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[ { "answer_id": 18213, "body": "<p>Scopolamine products to prevent motion sickness are to be placed behind the ear to. One brand name for this product is Transderm-Scop.</p>\n\n<p>I will write below why it is placed behind the ear, but in terms of the Facebook post, it's probably not accurate. In fact, Snopes.com did a 'Fact-Check' <a href=\"https://www.snopes.com/fact-check/burundangascopolamine-warning/\" rel=\"noreferrer\">article</a> on a similar subject.</p>\n\n<p>Scopolamine is an antimuscarinic medication with strong anticholinergic effects. Anticholinergics are used for a variety of purposes, from motion sickness to pupil dilation (if you ever had your doctor dilate your pupils, it most likely was from an anticholinergic drug such as atropine or tropicamide).</p>\n\n<p>Many drugs have 'anticholinergic' side effects as well. These side effects include:</p>\n\n<ul>\n<li>Sedation</li>\n<li>Dry mouth</li>\n<li>Urinary retention</li>\n<li>Dry eyes (blurred vision)</li>\n</ul>\n\n<p>Benadryl, perhaps the most commonly used over the counter antihistamine, has relatively strong anticholinergic effects, which is why it makes you tired. <a href=\"https://www.pharmacistanswers.com/questions/diphenhydramine-and-dimenhydrinate-what-is-the-difference\" rel=\"noreferrer\">Dramamine</a> also has strong anticholinergic effects, which is why it is marketed specifically for motion sickness.</p>\n\n<p>The anticholinergic effects of drugs are dose dependent, meaning high doses yield greater effects. Very high doses can cause:</p>\n\n<ul>\n<li>Hyperthermia</li>\n<li>Confusion</li>\n<li>Cardiac abnormalities</li>\n<li>Loss of muscle control</li>\n<li>Coma</li>\n</ul>\n\n<p>Oral anticholinergic drugs are notorious for their sometimes severe side effects and overdose, either accidental or deliberate, can be extremely serious.</p>\n\n<p>Going back to scopolamine...the anticholinergic effects of the drug are quite effective for preventing motion sickness. The patches go behind the ear not because it is close in proximity to the vestibular system of the inner ear (important for our sense of balance), but because it is one of the more permeable, and consistent trans-dermal absorption areas on our body.</p>\n\n<p>Very small amounts of scopolamine are in the Transderm-Scop patch. It is designed to deliver a <strong>total</strong> of 1mg <strong>over</strong> a 72 hours period at a constant rate. With such a small dose, it is important to not have significant deviations in drug absorption.</p>\n\n<p>Overall, the patch was designed to a provide predictable delivery of scopolamine, resulting in in precise plasma concentrations.</p>\n\n<p>In terms of skin permeability, the postauricular area (behind the ear) is the most <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/702282\" rel=\"noreferrer\">permeable</a> of any site on the body. This allows very small doses to be used, and reduces the risk of adverse reactions.</p>\n\n<p>Even though the area behind the ear generally provides more predictable drug delivery, there is still significant variation among individuals. </p>\n\n<p>Due to this, the patches have a rate-limiting membrane. This membrane produces a permeation rate that is slower than the skin can absorb (this is based on <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16719539\" rel=\"noreferrer\">studies</a> of different human skin types). So the system (and not individual variability of the skin), controls systemic scopolamine delivery.</p>\n\n<p>To summarize, the patches are put behind the ear because:</p>\n\n<ul>\n<li>Small doses of scopolamine can be used</li>\n<li>The skin behind the ear is the most permeable for trans-dermal absorption and provides the most consistent blood levels of the drug.</li>\n</ul>\n", "score": 5 } ]

[ "medications", "research", "ear" ]

[ { "answer_id": 17229, "body": "<p>Eating large amounts of carbs is not good if you already have diabetes or are prediabetic. But otherwise, whole grain carbs are very healthy. Type-2 diabetes is not caused by eating carbs, but by eating fat. This is explained in detail <a href=\"https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-type-2-diabetes/\" rel=\"nofollow noreferrer\">here</a>. As pointed out in <a href=\"https://www.youtube.com/watch?v=lLqINF26LSA\" rel=\"nofollow noreferrer\">this lecture</a>, countries like Japan where people used to eat large amounts of carbs used to have low rates of diabetes, and that changed when they started to eat less carbs and more fat.</p>\n\n<p>Fat consumption at levels considered to be normal in the West is not only implicated in diabetes, it also causes cardiovascular disease. This was first <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(59)91777-5\" rel=\"nofollow noreferrer\">rigorously established</a> in the late 1950s, <a href=\"https://academic.oup.com/ije/article/41/5/1225/712708\" rel=\"nofollow noreferrer\">see also here</a> for an article on this subject by the first author written more than 50 years later.</p>\n\n<p>A <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30752-3/fulltext\" rel=\"nofollow noreferrer\">more recent research result</a>:</p>\n\n<blockquote>\n <p>...the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date.</p>\n</blockquote>\n\n<p>And note how similar the diets of the Tsimane and the Africans in Uganda are, e.g. they both get less than 20% of their calories from fat. </p>\n\n<p>In general, it's not good to argue on the basis of X is bad because it will cause adverse health effects to people suffering from disease Y. Take e.g. X to be strenuous exercise and Y to be heart disease. Exercise can lower the risk of heart disease, but once you got heart disease, the exercise intensity may need to be limited. </p>\n", "score": 0 } ]

[ "diabetes", "carbohydrates", "glucose" ]

[ { "answer_id": 17338, "body": "<p>If you're searching for treatments that are not currently main stream, you need to look on <a href=\"https://clinicaltrials.gov/ct2/results?term=melanoma+and+spain&amp;Search=Search\" rel=\"nofollow noreferrer\">https://clinicaltrials.gov/ct2/results?term=melanoma+and+spain&amp;Search=Search</a> to see if there's a trial in your city or any other local to you.</p>\n\n<p>However, most oncologists will be aware of these trials. If you're prepared to travel, and can afford treatment in the USA or other countries, then you can look worldwide for experimental treatments.</p>\n", "score": 3 } ]

[ "cancer", "practice-of-medicine", "hospital", "melanoma" ]

[ { "answer_id": 17359, "body": "<p>No there isn’t. Your computer is lacking the hardware diagnostic tools, so a software won’t be able to help.</p>\n<p>An actual blood test is a compilation of multiple tests done by experts in a lab, and even the simplest and faster forms (an ABG, as an example takes &lt;5 minutes) use machines which cost <a href=\"https://www.labx.com/blood-gas-analyzers\" rel=\"nofollow noreferrer\">more than 300 dollars for sure</a>.</p>\n<p>Where would you inject a blood sample into the computer to start with...?</p>\n", "score": 2 } ]

[ "blood-tests", "medical-device", "diagnosis" ]

[ { "answer_id": 17404, "body": "<p>The WHO says between 6.5 and 9.5, but mostly due to the pH's effect on operational water-quality parameters. Between 4 and 10.5, apart from possible irritation the effect on humans may not be severe: </p>\n\n<blockquote>\n <p>EFFECTS ON HUMANS</p>\n \n <p>Exposure to extreme pH values results in irritation to the eyes, skin, and mucous membranes. Eye irritation and exacerbation of skin disorders have been associated with pH values greater than 11. In addition, solutions of pH 10–12.5 have been reported to cause hair fibres to swell. In sensitive individuals, gastrointestinal irritation may also occur. </p>\n \n <p>Exposure to low pH values can also result in similar effects. Below pH 4, redness and irritation of the eyes have been reported, the severity of which increases with decreasing pH. Below pH 2.5, damage to the epithelium is irreversible and extensive. In addition, because pH can affect the degree of corrosion of metals as well as disinfection efficiency, it may have an indirect effect on health.</p>\n \n <p>CONCLUSIONS</p>\n \n <p>Although pH usually has no direct impact on water consumers, it is one of the most important operational water-quality parameters. Careful attention to pH control is necessary at all stages of water treatment to ensure satisfactory water clarification and disinfection. For effective disinfection with chlorine, the pH should preferably be less than 8. </p>\n \n <p>The pH of the water entering the distribution system must be controlled to minimize the corrosion of water mains and pipes in household water systems. Failure to do so can result in the contamination of drinking-water and in adverse effects on its taste, odour, and appearance.\n <strong>The optimum pH will vary in different supplies according to the composition of the water and the nature of the construction materials used in the distribution system, but is often in the range 6.5–9.5</strong>. Extreme pH values can result from accidental spills, treatment breakdowns, and insufficiently cured cement mortar pipe linings.</p>\n \n <p>^{WHO: <strong><a href=\"http://www.who.int/water_sanitation_health/dwq/chemicals/ph.pdf\" rel=\"nofollow noreferrer\">pH in Drinking-water:\n Background document for development of WHO Guidelines for Drinking-water Quality</a></strong>. WHO/SDE/WHO/03.04/12.}</p>\n</blockquote>\n", "score": 1 } ]

[ "water", "stomach", "physical-health", "ph-levels" ]

[ { "answer_id": 17432, "body": "<p>Weight loss induced by calorie restriction is rather complex phenomenon which depends on plethora of factors like metabolic pathways, energy conservation, nutrient composition, BMI, age etc. (<a href=\"http://journals.sagepub.com/doi/full/10.1177/1745691617690878\" rel=\"nofollow noreferrer\">Reducing Calorie Intake May Not Help You Lose Body Weight, D. Benton et al, Perspectives on Psychological Science, June 28, 2017 </a>). However as a general guideline it can be taken that:</p>\n\n<blockquote>\n <p>Reduced energy intake (by about 500 kcal/d) will promote gradual\n weight loss over time at the expected rate of 1–2 kg per month.</p>\n \n <p><a href=\"http://www.cmaj.ca/content/cmaj/suppl/2007/09/04/176.8.S1.DC1/obesity-lau-onlineNEW.pdf\" rel=\"nofollow noreferrer\">\"2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children\", CMAJ, April 10, 2007, Vol. 176, No. 8</a></p>\n</blockquote>\n\n<p>After simple arithmetic transformation, ~10 000 kcal calorie restriction leads to the loss of 1 kg body mass. If we take <a href=\"https://en.wikipedia.org/wiki/Body_fat_percentage\" rel=\"nofollow noreferrer\">an average of 25% of mass of human body</a> is attributed to the fat tissue so roughly 40 000 kcal restriction is required to loose 1 kg of body fat.</p>\n\n<p>For additional information you can consult:</p>\n\n<ul>\n<li><a href=\"https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults\" rel=\"nofollow noreferrer\">Managing Overweight and Obesity in Adults: Systematic Evidence Review\nfrom the Obesity Expert Panel</a>;</li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1319349/[2]\" rel=\"nofollow noreferrer\">Diet in the management of weight loss, I. Strycher, CMAJ. 2006 Jan 3; 174(1): 56–63</a></li>\n</ul>\n", "score": 3 } ]

[ "weight-loss" ]

[ { "answer_id": 17710, "body": "<p>You can use the formula for blood vessel flowrate by accounting heart rate and radius using flow rate formula: Q=ΔP/R</p>\n\n<p>Wherein; flow rate (volume/time); ΔP = pressure difference (mm Hg); and R = resistance to flow (mm Hg x time/volume).</p>\n\n<p>\"This equation may be applied not only to a single vessel, but can also be used to describe flow through a network of vessels (i.e., the vascular bed of an organ or the even your entire systemic circulatory system). It is known that the resistance to flow through a cylindrical tube or vessel depends on several factors (described by Poiseuille) including: 1) radius, 2) length, 3) viscosity of the fluid (blood), and 4) inherent resistance to flow\"</p>\n\n<p>In practicality, these parameters will be difficult to measure.\nWe also have to take into account that over time the heart rate will increase and blood vessel diameter will decrease as a compensatory mechanism against blood loss.</p>\n\n<p>Source:\nUniversity of minnesota; atlas of human cardiac anatomy</p>\n\n<p><a href=\"http://www.vhlab.umn.edu/atlas/physiology-tutorial/blood-flow.shtml\" rel=\"nofollow noreferrer\">http://www.vhlab.umn.edu/atlas/physiology-tutorial/blood-flow.shtml</a></p>\n", "score": 4 } ]

[ "physiology", "anatomy", "hemorrhage" ]

[ { "answer_id": 17597, "body": "<blockquote>\n <p><strong>Q:</strong> When using a Philips Sonicare toothbrush with pressure sensor, is it possible to cause gum damage when pushing too hard?</p>\n</blockquote>\n\n<p>Yes, absolutely. That <em>is</em> the reason for the pressure sensor. It warns the user but the user may override this warning and continue. But see hte last quote on how influential pressure force is across the board.</p>\n\n<blockquote>\n <p><a href=\"https://www.philips.ca/c-p/HX6829_81/sonicare-protectiveclean-5000-sonic-electric-toothbrush\" rel=\"nofollow noreferrer\">Lets you know</a> when you're pressing too hard You may not notice if you’re brushing too hard, but your toothbrush will. <strong>If you start taking it out on your gums, the toothbrush will make a pulsing sound as a reminder to ease off on the pressure.</strong></p>\n</blockquote>\n\n<p>Most products from this manufacturer seem to provide a special \"sensitive\" for, well sensitive teeth and gums. But they seem to not include the matching brush head?</p>\n\n<blockquote>\n <p><a href=\"https://www.electricteeth.co.uk/best-electric-toothbrush-receding-gums-sensitive-teeth/\" rel=\"nofollow noreferrer\">Sensitive and Gum Care cleaning modes are provided, but no Sensitive brush head, this is an optional extra.</a></p>\n</blockquote>\n\n<p>The producer itself says this:</p>\n\n<blockquote>\n <p><a href=\"https://www.usa.philips.com/c-f/XC000001952/my-gums-are-tender-after-using-my-sonicare-toothbrush\" rel=\"nofollow noreferrer\"><strong>Troubleshooting</strong></a></p>\n \n <p>My gums are tender after using my Sonicare toothbrush?</p>\n \n <p>Sometimes your gums feel tender after brushing with an electric Philips Sonicare toothbrush. Find out what could be the cause and how to prevent it.\n Common causes and solutions</p>\n \n <p>If you have a gum disease, if you haven't been using an electric toothbrush before or haven't maintained regular gum care, some tenderness may occur. Apply only light pressure on the Sonicare when brushing your teeth and gums. <strong>Your gums should become less tender within a few days of use. If you still have concerns, consult your dental professional.</strong></p>\n</blockquote>\n\n<p>And the company wants you to stay calm:</p>\n\n<blockquote>\n <p><a href=\"https://www.philips.ca/c-f/XC000002008/can-the-speed-of-the-sonicare-toothbrush-harm-my-gums\" rel=\"nofollow noreferrer\">Can the speed of the Sonicare toothbrush harm my gums?</a></p>\n \n <p>A Philips Sonicare electric toothbrush behaves differently than a manual one. Be sure it cannot do any harm.\n Philips Sonicare toothbrushes will not harm your gums</p>\n \n <p>Sonicare toothbrushes have even been shown in studies to be gentler on dentin than a manual or an oscillating toothbrush.\n While gentle, Sonicare technology cleans effectively by:</p>\n \n <p>Gently whipping toothpaste and saliva into an oxygen-rich foamy liquid\n Directing the liquid between and behind teeth, and along the gum line where plaque bacteria flourish\n Gently massaging the gums, stimulating blood circulation and helping to dislodge plaque</p>\n \n <p>The Philips Sonicare DiamondClean, FlexCare+ and FlexCare toothbrushes come with special Gum Care and massage modes to assure even more comfort for sensitive gums. Gum Care mode provides two minutes of complete whole mouth cleaning, with one additional minute of gentle cleaning for problem areas and along the gum line. Massage mode uses our patented technology to drive fluids to stimulate gums, resulting in healthier gums.</p>\n</blockquote>\n\n<p>Note that I searched for pressure at the manufacturers site and was presented with an overly specific search result talking about the speed!</p>\n\n<p>The marketing phrases should not be taken at face value anyway. But on the other hand, following the 'advice' given out by that sensor is a great tool:</p>\n\n<blockquote>\n <p>Contrary to some research that indicates the superiority of power toothbrushes to manual toothbrushes, a recently published analysis of selected studies by Heanue et al. found that only one type of power toothbrush was more effective at removing plaque and decreasing gum disease than manual brushes. The study, whose ®ndings were published in early 2003 in the Cochrane Library, was conducted by a British-based non-profit health research group called the Cochrane Collaboration.</p>\n \n <p>Heanue et al. concluded that the only category of power toothbrushes that cleaned better than manual toothbrushes were those that worked with rotation±oscillation action, with brush heads</p>\n \n <p><strong>Gingival abrasion and safety</strong><br>\n The safety of power toothbrushes has been clearly established, and research indicates that daily use of a power toothbrush is at least as safe as a manual toothbrush (15). It is widely believed that use of a powered toothbrush, which employs a mechanical action instead of a manual action, reduces brushing force and the incidence of gingival bleeding because of gum damage. In a study by Danser et al., it was observed that brushing force was not influenced by the speed of the brush head and had no correlation with the incidence of gingival abrasion. In another study by Boyd et al., it was determined that power toothbrushes were used with about one-third the force of a manual toothbrush.</p>\n \n <p>In a Swiss study evaluating the clinical effects and gingival abrasion aspects of two power toothbrushes and one manual toothbrush, it was determined that in a group of dental students trained in manual brushing technique, where efficacy was similar with the three toothbrushes tested, there was no evidence of greater gingival abrasion with either powered toothbrush when compared with a manual brush.</p>\n \n <p>The concerns of gingival abrasion associated with tooth brushing are influenced by the filament end-rounding of the brush on either manual or power toothbrushes. The results of the Danser et al. study concluded that end rounding has no effect on plaque removal, but does affect the incidence of gingival abrasion. They showed that gingival abrasion is not influenced by brushing force, but is affected by filament end rounding.</p>\n \n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16451451\" rel=\"nofollow noreferrer\">Catherine Penick: \"Power toothbrushes: a critical review\", Int J Dent Hygiene P, 2004; 40–44</a>. DOI: <a href=\"https://doi.org/10.1111/j.1601-5037.2004.00048.x\" rel=\"nofollow noreferrer\">10.1111/j.1601-5037.2004.00048.x</a></p>\n</blockquote>\n\n<h1>Summary</h1>\n\n<p>It is possible to negatively influence gums by using powerbrushes. But the pressure with which they are used is usually already smaller than manual brushing with most people. Pressure is also a much smaller factor to consider, usually, than too bristles that are not well rounded. Still, gently does it.</p>\n", "score": 2 } ]

[ "gums", "toothbrush" ]

[ { "answer_id": 17625, "body": "<p>\"Menorrhagia\" = excessive menstrual bleeding, possibly associated with uterine fibroids.</p>\n\n<p>\"Hepatomegaly\" = liver enlargement (mild in this case).</p>\n\n<p>\"Fatty infiltration\" probably refers to \"fatty liver.\"</p>\n\n<p>\"Uterine fibroid\" = a benign (non-cancerous) tumor in the uterus.</p>\n\n<p>\"PUJ obstruction\" (sometimes called \"UPJ obstruction\") refers to a congenital abnormality that causes blockage of the urine flow in the kidney at the level of pelvico-ureteric junction (between the kidney and ureter). In this case it is in the right kidney. </p>\n\n<p>At the end of the report there is a suggestion to have an X-ray of the right kidney to check for eventual stones or other problems.</p>\n\n<p>You can get much more info if you read something about \"PUJ obstruction\" (or \"UPJ obstruction\") and \"uterine fibroids.\" It is then a doctor who can tell how serious these conditions are and what can be done.</p>\n", "score": 0 } ]

[ "liver", "kidney", "uterus", "pelvis-pelvic-bone" ]

[ { "answer_id": 17696, "body": "<p>There are some rare anecdotal reports of auditory hallucinations related to oxycodone. For example:</p>\n\n<p><a href=\"https://www.ajgponline.org/article/S1064-7481(12)61307-4/fulltext\" rel=\"nofollow noreferrer\">Example 1</a></p>\n\n<p><a href=\"https://www.centersite.net/poc/view_doc.php?type=doc&amp;id=36686&amp;cn=14\" rel=\"nofollow noreferrer\">Example 2</a></p>\n\n<p>But the half-life of oxycodone is a mere <a href=\"https://www.drugs.com/pro/oxycodone.html\" rel=\"nofollow noreferrer\">3-4 hours</a>, so after two days there should have been virtually no oxycodone present.</p>\n\n<p>However, according to the same link above, oxycodone and its metabolites are excreted primarily via the kidneys, so if the patient in question had impaired kidney function, it's possible that oxycodone remained present that long. And that brings into focus why questions about particular patients are a poor fit for this site. There are just too many variables to answer individual experiences.</p>\n", "score": 2 } ]

[ "side-effects", "post-surgical", "audiology", "hallucinate-hallucogenic", "opioids-opiates" ]

[ { "answer_id": 17739, "body": "<p>Arthralgia is one of trientine dihydrochloride adverse effects</p>\n\n<h2>Mild adverse effects:</h2>\n\n<blockquote>\n <p>rash (unspecified) / Early / Incidence not known</p>\n \n <p><strong>arthralgia / Delayed / Incidence not known</strong></p>\n \n <p>pyrosis (heartburn) / Early / Incidence not known</p>\n \n <p>abdominal pain / Early / Incidence not known</p>\n \n <p>diarrhea / Early / Incidence not known</p>\n \n <p>-<a href=\"http://www.e-lactancia.org/media/papers/trientine-DS-PDR2016.pdf\" rel=\"nofollow noreferrer\">Prescriber's digital reference/ PDR.net</a></p>\n</blockquote>\n\n<hr>\n\n<blockquote>\n <p>\"Unlike penicillamine, trientine hydrochloride is not recommended in cystinuria or rheumatoid arthritis.\"</p>\n \n <p>\"In 15 patients with rheumatoid arthritis, trientine hydrochloride was reported not to be effective in improving any clinical or biochemical parameter after 12 weeks of treatment.\" - <a href=\"https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=89970c97-2535-4856-b155-62d195b5147c\" rel=\"nofollow noreferrer\">dailymed.nlm.nih.gov</a></p>\n</blockquote>\n\n<hr>\n\n<p>There is an <a href=\"https://clinicaltrials.gov/ct2/show/record/NCT02426905\" rel=\"nofollow noreferrer\">ongoing study on this</a> with regards to use of trientine hydrochloride vs penicillamine but unfortunately, the website is not updated with the result of the study.</p>\n\n<p>P.S. Please consult your doctor</p>\n\n<p>*Additional reads: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/Triethylenetetramine_dihydrochloride#section=Top\" rel=\"nofollow noreferrer\">pubchem.ncbi</a></p>\n", "score": 2 }, { "answer_id": 17754, "body": "<p>There is a review of this treatment by <a href=\"https://www.engage.england.nhs.uk/consultation/trientine-for-wilson-disease/user_uploads/evidence-review-trientine-dihydrochloride-wilsons-disease.pdf\" rel=\"nofollow noreferrer\">NICE</a> and although they mention arthralgia, they don't mention arthritis. However, joint degeneration is rarely seen in Wilson disease, and there is also an osseomuscular presentation.</p>\n\n<p>Based on the data we have it's unlikely that it's related to treatment, and speculating on the cause is off topic here.</p>\n\n<p><a href=\"https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0818-1\" rel=\"nofollow noreferrer\">https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0818-1</a></p>\n", "score": 2 } ]

[ "side-effects", "wilsons-disease" ]

