interference in the emotional, cognitive and body areas</p>\n<p>grade IV: Causes full decompensation in the private area and inability to work</p>\n</blockquote>\n<p>The goal of the existing therapies is not to remove the tinnitus, but to lower it to grade II or I. They usually consist of a combination of relaxation techniques, mental relaxation (meditation, cognitive therapy) which allows you to concentrate on other things without being bothered by tinnitus, and music therapy, which trains your auditory perception to discriminate more between sounds and focus less on the tinnitus sound. After a successful therapy, sufferers of permanent tinnitus can tolerate the tinnitus well, sometimes forgetting it for hours at a time, while sufferers of episodic tinnitus can have less frequent episodes. The subjective loudness of the tinnitus can also go down.</p>\n<p>Tinnitus itself is not treatable, but most of its consequences are, for example sleep problems, depression, speech understanding difficulties, hyperacusis or tensions in the neck area. If they occur, don't hesitate to seek help for them.</p>\n<h3>Where to go for help</h3>\n<p>Tinnitus requires specialized cross-disciplinary knowledge in ENT, neurology and psychiatry. &quot;Standard&quot; ENT doctors are rarely well versed in tinnitus. Your first place to go with acute tinnitus is still the ENT, who can confirm the diagnosis and exclude other, more pressing problems. In the long term, you are much better off going to a clinic specializing in inner ear disorders, or even a pure tinnitus clinic. This type of clinic can also diagnose other, not yet detected types of inner ear damage. Find out if there is a local patient group for tinnitus or hearing loss, and ask them which clinic to go to. They can give you the best regional advice. Also consider becoming a member of your national association for tinnitus, such as <a href=\"http://www.tinnitus-liga.de/index.php\" rel=\"nofollow noreferrer\">Deutsche Tinnitus Liga</a> or <a href=\"https://www.ata.org/about-us\" rel=\"nofollow noreferrer\">American tinnitus association</a>. They are an excellent source for news about promising research.</p>\n<h3>Resources</h3>\n<p>As far as I'm aware, <a href=\"http://www.amazon.de/Tinnitus-Leiden-Chance-Helmut-Schaaf\" rel=\"nofollow noreferrer\">my preferred book</a> about tinnitus is not yet translated into English, but I can recommend it for anybody who reads German. It is written by the director of a clinic specializing in inner ear disorders and his senior physician who is a tinnitus patient himself. If you are researching literature on tinnitus, don't fall for the popular books which promise a miracle healing. I have never met a patient for whom they delivered.</p>\n", "score": 3 }, { "answer_id": 7324, "body": "<p>While there is no single treatment to tinnitus as a variety of reasons can cause it some kinds of therapy might help ease symptoms. Tinnitus is a symptom and not a disease so it is helpful to pinpoint the underlying issue itself and then address it. My tinnitus started after I was on a anti-depressants course(Escitalopram Oxalate) and as soon as I found out one night my ears won't stop ringing I discontinued the drug. The following weeks I experienced natural side-effects of the medication and since then the tinnitus has been there. Now I believe my issue is not with the ear but the auditory cortex itself: the part of the brain associated with processing audio signals. Overexcitation of neurons caused by hearing loss over certain frequencies so the neurons associated with those frequencies start generating their own signals and you get tinnitus or even chronic anxiety/depression. Acoustic neuromodulation is a nice effective therapy to combat this type of tinnitus. Watch this to understand what it is: <a href=\"https://www.youtube.com/watch?v=X_XjYnPooPk\" rel=\"nofollow\">https://www.youtube.com/watch?v=X_XjYnPooPk</a></p>\n\n<blockquote>\n <p>Also this website lets you use your earphones to do ACRN yourself:\n <a href=\"http://generalfuzz.net/acrn/\" rel=\"nofollow\">http://generalfuzz.net/acrn/</a></p>\n</blockquote>\n\n<p>The other kind of tinnitus is caused by mechanical issues to the ear and those might require a deep investigation and surgical intervention of the inner ear which I don't believe is safe. Pulsatile tinnitus is one of the variants where there is some blood vessel pressing to the inner ear causing a pulsing sound signal as blood is pumped by the heart. </p>\n\n<p>My best advice would be to find out what caused your tinnitus in the first place and then treat it. Of course while it may not be completely treatable you can still train yourself to ignore it and proceed on with life. If you constantly worry about it (<strong>stress aggravates tinnitus</strong>) then you're not helping.</p>\n", "score": 2 } ]

