• Thierry Beths added an answer:
    Are there alternative stimuli for increased ventilation ?

    Why not use a MULTIVIB mattress for transferring sound stimuli to these patients?

    It can transfer music as well at VAT stimuli, and will aid the process of ventilation significantly.

    Olav Skille

    Thierry Beths · University of Melbourne

    For those of you who maybe interested in holistic medicine, some anaesthetist use in animal an acupuncture point which, apparently may help with ventilation: GV 24...but it seems they use to stimulate breathing during recovery from anaesthesia, while weaning from the ventilator...not sure it will halp in terms of increasing ventilation in an alrady breathing aptient.

  • Mohammad Alsehimy added an answer:
    Which is more common, the occurrence of Hypotension Bradycardia Event (HBE) during shoulder arthroscopy in block alone or block associated with GA?
    Mohammad Alsehimy · Cairo University

    I think that the occurrence of Hypotension Bradycardia Event (HBE) during shoulder arthroscopy is more common  in block associated with GA rather than in block alone ..


  • Mozhdeh Bahrainian added an answer:
    Has anyone validated the questionnaire for doctors regarding palliative sedation?
    Palliative sedation is sometimes a necessary intervention near the end of life. I am concerned about professionals perception, attitudes and practices regarding palliative sedation.
    Mozhdeh Bahrainian · University of Wisconsin, Madison

    I agree with Cecile Furstenberg and  Bojana Hocevar Posavec.

  • Rameshwar Jatwa added an answer:
    Can hyperglycemia induce endothelial mesenchymal transition?


    Rameshwar Jatwa · Devi Ahilya University, Indore

    Well, hyperglycemia is reported to induce oxidative stress, and this in turn may induce the cellular transition. As the elevated levels of ROS cause the lipid peroxidation and these lipid intermediates might be having a crucial role in cellular transition.

  • Fahmi Khan added an answer:
    A patient with deep vein thrombosis under oral anticoagulants and INR of 2.9 wants to travel. How soon can he fly after a DVT?
    A patient with deep vein thrombosis under oral anticoagulants and INR of 2.9 wants to travel. How soon can he fly after a DVT?
    Fahmi Khan · Hamad Medical Corporation

    Twenty days after starting anti-coagulation, and under pressure of the patient's family, we allowed the patient to travel to Germany to continue her treatment their. As the trip last for 7 hours, we repeated lower limb Doppler; it showed partial re-canalization. The patient was on warfarin and the INR was 2.9. We advised the patient to be in the business class to rise her leg during the trip. also we advised her to drink much water. on the next day, we received a message from the family that the patient arrived safely to German.      

  • Tang Fei added an answer:
    Do you agree that an Expert System can replace the human in different expert areas?
    An Expert System is a special kind of software and they are working on knowledge base. They are specifically designed for an special purpose. They have logical ability like human and much more faster than human.
    Tang Fei · Huawei Technologies Co. Ltd.

    The robot's advantages: speed, range, without loss of memory

    Human advantages: tricks, does not conform to the rules, to obtain the final victory

  • Rhys Phillips added an answer:
    Have hospitals been catalysts in the development of modern medicine? Or have they simply been passive reflections of medical innovation?

    Considered as a logical next step from healthy house, have hospitals been catalysts in the development of modern medicine? Or have they, as many architectural and medical historians had assumed, simply been passive reflections of medical innovation? (Adams, 2008)

    Rhys Phillips · Canadian Interiors Magazine

    Here is piece I wrote in Building in 2012 on evidence-based healthcare facility design and new developments in Canada that you may find interesting.


    Rhys Phillips, Associate Editor, Building

  • Pardis Td added an answer:
    Is it appropriate for women to take iron supplements prior to surgery?
    What dose and for how long should this supplementation occur? Should it be a part of everyday life?
  • Salman Ahmed added an answer:
    Application of Galenical Preparations in current drug discovery?

    Please only share the published facts (reviews and chapters etc.)

    Salman Ahmed · University of Karachi

    Thanks both of you but i still need any review article about Application of Galenical Preparations in current drug discovery.



  • What are your opinions on the following drug combinations for anti-ulcer medication?
    In the setting of prescribing anti-ulcer medication please comment on the following combinations :
    1.Ranitidine with Omeprazole
    2.Antacid with Ranitidine
    3.Sucralfate with Omeprazole
    Mithun Vishwanath K. Patil · Bharati Vidyapeeth Deemed University

    ranitidine belongs to a group of drugs called histamine-2 blockers. it works by reducing the amount of acid your stomach produces.

    on the other hand Antacids work by counteracting (neutralising) the acid in your stomach that is used to aid digestion. This can reduce the symptoms of heartburn and relieve pain.