[ { "answer_id": 17725, "body": "<p>I think there is a misunderstanding of the circumstances to which \"break the glass\" applies, or perhaps the rules by which physicians nurses and other patient care professionals are granted access to patient records.</p>\n\n<p>Regarding accessing the chart in general, annual training is given to physicians and hospital staff on the laws and regulations (for example under <a href=\"https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/privacy-security-electronic-records.pdf\" rel=\"nofollow noreferrer\">HIPAA, the Health Insurance Portability and Accountability Act</a>) that no one is allowed to even open a patient chart without specific reasons for doing so - such as direct patient care or billing. These rules are a professionalism expectation, and any EMR (electronic medical record) keeps a record of access that can be traced. Additionally, EMR can restrict who can view what. For example, in one of the most prevalent EMRs called EPIC, the interface differs between users' job roles such that access to some areas in the chart is not even available for some users.</p>\n\n<p>Within the US medical system EMRs, \"Break the Glass\" is a mechanism within the EMR chart where it requires a two-step process (justification and signature) to view certain data in a chart, or other circumstances such as open a chart of a patient who has died. For most physician access, it is most commonly used when accessing any psychology or psychiatry notes; in that case one justification selection is \"for direct patient care.\" However, note that psychiatric meds will still appear in the medications list, and psychiatric diagnoses will appear in the problems list. </p>\n\n<p>It is assumed that a physician or nurse will only open a chart for whom they are participating in care, <strong>thus an ER physician will have full access to the EMR chart for a patient they are taking care of, and would only need to do the \"break the glass\" procedure to gain access to psych notes - and would only do so if it is pertinent to the visit.</strong></p>\n\n<p>When a patient registers to be seen at an ER, some of this is explained in the terms of treatment paperwork that they have to sign. An unconscious patient situation has unique laws and regulations that apply, including assumed consent for chart access for reasons of health and life preservation.</p>\n\n<p>Don't assume, however, that EMR between institutions communicate with each other. The technology to do so, although it's been possible since the 1980s, has not been implemented between most healthcare organizations. Even within the same city, they still don't often interface. If you go to a new hospital, they likely have access to zero medical information on you. This can be a significant barrier to continuity of care.</p>\n\n<p>Some information on HIPAA and its application to EMR:</p>\n\n<ul>\n<li><a href=\"https://medicine.yale.edu/ymadmin/news/summer2012/epic_hipaa.aspx\" rel=\"nofollow noreferrer\">https://medicine.yale.edu/ymadmin/news/summer2012/epic_hipaa.aspx</a></li>\n<li><a href=\"https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/privacy-security-electronic-records.pdf\" rel=\"nofollow noreferrer\">https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/privacy-security-electronic-records.pdf</a></li>\n<li><a href=\"https://www.hhs.gov/hipaa/index.html\" rel=\"nofollow noreferrer\">https://www.hhs.gov/hipaa/index.html</a></li>\n</ul>\n", "score": 1 } ]

[ "emergency", "medical-records", "emergency-room" ]

[ { "answer_id": 17731, "body": "<p>This question is fundamentally flawed as it is based on a common misunderstanding about dosage. Every medication has a different <a href=\"https://en.wikipedia.org/wiki/Potency_(pharmacology)\" rel=\"noreferrer\">potency</a>, which could be thought of as the # of mg required to have a clinically noticeable effect. This ranges from a tiny fraction of 1 mg to thousands of mg. </p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Toxicity\" rel=\"noreferrer\">Toxicity</a> level similarly varies: drug A that is clinically effective at 0.075 mg daily might reach toxic levels with just 0.5 mg daily, whereas drug B that is clinically effective at 2,000 mg daily might not reach toxic levels until exceeding 4,000 mg daily. There is not a standard ratio of potency to toxicity either; it depends on multiple factors and can be looked up for each medication.</p>\n\n<p>Therefore the # of mg can NOT be compared between different medications. You cannot compare whether a drug is better or worse for you based on the absolute # of mg you need to take of it. </p>\n\n<p>Another way to say it is that just because you only have to take 0.075 mg of Drug A doesn't mean it is better for you than 2,000 mg of Drug B. </p>\n", "score": 5 } ]

[ "medications" ]

[ { "answer_id": 17865, "body": "<p>Recommendations for dietary fiber intake are usually based on <strong>age/calorie intake:</strong></p>\n\n<p>The <a href=\"https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf\" rel=\"nofollow noreferrer\">Dietary Guidelines for Americans 2015-2020 (p.97)</a> recommendation for men age 19-30 (2,400 - 3,000 Cal range) is 33.6 g and for girls age 4-8 (1,200 Cal) is 16.8 g of fiber per day.</p>\n\n<p>According to <a href=\"https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/factsheets/Dietary_Fiber.pdf\" rel=\"nofollow noreferrer\">Food and Drug Administration</a>, the \"daily value\" for dietary fiber in a 2,000 Cal diet is 25 g.</p>\n\n<p>It may be more important to think about the soluble/insoluble fiber ratio: Most metabolic health effects suggested so far are associated with soluble fiber and bowel regularity with insoluble fiber. </p>\n", "score": 1 } ]

[ "nutrition", "digestion", "colon" ]

[ { "answer_id": 17799, "body": "<p>Your question is unclear. But I (and with me some others) think you are referring to <a href=\"https://www.healthline.com/health/tetanus\" rel=\"nofollow noreferrer\">Tetanus</a>. </p>\n\n<p>Tetanus is caused by Clostridium tetani, bacteria found in street dirt and animal dung (for example horse dung). The bacteria enters the wound through a dirty wound (for example a bike accident). It can be cured by a Tetanus vaccination that must be appllied in a few days. </p>\n\n<p>The vaccination last for 10 to 15 years but is sometimes renewed within 7 years. If the victim is not vaccinated the disease can be deadly. One of the symptoms is muscle stiffness often started with the jaw muscles hence the name lock jaw.</p>\n", "score": 2 } ]

[ "first-aid" ]

[ { "answer_id": 17854, "body": "<h2>Quick Introduction</h2>\n\n<blockquote>\n <p>She asked to increase to 60 mg, but he refused. She didn't challenge him.</p>\n</blockquote>\n\n<p>Let’s just analyse what has happened:</p>\n\n<ul>\n<li>your sister is suffering from acne</li>\n<li>the dosage of medication doesn’t alleviate the acne as much as she hoped they would </li>\n<li>she asks that the dosage is increased furthermore</li>\n<li>the dermatologist refuses </li>\n<li>she increases the dosage herself</li>\n</ul>\n\n<p>This seems like there is a lot of miscommunication going on here:</p>\n\n<ul>\n<li>the dermatologist hasn’t understood how severe the problem is to her and didn't communicate clearly what the treatment and prognosis are</li>\n<li>your sister didn’t understand why the dermatologist didn’t want to increase the dosage</li>\n</ul>\n\n<hr>\n\n<h2>Some Theory</h2>\n\n<p>The Revised Illness Perception Questionnaire (IPQ-R) categorises patient's perception of an illness into 5 categories:</p>\n\n<blockquote>\n <ul>\n <li>Identity</li>\n <li>Cause</li>\n <li>Timeline </li>\n <li>Consequences </li>\n <li>Cure-Control</li>\n </ul>\n \n <p>^{Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L.D., &amp; Buick, D. (2002). <strong><a href=\"https://www.uib.no/ipq/index.html\" rel=\"nofollow noreferrer\">The Revised Illness Perception Questionnaire (IPQ-R)</a></strong>. Psychology and Health. 17, 1-16.}</p>\n</blockquote>\n\n<p>It is a doctor's job to be aware of the patient's illness perception, but it is also good as a patient to be clear about one's perception. </p>\n\n<p>I've just gone ahead and did that for your sister (from what I got of your description). <em>I'm not saying that her perception of the illness is correct and that this is how the illness de-facto is, but that this is how your sister probably views her acne.</em></p>\n\n<p><a href=\"https://i.stack.imgur.com/b5nK0.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/b5nK0.png\" alt=\"enter image description here\"></a></p>\n\n<p>From what I understood from your post, your sister's perception clashes with her dermatologist's perception in three categories: Timeline, Consequences and Cure-Control. </p>\n\n<h2>A potential fix</h2>\n\n<p>The dermatologist needs to communicate more clearly </p>\n\n<ul>\n<li>why the dosage was not increased, and why an increased dosage is not an all-fix. <em>(Cure-Control)</em></li>\n<li>the consequences (Is it really permanent skin-scarring? How to prevent it? What damage control can be done?) <em>(Consequences)</em></li>\n<li>the timeline/prognosis: How long will the acne affect her? When will the symptoms get better? <em>(Timeline)</em></li>\n</ul>\n\n<p>Your sister can achieve this by <strong>telling the dermatologist her illness perception and asking the above questions</strong>.</p>\n\n<p><strong>Your sister should not blame the dermatologist for the miscommunication</strong>, the fault might be on both sides. </p>\n\n<p><strong>Your sister should also not leave before she understands why the dermatologist doesn't want her to take a higher dosage</strong>, and if she continues to go against the dermatologist's recommendations, should ask herself why she does it and if a change of dermatologists would be in order.</p>\n\n<hr>\n\n<h2>What you should ('nt) do</h2>\n\n<ul>\n<li><strong>Do</strong> accompany her to the appointment</li>\n<li><strong>Do</strong> talk with her about what she wants to achieve with this appointment</li>\n<li><strong>Don't</strong> go with her into the patient's room, just wait outside. <em>This is not a fight between your sister and an evil dermatologist</em>, this is just your sister needing to understand why the dermatologist doesn't want her to take more medication and the dermatologist needing to understand why your sister wants to take more medication. Your presence will hamper the communication between them, and you will not be able to do anything as you are neither patient nor doctor. </li>\n</ul>\n", "score": 2 } ]

[ "cystic-acne" ]

[ { "answer_id": 17937, "body": "<p>Alternative medicine is medicine that is outside the standard of care and typically has no strong evidence for effectiveness beyond placebo effects. If there is sufficient scientific evidence that a treatment is effective, it becomes part of the standard of care and is no longer alternative medicine.</p>\n\n<p>Alternative medicine does not mean \"using 'natural' ingredients\" or anything like that, because \"natural\" doesn't have any relationship to what is safe or effective: naturally occurring compounds can be poisons just as effectively as synthetic ones can be, chemistry doesn't care about the history of the atoms included in a molecule.</p>\n\n<p>Lithium used as a medicine has always been based on experiments that showed effectiveness (even if mechanisms are/were poorly understood). Therefore, no, it is not an alternative medicine when used to treat anything for which there is evidence of effectiveness.</p>\n\n<p>Lithium has also been used as <a href=\"https://en.wikipedia.org/wiki/Patent_medicine\" rel=\"nofollow noreferrer\">patent medicine</a> - in that context it could be thought of as \"alternative\" in that marketing claims were made that were not based on scientific evidence.</p>\n\n<p>Lithium was not originally regulated, nor was anything. Regulation of anything is a relatively recent phenomenon, with the US FDA for example only founded in the early 1900s. Not everything is regulated immediately, new regulations are continually added as evidence for harm is discovered. Pharmaceuticals are a bit of a special case in that they must be \"approved\" rather than simply absent from a \"harmful\" list, but their regulation is related to marketing them as medical drugs, not based on their production or consumption.</p>\n\n<hr>\n\n<p>Marmol, F. (2008). Lithium: bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 32(8), 1761-1771.</p>\n\n<p>Shorter, E. (2009). The history of lithium therapy. Bipolar disorders, 11, 4-9.</p>\n", "score": 3 } ]

[ "medical-history", "integrative-medicine" ]

[ { "answer_id": 18082, "body": "<p><strong>There seems to be no evidence that zinc supplements would cause hypocalcemia in humans.</strong></p>\n\n<p>According to the study <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3584729\" rel=\"nofollow noreferrer\">Effect of zinc supplements on the intestinal absorption of calcium (PubMed, 1987)</a>, calcium and zinc may inhibit each other's absorption:</p>\n\n<blockquote>\n <p>the high zinc intake decreased the intestinal absorption of calcium\n during a low calcium intake but not during a normal calcium intake</p>\n</blockquote>\n\n<p>But:</p>\n\n<p><a href=\"https://ods.od.nih.gov/factsheets/Zinc-Consumer/\" rel=\"nofollow noreferrer\">Office of Dietary Supplements by NIH.gov</a> does not mention hypocalcemia as a possible side effect of zinc supplements.</p>\n\n<p><a href=\"https://www.drugs.com/drug-interactions/zinc-sulfate,zinc.html\" rel=\"nofollow noreferrer\">Drugs.com</a> does not mention any interaction between zinc and calcium supplements.</p>\n\n<p>Also, the mentioned claim from <a href=\"https://en.wikipedia.org/wiki/Hypocalcaemia\" rel=\"nofollow noreferrer\">Wikipedia article</a> lacks any reference.</p>\n\n<p>In <em>rats,</em> zinc supplements can cause acute hypocalcemia (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7334451\" rel=\"nofollow noreferrer\">PubMed, 1981</a>), but I'm not aware of any association of this study with humans.</p>\n", "score": 2 } ]

[ "side-effects", "supplement", "calcium", "zinc" ]

[ { "answer_id": 18188, "body": "<p>As I pointed in <a href=\"https://medicalsciences.stackexchange.com/a/11676\">https://medicalsciences.stackexchange.com/a/11676</a>, since sperm are short-lived, they must constantly be replenished, so <a href=\"http://news.nationalgeographic.com/news/2010/03/100318-men-sperm-1500-stem-cells-second-male-birth-control/\" rel=\"nofollow noreferrer\">the testes produce 1,500 sperm per second</a>. Plus sperm is produced during the whole of the male life. If the dead sperm is not released through sex or masturbation, it will automatically be released by the body.</p>\n<p>Some males find that they are more prone to <a href=\"http://www.soc.ucsb.edu/sexinfo/article/nocturnal-orgasms-and-emissions\" rel=\"nofollow noreferrer\">nocturnal emissions</a> during times of less frequent sexual activity because they are not ejaculating as frequently from masturbation or sex with a partner, and in fact — as studies have confirmed — high ejaculation frequency was related to decreased risk of total prostate cancer <a href=\"http://dx.doi.org/10.1001/jama.291.13.1578\" rel=\"nofollow noreferrer\">(Leitzmann, et al., 2004)</a>.</p>\n<h2>References</h2>\n<p>Leitzmann, M.F.; Platz, E.A.; Stampfer, M.J.; Willett, W.C. and Giovannucci, E. (2004). <em>Ejaculation Frequency and Subsequent Risk of Prostate Cancer</em> JAMA 291(13): pp 1578-1586; DOI: <a href=\"http://dx.doi.org/10.1001/jama.291.13.1578\" rel=\"nofollow noreferrer\">10.1001/jama.291.13.1578</a></p>\n", "score": 0 } ]

[ "neurology", "urology", "neuroscience" ]

[ { "answer_id": 18236, "body": "<p>The amount of calories someone consumes is just one side of the coin - you have to consider how many of those calories they are actually expending.</p>\n\n<p>The most visible element of that is the amount of activity the person is doing - exercise for example. Imagine two otherwise identical people (Alex and Bob) who have both consumed say 2000 calories. Alex spends the rest of the day after eating sitting on the couch enjoying old episodes of <em>Rick and Morty</em> on Netflix (Keep Summer safe!) whereas Bob went out and ran a marathon, helped their elderly neighbor move their living room furniture around (Bob's a good guy or \"sucker\" depending on your perspective!) and then cycled 5km to the shop for cat food. Now who's going to have more calories available for storing in body fat - Alex or Bob?</p>\n\n<p>They've both consumed the same amount of calories but Bob has burned more of those off then Alex.</p>\n\n<p>Now you're no doubt thinking to yourself \"well that's obvious - but I've seen Charlie and Derek who <em>both</em> spent the afternoon watching Netflix but Charlie is obese and Derek is a stick insect, what gives?\"</p>\n\n<p>Well that's because the majority (~ 70%) of our calorie burning is actually done by the basic processes of keeping the body running. This is called the <a href=\"https://en.wikipedia.org/wiki/Basal_metabolic_rate\" rel=\"nofollow noreferrer\">Basal Metabolic Rate</a> (BMR) and this varies between different individuals and while some of the <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16280423\" rel=\"nofollow noreferrer\">factors</a> dictating this difference have been identified and understood we don't have a complete understanding of it yet.</p>\n\n<p>Additionally not only are we humans not all the same - not all calories are either. Different foods might have the same numeric calorie values but depending on how they are made up (fats, sugars, carbohydrates etc) the body will digest and process them differently and this can effect body fat levels. A person eating a diet high in saturated fats will gain fat faster than someone eating the same amount of calories from <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22157060\" rel=\"nofollow noreferrer\">Low-GI sources</a>.</p>\n\n<p>So just looking at the amount of calories people consume is insufficient to fully answer the question of why some people are obese and some aren't.</p>\n", "score": 2 }, { "answer_id": 18242, "body": "<p>There are various processes that influence weight gain based on calorie intake. It is in general clear that a severe reduction in calories (well below your body's basal needs) reduces weight in the longer term. I'm not sure any other scenario has consequences that are the same for all people.</p>\n\n<p>An important factor is actual intake. Based on your genetics, diseases and your gut biome, you may not take up calories from the same foods as efficiently as someone else. Extremer examples are people with celiac's, crohn's or ulcerative colitis. Though many milder afflictions will also influence weight gain. Note that people with the above diseases can still be obese due to other factors. You can effectively be in a state of malnutrition and obese (sugar is one of the easiest things to take up, essential vitamins are less easy).</p>\n\n<p>Another important factor is hormones and steroids. Imbalances in hormones and steroids can easily distort how you process sugar and fat, leading to a different reaction. Common example is too little or too many thyroid hormone. Too little causes weight gain (both due to fat and due to water swelling) and lethargy (exercising just got harder).</p>\n\n<p>On top of that, you would also need to look at what is actually gained in weight. You could gain fat, water or muscle. All of these are influenced to some extent by the factors above. And also by what you eat exactly and what you do otherwise.</p>\n\n<p>Note that most of these factors are influenced by both genetics and environment.</p>\n", "score": 2 } ]

[ "calories", "obesity" ]

[ { "answer_id": 18251, "body": "<p>The easiest explanation is that there is no \"knowledge\" involved, just physiology/molecular biology. In an area of low O2 and high CO2 (therefore a demand exists for O2), the oxygen dissociation curve will favor O2 release into the blood, which will then oxygenate the tissue.</p>\n\n<p>Similarly, concentration of CO2 affects localizes extravascular pH. If there is a high amount of CO2 - which occurs with muscle use, among other things - the change in pH caused dilation of arterioles, allowing more blood to flow to those tissues that need it, releasing oxygen via the O2 dissociation behavior. </p>\n\n<p>This is a simplified but essentially correct of the control of oxygen release to tissues that need it.</p>\n\n<blockquote>\n <p>But the greatest subsequent vasodilation [in skeletal muscle] is due to local chemical factors. These are changes that occur during exercise in the extracellular fluid surrounding skeletal muscle cells. Such changes occur naturally as the cells consume more energy; in other words, the effect occurs automatically as a muscle exercises and only in the specific muscles working. The brain does not need to get involved in trying to adjust blood flow to the correct muscles. It happens automatically through this local mechanism. </p>\n</blockquote>\n\n<p>More information can be obtained by reading the article linked to below.</p>\n\n<p><a href=\"https://courses.washington.edu/conj/heart/arterioles2011.htm\" rel=\"nofollow noreferrer\">Control of Arterioles</a></p>\n", "score": 2 } ]

[ "blood", "blood-circulation" ]

[ { "answer_id": 18275, "body": "<p>No, they aren’t.</p>\n\n<blockquote>\n <p>In the area of biological effects and medical applications of non-ionizing radiation approximately 25,000 articles have been published over the past 30 years. Despite the feeling of some people that more research needs to be done, scientific knowledge in this area is now more extensive than for most chemicals. Based on a recent in-depth review of the scientific literature, the WHO concluded that current evidence does not confirm the existence of any health consequences from exposure to low level electromagnetic fields. However, some gaps in knowledge about biological effects exist and need further research.</p>\n</blockquote>\n\n<p><a href=\"https://www.who.int/peh-emf/about/WhatisEMF/en/index1.html\" rel=\"nofollow noreferrer\">WHO</a></p>\n", "score": 1 } ]

[ "immune-system", "radiation", "radioactivity", "bioelectromagnetics" ]

[ { "answer_id": 18361, "body": "<p>The <a href=\"https://en.wikipedia.org/wiki/Heart\" rel=\"nofollow noreferrer\">heart</a> is not a center of intellect, it's a multi-chambered pump made primarily out of muscle. </p>\n\n<p>There <em>are</em> however \"heart signals\", at least in a sense. The <a href=\"https://en.wikipedia.org/wiki/Sinoatrial_node\" rel=\"nofollow noreferrer\">Sinoatrial Node</a> is a specialized group of cells in the heart that produces regular action potentials across the cell membranes in the heart (causing the contractions that pump the blood) but this isn't an intellect or anything like that, just a regular cycle that provides the heart's sinus rhythm (essentially the \"default\" heart rate), the bodies autonomic nervous system (via the release of different chemicals) can influence the rate of these action potentials to raise or lower heart rate.</p>\n", "score": 3 } ]

[ "brain", "cardiology", "nervous-system", "iq-intelligence" ]

[ { "answer_id": 18441, "body": "<p>The main use of St John's Wort is for depression but there are supposedly other uses (<a href=\"https://www.webmd.com/vitamins/ai/ingredientmono-329/st-johns-wort\" rel=\"nofollow noreferrer\">WebMD, n.d.</a>) which may or may not work.</p>\n<p>The only study I can find on the effectiveness of St John's Wort against mild to moderate depression is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19299116\" rel=\"nofollow noreferrer\">Brattström (2009)</a> which you linked to in the comments. The study looked at safety (adverse event frequency) and influence on depression (HAM-D, CGI). One key point I would like to make is that the report states that symptoms of depression did subside;</p>\n<blockquote>\n<p>Mean HAM-D scores decreased steadily from 20.58 at baseline to 12.07 at week 26 and to 11.18 at week 52. Mean CGI scores decreased from 3.99 to 2.20 at week 26 and 2.19 at week 52</p>\n</blockquote>\n<p>however;</p>\n<blockquote>\n<p>Two hundred and seventeen (49%) patients reported 504 adverse events.</p>\n</blockquote>\n<h2>General Safety of St John's Wort</h2>\n<p>The adverse events reported by <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19299116\" rel=\"nofollow noreferrer\">Brattström (2009)</a> could have been for a number of reasons and Brattström only attributed 30 (6%) to the treatment.</p>\n<p>There are many drugs which St John's Wort interacts badly with including antidepressants and birth control pills (<a href=\"https://www.webmd.com/vitamins/ai/ingredientmono-329/st-johns-wort\" rel=\"nofollow noreferrer\">WebMD, n.d.</a>; <a href=\"https://bnf.nice.org.uk/interaction/st-johns-wort-2.html\" rel=\"nofollow noreferrer\">British National Formulary, 2019</a>).</p>\n<blockquote>\n<p>Because of this, France has banned the use of St. John's wort in products. In other countries St. John's wort is only available with a prescription.</p>\n</blockquote>\n<p>Yet, St John's Wort is available in tablets over the counter here in the UK.</p>\n<p>The NHS here in the UK points out that,</p>\n<blockquote>\n<p>It should be noted that St. John’s wort is an unlicensed herbal medication, so would not be prescribed by a general practitioner (as the newspapers suggest). St. John’s wort can have serious interactions with a large number of commonly used medications (e.g. warfarin), by affecting enzymes in the body involved with the metabolic processing of drugs; therefore a discussion with a doctor is important. Additionally, St. John’s wort must not be started while another antidepressant is being taken (<a href=\"https://www.nhs.uk/news/mental-health/st-johns-wort-for-depression\" rel=\"nofollow noreferrer\">NHS, 2008</a>).</p>\n</blockquote>\n<p>WebMD also states</p>\n<blockquote>\n<p>St. John's wort is <strong>POSSIBLY UNSAFE</strong> when taken by mouth in large doses. When taken by mouth in large doses, it might cause severe skin reactions to sun exposure. Women may be at risk of severe skin reactions even at usual doses of St. John's wort. Wear sun block outside, especially if you are light-skinned.</p>\n</blockquote>\n<h2>St John's Wort and Major Depression</h2>\n<p>The NHS covers this too;</p>\n<blockquote>\n<p>The findings [of a systematic review and meta-analysis] – that it is more effective than placebo and the same as standard antidepressants (albeit safer) - apply mainly to people with mild to moderate depression. The authors say that for severe major depression, the evidence is ‘still insufficient to draw conclusions’.</p>\n</blockquote>\n<h2>Long Term Use</h2>\n<p>The answer to your question</p>\n<blockquote>\n<p>Are there any side effects or reduced efficiency of long term use of st Johns wort?</p>\n</blockquote>\n<p>depends on what you call long term for one thing.</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19299116\" rel=\"nofollow noreferrer\">Brattström (2009)</a> conducted the study over a 1 year period calling it long term. If you are talking about longer than this, as St John's Wort only helps with mild to moderate depression, I would wonder about the efficacy of St John's Wort in your case. Therefore, I would suggest seeking advice of your doctor again.</p>\n<p><strong>As long as you check with your doctor before taking it</strong>, plus</p>\n<ul>\n<li>you are not taking other medications which interact badly with St John's Wort, and</li>\n<li>you are not suffering any side effects</li>\n</ul>\n<p>then it is generally considered safe (WebMD, 2017) but must be used with caution, in the same dosages prescribed by the doctor or indicated on the packaging.</p>\n<h2>References</h2>\n<p>Brattström, A. (2009). Long-term effects of St. John's wort (Hypericum perforatum) treatment: A 1-year safety study in mild to moderate depression. <em>Phytomedicine, 16</em>(4), 277-283. doi: <a href=\"https://doi.org/10.1016/j.phymed.2008.12.023\" rel=\"nofollow noreferrer\">10.1016/j.phymed.2008.12.023</a> pmid: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19299116\" rel=\"nofollow noreferrer\">19299116</a></p>\n<p>British National Formulary (2019) <em>St John's Wort Interactions</em> [Online] Retreived from: <a href=\"https://bnf.nice.org.uk/interaction/st-johns-wort-2.html\" rel=\"nofollow noreferrer\">https://bnf.nice.org.uk/interaction/st-johns-wort-2.html</a></p>\n<p>NHS (2008) <em>St John's wort for depression</em> [Online] Retrieved from: <a href=\"https://www.nhs.uk/news/mental-health/st-johns-wort-for-depression\" rel=\"nofollow noreferrer\">https://www.nhs.uk/news/mental-health/st-johns-wort-for-depression</a></p>\n<p>WebMD (n.d.) <em>St John's Wort</em> [Online] Retreived from: <a href=\"https://www.webmd.com/vitamins/ai/ingredientmono-329/st-johns-wort\" rel=\"nofollow noreferrer\">https://www.webmd.com/vitamins/ai/ingredientmono-329/st-johns-wort</a></p>\n<p>WebMD (2017) <em>St. John's wort - ART-20362212</em> [Online] Retreived from: <a href=\"https://www.mayoclinic.org/drugs-supplements-st-johns-wort/art-20362212\" rel=\"nofollow noreferrer\">https://www.mayoclinic.org/drugs-supplements-st-johns-wort/art-20362212</a></p>\n", "score": 1 } ]