[ "hearing", "disease", "tinnitus", "ears-nose-throat-ent", "earwax" ]

[ { "answer_id": 1796, "body": "<p>It does so by drying out your mucous membranes. Air moving over your face as you sleep is going to have more of a drying effect on your nose, sinuses, and throat than still air. This is especially true when the air is dry, such as in winter or when the air is from an air conditioning unit.</p>\n\n<p>The reason the membranes inside your upper respiratory tract are called mucous membranes is because they secrete mucous, which serves a <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12510824\">protective role</a> against pathogens and airborne particles. In your mouth and throat you also have saliva, which serves a similar role. Inhaled bacteria, viruses, fungi and dust are trapped by the mucous and saliva, which is then either expelled or swallowed and digested. This is a very important part of your immune system, so if excessive drying leads to those membranes being directly exposed to air, pathogens will have an easier time invading and you will be more likely to become ill.</p>\n", "score": 7 } ]

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

[ { "answer_id": 18855, "body": "<p>I have written a few blog posts about this topic, to which I will share the links on the topic. In a short-as-possible answer, this is my thinking.</p>\n\n<p>Elevated blood glucose, hyperglycemia is extremely bad for a variety of organs, and the damage can accumulate over time. Free glucose in the blood can bind to positively charge amino acids on proteins. This includes proteins in your blood (like haemoglobin and albumin) protein in your kidneys, eyes, arteries etc. It is called glycation and it accumulates over time, contributing to what is called metabolic disease and all the risks and complications that are associated with being a type II diabetic. (<a href=\"https://medium.com/@finmn/were-toast-ageing-ourselves-in-fast-forward-d94e7603c053?source=friends_link&amp;sk=cb84633d6676b7e149a684c4691536fb\" rel=\"nofollow noreferrer\">Ageing ourselves in fast forward</a>)</p>\n\n<p>Glucose also binds to the cholesterol particles in your blood, specifically to LDL, the so called \"bad cholesterol\" and changes their character to become extremely harmful to your arteries and increases the risk for heart attack by 7-fold. (<a href=\"https://medium.com/@finmn/heart-disease-sugar-and-saturated-fat-the-great-confusion-120cdf8da540?source=friends_link&amp;sk=138baf948cb2deed004c3bba670b0769\" rel=\"nofollow noreferrer\">Heart disease, sugar and saturated fat</a>)</p>\n\n<p>In short, hyperglycemia is without any doubt, one of the most dangerous untreated chronic situations for your body to be in.</p>\n\n<p>As for your father's blasé attitude towards hyperglycemia, it is very bad indeed. Type II diabetes is merely the accumulation of years of prolonged damage caused by untreated hyperglycemia. Diabetes is when your body can no longer cope with the sugar burden and by then, the catastrophic effects that sugar has on your body, will be accelerated multiple times. This how Diabetics end up with kidney disease, fatty liver disease, vision loss, foot amputations etc, heart attacks, strokes, etc.</p>\n\n<p>Scientific thinking around how our modern diet is causing type II diabetes, is changing really fast. Type II Diabetes is no longer thought of as a chronic and terminal illness.</p>\n", "score": 3 } ]

[ "diet", "type-2-diabetes", "blood-sugar", "breaking-habits" ]