    Some antacids also coat the surface of the oesophagus (gullet) with a protective barrier against stomach acid or produce a gel on the stomach’s surface which helps stop acid leaking into the oesophagus so it is better to use this combination .. though i dont know it is rational or irrational therapy

  • Jai Ghosh added an answer:
    Is anyone using plasma technology for antimicrobial control?

    We have a tool that kills bacteria and leaves a growth inhibitory zone. Importance in medicine obviously, but what about water and grain antibacterial control instead of chemical, antibiotic and irradiation sterilisation, with their inherent dangers? 

    Jai Ghosh · Shivaji University, Kolhapur

    What you have asked are questions of validation: therefore, you must validate these parameters.  

  • Amy Crittenden added an answer:
    How can prescription errors best be addressed in developing countries?

    This research carried out revealed some important issues that can help curb prescription errors in developing countries and for that matter Ghana. What I'm your opinion can best help solve this problem in our health sector?

    Amy Crittenden · Guilford Technical Community College

    Dr. Upadhyay has hit the nail on the head.  Standardized best practices is really the only way to go.  Con ed offerings would help local physicians and nurses become familiar with these best practices.  It would help if the local Ministries of Health or equivalent of the US Joint Commission would promote and support said practices.

    One of the things that can help is influence from nurses by requesting physicians stick to standardized practices.  For example, in the US nurses are expected by the Boards of Nursing in their states to question orders that are incomplete, unclear, poorly written or contain errors that could harm the patient. 

    Now I realized that in the developing world nurses don't have the statute we do in the developed world.  But we managed decades ago on this issue when nursing had far less power and prestige, and when gender biases were more pronounced and even socially acceptable.  I'm sure a determined effort on the part of nurses in these countries, in collaboration with physicians who care about the issue, would turn things around.

  • Hristina Petrova added an answer:
    Definition of health - what should be and should not be?
    "Health is an ever evolving state of mind, body and relationships perceived by an individual, a family, a group or a community for self in a particular time, space and context" Suresh Vatsyayann 1995
    What do you think is missed out and, or wrongly included in this definition?

    They don't contradict you in terms of health being something that is ever-evolving and that is has a number of dimensions or types of health stretching beyond the physical. However, some of the definitions are more specific than yours and they don't emphasize the individual perception, it is only one part of the question.

    Your definition seems closer to the term of wellness - an integration of the body, spirit and mind (although mental and social health are included in the health definition). Looking at the history of the term wellness, there are also cultural and religious aspects attached to its meaning and use. It seems broader than health, there are far more connotations of spirituality, positive psychology, positive lifestyle change, happiness, pleasure and beauty, a focus on stress, food and diet. However, over the past 30 years it was widely used in marketing and therefore negative connotations displaced the original ones.

    It is interesting to explore the history of the term and its original use. According to Miller (2005), Oxford English Dictionary Iinguists traced its first written record to a 1654 diary entry by the Scot Archibald Johnston - wealnesse was used as an antonym of illness. 

    See Miller, James (2005): Wellness: The History and Development of a Concept (accessible via a number of sources on the Internet)

    I think that the main difference between health and wellness is that the former is neutral, it does not depart from any of the dimensions, it considers them all, while the latter departs from the spiritual, the manifestation of an illness in dimensions other than the physical, i.e. there is a direction and a bias (on positive values); it also looks at lifestyle, the mind and philosophy in a very broad sense.  

  • Jean Edelstein added an answer:
    Rare rupture of pes anserinus tendon.
    Does somebody know more about a rupture of the pes anserinus tendon? How should it be treated?
    Jean Edelstein · Independent Researcher

    Probably after Cortisone Injection? Pes anserinus ( Sartorius/ Gracilis/ Semitendinosus insertion at the medial tibia head) acts mainly as secondary medial joint stabilizer. So- if no stabilization problem is evident, the treatment remains conservative, according sport trauma therapy (RICE). Tests include Vlagus stress test in zero and 30 ° flexion as well as Lachmann Test, anterior drawer in neutral and in ext. rotation with knee in 90° flexion. Ultimate measure for functional stabilisation is gait analysis. If there is instability, than treatment depends- proper eccentric exercises, Galileo, skipping rope..., I haven´t seen instability due to pes anserinus tendon insufficiency, so surgery remains pretty rare, if at all.  