[ "supplement", "antidepressants" ]

[ { "answer_id": 18421, "body": "<p>Lean meats have less fat than fatty meats, so, yes, they are easier to digest; I'm not aware of any other thing that would make lean meat easier to digest. But this alone does not tell anything about health benefits of lean meat. For example, foods high in complex carbohydrates, which also contain dietary fiber (undigestible carbohydrates) are harder to digest than simple carbohydrates, like sugar, but are considered more beneficial for health (<a href=\"http://www.kumc.edu/Documents/cray/Glycemic%20Index.pdf\" rel=\"nofollow noreferrer\">kumc.edu</a>).</p>\n\n<p>\"Fiber\" in meat is different than fiber in plant foods and refers to connective tissue, which is made mainly of collagen, which is a protein, which is harder to digest than the protein from muscle (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073484/\" rel=\"nofollow noreferrer\">PubMed</a>). But it is not collagen fiber that makes meat lean; collagen fiber can be present in both lean and fatty meats.</p>\n", "score": 1 } ]

[ "nutrition" ]

[ { "answer_id": 18517, "body": "<p>Contralateral (opposite site) is the opposite of ipsilateral (same side) in anatomical terminology. In looking for references for this, I found \"counter side\" used in place of \"contralateral\" primarily in surgical literature, but it is not quite as common as contralateral, and ut isn't listed anywhere I could find with a clear definition. Nonetheless I think this is the most likely correct interpretation of it.</p>\n\n<p>Ax would most likely be \"axillary tail\" (the portion of the breast that extends into the axilla) in this setting, or possibly \"axilla\" as the <a href=\"https://www.nhs.uk/conditions/aphasia/symptoms/\" rel=\"nofollow noreferrer\">ipsilateral axillary lymph nodes</a> are generally the first site of cancer spread.</p>\n", "score": 2 } ]

[ "cancer", "anatomy" ]

[ { "answer_id": 18642, "body": "<p>Caffeine intake is associated with increased urination, but controlled studies (e.g., <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16167356\" rel=\"nofollow noreferrer\">here</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16167356\" rel=\"nofollow noreferrer\">here</a>) demonstrate fairly rapid adaptation and no chronic diuretic effect. </p>\n\n<p>For most people, if you want to take caffeine without experiencing the diuretic effect, you simply drink your caffeinated beverage regularly and wait for your nephron to move through the equilibration phase. One would expect some variation here, which is why I say for most people. There are, of course, other reasons for excessive urination (beyond caffeine consumption), which are best not addressed in this stack for reasons discussed <a href=\"https://medicalsciences.meta.stackexchange.com/questions/747/how-long-can-this-site-be-popular-if-everybody-is-asked-to-see-a-doctor/748#748\">here</a>. Since the OP states they have been drinking green tea for months and still experience a greater volume of urine output, I have both answered the general question about caffeine and voted to close the specific question (why am I urinating so much) as a personal medical question.</p>\n", "score": 2 } ]

[ "caffeine", "diuretics" ]

[ { "answer_id": 19083, "body": "<p>Lead paint was banned because it leads directly to <a href=\"https://en.wikipedia.org/wiki/Lead_poisoning\" rel=\"nofollow noreferrer\">lead poisoning</a> by contact rather than inhalation, which can arguably be considered slower and 'less' of a risk.^{<a href=\"https://en.wikipedia.org/wiki/Lead_poisoning#Exposure_routes\" rel=\"nofollow noreferrer\">1</a>}</p>\n\n<p>Children often place toys in their mouths, which, especially if the toy is painted with lead paint, is obvious harmful. Wikipedia says the paint also flakes and forms dust which is then inhaled.^{<a href=\"https://en.wikipedia.org/wiki/Lead_poisoning#Paint\" rel=\"nofollow noreferrer\">2</a>}</p>\n\n<p>Also, although a bit of a sorry excuse, lead poisoning from gasoline wasn't considered particularly any more lethal than straight-up <a href=\"https://en.wikipedia.org/wiki/Carbon_monoxide_poisoning\" rel=\"nofollow noreferrer\">carbon monoxide poisoning</a>!</p>\n\n<p>For reference, the blue line is also known as the <a href=\"https://medical-dictionary.thefreedictionary.com/lead+1\" rel=\"nofollow noreferrer\">lead line</a>, and also as <a href=\"https://en.wikipedia.org/wiki/Burton%27s_line\" rel=\"nofollow noreferrer\">Burton's line</a>, which from these references, is mainly caused by <a href=\"https://medical-dictionary.thefreedictionary.com/pica\" rel=\"nofollow noreferrer\">Pica</a>, or <a href=\"https://www.nejm.org/doi/10.1056/NEJMicm1801693\" rel=\"nofollow noreferrer\">added lead in opiates</a>:</p>\n\n<blockquote>\n <p>Burton’s line is a sign of chronic lead intoxication that develops when lead reacts with oral bacteria metabolites. </p>\n</blockquote>\n", "score": 1 } ]

[ "poison" ]

[ { "answer_id": 19098, "body": "<p>Perhaps a good idea for separate lobbies or waiting rooms, but definitely not for operating suites or patient care areas.</p>\n\n<p>Plants use CO2 and release O2, which is good. They also do filter <a href=\"https://toxtown.nlm.nih.gov/chemicals-and-contaminants/volatile-organic-compounds-vocs\" rel=\"nofollow noreferrer\">VOCs (volatile organic compounds)</a> and other air toxins, primarily via the microorganisms living on their roots. Also good. There is a ton of research including <a href=\"https://en.wikipedia.org/wiki/NASA_Clean_Air_Study\" rel=\"nofollow noreferrer\">the NASA research</a> you referenced on the benefits of plants for indoor air quality. </p>\n\n<p>But the toxins that a plant would filter from the air are actually not involved (or at most minimally involved) in hospital-acquired infections, which result from transmission of bacteria, viruses, and fungi. So they wouldn't help further \"clean\" the hospital from clinically significant pathogens. If anything, the soil would foster growth of some pathogens, and stirring it up even just with air flow could contaminate patients. As a comment mentioned, you would definitely NOT want that when someone is sick and immunocompromised, or intubated, or cut open on a table, or healing from wounds.</p>\n", "score": 2 } ]

[ "infection", "air-quality" ]

[ { "answer_id": 19131, "body": "<p>According to this study:</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10656352\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/10656352</a></p>\n\n<p>\"Alternative\"/\"natural\" cleaning products (vinegar and baking soda) were compared with regular disinfectants and tested against a variety of human pathogens including antibiotic-resistant bacteria.</p>\n\n<p>The conclusion found that \"a variety of commercial [excluding the natural alternatives] household disinfectants were highly effective against potential bacterial pathogens.\" Additionally, the natural alternatives were found to have lower effectiveness against bacteria compared to the commercial disinfectants. </p>\n\n<p>So the answer to your question appears to be a solid \"No.\"</p>\n", "score": 2 } ]

[ "hand-sanitizers" ]

[ { "answer_id": 19443, "body": "<p>It sounds like you're describing delayed orgasm. I've condensed the relevant bits of the following paper:</p>\n\n<blockquote>\n <p><a href=\"https://www.fertstert.org/article/S0015-0282(15)01957-3/fulltext\" rel=\"nofollow noreferrer\"><strong>Jenkins &amp; Mulhall. Delayed orgasm and anorgasmia. <em>Fertility and Sterility,</em> 2015; 104(5):1082-1088.</strong></a></p>\n \n <blockquote>\n <p>Delayed orgasm/anorgasmia defined as the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress. Delayed orgasm and anorgasmia are associated with significant sexual dissatisfaction. A focused medical history can shed light on the potential etiologies, which include medications, penile sensation loss, endocrinopathies, penile hyperstimulation, and psychological etiologies. Unfortunately, there are no excellent pharmacotherapies for delayed orgasm/anorgasmia, and treatment revolves largely around addressing potential causative factors and psychotherapy.</p>\n </blockquote>\n \n <p><strong>Definition</strong></p>\n \n <blockquote>\n <p>Delayed orgasm is further classified as lifelong/acquired, generalized/situational, and mild/moderate/severe. An acquired dysfunction establishes that the patient previously had normal orgasm timing. Situational dysfunction implies the man has problems in a particular scenario or scenarios, yet functioning normally in others.</p>\n \n <p>There is no set time threshold for what defines DO. Time threshold for distress is dependent on the partners involved. Some men will reach orgasm with one partner in 15 minutes and have no distress, but with another partner it may cause severe distress because the partner may complain of pain with prolonged intercourse. A population-based survey established that the median intravaginal ejaculatory latency time (IELT) was 5.4 minutes and 2 SD above was approximately 22 minutes. A provider with a patient complaining of IELT longer than 22 minutes will theoretically qualify him for the diagnosis of DO. One should differentiate between problems with of ejaculation and orgasm.</p>\n </blockquote>\n \n <p><strong>Physiology of orgasm</strong></p>\n \n <blockquote>\n <p>Orgasm is a complex neurobiological process that comes as a result of sexual activity (physical sensation) and/or arousal (cognitive awareness). The physiology of ejaculation is discussed elsewhere. When ejaculation occurs, the brain processes the sensation of the pressure buildup within the posterior urethra (bladder neck and external urinary sphincter are closed contemporaneously) leading up to seminal fluid emission and the contraction of the periurethral musculature. This processing leads to the triggering of an orgasm.</p>\n </blockquote>\n \n <p><strong>Pathophysiology</strong></p>\n \n <blockquote>\n <p><strong>Hyperstimulation</strong> </p>\n \n <blockquote>\n <p>Some men obtain greater pleasure from masturbation than they do with sexual intercourse and may continue deep-rooted habits such as frequent masturbation or using idiosyncratic masturbation techniques. Studies have shown a correlation between DO and men with idiosyncratic masturbation practices. Also, with increasing frequency of masturbation the sensitivity of the penis can decline and lead to a vicious cycle where the man increases masturbation force to counteract the declining sensitivity, therefore leading to worsening DO. Vaginal intercourse or orogenital stimulation may not be able to replicate the stimulation achieved through idiosyncratic masturbation and this may result in reduced penile stimulation leading to difficulty achieving an orgasm.</p>\n </blockquote>\n \n <p><strong>Penile Sensation Loss</strong></p>\n \n <blockquote>\n <p>Penile sensation loss has been shown to increase with age. In a literature review by Rowland, he plotted penile sensory thresholds as a function of age as well as sexual functional status. He found that penile sensation loss was more commonly present in those men with increased age and those with sexual dysfunctions.</p>\n </blockquote>\n \n <p><strong>Psychosexual Causes</strong></p>\n \n <blockquote>\n <p>Delayed orgasm based on situational aspects (i.e., difficulties with a specific partner and not with another) is more likely to be due to a psychological etiology. One study looked at stress and anxiety related to timed intercourse demands for fertility treatments and found DO developed in 6% of patients related to elevated anxiety levels. A novel study by Kirby et al. used a rat model to show how stress can suppress the hypothalamic-pituitary-gonadal axis, which is important in healthy normal sexual function. They showed that acute and chronic immobilization stress led to an increase in adrenal glucocorticoids causing an increase in gonadotropin inhibitory hormone, which suppresses the hypothalamic-pituitary-gonadal axis by inhibition of GnRH.</p>\n </blockquote>\n </blockquote>\n \n <p><strong>Management strategies</strong></p>\n \n <blockquote>\n <p>It is true that some men with DO/AO never have an etiology diagnosed that reflects our limited understanding of the physiology of orgasm and the pathophysiology of these conditions. Therapy is focused on defining and treating any overt underlying causes often in conjunction with psychotherapy. Various lifestyle changes include steps to improve intimacy, reduce masturbation frequency, change of masturbation style, and decreasing alcohol consumption.</p>\n \n <p><a href=\"https://i.stack.imgur.com/RLlfD.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/RLlfD.jpg\" alt=\"DO figure\"></a></p>\n </blockquote>\n</blockquote>\n\n<hr>\n\n<p>Other possibilities, if I'm misinterpreting your question:</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Hypersexual_disorder\" rel=\"nofollow noreferrer\">Hypersexual disorder</a> (HD; \"a pattern of behavior involving intense preoccupation with sexual fantasies, urges and activities, leading to adverse consequences and clinically significant distress or impairment in social, occupational or other important functions\") was considered for inclusion in the DSM-5, but was eventually rejected by the American Psychiatric Association:</p>\n\n<blockquote>\n <p><a href=\"https://link.springer.com/article/10.1007/s11930-014-0031-9\" rel=\"nofollow noreferrer\"><strong>Reid &amp; Kafka. Controversies About Hypersexual Disorder and the DSM-5. <em>Current Sexual Health Reports,</em> 2014; 6(4):259-264.</strong></a></p>\n \n <blockquote>\n <p>The concept of mental disorders has also been condemned by some who suggest it is a value-laden socially constructed phenomena used to impose conformity to cultural norms. Not surprisingly, similar arguments have been launched against the HD proposal with allegations that HD pathologizes normal variants of healthy sexual behavior, and hence, it does not meet the requirements for “deviance.” Another frequent criticism is that HD could be an extension or manifestation of an existing mental disorder. This latter critique should not be quickly dismissed given high comorbidity rates of other mental illness commonly reported among treatment-seeking samples of hypersexual patients. Further, it is widely believed among clinicians working with hypersexual patients that sex is used to “cope” with challenging situations or as a way of “coping” in the wake of emotional distress. Such assertions might imply that hypersexuality is an attempt to compensate for maladaptive systems designed to regulate emotion. Subsequently, wouldn’t the more parsimonious conceptualization of hypersexuality be some type of an emotional dysfunction disorder or an adjustment disorder rather than an independent pathology? </p>\n \n <p>If one argues for HD as an independent disorder, they must also identify which internal functions are failing to operate and advance some theory implicating what mechanisms of action are purported to cause the dysfunction. Sadly, sex researchers investigating hypersexuality have often failed in this endeavor with a few notable exceptions. For example, neurobiological mechanisms linked to sexual excitation and sexual inhibition has been advanced as a plausible explanation for hypersexuality. A broader hypothesis about executive deficits in frontal lobe functioning reported mixed findings where hypersexual patients self-reported executive deficits but did not exhibit executive dysfunctions when tested. Many have suggested addiction, impulsivity, and compulsivity models, although it’s questionable whether these conceptualizations really constitute theoretical models given their lack of specificity, falsifiable testability, or explanatory power for the construct of hypersexuality. Moreover, proponents of these approaches have yet to clearly operationalize and delineate the respective distinct contributions of addiction, impulsivity, or compulsivity as they relate to hypersexual behavior.</p>\n </blockquote>\n</blockquote>\n\n<p>While HD wasn't accepted as an established diagnosis, compulsive sexual behavior is a common disorder with similar criteria:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500883/\" rel=\"nofollow noreferrer\"><strong>Derbyshire &amp; Grant. Compulsive Sexual Behavior: A Review of the Literature. <em>Journal of Behavioral Addictions,</em> 2015; 4(2):37-43.</strong></a></p>\n \n <blockquote>\n <p>Compulsive sexual behavior can generally be divided into two categories: Paraphilic and nonparaphilic. Paraphilias are typically considered to be behaviors that have been deemed socially unacceptable that involve non-human objects, suffering of one’s self or a partner, children or a non-consenting person (for example, fetishism, exhibitionism, and pedophilia). Nonparaphilic CSB, which is characterized by more typical sexual desires, include compulsive sexual acts with multiple partners, constant fixation on a partner that may be considered unobtainable, compulsive masturbation, compulsive use of pornography, and compulsive sex and sexual acts within a consensual relationship.</p>\n </blockquote>\n</blockquote>\n", "score": 2 } ]

[ "sex", "sexuality" ]

[ { "answer_id": 19484, "body": "<p>Wilson leads (normally V1-V6) are so called <em>unipolar leads</em>: that means that 3 extremities' electrodes are put together over a high resistance to a so called \"indifferent\" electrode, against which you can record electrical activity to pretty much any point of the body. So, as you correctly stated, you need 3 extremities' leads RA, LA, LF (+ ground RF of course) for the imaginary 0 electrode, if you add a V2 you will get a lead with a main vector pointing from <em>approximately</em> middle of the chest towards the 4th ICR left parasternal (position of V2 electrode). This won't give you much information though since you can't really compare this lead to any of vertical leads (Einthhoven and Goldberger), that is why you do 6 Wilson leads to display the whole horizontal vector projection.</p>\n\n<p>As for your question about the \"percentage of heart activity\", it is a slightly wrong understanding of the idea of ECG. Technically you just need 2 electrodes to record the whole electrical activity, the question is what those 2 electrodes are and what does their recording show compared to other leads. For a complete, unspecific description of heart activity the standard is a 12-channel ECG.</p>\n\n<p>Decide if you wish to dig into the electrophysiological background of ECG, for a complete understanding of this examination technique you should do that, here's a good example of a book you can use (it's in German though), or take any other good physiology textbook\n<em>Lehrbuch Physiologie; Hans-Christian Pape, Armin Kurtz, Stefan Silbernagl; 7. Auflage; Stuttgart; New York : Georg Thieme Verlag, [2014]</em></p>\n", "score": 3 } ]

[ "electrocardiogram" ]

[ { "answer_id": 19512, "body": "<p>If an average Joe and Jane Smoe think they discovered a treatment that works for them but it's not currently used by conventional medicine and they want to validate it for effectiveness and safety, they can ask an experienced doctor, in case of psoriasis a dermatologist, for an opinion. The doctor can then judge if the treatment deserves further investigations and find experts who would be willing to do them. In the US, it's the Food and Drug Administration's (FDA) <a href=\"https://www.fda.gov/drugs/development-approval-process-drugs\" rel=\"nofollow noreferrer\">Center for Drug Evaluation and Research (CDER)</a> who makes the final validation and approval of a treatment:</p>\n\n<blockquote>\n <p>Drug companies seeking to sell a drug in the United States must first\n test it. The company then sends CDER the evidence from these tests to\n prove the drug is safe and effective for its intended use. A team of\n CDER physicians, statisticians, chemists, pharmacologists, and other\n scientists reviews the company's data and proposed labeling. If this\n independent and unbiased review establishes that a drug's health\n benefits outweigh its known risks, the drug is approved for sale.</p>\n</blockquote>\n\n<p>The best way to evaluate the effectiveness of treatment is by <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505292/\" rel=\"nofollow noreferrer\">randomized double blind placebo controlled studies</a>.</p>\n\n<p><em>Randomized</em> means that a group of participants is randomly divided into 2 groups: the main group receieves the studied treatment and the control group a placebo (the treatment with no effect).</p>\n\n<p><em>Double-blinded</em> means that during the study neither the researchers nor the participants know who receives the real treatment and who a placebo.</p>\n\n<p>The results of individual studies can be further evaluated by <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024725/\" rel=\"nofollow noreferrer\">systematic reviews and meta-analyses</a>, which are considered the <a href=\"https://libguides.winona.edu/c.php?g=11614&amp;p=61584\" rel=\"nofollow noreferrer\">highest level of evidence</a>. </p>\n", "score": 2 } ]

[ "disease", "cure", "public-awareness" ]

[ { "answer_id": 19584, "body": "<p>In short:</p>\n\n<ol>\n<li>Egg yolks can make you fat only if they contribute to excessive calorie intake.</li>\n<li>Consumption of up to 1 whole egg/day does not increase the risk of heart disease, but may increase the risk of diabetes; the risk of both diseases increases with the egg quantity.</li>\n<li>Egg whites are not typically associated with increased risk of disease. </li>\n<li>The idea behind throwing egg yolks away is to get the \"good\" (protein) from the egg white and to avoid the \"bad\" (fat, cholesterol and calories) from the yolk. But, egg yolk also contains protein, the fat in it is mostly unsaturated and the cholesterol from it does not raise blood cholesterol in most people. It is true that most of egg calories come from the yolk: the <a href=\"https://ndb.nal.usda.gov/ndb/foods/show/01123?fgcd=&amp;manu=&amp;format=&amp;count=&amp;max=25&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=egg%20raw&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">whole 50 g egg</a> has 72 Calories and 55 Calories come from <a href=\"https://ndb.nal.usda.gov/ndb/foods/show/01125?fgcd=&amp;manu=&amp;format=&amp;count=&amp;max=25&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=egg%20raw&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">yolk</a>.</li>\n</ol>\n\n<p>It is estimated that in ~2/3 of population, high dietary cholesterol intake does not result in increased blood cholesterol levels, but it can in the other 1/3, who are \"cholesterol hyper-responders;\" this does not increase the LDL/HDL ratio (which is a risk factor for atherosclerosis) <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586539/\" rel=\"nofollow noreferrer\">Nutrients, 2015</a>).</p>\n\n<p>According to 2 systematic reviews of studies (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683816/\" rel=\"nofollow noreferrer\">AJCN, 2013</a> ; <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586539/\" rel=\"nofollow noreferrer\">Nutrients, 2015</a>), consumption of up to 1 egg per day is not associated with increased risk of heart disease and stroke but may be associated with an increased risk of diabetes type 2 - this association was manly reported from studies in <em>Americans,</em> who tend to be more obese and consume more saturated fats and cholesterol than people in other countries (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27108219\" rel=\"nofollow noreferrer\">British Journal of Nutrition, 2016</a>).</p>\n\n<p>In 2 recent systematic reviews (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/31041448\" rel=\"nofollow noreferrer\">Advanced Nutrition, 2019</a> ; <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24500371\" rel=\"nofollow noreferrer\">European Journal of Nutrition, 2014</a>), high egg consumption (>1 egg/meal) was associated with an increased risk of some gastrointestinal cancers. </p>\n", "score": 2 } ]

[ "nutrition" ]