[ { "answer_id": 1876, "body": "<p>TL;DR: The only time you should induce vomiting is if the patient is showing no signs or symptoms and you are directed to by poison control or EMS dispatch.</p>\n\n<p>If you have a pill overdose situation and there are any complications such as altered level of consciousness, difficulty breathing, etc., then you want to get emergency medical (EMS) involved immediately. They will want to know such things as:</p>\n\n<ul>\n<li>Age of patient</li>\n<li>Symptoms</li>\n<li>Conscious/breathing?</li>\n<li>What drug(s) were taken (Locate bottles if possible, but don't delay the call to do so)</li>\n<li>Alcohol or multiple drugs involved</li>\n<li>How much was taken (if known)</li>\n</ul>\n\n<p>If the person involved is not showing any signs/symptoms yet, then you could possibly call poison control first. They will also want to know most of the same information.</p>\n\n<p>In some cases where the patient is not showing any symptoms, they may have you try to induce vomiting. The generally recommended method is syrup of ipecac, and if that is not available, then take the person to the nearest ER. You don't want to try to induce by shoving things down their throat. That can cause damage to both you and the patient. If they want you to induce, they will tell you.</p>\n\n<p>Also, speaking from a previous EMS/ER background, if they pump the stomach and/or induce vomiting, they will try and see if they can identify what was taken in the stomach contents that come up. If the person you are with vomits, it would help to try and gather the contents to take with you.</p>\n\n<p>Further reading:\n<a href=\"http://ncapda.org/index.php?option=com_content&amp;view=article&amp;id=79:drug-overdose&amp;catid=33:students&amp;Itemid=7\">http://ncapda.org/index.php?option=com_content&amp;view=article&amp;id=79:drug-overdose&amp;catid=33:students&amp;Itemid=7</a></p>\n", "score": 6 } ]

[ "first-aid", "stomach", "vomit", "overdose" ]