  • Enrico Curreri added an answer:
    Where are all the researchers who work with music therapy?
    I’m currently a Master's student of research oriented music therapy at the SRH in Heidelberg/Germany. Within a project, we are currently looking for all the research centers worldwide, dealing with music therapeutic questions. Therefor I would like to ask for your help. If you are currently working in a research field of music therapy, it would be very helpful if you could send a short e-mail or message explaining where you’re coming from and what you’re working on right now.
    Enrico Curreri · Elmhurst Hospital Center

    At the moment, I am an independent music therapy researcher in New York focusing on experimental and non-ordinary music, nondual psychotherapy, aesthetics, and introspection with  psychiatric children and adolescent patients. 

  • Max Stanley Chartrand added an answer:
    What studies have been done, or are underway, that look at a causal relationship between the paleolithic diet (Loren Cordain) and mental health?
    A recent systematic review looked at the association between diet quality, dietary patterns and depression in adults (Michael Berk: http://www.ncbi.nlm.nih.gov/pubmed/23802679).

    My question is whether the "paleo diet" is a "better" diet leading to mental "well-being"?
    Max Stanley Chartrand · DigiCare Behavioral Research

    Marcel, good points above. I've no doubt that we will find that societies that consume large quantities of caffeine suffer from more acid-based chronic diseases, especially CVD, diabetes, and cancer. I had not considered that a cultural thing, but of late with the relentless marketing of so-called energy drinks I am beginning to think they have created a culture of sorts, and one that lives shorter lives, depleted adrenals, and higher levels of physical (and mental) degeneration.  

  • Jean Edelstein added an answer:
    Who here would be believe in such odd causes of localized pain, disrupted muscle function, etc.?
    By a show of hands (or statements), how many doctors here, trained exclusively in Western medicine, would take seriously a patient who complains of suffering from side-effects (e.g. localized pain, disrupted muscle function) of eastern self-cultivation exercises (e.g. yoga, qigong). I am assuming that all the relevant tests that you sent him/her for are negative. And my main question is whether you'd believe that the cause of the condition is such eastern self-cultivation exercises. And if so, what would you suggest to such a patient?
    Jean Edelstein · Independent Researcher

    >That is called sports related trauma. No exclusivity here. Treat according diagnosis.

  • Abdullahi Musa Kirfi added an answer:
    Detection of high CMV -DNA in bronchoalveolar lavage in AIDS: Should it be treated or not?

    Last week a new HIV patient was admitted to the Infectious Diseases Unit where I'm currently working; he's coming from Pneumology where he was admitted for respiratory insufficiency. PCR from his sputum was negative for P. jiroveci, while it was positive for CMV-DNA (3 x 105); his CD4 were 5, HIVRNA 90170 cp. Clinical findings were suggestive for PCP and when he was transferred to our Unit we started treatment for PCP (TMP-SMX IV, corticosteroids, O2) and ARV therapy; the day after starting ARV we performed a BAL : PCR positive for CMV-DNA (2,5 x 108), positive forEBV-DNA (107), positive HHV6.

    Some colleagues of mine think we have to start antiCMV therapy (Gancyclovir), others suggest to attend ( they say that CMVDNA positive on BAL is not diagnostic for a CMV infection).

    What do you think about?

    Abdullahi Musa Kirfi · Abubakar Tafawa Balewa University

    Dear Goffredo,

    Treat the PCP

  • Najla Saeed Dar-Odeh added an answer:
    Would my colleagues help me with the diagnosis of this case?

    Malformations affecting some nails in a 20-year old woman, medically fit but underweight (45 KG for 170 cm height), normal CBC, B12, ferritin and thyroid function. No history of local trauma on the finger nails. Could this be due to psychological stress? or fungal infection?

    Najla Saeed Dar-Odeh · Taibah University

    Peace everyone,

    These are the patient's photos after about six months of the appearance of lesions. There is noticeable improvement. Patient was on and off vitamin supplements but never took an antifungal.

  • Closed account added an answer:
    How can one stop the cholera toxin effect?

    after the colonization of vibiro choleraea in intestinal of human being than cause diarrhea after secretion of cholera toxin. in serious case how can stop that secretion?

    Chlorpromazine may have some anthagonizing effect on cholera toxin.

  • Naeem Nabi added an answer:
    How to prevent Computer Vision Syndrome (CVS) and Digital Vision Syndrome (DVS) ?