[ { "answer_id": 19603, "body": "<p>The sensationalist press release for a <em>small</em> study does <em>not</em> warrant to conclude that</p>\n<blockquote>\n<p>Ecdysterone supplementation has been shown to have a significant anabolic effect</p>\n</blockquote>\n<p>While some previous studies have indicated that there <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447764/\" rel=\"nofollow noreferrer\">may</a> be an effect in cells, tissues and animals, previous human studies measured the effect for &quot;gaining muscle&quot; at <em>zero!</em><br />\n_{(Wilborn: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129166/\" rel=\"nofollow noreferrer\">&quot;Effects of Methoxyisoflavone, Ecdysterone, and Sulfo-Polysaccharide Supplementation on Training Adaptations in Resistance-Trained Males&quot;</a>, 2006.)}</p>\n<p>The study now circulated is not only <em>very</em> small and didn't account for actual bio-availability of the claimed to fame substance. Further, there are more than 400 substances in this class of ectosteroids identified so far. Which one or which combination of them was used in this particular study or all the others is difficult to ascertain and compare in an SE overview answer.</p>\n<p>It also did not explain how the alleged effect should be explained compared to control and placebo results. Unless replicated, the current study is &quot;interesting&quot;, and has no real-life value – so far.</p>\n<p>The main author of this study gives a lengthy interview (in German) acknowledging quite a few of the limitations of this study and its results <a href=\"https://www.damienzaid.de/2019/07/01/ecdysteron/\" rel=\"nofollow noreferrer\">in a podcast</a> (at 1:34:00 he can be quoted with &quot;with <em>hard</em> training we saw a small effect&quot; / &quot;don't take supplements&quot;). Coincidentally the manufacturer selling 6mg as 100mg seems to have pulled the product from the market. Whether the heightened awareness due to the study or the many negative testimonials for products claiming this as an ingredient (<a href=\"https://books.google.com/books?id=yI1oNneR6zkC&amp;lpg=PT145&amp;ots=-ml4XB3c0Y&amp;dq=ecdysterone&amp;pg=PT145\" rel=\"nofollow noreferrer\">example</a>) or plain quality issues remains an open speculative question.</p>\n<p>One big weakness is then that a very preliminary safety assessment was made looking at a few liver parameters. And &quot;kidney&quot; – via urine samples. That's laudable in itself, for such a study, but not enough.</p>\n<p>As among the concerns of &quot;<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18444661\" rel=\"nofollow noreferrer\">promotes growth</a>&quot; (what &quot;growth&quot;, cancer?) the substance is assumed to act on certain receptors</p>\n<blockquote>\n<p>but it is rather exhibited by the activation of the estrogen receptor beta.</p>\n</blockquote>\n<p>And longer term kidney health was not monitored in the new study.</p>\n<p>Well, that might mean really bad news, everyone.</p>\n<blockquote>\n<p>Minglei Lu: <a href=\"https://www.nature.com/articles/s41598-018-29483-7\" rel=\"nofollow noreferrer\">&quot;Activation of mineralocorticoid receptor by ecdysone, an adaptogenic and anabolic ecdysteroid, promotes glomerular injury and proteinuria involving overactive GSK3β pathway signaling&quot;</a>, Scientific Reportsvolume 8, Article number: 12225 (2018)</p>\n</blockquote>\n<p>It seems a rather prudent meaure of supplement vendors to not really rip off consumers by selling them 100mg ecdysterone caps that only contain 6mg (Isenmann). That's actually consumer protection! As now the alleged effects of the supplement should be obtainable with the equivalent of 250 mg of regular spinach. Or some insects, as they contain this steroid hormone, and need it.</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17065383?dopt=Abstract\" rel=\"nofollow noreferrer\">Most Internet claims for ‘spectacular’ effects of ecdysteroids on humans and other mammals are unsubstantiated or apocryphal.</a> However, most reports in the scientific literature have demonstrated that the pharmacological effects of ecdysteroids in mammals are positive, and it is clear that ecdysteroids may influence/improve many physiological functions. Unfortunately, no extensive, systematic trials on any mammalian species have been published. Dietary intake of ecdysteroids is possible but limited for most humans, since the crop species which contain phytoecdysteroids are not extensively eaten. Thus, there may be a future for ecdysteroids as dietary supplements to contribute to human well-being (as ‘adaptogenic’ substances). <strong>However, more study is required to elucidate the metabolism of exogenous ecdysteroids in mammals and the biochemical modes of action of the parent ecdysteroids and their metabolites.</strong> Such studies are also important to underpin the use of ecdysteroid-induced gene switches. These systems possess considerable potential for basic biological studies of gene function and in gene therapy.</p>\n</blockquote>\n<p>A quite recent summary of the sparse overall evidence for human application is found in</p>\n<blockquote>\n<p>We briefly summarise the many attributed positive pharmaceutical effects of ecdysteroids in vertebrates (especially humans) and critically assess the reports associating ecdysteroids with cancer and embryotoxicity and the probable use of ecdysteroids as doping substances for athletes. We stress the need for much more extensive research into the metabolism and mode of action of ecdysteroids particularly in mammals. The presence of natural and, increasingly, man-made ecdysteroid agonists and antagonists may have considerable impact on the environ- ment. On the one hand, non-steroidal (ant)agonists offer considerable promise as environmentally friendlier, more selective pesticides, but, on the other hand, could become endocrine disruptors of non-target species, especially in aquatic ecosystems. We consider in some depth the development of strategies for the identification and environmental monitoring of potential endocrine disruptors affecting ecdysteroid hormonal systems in invertebrates and emphasise the overwhelming need for basic research into the endocrinology of aquatic invertebrates which would be suitable as signal species.</p>\n<p>possible harmful effects of ecdysteroids on vertebrates had to be deter- mined, and these molecules have shown very low, if any, toxicity when ingested by mammals: acute toxicity value of 20-hydroxyecdysone for mice after oral adminis- tration could not be determined (so the LD50 is &gt;9 g/kg body weight), whereas that after intraperitoneal injections LD50 was as high as 6.4 g/kg (Ogawa et al., 1974b).</p>\n<p>tandard tests with pure molecules are needed to fully establish the lack of toxicity after daily administration over a long period (90-day test) (see also this <a href=\"http://www.medsafe.govt.nz/regulatory/CompMed/PIL/IJEACCM/2/Ecdysterone.pdf\" rel=\"nofollow noreferrer\">PDF</a>). Such experiments would allow the removal of ecdysone from the Carcinogenic Potency Database (<a href=\"http://potency.berkeley.edu\" rel=\"nofollow noreferrer\">http://potency.berkeley.edu</a>). Anyway, lack of toxicity does not mean lack of pharmacological effects (see above).</p>\n<p>The reported effects of ecdysteroids on tumorous cell induction/proliferation are conflicting (Table 23.2). Experiments are difficult to compare, as they differ in the molecules used (ecdysone, 20-hydroxyecdysone or other ecdysteroids), their concentrations, their purity, the assays used (in vitro/in vivo) and their duration. Thus, Burdette and Richards (1961) observed proliferation-inhibitory effects on sarcoma cells in vitro, but they used a semi-purified extract from silkworm pupae (ecdysone?). Later investigations with crystalline ecdysteroids obtained from plants showed no effects (Burdette, 1974b). Lagova and Valueva (1981) found that 20-hydroxyecdysone (0.1–300mg/kg daily subcutaneous injections for 5 days) was ineffective on the growth of several tumour types, whereas it stimulated that of mammary gland carcinomas. El-Mofty et al. (1987, 1994) reported that ecdysone was able to induce neoplastic lesions in toads and mice; surprisingly, these results were obtained with very low amounts of ecdysone (i.e. only 1μg/mouse (!) given orally twice a week for 22 months) and they are therefore difficult to reconcile with the data of other authors who used amounts several (2–4) orders of magnitude higher (albeit for shorter durations, e.g. 35 days) without observing any adverse effects (e.g. Ogawa et al., 1974b).</p>\n<p>These anabolic effects were first described in mice/rats and resulted in increased physical performance/endurance (Syrov, 2000). They have also been observed in humans, according to the few clinical experiments, the details of which are not readily available (Lafont and Dinan, 2003).</p>\n<p>The availability of other purified ecdysteroids is, however, seriously limited, and the few which are available are very expensive. The recent availability of large amounts of 20E has been driven by the belief that ecdysteroids possess anabolic properties (which has not been conclusively demonstrated in clinical trials, although a growing body of cir- cumstantial evidence exists) and the wish by many to exploit this. As a consequence, 20E is now a component of a very large number of preparations available over the Web (see Ecdybase), targeted at body-builders, sportsmen, health fanatics and their pets. These formulations incorporate purified 20E, or semi-purified ecdysteroid-containing plant extracts, together with other components; only in one product is 20E the only ‘active’ ingredient. Recommended doses have increased over time from 5 mg/pill in 1995 up to 300 mg/soft gel at the present. It is not clear if this reflects a reassessment of the required dosage, or the greater availability of 20E. One must also question the claimed amount of ecdysteroid present in the preparations, since Jadhav et al. (2007) found much lower levels than those claimed.</p>\n<p>_{–– René Lafont &amp; Laurence Dinan: &quot;Innovative and Future Applications for Ecdysteroids&quot;, in: Guy Smagghe (Ed): &quot;Ecdysone: Structures and Functions&quot;, Springer, 2009.}</p>\n</blockquote>\n", "score": 4 } ]

[ "side-effects", "supplement" ]

[ { "answer_id": 19610, "body": "<p>There is a site called <a href=\"https://www.anatomystuff.co.uk/\" rel=\"nofollow noreferrer\">Anatomy Stuff</a> which specialize in providing replications of the human body.</p>\n\n<p>In particular, they have a section called <a href=\"https://www.anatomystuff.co.uk/anatomical-models.html\" rel=\"nofollow noreferrer\">Anatomy Models</a>, which has a range of human-esque models, but these are a bit obsolete these days!</p>\n\n<p><a href=\"https://www.anatomystuff.co.uk/clinical-skills-training-models.html\" rel=\"nofollow noreferrer\">Clincal Skills Training</a>, another of their sections, has life-like human <em>manikins</em> that can be used to mimic real people.</p>\n", "score": 4 } ]

[ "practice-of-medicine" ]

[ { "answer_id": 19614, "body": "<p><a href=\"https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.91.4.636\" rel=\"nofollow noreferrer\">Porco et al</a> studied a situation where a phlebotomist in California admitted to <strong>intentionally reusing needles.</strong></p>\n\n<p>They estimated likelihood of HIV transmission (as well as hepatitis B/C) based on population prevalence (the first person needs to be HIV+), transmission probability (enough virus needs to remain alive and get transferred to the second person to cause infection), and rate of needle reuse.</p>\n\n<p>For HIV, the risk ranged from 1.4 in 100 million in the best case scenario (low prevalence, low transmission rate, correct number of reuses reported) to 6.8 in 1 million (more people already HIV positive than expected, highest transmission rate, 100X more reuse than reported). <strong>Even the best case scenario described is a situation where every single needle was being reused 5-10 times.</strong></p>\n\n<p>Even this best-case scenario is much worse than an event of accidental reuse, because this is all based on a scenario of <em>known, intentional reuse of every single needle</em>.</p>\n\n<p>In summary, the risk of HIV transmission from accidental reuse is effectively zero. There is no plausible way in the work flow for a used needle to be confused with an unused one. You are only at risk in a situation when needles are intentionally reused, and even then the risk is low unless you are in an area where HIV prevalence is very high. Intentional misuse has occurred even in places like the US (and perhaps Europe; I am aware of US cases but not European) but is more likely in places with stronger incentives to save costs, for example a recent event reported in Pakistan.</p>\n\n<p>@CareyGregory had a good suggestion in a comment that if you are at all concerned, you ask the staff to walk you through the procedure: if nothing else, this should reassure you of the process.</p>\n\n<hr>\n\n<p>Porco, T. C., Aragon, T. J., Fernyak, S. E., Cody, S. H., Vugia, D. J., Katz, M. H., &amp; Bangsberg, D. R. (2001). Risk of infection from needle reuse at a phlebotomy center. American journal of public health, 91(4), 636.</p>\n", "score": 1 } ]

[ "blood-tests", "hiv" ]

[ { "answer_id": 19649, "body": "<p>After CSF flows through ventricular space into the subarachnoidal space it is absorbed into venous stream through <a href=\"https://en.wikipedia.org/wiki/Arachnoid_granulation\" rel=\"nofollow noreferrer\">Arachnoid granulations</a>.</p>\n\n<p>My first one-line answer =)</p>\n", "score": 3 } ]

[ "eye", "brain", "glaucoma", "csf-cerebrospinal-fluid" ]

[ { "answer_id": 19723, "body": "<p><em>It is not generally recommended, but any individual person should speak to their doctor for individualized advice prior to traveling to areas with potential for concerning exposures. There are many health factors that determine how risky a disease exposure is for an individual, and what he/she should do about it.</em></p>\n\n<p>The term you're looking for is <a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/antibiotic-prophylaxis\" rel=\"nofollow noreferrer\">antibiotic prophylaxis</a>, and there are very few situations where this is done, such as some surgical procedures, or dental procedures for specific individuals, traveling to an area with endemic malaria (which is a parasite not bacteria), or for severely immunocompromised individuals like <a href=\"https://aidsinfo.nih.gov/drugs/401/sulfamethoxazole---trimethoprim/0/patient\" rel=\"nofollow noreferrer\">PCP prophylaxis with bactrim in AIDS when CD4 count is extremely low</a>. But it is not recommended for most situations - especially when an individual has a normal immune defense. <em>Again, for individual advice, speak with a doctor.</em></p>\n\n<p>Your linked \"flesh-eating bacteria\" article explains clearly that the individual was immunosuppressed due to cancer. That is a common reason for bad outcomes from a bacteria that usually would be fought off by a healthy immune system, or at least kept out by intact skin (wound-free). The other woman sustained an injury that broke her skin in the water that had the bacteria. The article states that</p>\n\n<blockquote>\n <p>people \"who are immunocompromised, e.g. chronic liver disease, kidney\n disease, or weakened immune system, should wear proper foot protection\n to prevent cuts and injury caused by rocks and shells on the beach.\"</p>\n</blockquote>\n", "score": 1 } ]

[ "immune-system", "bacteria", "treatment-options", "swimming" ]

[ { "answer_id": 29163, "body": "<p>I think it's hard to say because there seems to be substantial variability. The lowest figure I've heard was 30%, but it's from an <a href=\"https://www.theguardian.com/world/2020/may/03/happy-hypoxia-unusual-coronavirus-effect-baffles-doctors\" rel=\"noreferrer\">anonymous report</a> quoted in <em>The Guardian</em>:</p>\n<blockquote>\n<p>An anaesthetist at a London hospital, who spoke anonymously, recalled one patient who attended A&amp;E saying she felt cold. “When we put the stats probe on her, her saturation was 30% on air,” he said. “We obviously thought that was wrong, as usually patients are likely to have hypoxic cardiac arrests.” But when a blood sample was taken, her blood was very dark and had oxygen levels equivalent to those seen in people acclimatised to high altitudes. The patient was placed on a ventilator and survived for about a week before dying. “I have had a few patients like this,” the doctor said. “Sadly, their outcomes tend to be bad in my experience.”</p>\n</blockquote>\n<p>The same article says:</p>\n<blockquote>\n<p>Typically patients would lose consciousness below an oxygen saturation of 75%.</p>\n</blockquote>\n<p>But I'm having a hard time finding a paper or textbook to back up this specific number.</p>\n<p>Somewhat easier to find is <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376585/\" rel=\"noreferrer\">data</a> on oxygen saturation for patients whose life support has been withdrawn. (But these were unconscious already.)</p>\n<blockquote>\n<p>It was observed that 0/82 patients had saturations of less than 40% for more than 3 min prior to cardiac arrest and 74/82 for more than 2 min.</p>\n</blockquote>\n<p>Somewhat related: in patients predisposed to unexplained syncope,\nabsolute frontal cerebral tissue oxygen saturation (SctO2) during the\nhead-up tilt test <a href=\"https://academic.oup.com/europace/article/20/9/1535/4259808\" rel=\"noreferrer\">was</a> a good indicator: &quot;patients faint when SctO2 falls below 60%&quot;, but this doesn't correlate at all with peripheral saturation (SpO2) in such patients, which remained constant.</p>\n", "score": 5 } ]

[ "hypoxia" ]

[ { "answer_id": 19762, "body": "<p>The <em>revised</em> <strong>Adequate Intake</strong> values for potassium are <strong>2.6 g/day for adult women</strong> and <strong>3.4 g/day for men</strong> (<a href=\"https://www.nap.edu/resource/25353/030519DRISodiumPotassium.pdf\" rel=\"nofollow noreferrer\">National Academic Press, 2019</a>). The old value was 4.7 g/day for all adults (<a href=\"http://www.nationalacademies.org/hmd/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx\" rel=\"nofollow noreferrer\">National Academies, 2014</a>).</p>\n\n<p>I always believed they were exaggerating before and they are probably still exaggerating now. Note, that they themselves do not say these amounts are \"required\" but \"adequate.\"</p>\n\n<p>Recommended Dietary Allowance and Adequate Intake explained (<a href=\"https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx\" rel=\"nofollow noreferrer\">NIH.gov - Office of Dietary Supplements</a>):</p>\n\n<ul>\n<li>Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of <em>nearly all (97%-98%) healthy people.</em></li>\n<li>Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.</li>\n</ul>\n\n<p>For potassium, they set only Adequate Intake and not Recommended Dietary Allowance, so they openly say they are not sure about the actual needs.</p>\n\n<p>Recommended Dietary Allowance is a value that meets <em>the needs of nearly all people in a certain age and sex group,</em> including the ones with the greatest needs, such as athletes and heavy physical workers who lose potassium with sweat (<a href=\"http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2019/Dietary-Reference-Intakes/webinar-slides.pdf\" rel=\"nofollow noreferrer\">National Academies</a>). If you are not very physically active and you do not sweat a lot, you do not need so much potassium as RDA suggests. I don't know what is a minimal or optimal requirement for you, but it probably does not need to be 3.4 g/day, if you are not very physically active.</p>\n\n<p>US Department of Agriculture has <a href=\"https://ndb.nal.usda.gov/ndb/nutrients/report/nutrientsfrm?max=25&amp;offset=0&amp;totCount=0&amp;nutrient1=306&amp;nutrient2=&amp;subset=1&amp;sort=c&amp;measureby=m\" rel=\"nofollow noreferrer\">a list of nutrients high in potassium</a> and cloves do not rank high.</p>\n\n<ul>\n<li>A large potato with skin, baked (300 g) = 1.6 g</li>\n<li>Breadfruit, raw (220 g) = 1.1 g</li>\n<li>Grapefruit juice (6 fl oz; 207 g) = 1 g</li>\n<li>Cowpeas, boiled (165 g) = 0.7 g</li>\n<li><strong>Cloves, ground (2 tsp) = 0.042 g, which is ~1% of adequate intake (3.4 g).</strong></li>\n</ul>\n\n<p>For someone on a low-carb diet, good sources of potassium include most nuts and seeds, cabbage, spinach, tomatoes, etc. (see the USDA source above).</p>\n\n<hr>\n\n<p>Cloves may slow down blood clotting and may enhance the effect of anticoagulants, such as aspirin, heparin, etc. (<a href=\"https://www.rxlist.com/clove/supplements.htm\" rel=\"nofollow noreferrer\">RxList</a>).</p>\n\n<p>I didn't find any information about the effect of cloves on absorption of nutrients. <a href=\"https://www.drugs.com/drug-interactions/clove.html\" rel=\"nofollow noreferrer\">Drugs.com</a> has a list of 41 nutrients/drugs, absorption of which could be potentially affected by cloves, but it is not. Few teaspoons of cloves would quite likely cause upset stomach or diarrhea, though.</p>\n\n<hr>\n\n<p>In conclusion, cloves are a spice and not food and exaggerating with spices may not be good for your stomach. <strong><a href=\"https://ndb.nal.usda.gov/ndb/foods/show/02011?fgcd=&amp;manu=&amp;format=&amp;count=&amp;max=25&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=cloves&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">Cloves</a> are a very poor source of potassium</strong> and other nutrients.</p>\n\n<p>The idea that regularly consuming small amounts of cloves, pepper, turmeric, ginger and other spices would add to general amount of minerals in the diet does not work in the same sense like few drops of water does not add much to your hydration when you need at least a liter or more water per day. You constantly lose minerals from your body, so you need to constantly replace them in the appropriate amounts; it's not that minerals gradually build up in your body.</p>\n\n<p><a href=\"https://medlineplus.gov/druginfo/herb_All.html\" rel=\"nofollow noreferrer\">MedlinePlus</a> has a comprehensive database of herbs and supplements. If any herb inhibits the absorption of any nutrient, it would be likely mentioned there under \"interactions.\" It would be also mentioned if there is any difference between a raw or cooked herb. I haven't found anything significant about cloves in this regard.</p>\n", "score": 5 } ]

[ "nutrition", "minerals", "potassium" ]

[ { "answer_id": 19878, "body": "<p>Symptomatic magnesium deficiency due to \"chronic stress\" and \"mental effort\" in an otherwise healthy person on a regular diet is unlikely.</p>\n\n<blockquote>\n <p>Symptomatic magnesium deficiency due to low dietary intake in\n otherwise-healthy people is uncommon because the kidneys limit urinary\n excretion of this mineral (<a href=\"https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/\" rel=\"nofollow noreferrer\">Office of Dietary Supplements,\n NIH.gov</a>).</p>\n</blockquote>\n\n<p>According to the same source, Tolerable Upper Intake Levels (ULs) for supplemental magnesium is 350 mg/day for adults, which is even lower than the Recommended Dietary Allowance, which is 420 mg/day. This is because magnesium from supplements tends to have a <strong>laxative effect</strong> in lower doses than the magnesium from food. The actual Mg dose that can trigger diarrhea can vary greatly from person to person, though.</p>\n", "score": 1 } ]

[ "magnesium" ]

[ { "answer_id": 20088, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Tendinopathy\" rel=\"nofollow noreferrer\">Tendinopathy</a> is a type of <a href=\"https://en.wikipedia.org/wiki/Tendon#Functions\" rel=\"nofollow noreferrer\">tendon</a> disorder:</p>\n\n<blockquote>\n <p>Traditionally, tendons have been considered to be a mechanism by which muscles connect to bone as well as muscles itself, functioning to transmit forces. This connection allows tendons to passively modulate forces during locomotion, providing additional stability with no active work.</p>\n</blockquote>\n\n<p>The difference between <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807950/\" rel=\"nofollow noreferrer\">non-insertional</a> and insertional is that the insertional tendon is where the tendon meets the bone and non-insertional is the 'in-between'. And so the related injuries are different - insertional tendons can come loose from the bone (e.g. tearing), whereas non-insertional tendons can't.</p>\n\n<p>I think this is what the author is implying (that non-insertional tendon's have <strong>less</strong> possible forms of being injured, and the main one is caused by repetitive stressings).</p>\n\n<p>Tendon injuries are covered <a href=\"https://en.wikipedia.org/wiki/Tendon#Injury\" rel=\"nofollow noreferrer\">here</a>:</p>\n\n<blockquote>\n <p>Tendinopathies may be caused by several intrinsic factors including age, body weight, and nutrition. The extrinsic factors are often related to sports and include excessive forces or loading, poor training techniques, and environmental conditions.</p>\n</blockquote>\n\n<p>which is from the reference given:</p>\n\n<ul>\n<li><a href=\"https://ueaeprints.uea.ac.uk/30737/1/Riley_-_Rheumatology%2C_2004%2C_43%2C_131-142.pdf\" rel=\"nofollow noreferrer\">Riley, G. (2004). \"The pathogenesis of tendinopathy. A molecular perspective\"</a></li>\n</ul>\n", "score": 2 } ]

[ "tendinopathy", "tendons" ]