[ { "answer_id": 1898, "body": "<p>Patients successfully treated for Lyme Disease do not need monitoring of any kind (there is no advantage to this.) There are no recommendations for routine antibody levels post Lyme (in fact, it is discouraged, because no one knows what the levels signify), nor yearly exams or other.</p>\n\n<p>It is the responsibility of the patient (and the patient should be so instructed) to return if they are having continuing or new problems.</p>\n\n<p>A bit of background:</p>\n\n<p>The diagnosis and (standard) treatment of Lyme should be swift and proactive, <strong>not</strong> reliant on positive antibodies. The possibility of Lyme should be present in a physician's mind when seeing a patient with typical signs and symptoms (and should be treated <em>before</em> any confirmatory testing is completed), as well as any illness which presents a diagnostic challenge. Unfortunately <em>should</em> doesn't always translate to <em>is</em>.</p>\n\n<blockquote>\n <p>Antibody test results generally are not useful for the diagnosis of early Lyme disease because only a few patients with single EM [erythema migrans] will have a positive result because the rash usually develops before antibodies are detectable. The antibody test result is often negative in the acute phase even in those with multiple EM. Even in the convalescent phase after antimicrobial treatment, antibody test results are negative in approximately half of those with single EM and a quarter of those with multiple EM. </p>\n</blockquote>\n\n<p>This is an interesting question on a lot of levels, some of the answers to which are still being worked out.</p>\n\n<p>Typically when a person is first exposed to a pathogen, the early antibodies made are of the IgM class, followed temporally by IgG. IgM should not be made on re-exposure, but re-exposure should kick up the level of IgG. However, Borrelia <em>burgdorferi</em> infections are not typical.</p>\n\n<p>In people treated early for Lyme, often IgG never develops. IgM, on the other hand, can persist for two decades or more (studies are still ongoing) as well as IgG in those who formed these antibodies. IgM, therefore, is not as predictive of initial infection as in other infections. Antibodies can't be relied upon to make a diagnosis.</p>\n\n<p>Many patients who receive early and appropriate treatment for Lyme disease continue to live in or frequent regions where ticks are endemic, therefore repeated tick bites are quite common. </p>\n\n<blockquote>\n <p>In 1 study of persons from New York with recently recognized Ixodes scapularis tick bites, 59 (17.6%) of 335 subjects reported new tick bites during a 6-week follow-up period...</p>\n</blockquote>\n\n<p>This was <em>6 weeks</em>! In one study, the reinfection (not to be confused with continuing symptoms following treatment) rate within the 5 years following initial successful treatment was ~50%. </p>\n\n<p>Reinfection is usually accompanied by recurrence of EM and/or the fever, myalgia, and arthralgia common with initial Lyme Disease, though there is <em>some</em> (not strong) evidence that symptoms may be less severe on reinfection. So suspicion should remain high in people who live in endemic areas, of those counties near to endemic areas because of the spreading of the bacterium, time of year (most new infections occur in July, June, August and May, in descending order; there's no reason to suspect reinfection is any different), etc.</p>\n\n<p>In the foreseealbe future, there will be tests to determine the presence of bacterial DNA in joint fluid, tissue samples and other, which will help in the diagnosis of the illness, success of treatment, and reinfection. But medicine isn't quite there yet.</p>\n\n<p><strong>Edited to add:</strong> </p>\n\n<blockquote>\n <p>If this patient were to be bitten by another tick in the future, would it be possible to make a determination of Lyme Disease? If so, how?</p>\n</blockquote>\n\n<p>No, it wouldn't be possible to test for the diagnosis. If a person in an endemic area presents with a tick bite in which the tick was starting to become engorged, a single 200mg dose of doxycycline has been shown to effectively prevent 80+% of new infections, so that's always an option (one I'm not <em>quite</em> sure of.) If the patient goes on to develop the rash or flu0like symptoms, a full course of antibiotics is then given.</p>\n\n<p><strong>TL;DR:</strong> There are insufficient studies about the immunology of reinfection. The diagnosis and treatment will depend on the discernment of the patient + physician. If the person is in an area with high infection rates, the index of suspicion and willingness to treat should be high. </p>\n\n<blockquote>\n <ul>\n <li><strong>Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks.</strong> </li>\n <li>Current diagnostics are less than optimal for early disease because it can take weeks for a detectable immune response to be sufficiently measured. So the early stages of disease which when treatment is typically most effective unfortunately are when serum diagnostics are least effective. - <a href=\"http://www.cdc.gov/lyme/resources/webinar/09242012_diagnosticswebinartranscript.pdf\" rel=\"nofollow\">CDC Webinar Sept 2012</a></li>\n </ul>\n</blockquote>\n\n<p>_{<a href=\"http://pedsinreview.aappublications.org/content/35/12/500.full.pdf+html\" rel=\"nofollow\">Borrelia burgdorferi (Lyme Disease) &lt;-- <em>decent overview with some mistakes</em></a>}<br>\n_{<a href=\"http://cid.oxfordjournals.org/content/33/6/780.short\" rel=\"nofollow\">Persistence of Immunoglobulin M or Immunoglobulin G Antibody Responses to Borrelia burgdorferi 10–20 Years after Active Lyme Disease</a>}<br>\n_{<a href=\"http://cid.oxfordjournals.org/content/50/4/512.full.pdf+html\" rel=\"nofollow\">Antibiotic Treatment Duration and Long-Term Outcomes of Patients with Early Lyme Disease from a Lyme Disease–Hyperendemic Area</a>}<br>\n_{<a href=\"http://cid.oxfordjournals.org/content/45/8/1032.full\" rel=\"nofollow\">Reinfection in Patients with Lyme Disease</a>}<br>\n_{<a href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm\" rel=\"nofollow\">some statistics (not all up to date but still helpful)</a>}<br>\n_{<a href=\"http://www.cdc.gov/lyme/stats/chartstables/casesbymonth.html\" rel=\"nofollow\">more statistics</a>} </p>\n", "score": 6 } ]