    Computer vision syndrome (CVS) is a temporary condition resulting from focusing the eyes on a computer display for protracted, uninterrupted periods of time. Some symptoms of CVS include headaches, blurred vision, neck pain, redness in the eyes, fatigue, eye strain, dry eyes, irritated eyes, double vision, vertigo/dizziness, polyopia, and difficulty refocusing the eyes. These symptoms can be further aggravated by improper lighting conditions (i.e. glare  or bright overhead lighting) or air moving past the eyes (e.g. overhead vents, direct air from a fan). [Source: Wikipedia]

    With the increasing access to digital devices, Computer Vision Syndrome is becoming a common ailment

    Nowadays ours eyes do not get adequate rest as most of the time we are either on our computer, laptop, i-pad, mobile or watching television. Eye strain caused by excessive use of computer is called Computer Vision Syndrome or digital vision syndrome. It manifests as tiredness, inability to work for long hours, blurring of vision, double vision, watering, redness, itching and pain in eyes. These symptoms will be present in 95 per cent of people who use the computer for more than three hours a day.[Source: The Hindu]

    Some Excerpts from the second article:

    What To Do

    Posture and Exercises

    Good posture and regular exercises of back and cervical muscles are a must if you use the computer for more than three to four hours a day.


    The room should be well illuminated with the light source positioned in a way that light does not fall directly on your eyes or on the screen The light source should be behind the screen or on the ceiling and partially covered. anti-glare screens and spectacles can also help.


    Normally we blink 10 to 12 times a minute. When we watch TV our blink rate is 5 to 6 a minute and while working on the computer it further goes down to 3 to 4 times a minute. Reduced blinking causes evaporation of tears thereby increasing the osmolarity (concentration) of the tears. The hyperosmolar tears induce inflammation and tear film instability which in turn cause increase reflex lacrimation. In other words, the dry eye caused by Computer Vision Syndrome may present not only as dry eye but may present as watering and inflamed eye.

    To overcome this, it is better to have the computer screen 20 to 40 degrees below the eye level. This causes partial closure of the eyes by the lids thereby decreasing the evaporative surface.

    Your comments and views are welcome. Muchas Gracias !!

    Naeem Nabi · Dalhousie University

    Following may be of interest to you. AAPOSS also has guidelines for children.

    Kind regards

    A French health watchdog has recommended that children under the age of six should not be allowed access to 3D content.

    The Agency for Food, Environmental and Occupational Health and Safety (Anses) added that access for those up to the age of 13 should be "moderate".

    It follows research into the possible impact of 3D imaging on still-developing eyes.

    There is scientific basis. If anyone is interested you will find the link and the report is below "en savoir plus" (152 pages)

  • Desmond Brian Fernandes added an answer:
    Sun exposure, what is the cut-off to balance the beneficial effects (producing vitamin D) and prevent detrimental effects (skin cancer)?

    Sun exposure, on the one hand, is beneficial to produce vitamin D and prevent many detrimental effects due to its deficiency. On the other hand, it may cause skin cancer, such as basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). How much daily exposure is suitable to balance these?! Is there any evidence-based cut-off guideline?

    Desmond Brian Fernandes · Groote Schuur Hospital and private practice

    Thanks Jos.  I think we will see trends but in humans we are never going to be able to do careful double blind studies but we are learning that regular (probably controlled would be better) sun exposure leads to less cancer but that brings us back to your original question:  how much sunlight.  The exact roles of vitamin D or other favorable molecules like melatonin may take many years to define.

  • Dragica Pesut added an answer:
    What is the incidence of Tuberculosis in medical Residents?
    I have recently noted an upsurge in the incidence of tuberculosis (both pulmonary and extrapulmonary) in medical Residents. What precautions/ measures can prove effective in curtailing such an occurrence?
    Dragica Pesut · University of Belgrade

    I fully agree that the measures of TB infection control should be in place at health care facilities. They usually are in place at TB departments. It is considered that health care providers working at triage are more exposed to TB. In 2013, a cross-sectional study from Japan involved HCWs from a hospital without TB-specific wards. The screening for latent tuberculosis infection (LTBI) has been performed by interferon gamma release assay (Quantiferon TB Gold in tube). LTBI prevalence rate was 11% and questionnaire revealed previous close contact of the staff with TB patients. Please find attached the paper.

  • Arjyabrata Sarker added an answer:
    Can we think of different options as thyroid suppression?

    Many drugs and metal ions in the plasma reduces the incidence of hormonal secretions i.e. Calcium supplements (Ca-citrate) can reduce the parathyroid secretion by 50 % more than the carbonates by PTH suppression. Can we think of this type of different medication strategy for cost effective manner only for the lower extent of suppression if needed?

    Arjyabrata Sarker · Jahangirnagar University

    Dear, Michaela Yakubovich-Dirks, 

    It seems the drug could have increased the effect of parathyroid suppression therapy if used simultaneously in my view.

  • Aline Israel added an answer:
    Which form of Calcium is best for consumption as medicine??

    In ayurveda following calcium sources are used in Bhasm form (Calx)

    conch shell




    Pearl shell. 