[ { "answer_id": 20187, "body": "<p>According to Thought.co, table salt is 97-99% sodium chloride:</p>\n\n<blockquote>\n <p><a href=\"https://www.thoughtco.com/what-is-table-salt-604008\" rel=\"nofollow noreferrer\">https://www.thoughtco.com/what-is-table-salt-604008</a></p>\n</blockquote>\n\n<p>with common additives being potassium iodide and sodium fluoride, and anti-caking agents:</p>\n\n<ul>\n<li>Calcium aluminosilicate</li>\n<li>Calcium carbonate</li>\n<li>Calcium silicate</li>\n<li>Fatty acid salts (acid salts)</li>\n<li>Magnesium carbonate</li>\n<li>Magnesium oxide</li>\n<li>Silicon dioxide</li>\n<li>Sodium aluminosilicate</li>\n<li>Sodium ferrocyanide or yellow prussiate of soda</li>\n<li>Tricalcium phosphate</li>\n</ul>\n\n<p>Salt tablets are generally only used for sports, and as such are manufactured to enhance performance, and therefore are more likely to contain any number of additives.</p>\n\n<p>According to TorqFitness:</p>\n\n<blockquote>\n <p><a href=\"http://www.torqfitness.co.uk/news/electrolyte-tablets\" rel=\"nofollow noreferrer\">http://www.torqfitness.co.uk/news/electrolyte-tablets</a></p>\n</blockquote>\n\n<p>typical composition is:</p>\n\n<blockquote>\n <p>What is an electrolyte tablet? </p>\n \n <p>Manufacturing methods vary, but generally an electrolyte tablet you’d hope would contain all 5 electrolytes (Sodium, Chloride, Potassium, Magnesium and Calcium) although this isn’t necessarily guaranteed. You’d also hope that it delivers electrolytes somewhere within the range recommended by an expert researcher like Burke (1999): </p>\n \n <ul>\n <li>Sodium: 400-1,100mg/l</li>\n <li>Chloride: 500-1,500mg/l</li>\n <li>Magnesium: 10-100mg/l</li>\n <li>Potassium: 120-225mg/l</li>\n </ul>\n</blockquote>\n\n<p>I doubt there will be any official literature, <a href=\"https://en.wikipedia.org/wiki/Salt\" rel=\"nofollow noreferrer\">salt</a> is just simply <a href=\"https://en.wikipedia.org/wiki/Himalayan_salt\" rel=\"nofollow noreferrer\">salt</a> after all!</p>\n", "score": 1 }, { "answer_id": 20190, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Salt\" rel=\"nofollow noreferrer\"><strong>Salt</strong></a> that is meant for human consumption refers to <strong>sodium chloride.</strong> Both table salt and salt tablets contain sodium chloride and not just sodium. They can both contain other naturally present or added minerals.</p>\n\n<p><strong>Table salt</strong> usually refers to <a href=\"https://en.wikipedia.org/wiki/Halite\" rel=\"nofollow noreferrer\"><strong>rock salt</strong></a>, which is obtained from underground mines. It should contain at least 97% of sodium chloride and can also contain <a href=\"http://www.ceecis.org/iodine/07_legislation/00_mainpage/codex_food_grade_salt.pdf\" rel=\"nofollow noreferrer\">other natural or added substances</a>. </p>\n\n<p><strong><a href=\"https://en.wikipedia.org/wiki/Sea_salt\" rel=\"nofollow noreferrer\">Sea salt</a></strong> is obtained from the sea. The main ingredient is sodium chloride and it can naturally contain 0.2 to 10% of other salts, such as calcium, potassium, and magnesium salts of chloride and sulfate. </p>\n\n<p>In some countries, iodine is added to rock or sea salt (<a href=\"https://en.wikipedia.org/wiki/Iodised_salt\" rel=\"nofollow noreferrer\"><strong>iodized salt</strong></a>) to prevent iodine deficiency. </p>\n\n<p><strong><a href=\"https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f3f09817-8a38-4aa1-956b-69d9cf695074&amp;type=display\" rel=\"nofollow noreferrer\">Salt tablets</a></strong> are available as:</p>\n\n<ul>\n<li>commercial products, which contain sodium chloride, and may or may not contain other minerals, such as potassium and magnesium, in various amounts (depending on the brand); they are popular among long-distance runners</li>\n<li>prescribed supplements, usually named \"<a href=\"https://www.drugs.com/monograph/sodium-chloride.html\" rel=\"nofollow noreferrer\">sodium chloride tablets</a>,\" in which the only active ingredient is sodium chloride and which are intended for various health conditions.</li>\n</ul>\n\n<p><strong><a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/1541-4337.12291\" rel=\"nofollow noreferrer\">Salt substitutes</a></strong>, which mainly contain <strong>potassium chloride,</strong> are commercially available or prescribed and are intended to use instead of rock or sea salt to prevent excessive sodium intake.</p>\n", "score": 1 } ]

[ "prescription", "salt", "sodium", "electrolytes" ]

[ { "answer_id": 20204, "body": "<p><img src=\"https://i.stack.imgur.com/Xeswn.jpg\" alt=\"Hypothalamic activation during migraine attack\">\nThis study shows that hypothalamus is key as the migraine attack generator.\n<a href=\"https://doi.org/10.1177/0333102419867280\" rel=\"nofollow noreferrer\">https://doi.org/10.1177/0333102419867280</a></p>\n", "score": 1 } ]

[ "pain", "neurology" ]

[ { "answer_id": 20229, "body": "<p>A medium apple (182 g) can contain ~10 grams of fructose (<a href=\"https://nutritiondata.self.com/facts/fruits-and-fruit-juices/1809/2\" rel=\"nofollow noreferrer\">NutritionData</a>).</p>\n\n<p><strong>1) The claims that apples lower blood uric acid are not supported by evidence.</strong> </p>\n\n<p><a href=\"https://timesofindia.indiatimes.com/life-style/health-fitness/diet/20-foods-to-keep-your-uric-acid-at-normal-levels/articleshow/20585546.cms\" rel=\"nofollow noreferrer\">Times of India</a> says that apples, because they are high in malic acid, can lower blood uric acid and <a href=\"https://www.livestrong.com/article/533102-apples-gout/\" rel=\"nofollow noreferrer\">Livestrong</a> says that apples have this effect, because they are high in vitamin C, but neither of them provide any evidence for that.</p>\n\n<p><strong>2) Apples increase blood uric acid shortly after ingestion.</strong></p>\n\n<p>In the study <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29529161\" rel=\"nofollow noreferrer\">The effects of apples and apple juice on acute plasma uric acid concentration (AJCN, 2018)</a>, the ingestion of apples with 26.7 g fructose in total increased blood uric acid (measured 30 minutes after ingestion).</p>\n\n<p><strong>3) Frequent consumption of apples have been associated with an increased risk of gout.</strong></p>\n\n<p>The study <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234536/\" rel=\"nofollow noreferrer\">Soft drinks, fructose consumption, and the risk of gout in men (BMJ, 2008)</a> found an association, but not a direct cause-effect relationships, between high apple consumption and gout:</p>\n\n<blockquote>\n <p>Other major contributors to fructose intake such as total fruit juice\n or fructose rich fruits (apples and oranges) were also associated with\n a higher risk of gout.</p>\n</blockquote>\n\n<p><strong>4) Moderate fructose intake does not increase uric acid levels in blood and the risk of cardiovascular disease.</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409734/\" rel=\"nofollow noreferrer\">Fructose Intake, Serum Uric Acid, and Cardiometabolic Disorders: A Critical Review (Nutrients, 2017)</a>:</p>\n\n<blockquote>\n <p>In summary, a specific causal link between fructose consumption,\n hyperuricemia, and CVD has not yet been established. There is an\n association between UA and established cardiovascular risk factors,\n and there is a limit to how much population-based studies can adjust\n for confounding variables. As such, <strong>it is not yet possible to\n conclude that fructose intake is the main contributor to an increase\n in blood UA,</strong> and that this detrimentally affects vascular health.</p>\n \n <p>...<em>hypercaloric</em> supplementation of control diets with <strong>fructose (+35%\n excess energy) at extreme doses (213–219 g/day)</strong> significantly\n increased serum UA compared with the control diets alone.</p>\n</blockquote>\n\n<p><strong>5) Fructose intake that does not contribute to excessive calorie intake does not increase the risk of gout.</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327749/\" rel=\"nofollow noreferrer\">The Effects of Fructose Intake on Serum Uric Acid Vary among Controlled Dietary Trials (The Journal of Nutrition, 2012)</a>:</p>\n\n<blockquote>\n <p>These analyses do not support a uric acid-increasing effect of\n <em>isocaloric</em> fructose intake in nondiabetic and diabetic participants.\n <em>Hypercaloric</em> fructose intake may, however, increase uric acid\n concentrations.</p>\n</blockquote>\n\n<p><strong>6) Fruits and gout</strong></p>\n\n<p><a href=\"https://academic.oup.com/rheumatology/article/58/7/1133/5475481\" rel=\"nofollow noreferrer\">The effects of fruit consumption in patients with hyperuricaemia or gout (Rheumatology, 2019)</a>:</p>\n\n<blockquote>\n <p>Fruits contain fructose, but not all studies suggest they increase the\n risk for gout. Several reasons appear to account for this, including\n the relatively small amount of fructose in an individual fruit and the\n association with substances in fruits that slow absorption (e.g.\n fibre), stimulate excretion (vitamin C) or block fructose metabolic\n effects (epicatechin)...In addition, people\n who ingest high amounts of fruit are often reducing their intake of\n refined sugars, so that overall fructose intake may be low.</p>\n</blockquote>\n\n<p><strong>In summary,</strong> apples do not decrease but increase the levels of uric acid in blood, but an apple or two a day (10-20 g fructose) is unlikely to increase the risk of gout or other conditions related to blood uric acid levels.</p>\n", "score": 0 } ]

[ "fructose", "uric-acid" ]

[ { "answer_id": 20339, "body": "<p>From what I know from as a general practitioner, NO and drugs that release NO do not prevent nor reverse coronary disease. Nitrates, so drugs that release NO, are commonly prescribed to treat coronary disease symptoms though. NO mainly dialates venes, not arteries, so the effect is due to less blood for the heart to pump, rather than more blood flowing through the coronary arteries.</p>\n\n<p>I do not have any studies to cite here, but it is a well-established fact in the medical community, that nitrates only alleviate the symptoms of coronary disease, but do not decrease morbidity or overal survival.</p>\n\n<p>I do not know about other cardiovascular diseases though. Coronary is what you deal with on a daily basis.</p>\n", "score": 3 } ]

[ "cardiovascular-disease" ]

[ { "answer_id": 20409, "body": "<p>I think the closest thing to a \"standardization of drugs\" are the pharmacopeia:</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/United_States_Pharmacopeia\" rel=\"nofollow noreferrer\">USP</a></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/European_Pharmacopoeia\" rel=\"nofollow noreferrer\">European Pharmacopoeia</a></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Japanese_Pharmacopoeia\" rel=\"nofollow noreferrer\">Japanese Pharmacopoeia</a></p>\n\n<p>(just some examples)</p>\n\n<p>As you will notice, these are not global standards, but each one defines the parameters by which a drug is of adequate quality and purity to be deemed that drug. To generate a global standard, it would be necessary to combine some truly massive documents into one, which would require agreement among everyone regarding which standards to use in the unified document.</p>\n\n<p>The WHO has an effort to make such a resource:</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/The_International_Pharmacopoeia\" rel=\"nofollow noreferrer\">The International Pharmacopoeia</a></p>\n\n<p>But as of now, it is more of a recommendation than a legally enforceable document in most locations (as far as I know). The WHO also has a great document talking about various pharmacopeia:</p>\n\n<p><a href=\"https://www.who.int/medicines/areas/quality_safety/quality_assurance/resources/InternationalMeetingWorldPharmacopoeias_QAS13-512Rev1_25032013.pdf\" rel=\"nofollow noreferrer\">https://www.who.int/medicines/areas/quality_safety/quality_assurance/resources/InternationalMeetingWorldPharmacopoeias_QAS13-512Rev1_25032013.pdf</a></p>\n\n<p>including their legal basis, origins, and a bit of history about attempts to develop international pharmacopeia.</p>\n\n<p>In that sense, it's somewhat more remarkable that there are internationally recognized diagnostic codes than that there isn't a (legally binding) internationally standardized pharmacopoeia.</p>\n\n<p>See also: <a href=\"https://xkcd.com/927/\" rel=\"nofollow noreferrer\">https://xkcd.com/927/</a></p>\n\n<p>The pharmacopeia are more interested in the manufacture and identity of drugs (and supplements), rather than indications or dosage recommendations. These are far too complex and depend on other variables to be collected in a single reference. That's partly why physicians and pharmacists exist, and why you should consult them for medical advice.</p>\n\n<p>Similarly, the ICD-10 is not something like a dichotomous key for diagnosis. It contains a list of diseases and their characteristics for standardization and billing purposes, but it is not a substitute for a physician's care.</p>\n", "score": 3 }, { "answer_id": 20407, "body": "<p>The idea that the International Statistical Classification of Diseases and Related Health Problems (ICD) forms an international standard on health problems is contentious within some groups of people when there is the <a href=\"https://www.psychiatry.org/psychiatrists/practice/dsm\" rel=\"nofollow noreferrer\">Diagnostic and Statistical Manual of Mental Disorders (DSM)</a>, which cross-references the ICD and there can sometimes be conflicting criteria stated, (see <a href=\"https://journal.ahima.org/2016/08/10/dsm-5-vs-icd-10-cm/\" rel=\"nofollow noreferrer\">https://journal.ahima.org/2016/08/10/dsm-5-vs-icd-10-cm/</a> for more on that) but that is a separate issue.</p>\n\n<p>When it comes to an international standards for drugs, different countries have different regulations regarding drug use and drug licensing (see <a href=\"https://www.gov.uk/government/collections/drugs-licensing\" rel=\"nofollow noreferrer\">https://www.gov.uk/government/collections/drugs-licensing</a> for example on UK drug licensing) and therefore having an international control on drugs would not work.</p>\n\n<p>You mentioned drugs.com (US) and drugsbank.ca (Canada) and there is a go to for the UK medical profession called the <a href=\"https://bnf.nice.org.uk/\" rel=\"nofollow noreferrer\">British National Formulary (BNF)</a> which is part of the <a href=\"https://www.nice.org.uk/\" rel=\"nofollow noreferrer\">National Institute for Health and Care Excellence (NICE)</a>. I am pretty sure there are similar organisations in other countries controlling the use of drugs.</p>\n", "score": 2 } ]

[ "statistics", "drug-interactions", "database", "preventative-medicine", "who-world-health-org" ]

[ { "answer_id": 20542, "body": "<p><strong>Free videos with subtitles:</strong></p>\n\n<p><a href=\"https://www.youtube.com/watch?v=f6rZw7QkGLw\" rel=\"nofollow noreferrer\">Introduction to Anatomy</a>: basic anatomical terms, planes, positions, directions..a single 20 min video</p>\n\n<p><a href=\"https://www.kenhub.com/en/dashboard\" rel=\"nofollow noreferrer\">Kenhub</a>, comprehensive, organized, with basic anatomical terms, medical imaging, also histology, premium account available with quizzes and study questions</p>\n\n<p><a href=\"http://anatomyzone.com/\" rel=\"nofollow noreferrer\">Anatomy Zone</a>, also available on <a href=\"https://www.youtube.com/results?search_query=anatomy%20zone\" rel=\"nofollow noreferrer\">YouTube</a>: 190+ videos, maybe not organized best</p>\n\n<p><a href=\"https://www.khanacademy.org/\" rel=\"nofollow noreferrer\">Khan Academy</a>: anatomy + physiology combined</p>\n\n<p><a href=\"https://www.innerbody.com/htm/body.html\" rel=\"nofollow noreferrer\">Innerbody</a>: interactive images with detailed description</p>\n", "score": 2 } ]

[ "anatomy", "internal-organs", "video" ]

[ { "answer_id": 23859, "body": "<p>So yes, full coverage metallic crowns are indicated for carious lesions as well as patients wherein the oral hygiene is poor. \nHowever you should know whether it is for primary teeth or permanent teeth.\nIn permanent teeth usually full metallic crowns are given after the endodontic procedure. When the patient has extensive caries reaching pulp, endodontic treatment is done followed by a full crown in the posterior teeth. Usually in anterior teeth full metal crown is not required and they can simply be restored by composite/amalgam build up. \nHowever there are certain indications for full metal crowns in anterior teeth also(1).\nFull metal crowns in posterior permanent teeth is required since after an endodontic treatment tooth becomes brittle. Especially for posterior teeth wherein the masticatory forces may fracture the tooth full metal crown is beneficial(1).\nA tooth colored crown, eg zirconia crown can also be given.</p>\n\n<p>Now talking about the primary teeth. In primary teeth a non invasive method is preferred for a carious lesion which has not extended till pulp. This technique is known as Hall technique (2).\nIn this after confirming through a radiograph that sufficient dentin is present between the pulp and caries, then <em>without removing the caries</em> a full metal crown is placed on the tooth (2,3)\nNow the question arises that what about the infection, it may progress?!\nThe full metal crown prevents further infection from the oral environment. The infection which is still there, yes it does progress but in a very slow manner. From a study (3) it takes atleast 5 years to progress at its full. By then the baby develops his/her permanent teeth.</p>\n\n<p>Now in cases wherein the lesion has reached the pulp then depending on the case pulpotomy or pulpectomy is performed followed by the full metal crown coverage(4).</p>\n\n<p>Talking about oral hygiene, in paediatric patients who cannot maintain their oral hygiene maybe because they are medically or physically compromised then a full metal crown provides a very good option to prevent the tooth from caries or plaque deposits.\nHope I have answered your question :)\nIt would have been better if you would have mentioned the extent of caries. Hence I have taken all the case scenarios.</p>\n\n<p>References-\n(1)Are full cast crowns mandatory after endodontic treatment in posterior teeth?\nAseem Prakash Tikku, Anil Chandra, and Ramesh Bharti</p>\n\n<p>(2)The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months\nNicola P Innes, Dafydd JP Evans &amp; David R Stirrups </p>\n\n<p>(3)Innes, N. P. T., Evans, D. J. P., &amp; Stirrups, D. R. (2011). \"Sealing caries in primary molars randomized control trial, 5-year results\". Journal of Dental Research, 90(12), 1405-1410</p>\n\n<p>(4)Preformed metal crowns for primary and\npermanent molar teeth: review of the literature\nRos C. Randall, PhD, MPhil, BChD</p>\n", "score": 2 } ]

[ "dentistry" ]

[ { "answer_id": 20624, "body": "<p>Although I doubt that term would be applied to a suicide in a modern country, death records can be unreliable in other times and other cultures when suicide was involved. 100+ years ago suicide was often considered shameful and embarrassing to the family, so it's possible the death record was falsified to protect the family name. Since we have no way of ruling suicide in or out, it's a moot question that I will ignore. </p>\n\n<p>I think the most likely explanation is your relative died of a stroke, head injury or brain tumor that caused increased intracranial pressure. Congestion in the brain usually refers to venous congestion, meaning blood isn't being drained from the brain normally so it's backing up. Venous congestion can be caused by several things but since no mention was made of head injury, the most likely explanation in a 41 year old man would probably be an expanding mass. A tumor that was growing, causing increased intracranial pressure, and possibly physically pressing on the veins that drain the mid-brain region would seem like the most likely explanation.</p>\n\n<p>There are several uses of the phrase \"congestion of the midbrain\" found in neurology texts and they all occur in the context of expanding masses. I can't copy/paste from Google Books so you'll have to follow the links to read it as text.</p>\n\n<p><a href=\"https://books.google.com/books?id=R_-tCgAAQBAJ&amp;pg=PA206&amp;lpg=PA206&amp;dq=%22congestion%20of%20the%20midbrain%22&amp;source=bl&amp;ots=ppCcQse1E2&amp;sig=ACfU3U2i_j8oEhBkxTNH-Bg-wXNXyChXdA&amp;hl=en&amp;ppis=_c&amp;sa=X&amp;ved=2ahUKEwiD6YbK1rPmAhUKIKwKHTO8AmwQ6AEwAHoECAIQAQ#v=onepage&amp;q=%22congestion%20of%20the%20midbrain%22&amp;f=false\" rel=\"nofollow noreferrer\">Google Books 1</a></p>\n\n<p><a href=\"https://i.stack.imgur.com/A6pkd.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/A6pkd.jpg\" alt=\"enter image description here\"></a></p>\n\n<p><a href=\"https://books.google.com/books?id=1_7qBwAAQBAJ&amp;pg=PA51&amp;lpg=PA51&amp;dq=%22congestion%20of%20the%20midbrain%22&amp;source=bl&amp;ots=3cYW1ReFf_&amp;sig=ACfU3U25G3LioT02c-vtC7sdTU0lVOETxg&amp;hl=en&amp;ppis=_c&amp;sa=X&amp;ved=2ahUKEwiD6YbK1rPmAhUKIKwKHTO8AmwQ6AEwAXoECAMQAQ#v=onepage&amp;q=%22congestion%20of%20the%20midbrain%22&amp;f=false\" rel=\"nofollow noreferrer\">Google Books 2</a></p>\n\n<p><a href=\"https://i.stack.imgur.com/3KPQS.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/3KPQS.jpg\" alt=\"enter image description here\"></a>\nIf you search on the more common English wording \"midbrain congestion\" you'll find many more references, most of them also discussing brain tumors and other causes of increased pressure within the skull. Google finds no hits at all on the Spanish expression \"congestión del mesencéfalo.\"</p>\n\n<p>Remember, this is completely speculative. </p>\n", "score": 2 } ]

[ "death", "medical-history" ]

[ { "answer_id": 20676, "body": "<p>Healthy kidneys practically completely excrete <a href=\"https://en.wikipedia.org/wiki/Creatinine\" rel=\"nofollow noreferrer\">creatinine</a>, which means it is not reabsorbed in the kidneys. In kidney damage, less blood is filtered by the kidneys (decreased glomerular filtration), which means less creatinine is excreted, so it accumulates in the blood. So, creatinine excretion is not \"impaired\" but slowed down because of decreased blood flow through the kidneys.</p>\n\n<p>In a healthy person, glucose glucose and proteins are not excreted into the urine in significant amounts. In kidney damage, there is increased permeability of glomerular capillary wall and decreased reabsorption of the proteins (<a href=\"https://www.sciencedirect.com/science/article/pii/S0085253815489495\" rel=\"nofollow noreferrer\">proteinuria</a>), so they can be excreted into the urine. Kidney disease only rarely results in the excretion of glucose into urine (<a href=\"https://en.wikipedia.org/wiki/Glycosuria\" rel=\"nofollow noreferrer\">glycosuria</a>).</p>\n\n<p>When blood glucose levels exceed \"plasma glucose threshold,\" which is 180 mg/L (10 mmol/L), which is usually due to diabetes mellitus, some glucose will be excreted into the urine, even when the kidneys are not damaged (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046828/\" rel=\"nofollow noreferrer\">Diabetes, 2011</a>).</p>\n", "score": 1 } ]

[ "kidney", "glucose", "kidney-disease", "creatinine" ]

[ { "answer_id": 20681, "body": "<p>Yes, <a href=\"https://en.wikipedia.org/wiki/Nicotine_replacement_therapy\" rel=\"nofollow noreferrer\">nicotine replacement therapy</a> is used in multiple forms, including a skin patch and oral dosing with gums and lozenges.</p>\n\n<p>The purpose is to help avoid the side effects of nicotine withdrawal, while delivering nicotine at lower doses than is obtained through smoking, to help manage craving and eventually stop smoking entirely.</p>\n\n<hr>\n\n<p>As far as the delivery mechanism, nicotine undergoes substantial first-pass metabolism in the liver. This could make it harder to dose, because you would need to give 3-4 times the sublingual dose to get the same plasma concentration, and because individual differences or drug interactions might make the extent of first-pass metabolism variable and unpredictable between individuals.</p>\n\n<p><em>Benowitz, N. L., Jacob III, P., &amp; Savanapridi, C. (1987). Determinants of nicotine intake while chewing nicotine polacrilex gum. Clinical Pharmacology &amp; Therapeutics, 41(4), 467-473.</em></p>\n\n<p><em>Benowitz, N. L. (1996). Pharmacology of nicotine: addiction and therapeutics. Annual review of pharmacology and toxicology, 36(1), 597-613.</em></p>\n", "score": 2 } ]

[ "smoking", "recreational-drugs", "nicotine", "preventative-medicine", "tobacco" ]

[ { "answer_id": 20706, "body": "<blockquote>\n <p>In general, the calculation of the first dose in man is based on No Observed Adverse Effect Level\n (NOAEL) determined in non-clinical safety studies performed in the most sensitive and relevant\n animal species, adjusted with allometric factors or on the basis of pharmacokinetics. The relevant dose\n is then reduced/adjusted by appropriate safety factors according to the particular aspects of the\n molecule and the design of the clinical trials.</p>\n</blockquote>\n\n<p>In other words, the dosage is incremented (following special algorithms) until toxic effects are observed and then is reduced until an optimal effect/risk ratio is achieved. This procedure is most important during the \"first-in-a-man\" stage of drug development, but is also used in Phase 0 (lab work/animals).</p>\n\n<p><em>Source: <a href=\"https://www.ema.europa.eu/en/documents/scientific-guideline/draft-guideline-requirements-first-man-clinical-trials-potential-high-risk-medicinal-products-first_en.pdf\" rel=\"nofollow noreferrer\">https://www.ema.europa.eu/en/documents/scientific-guideline/draft-guideline-requirements-first-man-clinical-trials-potential-high-risk-medicinal-products-first_en.pdf</a></em></p>\n", "score": 1 } ]