[ "diagnostics", "lyme-disease" ]

[ { "answer_id": 7582, "body": "<p>According to <a href=\"http://www.popsugar.com/fitness/Can-Prolonged-Earplug-Use-Cause-Damage-Ears-8872394\" rel=\"nofollow noreferrer\">one site</a>:</p>\n<blockquote>\n<p>studies show that long-term use of foam earplugs can cause earwax to build up or become impacted. Earplugs block the outward flow of earwax that our bodies naturally produce in order to self-clean the ears. Foam plugs are often pushed in too far, which can also pack the wax deep inside your ear canal, and possibly against the eardrum. You'll end up with constant ringing of the ears (tinnitus), pain, or hearing loss. What's more — not to gross you out — bacteria thrive on warm, moist, foam earplugs, and since they can't be thoroughly cleaned, people often end up with ear infections.</p>\n<p>Using store-bought foam earplugs that don't fit your ear perfectly can also irritate the skin, another cause of infection, so if you only use them every so often, it's best to invest in a custom-molded pair. These will fit your ears like a glove, and reduce the risk of being pushed in too far. They're also easier to keep clean, so your risk of infection is greatly reduced.</p>\n</blockquote>\n", "score": 0 } ]

[ "hearing", "otolaryngology" ]

[ { "answer_id": 1949, "body": "<p>It is true that high altitudes can cause an increased risk of ear infection. JohnP mentioned in <a href=\"https://health.stackexchange.com/questions/1948/are-ear-infections-more-likely-when-visiting-high-altitudes#comment3737_1948\">his comment</a> that on the <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm\" rel=\"nofollow noreferrer\">National Institutes of Health (NIH) website for acute ear infections</a>, it says that \"Changes in altitude or climate\" can increase the risk of getting an ear infection. The reason for this is also <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/002077.htm\" rel=\"nofollow noreferrer\">explained on the NIH website</a>. That page describes very succinctly what happens to your ears when you experience changes changes altitude (ie: going up a mountain, flying in a plane).</p>\n\n<blockquote>\n <p>The air pressure outside of your body changes as altitude changes. This creates a difference in pressure on the two sides of the eardrum.</p>\n</blockquote>\n\n<p>This difference in pressure can block your <a href=\"https://en.wikipedia.org/wiki/Eustachian_tube\" rel=\"nofollow noreferrer\">Eustachian tube</a>, the tube that connects the back of your nose and upper throat to your middle ear, which can cause an ear infection. A blockage in the Eustachian tube can also lead to something known as <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/001064.htm\" rel=\"nofollow noreferrer\">ear barotrauma</a>, which is just discomfort in the ear, not a full ear infection, but may look and feel similar to one if it is severe enough. It should also be noted that young children are at a much higher risk for their Eustachian tube to be blocked, which may also be a contributing factor to why your daughter got an ear infection.</p>\n\n<hr>\n\n<p>^{<a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm\" rel=\"nofollow noreferrer\">NIH: Ear infection - acute</a>}</p>\n\n<p>^{<a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/002077.htm\" rel=\"nofollow noreferrer\">NIH: Ear - block at high altitudes</a>}</p>\n\n<p>^{<a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/001064.htm\" rel=\"nofollow noreferrer\">NIH: Ear barotrauma</a>}</p>\n\n<p>^{<a href=\"http://www.webmd.com/a-to-z-guides/blocked-eustachian-tubes-topic-overview\" rel=\"nofollow noreferrer\">WebMD: Blocked Eustachian Tubes</a>}</p>\n\n<p>^{<a href=\"http://www.healthline.com/health/ear-barotrauma\" rel=\"nofollow noreferrer\">Healtline: Ear Barotrauma</a>}</p>\n", "score": 4 }, { "answer_id": 25326, "body": "<p>Eustachian tube which connects the ear and throat can get blocked and the pressure difference during the altitude change can give rise to pain. If there is infection in the throat it can produce infection in the ear through the ET. Altitude is not the cause of ear infection. ET has to open for the pressure on both sides of the ear drum to become equal and the pain and blockage in the ear will be reduced.</p>\n", "score": 0 } ]