[ "medications" ]

[ { "answer_id": 20758, "body": "<p>I have seen photos of tattoos done for those who have had surgery for breast cancer, (<a href=\"https://breastcancernow.org/information-support/facing-breast-cancer/living-beyond-breast-cancer/your-body/decorative-tattoos-after-breast-cancer-surgery\" rel=\"nofollow noreferrer\">example - <strong>not safe for work</strong></a>) and in these cases it can be to hide the fact they have no nipple(s) as well as to hide scarring.</p>\n\n<p>For what you are talking about, I would have said any registered and licensed tattooist who is good at mixing the colours would be able to do it. One point I would make though is that when wanting specific colouring, <a href=\"https://authoritytattoo.com/tattoo-fading/\" rel=\"nofollow noreferrer\">tattoo colours do fade over time</a> so you may need retouching work done after a time if you wish to maintain the same depth of colour.</p>\n\n<blockquote>\n <p>While <a href=\"https://authoritytattoo.com/do-all-tattoos-fade/\" rel=\"nofollow noreferrer\">all tattoo fade</a> <em>[sic]</em>, color tattoos certainly will fade quicker if you don’t take good care of them from the outset. Light colors will generally fade quicker than darker colors, with white ink being the one that will usually fade the quickest out of all the colors.</p>\n \n <p>Watercolor and pastel-color tattoos also generally fade much faster than others due to the fact that the technique generally requires much lighter and more delicate coloring.</p>\n \n <p>However, colored inks have improved considerably in recent years, and these enhancements help to prevent tattoos from fading as much as they would have a decade ago.</p>\n</blockquote>\n", "score": 1 } ]

[ "dermatology" ]

[ { "answer_id": 20869, "body": "<p>Easy answer is simply \"we don't know\". The burden of proof is on the manufacturer, who probably will never spend the millions to know. But since it is a nutritional agent, one does not have to substantiate claims, just print it up and sell em. But if you think eating collagen will help joints and tendons, you must also believe that eating teeth will help yours, and eating brain will make yours work better. And that dumping a can of gas on the engine under the hood will make your car more powerful. Unfortunately, collagen is digested into its components just like eating meat, calcium, proteins are digested. Don't waste your money. The claims have no basis in fact, nor do they make any biological sense.</p>\n", "score": 1 } ]

[ "micronutrients", "tendinopathy", "collagen" ]

[ { "answer_id": 20928, "body": "<p>The only one of those categories that should get the \"general\" modifier is <em>anesthetic</em> - this is to contrast them with <em>local</em> anesthetics, which are the \"numbing agents\" you describe.</p>\n\n<p><strong>General anesthetics</strong></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/General_anaesthetic\" rel=\"nofollow noreferrer\">General anesthesics</a> are agents that cause <em>loss of consciousness</em>. They prevent conscious perception of pain by causing loss of consciousness, rather than impacting pain pathways directly (some can also have direct analgesic effects, but this is not part of being a general anesthetic). It is still possible under general anesthesia for other systemic responses to pain to occur, and painful stimuli can cause arousal under lower levels of anesthesia. Therefore, general anesthesia is typically used alongside other methods for pain reduction.</p>\n\n<p>There are several classes of general anesthetic. Commonly used are inhaled anesthetics like sevoflurane, intravenous anesthetics like propofol, and ketamine (which is a bit atypical). The mechanism by which general anesthetics causes loss of consciousness is a current area of research without clear answers, even though more is known about the molecular targets.</p>\n\n<p><strong>Local anesthetics</strong></p>\n\n<p>The drugs you call \"numbing agents\" are called <a href=\"https://en.wikipedia.org/wiki/Local_anesthetic\" rel=\"nofollow noreferrer\">local anesthetics</a>. Local anesthetics block neuronal activity - they aren't particularly specific in a pharmacological sense. Instead, they gain specificity for pain by local administration.</p>\n\n<p>The canonical class of local anesthetics are the '-caine's. Consumers are likely most familiar with lidocaine (available in over-the-counter creams for topical use) and procaine/Novocain (common in dentistry), but many other derivatives are used. Cocaine is also in this group, though typically used as a drug of abuse for other reasons, rather than as a local anesthetic.</p>\n\n<p>The shared mechanism of these drugs is a block of sodium channels, which prevents neurotransmission. Local anesthetics can be applied topically, to target pain receptors, or can be injected in the vicinity of a nerve to block sensory neurotransmission through that nerve. Epidural anesthesia, such as used during child birth, is a particular use of local anesthesia targeted to the spinal cord.</p>\n\n<p><strong>Analgesics</strong></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Analgesic\" rel=\"nofollow noreferrer\">Analgesics</a> (\"painkillers\") more selectively target pain pathways. There are several classes, most medically relevant are the opioids, NSAIDs, and paracetamol/Tylenol. Opioids primarily target pain through inhibition of mu-opioid receptors; NSAIDs and related drugs through inhibition of COX-1/COX-2 and suppression of prostaglandin synthesis; the mechanism of paracetamol in pain relief is unknown.</p>\n\n<p><strong>Caveats</strong></p>\n\n<p>Of course, all these drugs have affects on other systems, as well. Opioids in particular are not themselves typically considered general anesthetics (high doses can cause loss of consciousness, but the margins for safety are not acceptable for most purposes), but can aid in general anesthesia. The classification into these three categories is about the primary mechanisms of action at the doses they are used.</p>\n", "score": 1 } ]

[ "anesthesia", "pain-management", "analgesics" ]

[ { "answer_id": 20988, "body": "<p>This answer is about medical terminology as widely agreed and commonly used by medical professionals. </p>\n\n<p><strong>Rhinitis</strong> is a broad name of a <strong>disease</strong> or <strong>condition</strong> with <em>inflammation of the mucosal lining in the nasal cavity</em> (<a href=\"https://my.clevelandclinic.org/health/diseases/17431-rhinitis\" rel=\"nofollow noreferrer\">Cleveland Clinic</a>, <a href=\"https://www.malacards.org/card/rhinitis\" rel=\"nofollow noreferrer\">Malacards</a>). Inflammation can be infectious, irritant, allergic, drug-induced, etc. (a more detailed list on <a href=\"https://www.aafp.org/afp/2006/0501/p1583.html\" rel=\"nofollow noreferrer\">American Family Physician</a>).</p>\n\n<p>Rhinitis is listed in the <a href=\"https://www.icd10data.com/ICD10CM/Index/R/Rhinitis\" rel=\"nofollow noreferrer\">International Classification of Diseases (ICD-10)</a> and various subtypes have their own codes, for example, allergic rhinitis has the code J30.9. So, if it's in ICD-10, it can be considered a disease.</p>\n\n<p>An example of a practical definition of disease:</p>\n\n<blockquote>\n <p><strong>Disease,</strong> any harmful <em>deviation from the normal structural or functional state</em> of an organism, generally associated with certain\n signs and symptoms and differing in nature from physical injury. <em>(<a href=\"https://www.britannica.com/science/disease\" rel=\"nofollow noreferrer\">Britannica</a>)</em></p>\n</blockquote>\n\n<p>An abnormal structural state refers to pathology (tissue/cellular damage) and pathophysiology (abnormal functions). The main point of defining disease is to differ diseases from symptoms and signs. Diseases are described by concepts and mechanisms, while symptoms and signs are described on the basis of simple observation. </p>\n\n<p><strong>Illness</strong> is a disease from the patient's perspective:</p>\n\n<blockquote>\n <p>Patients suffer ‘illnesses’; doctors diagnose and treat ‘disease.’\n <em>(<a href=\"https://www.researchgate.net/post/Is_there_a_difference_between_illness_and_disease_in_what_we_do_as_nurses2\" rel=\"nofollow noreferrer\">ResearchGate</a>)</em></p>\n</blockquote>\n\n<p>A lay person with rhinitis would often describe his/her illness just by the most obvious symptom(s), like blocked or runny nose. </p>\n\n<p><strong>Condition</strong> is <em>not a clearly defined term,</em> but is kind of informal one-word umbrella term that can cover the terms disease, illness, syndrome and similar abnormal states. This is why there are usually no separate lists of diseases and conditions, but just lists of \"diseases and conditions,\" such as the one on the <a href=\"https://www.mayoclinic.org/diseases-conditions/index?letter=R\" rel=\"nofollow noreferrer\">Mayo Clinic website</a>. So, one author can mention rhinitis as a disease and another as a condition. </p>\n\n<p><strong>Blocked nose</strong> and <strong>runny nose</strong> are both symptoms.</p>\n\n<p><strong>A symptom</strong> is any health-related abnormality <em>a patient</em> perceives (feels, observes) or reveals to a doctor in medical history (anamnesis). </p>\n\n<p><strong>A sign</strong> is a health-related disorder as detected by <em>examiner.</em></p>\n\n<p><strong>Nasal congestion</strong> is the term more likely used by a doctor than a patient and refers to a thickening of nasal mucosa as a doctor observes it during a physical examination, so it is a sign.</p>\n\n<p>Table 1 in the article <a href=\"http://ceur-ws.org/Vol-1309/paper4.pdf\" rel=\"nofollow noreferrer\">Defining 'sign' and 'symptom'</a> mentions several variations of the definitions of a sign and a symptom. </p>\n\n<p>An abnormality, for example, blocked nose, can be a symptom and a sign at the same time, depending on who observes it.</p>\n\n<p>In various medical texts, diseases can be classified by a cause (allergic vs nonallergic rhinitis), course (acute vs chronic), pathology (lobar pneumonia vs bronchopneumonia), pathophysiology (ischemic vs hemorrhagic stroke), etc.</p>\n\n<p>Authors of health/medical texts may not always follow these official definitions and may create some \"apples and oranges\" situations by mentioning diseases, symptoms and signs in a single list.</p>\n", "score": 2 } ]

[ "terminology", "nasal-congestion", "respiratory-system", "vasomotor-rhinitis", "nasal-cavity" ]

[ { "answer_id": 23332, "body": "<p>According to this <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652894/\" rel=\"nofollow noreferrer\">review article</a>:</p>\n\n<blockquote>\n <p>Estradiol and, to lesser degree, other estrogens, increase proliferation of breast epithelium and stroma and, consequently, increase the chances of mutation in rapidly proliferating epithelium</p>\n</blockquote>\n\n<p>Tamoxifen and other SERMs generally act as competitive antagonist on breast estrogen receptor, which decreases estrogen's ability to induce breast tissue proliferation, hence its possible effect on gynecomastia.</p>\n\n<p>As for your other questions, the first article you linked doesn't mention subtypes of gynecomastia in the abstract, and I can't find anything online about it. Necrosis is a cellular reaction to a pathological state such as infections. In general, drugs do not cause necrosis as an intended effect. </p>\n", "score": 2 } ]

[ "body-fat", "breast", "estrogen", "gynecomastia-man-boobs", "fatty-acids" ]

[ { "answer_id": 21096, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Peak_bone_mass\" rel=\"nofollow noreferrer\">Peak bone mass</a> is the maximum amount of bone a person has during their life. It typically occurs in the early 20s in females and late 20s in males. Peak bone mass is typically lower in females than males</p>\n\n<p>The risk of development of osteoporosis can be minimized by understanding the development of the skeletal system and the lifestyle choices that maximize bone development.</p>\n\n<blockquote>\n <p>Bone mass and strength achieved at the end of the growth period, simply designated as \"Peak Bone Mass (PBM)\", plays an essential role in the risk of osteoporotic fractures occurring in adulthood. It is considered that an increase of PBM by one standard deviation would reduce the fracture risk by 50%.<a href=\"https://scielosp.org/article/spm/2009.v51suppl1/s5-s17/en/\" rel=\"nofollow noreferrer\">Link</a></p>\n</blockquote>\n\n<p>The risk of fracture is determined largely by bone density, which is the end result of peak value achieved at skeletal maturity and subsequent age- and menopause-related bone loss. The risk of osteoporotic fracture at any site relates to bone mineral density at that site and the amount of stress applied to that bone.<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8499027\" rel=\"nofollow noreferrer\">Link</a></p>\n\n<blockquote>\n <p>It is commonly accepted that development of a higher peak bone mass during adolescent years protects against postmenopausal osteoporosis. There is a strong inverse relationship between bone mineral density and incidence of fracture in postmenopausal women. Bone loss in a postmenopausal woman with low peak bone density will have greater consequences for fracture than that in a woman with higher peak bone mineral density.<a href=\"https://academic.oup.com/jcem/article/84/6/1839/2864329\" rel=\"nofollow noreferrer\">Link</a></p>\n</blockquote>\n\n<p>As mentioned in <a href=\"https://www.cochrane.org/CD000333/MUSKEL_exercise-for-preventing-and-treating-osteoporosis-in-postmenopausal-women\" rel=\"nofollow noreferrer\">Cochrane</a>, exercise will improve bone mineral density just slightly so it can reduce the chance of having a fracture to some extent.</p>\n", "score": 1 } ]

[ "bones", "osteoporosis" ]

[ { "answer_id": 21278, "body": "<p>Most of the COVID-19 deaths in Washington <a href=\"https://www.bellevuereporter.com/news/life-care-center-of-kirkland-breaks-silence-at-saturday-press-conference/\" rel=\"nofollow noreferrer\">involve a single nursing home</a>, where the virus spread widely before being detected.</p>\n\n<p>The patients at that facility are in a high-risk category for this disease due to their advanced age; there is no similar cluster of cases at a nursing facility elsewhere in the US, therefore it is not surprising that the mortality rate is quite different so far.</p>\n\n<p>There is speculation that there are far more <a href=\"https://www.pbs.org/newshour/show/why-washington-health-officials-fear-novel-coronavirus-may-have-been-quietly-spreading\" rel=\"nofollow noreferrer\">undiagnosed cases in Washington</a>, many of which would be mild cases. Given issues and limitations with testing, it is difficult to know what the true rate is.</p>\n", "score": 3 } ]

[ "virus" ]

[ { "answer_id": 21329, "body": "<p>your question is related with mine:</p>\n\n<p>We will never know how many individuals have been infected, we can only count the cases that have been diagnosed and these are those who are died or have been hospitalized or have visited the doctor.</p>\n\n<p>So it could be possible that 80 % of a population is infected but only 50% are diagnosed and as we had also a medial hype in 2009 it is really surprising that the spread trend of H1N1 2009 in Argentina was so low:</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/2009_flu_pandemic_by_country\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/2009_flu_pandemic_by_country</a></p>\n\n<p>I don't know where from Merkel has her information ...</p>\n", "score": 1 } ]

[ "influenza" ]

[ { "answer_id": 21436, "body": "<p>Since methanol had been added the resulting solution is toxic. Furthermore methanol can be absorbed through the skin making it dangerous to use methylated spirits.</p>\n\n<p><a href=\"https://www.biodiesel.org/docs/default-source/fact-sheets/faq--safe-handling-and-use-of-methanol.pdf\" rel=\"nofollow noreferrer\">https://www.biodiesel.org/docs/default-source/fact-sheets/faq--safe-handling-and-use-of-methanol.pdf</a></p>\n\n<p>Note that in NZ and Australia methylated spirits no longer contains methanol that has been deliberately added and uses other additives to denature it.</p>\n", "score": 1 } ]

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

[ { "answer_id": 21492, "body": "<p>There is no published data whether Hydroxychloroquine or anti-viral drugs can be used to prevent infection in an immune naive population.</p>\n\n<p>We await clinical trials but the best hope usually has always been vaccination.</p>\n\n<p>Trials have now started with healthcare workers who are exposed to covid-19 patients to take either prophylactic placebo or Hydroxychloroquine to see if it harms, or helps.</p>\n", "score": 1 } ]

[ "virus", "covid-19", "infectious-diseases" ]

[ { "answer_id": 21498, "body": "<p>All interferons interfere with viral replication but until the Cubans show that their drug <code>Interferon alpha 2B</code> is any better than anything else, then there's nothing to recommend it over anything else used in the treatment of COVID-19.</p>\n\n<p>The list of drugs recommended by CPAM are:</p>\n\n<blockquote>\n <p>For direct antiviral treatment of SARS-CoV-2, CPAM recommends use\n of lopinavir; ritonavir [2 capsule (dose undefined) by mouth twice daily] in combination with nebulized alfa-interferon (5 million units in Sterile Water for Injection inhaled twice daily). CPAM ( China International Exchange and Promotive\n Association for Medical and Health Care) has based this recommendation on weak evidence from retrospective cohort, historically controlled studies, case reports, and case series that suggest clinical benefit of lopinavir; ritonavir in the treatment of other\n coronavirus infection [i.e., 2002 SARS-CoV and 2012 Middle East respiratory syndrome coronavirus\n (MERS-CoV)]. (4) (8) (7)</p>\n</blockquote>\n\n<p>..</p>\n\n<blockquote>\n <p>In addition to CPAM, a group of Korean physicians with experience in treating SARS-CoV-2 infected\n patients have developed recommendations for the treatment of COVID-19. According to these\n physicians, antiviral medications are not recommended for use in young, healthy patients with mild\n symptoms and no underlying comorbid conditions. However, treatment with lopinavir 400 mg; ritonavir\n 100 mg (2 tablets by mouth twice daily) or chloroquine (500 mg by mouth twice daily) should be\n considered for use in older patients or patients with under underlying conditions and serious symptoms.\n If chloroquine is unavailable, they recommend considering use of hydroxychloroquine (400 mg by mouth\n once daily). Use of ribavirin and interferon were not recommended as first-line treatments because of\n the risk for side effects; however, use of these medications may be considered if treatment with\n lopinavir; ritonavir, chloroquine, or hydroxychloroquine are ineffective. (12) (13)</p>\n</blockquote>\n\n<p>It is unclear if the alpha interferon used in China is the same as the one the Cubans are selling.</p>\n\n<p><a href=\"https://www.elsevier.com/__data/assets/pdf_file/0007/988648/COVID-19-Drug-Therapy_Mar-2020.pdf\" rel=\"nofollow noreferrer\">https://www.elsevier.com/__data/assets/pdf_file/0007/988648/COVID-19-Drug-Therapy_Mar-2020.pdf</a></p>\n", "score": 1 } ]

[ "covid-19", "epidemiology", "virus", "antivirals" ]

[ { "answer_id": 21528, "body": "<p>Being near water appears to make people happy, British newspaper the Guardian ran this piece on it:\n<a href=\"https://www.theguardian.com/lifeandstyle/2019/nov/03/blue-space-living-near-water-good-secret-of-happiness\" rel=\"nofollow noreferrer\">https://www.theguardian.com/lifeandstyle/2019/nov/03/blue-space-living-near-water-good-secret-of-happiness</a></p>\n\n<p>It contains links to peer reviewed papers about the positive effects of being or living near water or on the coast on well-being, like <a href=\"https://www.sciencedirect.com/science/article/abs/pii/S1353829213000816\" rel=\"nofollow noreferrer\">this one</a>.\nThe newspaper article and the scientific papers deal with psychological well-being, you would have to look elsewhere for purely physical effects.</p>\n", "score": 2 } ]

[ "water" ]

[ { "answer_id": 21515, "body": "<blockquote>\n <p>Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.</p>\n</blockquote>\n\n<p>Prepare a bleach solution by mixing:</p>\n\n<p>5 tablespoons (1/3rd cup) bleach per gallon of water or</p>\n\n<p>4 teaspoons bleach per quart of water</p>\n\n<p><a href=\"https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html</a></p>\n", "score": 3 }, { "answer_id": 21531, "body": "<p>There's no evidence that ozonated water is of any use for killing COVID-19 or any other disease organism. <a href=\"https://en.wikipedia.org/wiki/Ozone#Applications_2\" rel=\"nofollow noreferrer\">Gaseous ozone is effective as a disinfectant</a>, but it requires concentrations far higher than can be dissolved in water (or can be tolerated by humans -- if you were to step into a room being treated with ozone, you'd die of lung damage in short order).</p>\n\n<p><a href=\"https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2\" rel=\"nofollow noreferrer\">The EPA has a list of cleaners known to be able to kill COVID-19</a>. Common household cleaning agents on that list include concentrated ethanol (70% or higher concentration -- vodka won't cut it), hydrogen peroxide, isopropyl alcohol (listed as \"isopropanol\"), and chlorine bleach (listed as \"sodium hypochlorite\"). Note that a quick wipe won't do the job: you need to keep the surface wetted for between ten seconds and ten minutes, depending on what you're using.</p>\n", "score": 1 } ]

[ "covid-19" ]

[ { "answer_id": 21532, "body": "<p>Vaccines need extensive testing before they can be used. There's essentially no medical intervention which requires more testing than vaccines, which are used in extremely large numbers of healthy patients.</p>\n\n<p>Generally this involves basic research, animal testing, Phase I testing (\"Is it safe in humans? At what dose?\"), Phase II testing (\"Is it effective? At what dose? Are there side effects?\"), and Phase III testing (\"Is it safe and effective across all different subpopulations?\").</p>\n\n<p>As just one example of what could potentially go wrong: many/most COVID-19 deaths involve <a href=\"https://en.wikipedia.org/wiki/Cytokine_release_syndrome\" rel=\"noreferrer\">cytokine storms</a> which are, roughly, damaging inflammatory immune overreactions. Priming the immune system could potentially worsen them and increase deaths by strengthening the immune response. (It doesn't seem likely, but this is why we test.)</p>\n", "score": 7 }, { "answer_id": 21570, "body": "<p>We don't know if the spike proteins are an immune epitope that can be recognized by the human immune system.</p>\n\n<blockquote>\n <p>a team of researchers at La Jolla Institute for Immunology, in collaboration with researchers at the J. Craig Venter Institute, provides the first analysis of potential targets for effective immune responses against the novel coronavirus. The researchers used existing data from known coronaviruses to predict which parts of SARS-CoV-2 are capable of activating the human immune system.\n ..</p>\n \n <p>When the immune system encounters a bacterium or a virus, it zeroes in on tiny molecular features, so called epitopes, which allow cells of the immune system to distinguish between closely related foreign invaders and focus their attack. Having a complete map of viral epitopes and their immunogenicity is critical to researchers attempting to design new or improved vaccines to protect against COVID-19, the disease caused by SARS-CoV-2.</p>\n \n <p>\"Right now, we have limited information about which pieces of the virus elicit a solid human response,\" says the study's lead author Alessandro Sette, Dr. Biol.Sci, a professor in the Center for Infectious Disease and Vaccine Research at LJI. \"Knowing the immunogenicity of certain viral regions, or in other words, which parts of the virus the immune system reacts to and how strongly, is of immediate relevance for the design of promising vaccine candidates and their evaluation.\"</p>\n \n <p>While scientists currently know very little about how the human immune system responds to SARS-CoV-2, the immune response to other coronaviruses has been studied and a significant amount of epitope data is available.</p>\n</blockquote>\n\n<p><a href=\"https://marlin-prod.literatumonline.com/pb-assets/journals/research/cell-host-microbe/PDFs/CHOM_2264_S50.pdf\" rel=\"nofollow noreferrer\">https://marlin-prod.literatumonline.com/pb-assets/journals/research/cell-host-microbe/PDFs/CHOM_2264_S50.pdf</a></p>\n\n<p>There's also experimental data to suggest that strong binding of the spike proteins to the ACE2 receptor, that could cause ARDS as it blocks inhibition of AT1-R.</p>\n", "score": 1 } ]

[ "covid-19", "vaccination" ]