[ "infection", "pediatrics" ]

[ { "answer_id": 3100, "body": "<p>In general, the answer seems to be no, it does not contain a meaningful quantity. Refer first to <a href=\"https://cooking.stackexchange.com/a/56700/7632\">this answer</a> in <em>Seasoned Advice</em>. </p>\n\n<p>Although not peer reviewed, <a href=\"http://www.spexcertiprep.com/knowledge-base/files/AppNote_GourmetSalts.pdf\" rel=\"nofollow noreferrer\">this article</a> appears to be a credible source and it's the only documented direct test for mercury in sea salts that I've seen. Refer to Table 3 (Hg is mercury).</p>\n\n<p><a href=\"https://i.stack.imgur.com/Ni6bz.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Ni6bz.png\" alt=\"\"></a></p>\n", "score": 5 } ]

[ "food-safety", "salt" ]

[ { "answer_id": 3976, "body": "<p>While not all patients with an atrial septal defect experience, complications, but it can be beneficial to surgically repair the defect to prevent future complications that could occur. </p>\n\n<p>Sometimes children with an atrial septal defect will not need surgery as the defect may close itself, but if the hole is large and is determined to be likely to cause problems as an adult, the doctor will usually recommend surgery to prevent possible future complications. This does not really answer your question, though, as you specifically ask about atrial septal defects in adults.</p>\n\n<p>By the time they are adults, patients with an atrial septal are likely to start showing symptoms, unless the hole is very small (smaller than 5 millimeters). Studies on patients who have begun to show symptoms show that it is generally beneficial to close the atrial septal defect and can improve the life span in adults and help to prevent further complications, especially in younger patients, usually those younger than 25, while the symptoms may still be nearly non-existent. Even though the closure is not <em>as</em> beneficial to older patients, it is still usually recommended when there are symptoms.^{<a href=\"http://eurheartj.oxfordjournals.org/content/ehj/32/5/553.full.pdf\" rel=\"nofollow\">1</a>}^, ^{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767414/\" rel=\"nofollow\">2</a>}^,^{<a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199508243330801\" rel=\"nofollow\">3</a>}</p>\n\n<p>Though the results shown from those studies mentioned above, it can be reasoned that closing an atrial septal defect in a patient in which the defect was found incidentally can be beneficial. Having a very small defect will not typically cause the symptoms associated with atrial septal defects and usually a doctor will not recommend surgical closure of the defect. If a larger defect is found incidentally and any symptoms have yet to occur, then it would be logical to the hole closed. This will help prevent the complications that could occur later in your life and is likely to increase your overall life-quality and lengthen your lifespan.</p>\n\n<hr>\n\n<p>^{<a href=\"http://eurheartj.oxfordjournals.org/content/ehj/32/5/553.full.pdf\" rel=\"nofollow\">1: Benefit of atrial septal defect closure in adults: impact of age</a>}</p>\n\n<p>^{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767414/\" rel=\"nofollow\">2: Surgical closure of atrial septal defects in adults: effect of age at operation on outcome</a>}</p>\n\n<p>^{<a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199508243330801\" rel=\"nofollow\">3: A Comparison of Surgical and Medical Therapy for Atrial Septal Defect in Adults</a>}</p>\n\n<p>^{<a href=\"http://www.mayoclinic.org/diseases-conditions/atrial-septal-defect/basics/definition/con-20027034\" rel=\"nofollow\">Mayo Clinic - Atrial septal defect (ASD)</a>}</p>\n\n<p>^{<a href=\"http://emedicine.medscape.com/article/162914-treatment\" rel=\"nofollow\">Medscape - Atrial Septal Defect Treatment &amp; Management</a>}</p>\n", "score": 1 }, { "answer_id": 3994, "body": "<p>Agree with @michaelpri regarding some of the timing considerations and the overall sense of factors affecting whether closure is necessary. </p>\n\n<p>As to how ASDs cause harm, the usual effect is one of blood shunting from the left heart to the right heart through the ASD. Over time, this increases the filling volumes of the right heart and can lead to right heart failure as the right heart is pumping some excess volume of blood in a circuit from the right heart to the left atrium, back to the right atrium via the ASD and, ultimately, back to the right ventricle again. In this fashion, left ventricular filling can also be decreased, but generally no penalty on systemic circulation occurs, except in extreme cases.</p>\n\n<p>Asymptomatic patients may have a closure depending on the size of the ASD and its specific location. There are studies underway to better understand when to close ASDs. </p>\n\n<hr>\n\n<p>Citations:</p>\n\n<p><a href=\"http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Atrial-Septal-Defect-ASD_UCM_307021_Article.jsp#\" rel=\"nofollow\">American Heart Association: Atrial Septal Defect (ASD)</a></p>\n\n<p>Konstantidides, et al. <a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199508243330801\" rel=\"nofollow\"><em>A Comparison of Surgical and Medical Therapy for Atrial Septal Defect</em></a> N Engl J Med 1995; 333:469-473.</p>\n\n<p>See also an editorial challenging the methodology of the above study:<br>\nC. Ward and R.A. Henderson. <a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199508243330801\" rel=\"nofollow\"><em>Correspondence.</em></a> N Engl J Med 1996; 334:56-57</p>\n", "score": 1 } ]