[ { "answer_id": 24481, "body": "<p>There is a “standard” definition of the epidemiological measure of the case fatality rate (or case fatality ratio—preferred term) for a disease. This is the number of people diagnosed with a disease who died because of the disease in an interval of time after the diagnosis divided by the number of people who had been diagnosed with the disease in the same interval.</p>\n<p><a href=\"https://www.britannica.com/science/case-fatality-rate\" rel=\"nofollow noreferrer\">https://www.britannica.com/science/case-fatality-rate</a></p>\n<p>There is also a standard definition for the mortality rate from a disease. This is the number of people who died from the disease in a specific period of time divided by the number of people who could have died from the disease in the same interval of time—the total population.</p>\n<p><a href=\"https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section3.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section3.html</a></p>\n<p>EXAMPLE FOR NON-INFECTIOUS DISEASE</p>\n<p>For these two measures (the case fatality ratio and the mortality rate), an example for a non-infectious disease—pancreatic cancer in 2016--is useful.</p>\n<p>The one-year case-fatality ratio for pancreatic cancer is the number of people diagnosed with pancreatic cancer in (for example) 2016 who died in the year after their diagnosis divided by the number of people diagnosed with pancreatic cancer in 2016.</p>\n<p>In 2016, about 53,000 people were diagnosed with pancreatic cancer in the United States. In the year after diagnosis, about 38,000 of these people had died of pancreatic cancer. The one-year case fatality ratio for people with diagnosed with pancreatic cancer in 2016 was 0.72 or 72%.</p>\n<p>The (crude) mortality rate from pancreatic cancer in 2016 in the United States is the number of people who died from pancreatic cancer in 2016 divided by the number of people in the United States in 2016.</p>\n<p>In 2016, about 42,000 people died from pancreatic cancer. The population of the United States in 2016 was about 323,000,000. In 2016, the crude mortality rate for pancreatic cancer was 13 per 100,000 (it is common practice to state mortality rates for a large population per 100,000).</p>\n<p>INFECTIOUS DISEASES</p>\n<p>For many infectious diseases (e.g., polio, influenza, hepatitis C), there is a “pool” of people that have been infected and but who are not diagnosed as having the disease and do not know they have been infected. This is because they don’t have symptoms or because the symptoms are minimal and the infection is unrecognized.</p>\n<p>For infectious diseases, a third measure of mortality is the “infection fatality ratio.” This is the number of people who died from the disease in a given time interval divided by the number of people who have been infected in the same time interval.</p>\n<p>The number of people infected in a given time interval—the denominator--is usually difficult to measure directly. It requires information on point or period prevalence of infection.</p>\n<p>The infection fatality ratio can be <strong>estimated</strong> if there is reliable information about the proportions of people infected who are asymptomatic, who are minimally symptomatic, who develop the potentially fatal disease/condition caused by the infection, and, the proportion of those with the potentially fatal disease/condition who actually die. The latter— the proportion of those with the potentially fatal disease/condition who actually die—is the case fatality ratio.</p>\n<p>INFECTION FATALITY RATIO EXAMPLE FOR INFECTIOUS DISEASE</p>\n<p>An example—poliomyelitis--helps.</p>\n<p>Polio is a highly infectious disease caused by the polio virus. It mainly affects children under the age of 5. After decades of study, much is known about the course of polio infection in children. About 70% are asymptomatic, 25%of have people infected with the polio virus have minimal or non-specific symptoms. About 0.5-1% develop acute flaccid paralysis. Of children who develop acute flaccid paralysis, 2-10% die.</p>\n<p><a href=\"https://www.who.int/news-room/fact-sheets/detail/poliomyelitis\" rel=\"nofollow noreferrer\">https://www.who.int/news-room/fact-sheets/detail/poliomyelitis</a></p>\n<p><a href=\"https://www.aappublications.org/news/2020/03/18/mmwr031720\" rel=\"nofollow noreferrer\">https://www.aappublications.org/news/2020/03/18/mmwr031720</a></p>\n<p>With these known facts, the infection mortality ratio for polio in children less than age 5 years can be estimated.</p>\n<p>In 100,000 children less age 5 years, infected with polio:</p>\n<pre><code>Estimated cases of acute flaccid paralysis (lower estimate) = 100,000 x 0.005 = 500\n\nEstimated cases of acute flaccid paralysis (upper estimate) = 100,000 x 0.01 = 1,000\n\n\nDeaths in children with acute flaccid paralysis (lower estimate) = 500 x 0.02 = 10\n\nDeaths in children with acute flaccid paralysis (upper estimate) = 1,000 x 0.10 = 100\n\n\nInfection fatality ratio (lower estimate) = 10 / 100,000 = 0.0001\n\nInfection fatality ratio (upper estimate) = 100 / 100,000 = 0.001\n</code></pre>\n", "score": 2 } ]

[ "epidemiology" ]

[ { "answer_id": 21541, "body": "<blockquote>\n <p>The novel Wuhan coronavirus (SARS-CoV-2) has been sequenced, and the virus shares substantial similarity\n with SARS-CoV. Here, using a computational model of the spike protein (S-protein) of SARS-CoV-2\n interacting with the human ACE2 receptor, we make use of the world's most powerful supercomputer,\n SUMMIT, to enact an ensemble docking virtual high-throughput screening campaign and identify\n small-molecules which bind to either the isolated Viral S-protein at its host receptor region or to the S\n protein-human ACE2 interface. We hypothesize the identified small-molecules may be repurposed to limit viral\n recognition of host cells and/or disrupt host-virus interactions. A ranked list of compounds is given that can be\n tested experimentally</p>\n</blockquote>\n\n<p>..</p>\n\n<h2>Docking Results for the Host-Virus Interface (S-protein-ACE2 Receptor Complex)</h2>\n\n<blockquote>\n <p>Of the top 41 ranked compounds, we highlight four (with scores ranging from -7.4 to -\n 7.1) based on their poses, which are represented in figure 2. These highlighted compounds are\n pemirolast41-42 (ZincID: 5783214), isoniazid pyruvate (ZincID: 4974291), nitrofurantoin\n (ZincID: 3875368), and eriodictyol (ZincID: 58117). Of the four small-molecules shown in\n figure 2, the top-ranked, pemirolast, is an anti-allergy medication or for use in treating chronic\n asthma41-42, while the second and third of the highlighted hits are related to well-known\n antibiotics, with nitrofurantoin an antibiotic for use against urinary tract infections43 and\n isoniazid pyruvate being a metabolite of the tuberculous antibiotic Isoniazid44. The last,\n Eriodictyol, is a flavanone found in Herba Santa and is a traditional herbal remedy used for\n asthma and treating colds45</p>\n</blockquote>\n\n<h2>Docking Results for the Isolated Virus S-protein Host Recognition Domain</h2>\n\n<blockquote>\n <p>The three top-scoring ligands (with ZINC15 annotations denoting regulatory data\n available) for the isolated S-protein were: Cepharanthine, Ergoloid, and Hypericin.\n Cepharanthine and Hypericin are both natural products with both having been the subject of\n multiple studies on their ability to act as antiviral46-49 agents (including against coronaviruses47,\n 49), while Ergoloid is an FDA approved50 drug component of interest in dementia therapies51-53</p>\n</blockquote>\n\n<p><a href=\"https://s3-eu-west-1.amazonaws.com/itempdf74155353254prod/11871402/Repurposing_Therapeutics_for_COVID-19__Supercomputer-Based_Docking_to_the_SARS-CoV-2_Viral_Spike_Protein_and_Viral_Spike_v4.pdf\" rel=\"nofollow noreferrer\">https://s3-eu-west-1.amazonaws.com/itempdf74155353254prod/11871402/Repurposing_Therapeutics_for_COVID-19__Supercomputer-Based_Docking_to_the_SARS-CoV-2_Viral_Spike_Protein_and_Viral_Spike_v4.pdf</a></p>\n", "score": 1 } ]

[ "covid-19", "ace2" ]

[ { "answer_id": 21545, "body": "<blockquote>\n <p>Meridian of the eye: Considering the center of the pupil as a pole, imaginary lines are drawn around the eyeball that is intersected at the poles (both anterior and posterior) and are called as the meridians of the eye. The flattest and steepest meridians of the eye are termed as the principal meridians.</p>\n</blockquote>\n\n<p><a href=\"https://www.news-medical.net/health/Astigmatism-Types-Regular-and-Irregular.aspx\" rel=\"nofollow noreferrer\">https://www.news-medical.net/health/Astigmatism-Types-Regular-and-Irregular.aspx</a></p>\n", "score": 2 } ]

[ "eye", "terminology" ]

[ { "answer_id": 21557, "body": "<p>The eye does not move in and out in the sense of the eye socket. The in and out movement is best described in <a href=\"https://kidshealth.org/en/kids/strabismus.html\" rel=\"nofollow noreferrer\">this kids eye health page</a> where it describes a condition called strabismus (emphasis mine).</p>\n\n<blockquote>\n <p>Strabismus is the term used for eyes that are not straight and do not focus on the same object. <strong>Eyes can turn in (toward the nose), out (toward the ear)</strong>, up, or down if the muscles that move the eyes don't work right or if the eyes are not able to focus properly. <strong>Strabismus is also sometimes called crossed eyes (when the eyes turn in) or walleye (when they turn out)</strong>.</p>\n</blockquote>\n\n<p>The most common type of strabismus is esotropia, which occurs when either one or both eyes turn in toward the nose, and exotropia is the second most common kind of strabismus, where one or both eyes turn out (<a href=\"https://shileyeye.ucsd.edu/eye-conditions/eye-movement-disorders\" rel=\"nofollow noreferrer\">Shiley Eye Institute - University College San Diego Heath</a>). </p>\n", "score": 1 } ]

[ "eye" ]

[ { "answer_id": 23170, "body": "<p>The following standard, EN <a href=\"https://www.iso.org/obp/ui#iso:std:iso:10651:-4:ed-1:v1:en\" rel=\"nofollow noreferrer\">ISO 10651-4:2002</a>\nLung ventilators Part 4: Particular requirements for operator-powered resuscitators</p>\n<p>is for AMBU Bags!</p>\n", "score": 1 } ]

[ "covid-19", "mechanical-ventilation" ]

[ { "answer_id": 21720, "body": "<p>Like you mentioned, 12 ounces of sardines a week fits under the FDA's guidelines, so it should not be harmful to the adult that you described. Sardines contain a lot less mercury than many other fish species¹.</p>\n\n<p>Second of all, not all cans contain BPA or PVC. Even in cans that <strong>do</strong> contain BPA or PVC, the FDA considers them safe at low levels of exposure^2,3. However, some researchers mentioned health concerns related to BPA and PVC that have not yet been fully researched^2,4. Those concerned about exposure to BPA or PVC can purchase cans that do not contain the compound. </p>\n\n<p>It is considered safe by the FDA to consume up to 12 ounces of canned sardines a week for a period of two months according to current guidelines. </p>\n\n<ol>\n<li><a href=\"https://www.fda.gov/food/seafood-guidance-documents-regulatory-information/fish-and-fishery-products-hazards-and-controls\" rel=\"nofollow noreferrer\">https://www.fda.gov/food/seafood-guidance-documents-regulatory-information/fish-and-fishery-products-hazards-and-controls</a></li>\n<li><a href=\"https://www.fda.gov/food/food-additives-petitions/bisphenol-bpa\" rel=\"nofollow noreferrer\">https://www.fda.gov/food/food-additives-petitions/bisphenol-bpa</a></li>\n<li><a href=\"https://www.packaginglaw.com/ask-an-attorney/pvc-permitted-use-food-contact-articles\" rel=\"nofollow noreferrer\">https://www.packaginglaw.com/ask-an-attorney/pvc-permitted-use-food-contact-articles</a></li>\n<li><a href=\"https://toxtown.nlm.nih.gov/chemicals-and-contaminants/polyvinyl-chloride-pvc\" rel=\"nofollow noreferrer\">https://toxtown.nlm.nih.gov/chemicals-and-contaminants/polyvinyl-chloride-pvc</a></li>\n</ol>\n", "score": 5 } ]

[ "nutrition", "diet", "food-safety", "fish", "mercury" ]

[ { "answer_id": 21638, "body": "<p>Let's not get ahead of ourselves here.. chloroquine/hydroxychloroquine (and possibly in concert with azithromycin) have been touted over the past few days as a possible treatment regimen.</p>\n\n<p>And there's some cause for that - the antiviral properties of chloroquine/hydroxychloroquine in vitro are broad and it's been trialed against various things (HIV, Ebola etc), however this hasn't always transferred particularly well into an actual treatment. And there's some research suggesting that it can successfully battle SARS-CoV-2 <a href=\"https://www.nature.com/articles/s41422-020-0282-0\" rel=\"noreferrer\">in vitro</a> too. However, killing something in a petri dish is one thing, treating a disease in a human is <a href=\"https://xkcd.com/1217/\" rel=\"noreferrer\">another</a>.</p>\n\n<p>There has been some preliminary trials done - I believe there's been some fairly non-specific vagueness about it being promising when used in China and there's a relatively new study that's come from <a href=\"https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf\" rel=\"noreferrer\">Gautret et al</a> in France.</p>\n\n<p>The <em>Gautret et al</em> paper looks promising - on the surface. It seems to suggest that treating people with a combination of hydroxychloroquine and azithromycin looks <em>great</em>:</p>\n\n<p><a href=\"https://i.stack.imgur.com/Dirtf.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/Dirtf.png\" alt=\"Percentage of patients with PCR-positive..\"></a></p>\n\n<p>Unfortunately though it's not that simple.. first up we aren't talking about a great number of people here. The entire study comprised 42 patients (16 of which were the control), which isn't a huge sample size. And any patients who were on the treatment who got worse were removed from the analysis:</p>\n\n<blockquote>\n <p>Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCR- positive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3. </p>\n</blockquote>\n\n<p>So the picture isn't quite as rosy as the graph makes it look. Some people on this treatment still got worse, one <em>died</em>.</p>\n\n<p>It get's even shonkier (technical term) when you look at the large swathes of control patients who didn't have the PCR test done for viral loads:</p>\n\n<p><a href=\"https://i.stack.imgur.com/t63vT.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/t63vT.png\" alt=\"Supplemental Table 1\"></a></p>\n\n<p>They effectively only properly measured the viral loads for 4 of the 16 control patients, so trying to compare the groups is verging on meaningless.</p>\n\n<p>So before we look at \"when\" they'll be widely available to treat SARS-CoV-2 I'd be more concerned with answering whether they <em>should</em> be used to treat it. Hydroxychloroquine is not exactly harmless - while less toxic to humans than chloroquine, it's not something to give lightly, it can have immunosuppressant effects, and in sufficient dosages can result in potentially lethal <a href=\"https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf\" rel=\"noreferrer\">cardiotoxicity</a>.</p>\n\n<p>It may yet prove to be an effective treatment - and the WHO is trialing it (along with other potential treatments) as part of their mega-trial <a href=\"https://www.sciencemag.org/news/2020/03/who-launches-global-megatrial-four-most-promising-coronavirus-treatments\" rel=\"noreferrer\">SOLIDARITY</a>, but let's not get too excited just yet.</p>\n", "score": 6 } ]

[ "covid-19", "treatment", "coronavirus" ]

[ { "answer_id": 23151, "body": "<p>Apparently yes. The South China Morning Post reports that Professor Yuen Kwok-yung of HKU has been using ozone for respirator sterilization: <a href=\"https://www.scmp.com/news/hong-kong/health-environment/article/3078195/coronavirus-hong-kong-scientists-look\" rel=\"nofollow noreferrer\">https://www.scmp.com/news/hong-kong/health-environment/article/3078195/coronavirus-hong-kong-scientists-look</a></p>\n", "score": 1 } ]

[ "covid-19", "face-mask-respirator" ]

[ { "answer_id": 21676, "body": "<p>Viruses are below the resolution of light microscopy.</p>\n\n<p><img src=\"https://www.sciencealert.com/images/2020-02/49531042877_4aaa42ea6c_k.jpg\" alt=\"\"></p>\n\n<p>Scanning electron microscope image with colours assigned by software</p>\n\n<p><a href=\"https://www.sciencealert.com/this-is-what-the-covid-19-virus-looks-like-under-electron-microscopes\" rel=\"nofollow noreferrer\">https://www.sciencealert.com/this-is-what-the-covid-19-virus-looks-like-under-electron-microscopes</a></p>\n", "score": 1 } ]

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

[ { "answer_id": 21680, "body": "<p>Phylogenetic analyses of the virus in the community has shown that the virus has been introduced at multiple times by different persons because clades inside one city differ from clades in different cities in the same country.</p>\n\n<blockquote>\n <p>By analysing 48 almost complete virus genome sequences,\n we found out that the viruses that invaded Taiwan, the United\n States, and Japan were introduced independently. We identified\n thirteen parsimony-informative sites and three groups (CTC,\n TCC, and TCT). None of the viruses found in cities in Taiwan,\n the United States, and Japan formed a monophyletic clade with\n viruses found in other cities in the same country. These results\n suggest the difficulty of implementing effective border measures\n against this virus.</p>\n</blockquote>\n\n<p>Genome phylogenetic tree analyses revealed evidence that the\nsevere acute respiratory syndrome coronavirus 2 had been\nintroduced to Taiwan, the United States, and Japan several times\nTomoko Matsuda1 and Norichika Ogata1,2,*1\nNihon BioData Corporation, Kawasaki, Japan, 2\nMedicale Meccanica Inc., Kawasaki, Japan</p>\n", "score": 1 } ]

[ "covid-19", "epidemiology", "sars-cov-2" ]

[ { "answer_id": 21704, "body": "<p>One of the issues with COVID-19 is the fact that it is transmissible even by people who are asymptomatic. You've probably heard about R0, which is the basic reproduction rate of a disease, that takes into account transmission modes and contact rate, among other things. I'm not an epidemiologist, but I'm operating under the assumption that someone who is obviously sick will infect relatively fewer people than someone who is asymptomatic, assuming similar contagiousness - the sick person should quarantine themself and clearly take measures to avoid spreading their sickness. A seemingly well individual, on the other hand, may not reduce their contact rate and unwittingly spread the disease. </p>\n\n<p>Under this assumption, consider what happens when the incubation time is equal to the doubling rate. Suppose we have 1000 individuals who have the disease, but don't know it yet because they are still in the incubation period. 5.8 days later, there are now 2000 people with the disease, 1000 of which now feel sick, and 1000 of which still feel fine. Those 1000 sick people quarantine themselves, dramatically lowering their rate of infecting others, let's say to 0 for the sake of simplicity. 5.8 days later, the 1000 asymptomatic people now feel sick, after having infected another 1000 people, although the 1000 already-sick individuals haven't infected anyone else. At this rate, we have a linear increase in the number of cases, since old cases are quarantining themselves at the same rate new cases are spread - the number of people spreading the disease unwittingly remains constant!</p>\n\n<p>I've made several assumptions here, like that the transmission rate for asymptomatic individuals is higher than that of symptomatic individuals (although some symptoms, like cough, increase infectivity, and not all symptomatic individuals quarantine appropriately). I'm also not sure this is really an appropriate use of \"doubling time\" - strictly speaking, if 1000 people quarantine, and 1000 asymptomatic people infect 1000 others, it is not a doubling of cases. The statement also seems a bit of tautological red herring - if you are able to lengthen the doubling time, you <em>have already flattened the curve</em>, regardless of the incubation period. But I think the general idea is that a longer doubling time can lessen the impact of asympomatic, but contagious individuals spreading the disease.</p>\n", "score": 4 } ]

[ "covid-19", "virus", "disease-transmission", "epidemiology", "coronavirus" ]

[ { "answer_id": 21778, "body": "<p>The best data we have from Guangdong, China, is that household transmission is not 100%</p>\n\n<blockquote>\n <p>preliminary studies ongoing in Guangdong estimate the secondary attack rate in households ranges from 3-10%.</p>\n</blockquote>\n\n<p>So, this suggests that if either of you are potentially infected, then social distancing and other infection control measures will likely prevent the transmission from one to the other.</p>\n\n<p>If, on the other hand, you have all been tested to be infection free (PCR or other reliable test), and you are in isolation without the risk of catching the infection from someone else, then as adults what you do in the privacy of your own homes is only limited by local laws and imagination.</p>\n\n<p><a href=\"https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf\" rel=\"nofollow noreferrer\">https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf</a></p>\n", "score": 1 } ]

[ "covid-19", "oral-health", "anus", "oral-sex" ]

[ { "answer_id": 21774, "body": "<p>Your proposed method assumes that the \"no outcome yet\" group is going to have the same ratio of outcomes as the \"died\" and \"recovered\" groups. This is true only if either the number of infections is not changing and has been constant for longer than the case-resolution time, or if \"time to recovery\" and \"time to death\" are equal.</p>\n", "score": 1 } ]

[ "covid-19" ]

[ { "answer_id": 22843, "body": "<p>The current guidelines for treatment of Adult Respiratory Distress Syndrome do not recommend such treatment.</p>\n\n<p>In SARDS associated with covid-19 disease there is alveolar collapse due to infection and death of the surfactant making pneumocytes lining the alveoli. the recommendation is to generally run these patients on the dry side while being ventilated as there is a tendency to fluid overload the lungs. Adding fluid with pulmonary irrigation sounds counterproductive and is not going to correct the underlying issue of a lack of surfactant.</p>\n\n<p><a href=\"https://bmjopenrespres.bmj.com/content/6/1/e000420.full\" rel=\"nofollow noreferrer\">https://bmjopenrespres.bmj.com/content/6/1/e000420.full</a>\nGuidelines on the management of acute respiratory distress syndrome</p>\n", "score": 3 } ]

[ "covid-19", "lungs", "pneumonia" ]

[ { "answer_id": 22864, "body": "<p>The risk of infection is from inhalation of viral particles, or, from those particles landing on mucosal surfaces including the eyes, or being transferred there by ones hands.</p>\n\n<p>I am not aware of any data that shows people with respiratory disease are more or less likely to develop covid-19. But if you have a co-morbid illness, then you're less likely to survive.</p>\n\n<p>Most \"healthy\" bacteria are ingested and not inhaled.</p>\n\n<p>The disinfectant is likely to be dilute bleach which converts quickly back to mainly table salt, oxygen and water with a few adsorbable organic halides. They won't be spraying in your immediate vicinity without telling you to move on until after it's been inactivated.</p>\n\n<p>Remember also that most municipal water supplies effectively have had bleach added to them.</p>\n\n<p><a href=\"https://www.clorox.com/how-to/laundry-basics/bleach-101/bleach-101/\" rel=\"nofollow noreferrer\">https://www.clorox.com/how-to/laundry-basics/bleach-101/bleach-101/</a></p>\n", "score": 2 } ]

[ "covid-19", "infection", "lungs", "respiratory-system", "disinfection" ]

[ { "answer_id": 22852, "body": "<p>You are asking for speculation since there aren't any other papers that address this issue.</p>\n\n<p>I can think of a number of reasons in addition to the ones mentioned in the paper.</p>\n\n<p>We know medical workers were hit higher than than the general population. This implies a higher viral load initially leads to more severe disease. If more of the lung is affected initially there is less time to mount an immune response.</p>\n\n<p>China removed the mildly infected and asymptomatic infected quickly by large scale testing. When testing by PCR was unavailable they even used chest CT scans for screening.</p>\n\n<p>It's culturally acceptable to wear face masks after the sars epidemic in China. You didn't see this in Italy. But it reduces viral shedding into the environment.</p>\n\n<p>Italians are more touchy than Chinese. Whereas a handshake in China might do, Italians are more likely to face kiss and engage in other more dangerous close contact acts. </p>\n\n<p>The one child policy also meant that the population has fewer mobile vectors of disease moving around viz younger children.</p>\n\n<p>Household transmission was kept at 10% in Guangdong. If Italy failed to test early and frequently this would have increased this rate of transmission, with higher viral loads.</p>\n\n<p>So I conclude that death rates were higher in the over 70s because numerous factors lead to higher viral loads.</p>\n\n<p><a href=\"https://www.cnbc.com/2020/03/27/why-coronavirus-deaths-are-higher-in-italy-spain-than-in-china.html\" rel=\"nofollow noreferrer\">https://www.cnbc.com/2020/03/27/why-coronavirus-deaths-are-higher-in-italy-spain-than-in-china.html</a></p>\n", "score": 1 } ]

[ "covid-19" ]

[ { "answer_id": 22855, "body": "<p>It's not a given, that they are not useful in solid tumors (also lymphoma are accounted among the solid tumors).</p>\n\n<p>There are pyrimidine-like antimetabolites, e. g. 5-FU: <a href=\"https://en.wikipedia.org/wiki/Fluorouracil\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Fluorouracil</a>, while some <em>purine</em> antimetabolites were in development, see e. g. here: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/4066218\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/4066218</a>.</p>\n\n<p>There are some approaches that try to make tumors more sensitive to purine antimetabolites, e. g. <a href=\"https://www.sciencedirect.com/science/article/abs/pii/S0006295219304691\" rel=\"nofollow noreferrer\">https://www.sciencedirect.com/science/article/abs/pii/S0006295219304691</a>.</p>\n\n<p>Another, older, paper that describes a purine antimetabolite in lymphoma: <a href=\"https://ascopubs.org/doi/abs/10.1200/JCO.1991.9.1.175\" rel=\"nofollow noreferrer\">https://ascopubs.org/doi/abs/10.1200/JCO.1991.9.1.175</a></p>\n\n<p>A more recent approach on the purine metabolism: <a href=\"https://www.frontiersin.org/articles/10.3389/fimmu.2018.01697/full\" rel=\"nofollow noreferrer\">https://www.frontiersin.org/articles/10.3389/fimmu.2018.01697/full</a></p>\n", "score": 1 } ]

[ "cancer", "chemotherapy" ]

[ { "answer_id": 23139, "body": "<p>I think you're asking if multiple courses will exceed the maximally recommended cumulative dose of 120-150 mg/kg though that is not steadfast as your reference also says</p>\n\n<blockquote>\n <p>One recent study of 116 patients found that a cumulative dose of 220 mg/kg or more may result in lower relapse rates, but confirmation will require study in larger populations.278</p>\n</blockquote>\n\n<p>However, the half life of isotretinoin is </p>\n\n<blockquote>\n <p>The half life is 22 hours and the bioavailability is 25%. </p>\n</blockquote>\n\n<p>So, once a course of treatment has finished, and a delay is instituted to allow the drug to clear from the system, another course of treatment can be instituted.</p>\n\n<blockquote>\n <p>Further courses of therapy are usually successful when required. There are no reports of cumulative toxicity from using repeat courses and tachyphylaxis has not been noted.</p>\n</blockquote>\n\n<p>In other words, the cumulative dose refers to a single treatment course and not a combination of all treatment courses.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835909/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835909/</a></p>\n", "score": 1 } ]

[ "acne" ]

[ { "answer_id": 22870, "body": "<p>Sounds like science fiction and not much use for treating patients. They talk about shining laser light on the virus to induce the resonant frequency to shatter the virus.</p>\n\n<p>But, Covid-19 is a deep tissue infection, and I can't imagine how lasers could possibly get inside the lung, heart and other tissues affected by this virus.</p>\n", "score": 6 }, { "answer_id": 23037, "body": "<p>[High intensity focused ultrasound][1] can be quite targeted and get into deep parts of the body, including into the brain. But while it would likely kill the virus, I don't think it's very realistic to be sonicating everywhere the virus might be, because it isn't very localized. You can't use FUS on the entire lung, as that would cause far too much damage if you were to have any impact on reducing viral load. This is just my opinion, but I do think that a good antiviral treatment for SARS COV 2 will need systemic effects, not localized.</p>\n", "score": 0 } ]

[ "covid-19", "ultrasounds" ]

[ { "answer_id": 22883, "body": "<p>This form of approach, called mitigation, was modelled and led to disease cases exceeding surge capacity of the health system by eight fold, and deaths of about 1.2M.</p>\n\n<p>That is why they changed to disease suppression.</p>\n\n<p>WHO Collaborating Centre for Infectious Disease Modelling\nMRC Centre for Global Infectious Disease Analysis\nAbdul Latif Jameel Institute for Disease and Emergency Analytics\nImperial College London.</p>\n", "score": 1 } ]

[ "virus", "epidemiology", "coronavirus", "quarantine" ]

[ { "answer_id": 23165, "body": "<p>The work you’re likely referring to is Neeltje van Doremalen et al. (2020), which evaluates the surface stability of <em>viable</em> SARS-CoV-2 virus. In this experiment viable virus was found to survive for three days on plastic and stainless steel surfaces. This result has been widely reported in news media. You can read the methods appendix to understand exactly how viability is determined. See: <a href=\"https://www.nejm.org/doi/full/10.1056/NEJMc2004973\" rel=\"nofollow noreferrer\">https://www.nejm.org/doi/full/10.1056/NEJMc2004973</a></p>\n\n<p>Fragments of viral RNA, which pose no risk of infection, remain detectable for much longer — at least 17 days per Leah F. Moriarty et al. (2020). See: <a href=\"https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm6912e3_w\" rel=\"nofollow noreferrer\">https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm6912e3_w</a></p>\n", "score": 2 } ]

[ "covid-19", "infection", "virus", "sars-cov-2" ]

[ { "answer_id": 22973, "body": "<p>The European Food Safety Authority <a href=\"http://www.efsa.europa.eu/sites/default/files/efsa_rep/blobserver_assets/ndatolerableuil.pdf\" rel=\"nofollow noreferrer\">lists a population reference intake of 9.5 mg/day for men and 7.0 mg/day for women</a>. The same source lists a tolerable upper intake limit (\"UL\", a level that should be safe in the long term for everyone) of 25 mg/day for adults. Long-term intake of 50 mg/day has been shown to be enough to cause problems.</p>\n\n<p><em>One</em> of those tablets of yours per day, in addition to the zinc content of your food, is enough to put you into the uncertain region between the UL and the known-problematic dose.</p>\n", "score": 1 } ]

[ "supplement", "dosage", "zinc" ]

[ { "answer_id": 22954, "body": "<p><strong>TLDR: They're both equally effective.</strong> Technically, liquid soap is \"cleaner\" than bar soap unless the soap container is usually refilled.</p>\n\n<p>In more detail:</p>\n\n<p>From my understanding, any soap is effective at destroying viruses because it literally shreds apart the coating of the virus, obliterating it in the process. This is due to the nature of the soap being both hydrophilic (bonding to water) and lipidphilic (bonding to the viruses' lipid shells). So you would be seeing the same outcome from both bar and liquid soap.</p>\n\n<p>Then, the question remains on what happens to the shredded bodies of the pathogens. Well, when you rinse with water, any of the viral remains will wash down the drain, so again there is effectively no argument for neither bar nor liquid soap.</p>\n\n<p>However, when first making contact with bar soap, you are effectively transferring some of the pathogens onto the surface of the soap. These pathogens will still be destroyed, but their remains will sit on the soap. So in that sense, using bar soap is \"less clean\" because you are leaving viral debris on the surface of the soap (though this debris is benign). <strong>Score 1 for liquid soap</strong></p>\n\n<p>Now, if the liquid soap is being refilled regularly (like a refillable pump bottle, or a refillable public bathroom dispensor) <a href=\"https://www.cleanlink.com/cp/article/Refillable-Soap-Dispensers-Are-A-Haven-For-Bacteria--22011\" rel=\"nofollow noreferrer\">then this soap container is likely to already be contaminated with live pathogens</a>. <strong>Score 1 for bar soap</strong></p>\n\n<p>In the end, both bar soap and liquid soap are equally effective at destroying pathogens. If you wanted to get really nitty-gritty, I'd say liquid soap is the \"cleanest\" option, unless the container is one which gets refilled, then the bar soap is the \"cleanest\".</p>\n", "score": 1 } ]

[ "virus", "bacteria", "hygiene", "soap" ]

[ { "answer_id": 22961, "body": "<p>The EPA has a database that you can search for tested effectiveness against SARS-CoV-2 virus. You need to find the EPA registration number of the product you have and check it against their database.</p>\n<p>Dettol products containing a high concentration of alcohol are thought to be effective as a surface disinfectant ( greater than 70% ethanol/propylalcohol ).</p>\n<blockquote>\n<p>Specific Dettol products have demonstrated effectiveness (&gt;99.9% inactivation) against coronavirus strains from the same family as the 2019 Novel Coronavirus (COVID-19) in third party laboratory testing, when used in accordance with the directions for use. These products are: Dettol Antibacterial Surface Cleanser Spray, Dettol Antibacterial Surface Cleanser Wipes, Dettol All-In-One Disinfectant Spray, and Dettol Disinfectant Liquid.</p>\n<p>Given the structural similarities of the COVID-19 virus to the coronavirus strains tested previously (SARS-CoV, MERS-CoV, Human Coronavirus), and based on the evidence available to us, we would expect our Dettol products (listed above) to be effective against the new strain. Definitive scientific confirmation of this, as with all other commercially available virucides, can only be provided once testing against COVID-19 Coronavirus has been conducted, following release of the strain by relevant health authorities.</p>\n</blockquote>\n<p><a href=\"https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2\" rel=\"nofollow noreferrer\">https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2</a></p>\n<p><a href=\"https://www.dettol.co.uk/about-us/understanding-coronavirus/\" rel=\"nofollow noreferrer\">https://www.dettol.co.uk/about-us/understanding-coronavirus/</a></p>\n", "score": 1 } ]

[ "covid-19", "disinfection" ]

[ { "answer_id": 22967, "body": "<p>The paper you reference postulates that this occurs in patients who have malaria</p>\n\n<blockquote>\n <p>Another hypothesis is that the fever associated with malaria may directly decrease brain amines (norepinephrine, dopamine, and serotonin) because of the malaria-induced spike in temperature. Spikes in temperature can disrupt brain amine function (including synthesis and signaling activity) that can be further exacerbated by exposure to the antimalarials.82</p>\n</blockquote>\n", "score": 1 } ]

[ "neurology", "rheumatology" ]

[ { "answer_id": 22975, "body": "<p>I would think that this is a reasonable possibility. We assume that they are largely immune but there is a possibility that this is not the case in 100% of recovered patients.</p>\n\n<blockquote>\n <p>But some Wuhan residents who had tested positive earlier and then recovered from the disease are testing positive for the virus a second time. Based on data from several quarantine facilities in the city, which house patients for further observation after their discharge from hospitals, about 5%-10% of patients pronounced \"recovered\" have tested positive again.</p>\n</blockquote>\n\n<p><a href=\"https://www.npr.org/sections/goatsandsoda/2020/03/27/822407626/mystery-in-wuhan-recovered-coronavirus-patients-test-negative-then-positive\" rel=\"nofollow noreferrer\">https://www.npr.org/sections/goatsandsoda/2020/03/27/822407626/mystery-in-wuhan-recovered-coronavirus-patients-test-negative-then-positive</a></p>\n", "score": 1 }, { "answer_id": 22977, "body": "<p>Projects for broad-based antibody blood tests are currently springing up like mushrooms.\nBut the first test series available will be needed for the staff of health care.</p>\n\n<p>of course there are other interests for antibody tests: virological, epidemiological and as your question implies economical. </p>\n\n<p><em>Antibody blood tests should provide information about the spread of the corona virus so that the measures taken by the authorities can be adapted. A nationwide initiative is now putting pressure.</em></p>\n\n<p><a href=\"https://www.sciencemag.org/news/2020/03/new-blood-tests-antibodies-could-show-true-scale-coronavirus-pandemic\" rel=\"nofollow noreferrer\">https://www.sciencemag.org/news/2020/03/new-blood-tests-antibodies-could-show-true-scale-coronavirus-pandemic</a></p>\n\n<p><em>For example, if a selected group of people were tested for Sars-CoV-2 antibodies every two weeks, the course of the epidemic would be clearly visible.</em></p>\n\n<p><em>The interest, especially in business circles, is huge. Everyone urgently wanted to know where they were in the pandemic, who was at best already immune and could therefore probably move around and work safely again.</em> </p>\n\n<p><a href=\"https://www.srf.ch/news/schweiz/coronavirus-antikoerper-tests-ein-schweizweites-projekt-wird-aufgegleist\" rel=\"nofollow noreferrer\">https://www.srf.ch/news/schweiz/coronavirus-antikoerper-tests-ein-schweizweites-projekt-wird-aufgegleist</a></p>\n\n<p><em>Such data could inform practical issues such as whether and how to reopen schools that have been closed. Relatively few cases have been diagnosed among children, but it isn’t clear whether that’s because they don’t get infected or because their infections are generally so mild that they go unnoticed. Testing children for SARS-CoV-2 antibodies should resolve that.</em></p>\n\n<p><a href=\"https://www.sciencemag.org/news/2020/03/new-blood-tests-antibodies-could-show-true-scale-coronavirus-pandemic\" rel=\"nofollow noreferrer\">https://www.sciencemag.org/news/2020/03/new-blood-tests-antibodies-could-show-true-scale-coronavirus-pandemic</a></p>\n\n<p>Authorities are still afraid of a roll back of the wave when people start moving freely again. It must have a great acceptance and also be respected by those who should still stay at home. </p>\n", "score": 0 } ]

[ "sars-cov-2", "antibodies" ]

[ { "answer_id": 22979, "body": "<p>It's the number of deaths an event has caused to be shifted in time. So，there's a very high rate of deaths right now from covid-19 in Italy amongst the older population. Those deaths are occurring now instead of in the future so those deaths are displaced from the future to now. As a result the number of deaths in the older population after the pandemic finishes will be less since they were displaced to a different time.</p>\n", "score": 2 } ]

[ "statistics" ]

[ { "answer_id": 23033, "body": "<p>Fundus photography and fundus images are pictures of the retina. The <a href=\"https://www.aao.org/eye-health/anatomy/fundus\" rel=\"nofollow noreferrer\">fundus</a> of the eye is just the interior surface of the eye opposite the lens, so it includes the retina as well as the optic disc, macula, fovea, and posterior pole. In my reading, fundus cameras are also referred to as retinal cameras, and vice versa. \"<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131209/\" rel=\"nofollow noreferrer\">Retinal imaging</a>\" may be a more general term, as it may also include 3D optical coherence tomography and other imaging techniques that aren't necessarily photography. </p>\n", "score": 4 } ]

[ "eye" ]

[ { "answer_id": 23163, "body": "<p>Using weakened virus, or attenuated virus, is very old biotechnology to create vaccines. I doubt that there is any ethics committee that would sanction the use of live attenuated virus as a vaccine through whatever route as there is no data on safety via this route.</p>\n\n<p>Also, you would want to be able inject enough virions to induce an immune response without killing the patient.</p>\n\n<p>The latest technology is to use mRNA which would be used by the body to create the proteins seen on the virus, and the body would then create the antibodies against these proteins.</p>\n\n<blockquote>\n <p>Moderna is studying its messenger RNA (mRNA) vaccine in the US, and CanSino Biologics has begun a trial of its adenoviral vector vaccine in China.</p>\n</blockquote>\n\n<p><a href=\"https://cen.acs.org/pharmaceuticals/vaccines/coronavirus-help-mRNA-DNA-vaccines/98/i14\" rel=\"nofollow noreferrer\">https://cen.acs.org/pharmaceuticals/vaccines/coronavirus-help-mRNA-DNA-vaccines/98/i14</a> </p>\n", "score": 2 } ]

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

[ { "answer_id": 23083, "body": "<p>There has been a lack of masks outside Asia. Instead of saying: We don't have enough masks the governments and health authorities announced: masks are not to protect the one who wears it but all others in the environment of an infected person who wears it. </p>\n\n<p>Other arguments have been: </p>\n\n<ul>\n<li>wearing a mask gives a false security</li>\n<li>folks of western civilization don't know how to wear the mask correctly</li>\n<li>they will even touch their face more often as they do without mask to reset the mask</li>\n</ul>\n\n<p>Now as we have our own mask production outside Asia they say wearing masks could also protect all of us ... and in some countries (e.g. Austria) it will be obligatory to wear it in public and when working or shopping. Wonder if there will be enough masks then.</p>\n\n<blockquote>\n <p>Could a face masks prevent droplets even though it does not avoid virus infection?</p>\n</blockquote>\n\n<p>You mean: do the simple cheap face mask really protect of infecting others (by droplets)?</p>\n\n<p>Experts suggest that in Asia they are worn against air pollution and not in purpose to protect others. They also say that these masks are too thin without a special filter. </p>\n\n<p>So the change is true. But they might change from day to day. The purpose was to sensitize the population for the seriousness of the situation and to not provide a false security.</p>\n", "score": 1 } ]

[ "covid-19", "face-mask-respirator" ]

[ { "answer_id": 23098, "body": "<p>The current data suggests that SARS-CoV-2 can enter cells by at least 4 methods: </p>\n\n<ul>\n<li><p>ACE2 receptor - Angiotensin-converting enzyme 2 which is involved in protecting the lung (and other organs) from damage</p></li>\n<li><p>CD147 - is a transmembrane glycoprotein that belongs to the immunoglobulin superfamily, which is involved in tumor development, plasmodium invasion and virus infection.</p></li>\n<li><p>GRP78 receptors</p></li>\n<li><p>Furin targets - an enzyme that works as a protein activator </p></li>\n</ul>\n\n<blockquote>\n <p>Typically, a virus uses the outreaching spike protein to hook on to the host cell, but normally this protein is inactive. The cleavage site structure’s role is to trick the human furin protein, so it will cut and activate the spike protein and cause a “direct fusion” of the viral and cellular membranes.</p>\n \n <p>The result findings show that when compared to the initial SARs mode of entry, this binding method is more than a 1,000 times efficient.</p>\n</blockquote>\n\n<p>So, it seems possible that a neutralising antibody or protein could be produced that looks like the receptors on cell surfaces so that the virus preferentially binds to the neutralising antibody, and is thus deactivated.</p>\n\n<p>Such drugs are available or in the drug pipeline and are awaiting clinical trials.</p>\n\n<p><a href=\"https://www.thailandmedical.news/news/breaking-latestcoronavirus-research-reveals-that-the-virus-has-mutated-gene-similar-to-hiv-and-is-1,000-times-more-potent-\" rel=\"nofollow noreferrer\">https://www.thailandmedical.news/news/breaking-latestcoronavirus-research-reveals-that-the-virus-has-mutated-gene-similar-to-hiv-and-is-1,000-times-more-potent-</a></p>\n\n<p><a href=\"https://pubmed.ncbi.nlm.nih.gov/32057769/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/32057769/</a></p>\n", "score": 1 } ]

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

[ { "answer_id": 23090, "body": "<p>Because viruses often infect a specific cell type, and the viral particles may not be common in the blood, filtering of the blood might not be an effective way to prevent the spread of a virus inside a patient.</p>\n\n<p>Table 3 of this <a href=\"https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930183-5\" rel=\"nofollow noreferrer\">paper</a> on the original outbreak of COVID-19 reports that 15% of patients had RNAaemia, which is their term for finding indications of the virus' RNA in the bloodstream. But that presence doesn't seem to correlate with prognosis. I.e. 15% of those patients who died tested positive for RNAaemia, and 14% of the patients who survived also tested positive for RNAaemia.</p>\n\n<p>So maybe removing the virus from the bloodstream wouldn't make much difference anyway.</p>\n", "score": 2 }, { "answer_id": 23091, "body": "<p>The only viral diseases for which I found this method <a href=\"https://time.com/3586271/ebola-treatment-dialysis-blood/\" rel=\"nofollow noreferrer\">mentioned (in the popular pres)</a> has been Ebola (in 2014), and that's an experimental treatment.</p>\n<blockquote>\n<p>The device, called the Hemopurifier, was attached to the dialysis machine that was already filtering the patient’s blood. The specially designed filter is made of a protein that acts as glue for proteins found on the Ebola virus’s surface. Over a period of 6.5 hours, the filter extracted the virus from the blood that flows through. While most dialysis filters can pull out molecules that are less than 4 nanometers in diameter, the virus filter boasts a mesh that’s able to filter out larger viral particles that are less than 250 nanometers. That means only the virus is pulled out, and the immune cells remain in the blood, ready to fight off any remaining viral invaders.</p>\n<p>“We had no [idea] about how much [virus] would be extracted, because this was the first patient, but I was very surprised because the drop in viral load was deeper than I expected,” says Geiger. Before the filtration began, the patient’s virus count was about 400,000 per mL blood. After the session it had dropped to 1,000 copies/mL. [...]</p>\n<p>Freed from that viral burden, the patient soon began to improve rapidly. His own immune system began fighting off the remaining virus, and he no longer needs dialysis or a ventilator. The patient is walking and waiting to be released from the hospital.</p>\n<p>Geiger stresses that it’s not clear yet whether the Hemopurifier alone was responsible for the patient’s recovery, since he was given other experimental therapies, but the amount of virus removed from his body and his rapid recovery after the filtration suggests that it at least played a role in helping him survive his infection.</p>\n<p>While <strong>puling viruses out of infected individuals has never been tried before</strong>, Geiger believes it will be an important strategy for treating not just Ebola but other vial infections as well, including HIV, hepatitis and even influenza. “It’s a very interesting concept. The big advantage is that the plasma is filtered, and only the virus is removed and the other plasma components like immune cells go back to the patient. That’s important because with viral infections, the patient is in a reduced immune situation.”</p>\n</blockquote>\n<p>The inventors mention influenza as a possible target too, but frankly I suspect that was way optimistic.</p>\n<p>A <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Hemopurifier\" rel=\"nofollow noreferrer\">search</a> in pubmed for &quot;Hemopurifier&quot; only finds 3 articles (and the 2001 hit is a name coincidence for an unrelated device), none of which are even about Ebola (never mind influenza), but there is (a 2009) one <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19169020\" rel=\"nofollow noreferrer\">about hepatitis C</a>. You can look through the <a href=\"https://scholar.google.com/scholar?cites=1451534700552079321&amp;as_sdt=2005&amp;sciodt=0,5&amp;hl=en\" rel=\"nofollow noreferrer\">(37) Google Scholar citations</a> of that 2009 paper for subsequent research.</p>\n<p>(The 2nd real hit in pubmed for &quot;Hemopurifier&quot; was a more cited 2012 article on exosome removal in cancer patients. Unfortunately, most of the citations for the 2009 hep-C paper seem to also be about exosome removal...) There is one <a href=\"https://www.karger.com/Article/FullText/375257\" rel=\"nofollow noreferrer\">2014 review</a> about Ebola though that mentions the Hemopurifier as follows:</p>\n<blockquote>\n<p>Recent discoveries have led to the development of specific extracorporeal sorbent techniques to reduce viral particle concentrations in blood. The application of a specific device called ‘Hemopurifier' has been advocated to reduce viral load in several acute viral infections [8]. Blood is circulated through a hollow fiber plasma filter that has a specific sorbent matrix stuffed in the compartment external to hollow fibers. Due to the fluid mechanics inside the device, plasma is produced from whole blood in the proximal part of the fibers and it is forced to flow through the sorbent bed. In the distal part of the device, plasma reenters the hollow fibers by a backfiltration mechanism. No plasma loss occurs since plasma never leaves the device (the plasma ports are left capped). According to the company's specifications (Aethlon Medical Inc., San Diego Calif., USA), the sorbent is highly specific for glycoproteins (GP) that viral envelopes. Viral particles are thereby captured and their concentration in blood is significantly reduced [9]. This process, called ‘Lectin Affinity Plasmapheresis', is based on the concept of affinity chromatography developed in the 1970s [10]. A unique lectin protein (Galanthus nivalis agglutinin, GNA) from Galanthus nivalis (the common snowdrop) has a high affinity to the mannose-rich GP that ubiquitously populate the surface of enveloped viruses [11,12] to inter alia mediate entry into host cells. This device has been used either alone or in series with a hemodialyzer and has displayed encouraging results both in vitro and in vivo on hepatitis C and HIV infected blood. Assuming a delicate equilibrium between the viral load and the immunological system, the eradication of a viral infection may be realized only by tipping the balance in favor of the innate immune response by lowering the circulating viral particle concentration in blood.</p>\n</blockquote>\n<p>Unlike the Hemopurifier's invetors' own claims, this review doesn't mention respiratory viruses as a likely (useful) target. (It only mentioned Ebola, Hep C, and HIV.)</p>\n<p>I <a href=\"https://academic.oup.com/ndt/article/30/suppl_3/iii229/2512298\" rel=\"nofollow noreferrer\">found</a> the (2015) scientific publication on the Eblola experiment now too; it mainly uses the generic name of the method &quot;Lectin Affinity Plasmapheresis&quot; (LAP), although Hemopurifier is mentioned in there. This paper is not indexed by pubmed; I think it's because it's a conference rather than a journal paper.</p>\n<p>There's a <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29698959\" rel=\"nofollow noreferrer\">more recent (2018) paper</a> testing LAP (in vitro) on MERS, which is indexed in pubmed though. The fact that most of these papers appear in rather niche <em>methods</em> publications like the <em>Blood Purif.</em> journal should tell you something though.</p>\n", "score": 2 } ]

[ "covid-19", "coronavirus" ]