[ "cardiology", "birth-defect" ]

[ { "answer_id": 3903, "body": "<p>The herpes virus responsible for chickenpox, <em>Varicella zoster</em> lays dormant in nerves after the chickenpox outbreak. Shingles (called herpes zoster) break out in the region affected by that nerve or nerves, which is also why shingles are usually restricted to one body side (as nerves don't cross the spine). [<a href=\"http://www.nhs.uk/Conditions/Shingles/Pages/Symptoms.aspx\" rel=\"noreferrer\">NHS page on shingles</a>] </p>\n\n<p>Spreading the virus to other parts of the body is called <em>autoinoculation</em>. I could not find this described anywhere for <em>Varicella zoster</em> in healthy patients. In the related <em>Herpes simplex</em>, it is uncommon. </p>\n\n<blockquote>\n <p>Sometimes, infected people can transmit the virus and infect other parts of their own bodies (most often the hands, thighs, or buttocks). This process, known as autoinoculation, is uncommon, since people generally develop antibodies that protect against this problem</p>\n</blockquote>\n\n<p>[<a href=\"http://umm.edu/health/medical/reports/articles/herpes-simplex\" rel=\"noreferrer\">University of Maryland Medical Center - Herpes simplex</a>] </p>\n\n<p>Basically, the other parts of your body are vaccinated against the virus. </p>\n\n<p>For <em>Varicella zoster</em>, it is a concern when considering immunocompromised patients (patients receiving chemotherapy, or infected with HIV, for example):</p>\n\n<blockquote>\n <p>If your immune system is weakened, shingles blisters may spread to other parts of your body and it will likely take longer for the symptoms to heal, maybe lasting for months</p>\n</blockquote>\n\n<p>[<a href=\"https://umm.edu/health/medical/altmed/condition/varicellazoster-virus\" rel=\"noreferrer\">University of Maryland Medical Center - Varicella</a>] </p>\n\n<p>This is a bit of an unsatisfactory answer - to me, it looks like it is at the very least not a common concern. No source I could find even recommended washing hands after touching the rash before touching other parts of your body (except for the eyes), which would be a basic precaution if spreading the rash were a concern in not immunocompromised patients. </p>\n", "score": 6 } ]

[ "virus", "herpes", "shingles" ]