    It is regarded as Conch Shell> Coral> Pearl  calcium source us best according to the expert Physicians of Ayurveda. is there any scientific rationale?? plz explain with research evidences 

    IAccording to the data that I know and my experience, the calcium citrate complex is the only one that does not cause constipation at all.

  • Surendra Mantoo added an answer:
    Is there a role of Geriatric Colorectal Surgery as a special service?

    There is an increasing trend in the number of elderly patients with colorectal pathologies.

    Surendra Mantoo · Khoo Teck Puat Hospital

    One of the important goals of surgery in elderly patients should be  to restore them to the preoperative functional status after surgery. It is no point to operate on an 80y old patient and render him dependent for the rest of his life. Our results have shown that if there is good pre-operative optimisation, good intra-operative and postoperative care in collaboration with anesthetist, geriatric physicians, physiotherapists, pharmacists, dietiticians and others, a majority of elderly patients have a good functional recovery.

  • Devin Hosea added an answer:
    What proportion of medicine is evidence-based?
    There is a high bar for introducing a new intervention (social/behavioral, drug, device, etc). However, I suspect that many interventions, treatments, and decisions in medicine do not have a high level of evidence base (i.e. no formal trials, decisions are based on experience, practice, etc). Have there been studies that estimate what proportion of medicine is evidence-based?
    Devin Hosea · Princeton University

    Drs. Eiser and Leibovitz make good points.  However, I truly believe that Outcome-Based Medicine (OBM), driven by raw data, a form of "evidence", will actually make the clinician's job much easier, especially when making tough clinical decisions that can dramatically affect the probabilistic Px for a given Pt.  Take a simple enough question in the psychiatric Tx for opioid use disorder (OUD, DSM Dx 304.xx).  A clinical psychiatrist is often asked to decide whether to place a Pt with Dx 304 on maintenance medication (such as buprenorphine) or to instead hope they can sustain remission without such medication.  This decision can have a huge impact on a patient's Px - in some cases, medicating the Pt saves her life, in others it can lead to morbidity or mortality --  and it is a binary decision that is hard to adjust during treatment (because of the extreme difficulty of discontinuing such medication).  

    As Dr. Eiser points out, it is too much to ask that the busy clinician be up-to-date with the academic literature, and even that source of "evidence" lacks consensus and tries to draw inductive conclusions, "e.g. one rule for all patients".  What I am suggesting, instead, is that the clinician have access to statistical outcome data that apply to his Pt.  This is not the "future", but is already happening in some specialties.  

    So, back to the example above - whether or not to prescribe buprenorphine to a patient with OUD.  The current process is intuitive (to describe it kindly); there is little understanding of the etiology of addictive disorders; the academic/medical literature generally favors medicating but also highlights the risks in terms of morbidity and mortality.  I think, in a case like this, a clinician would love to know that, empirically speaking, a statistically significant group of patients just like the Pt in question (in terms of Dx, Hx, gender, demographic, etc, etc, and all other relevant factors) had a better prognosis with (or without) medication.  And a good clinical decision support system would show the clinician this personalized Px "forecast" that would inform his decision.  Of course, the clinician could bring to bear intuition, what they have read, EBM synopses, etc, but I for one would be interested to know WHAT THE DATA SUGGESTS.  Of course, one has to be careful in how these Tx suggestions are presented, and as Amarasingham, Patzer, et al explain in a recently published article entitled "Implementing Electronic Healthcare Predictive Analytics: Considerations and Challenges" (link below) there are a multitude of considerations.  

    Yet I would submit that it would be irresponsible for a clinician to ignore statistical outcome data when making a crucial Tx decision, especially if it is readily available and customized to the Pt, glowing on the nearby screen of an easy-to-use clinical decision support system.  Outcome data, properly analyzed, will enable the busy clinician to make better Tx decisions in LESS TIME than any other method.  

    Furthermore, I believe that eventually Px will obviate Dx, which is to say, we should only care about optimizing prognosis.  Assuming that prognosis is optimized (a big assumption, I'll admit), then diagnosis and etiology become academic (although they remain means to the end of an accurate Px)  That, I'll agree with Dr. Eiser, is for the future, but it's my prognosis for EBM (please excuse all these puns), or whatever we eventually call data-driven medicine.  

  • Does anyone have any insight into what a magnesium bolus would do to vascular permeability in a patient taking a VEGF inhibitor?

    Avastin can affect vascular permeability, normal BBB restrictions on Mg diffusion would thereby be bypassed opening the possibility of excitation and possibly seizures in those prone,

    Antonio R. Delgado-Almeida · University of Carabobo Medical School

    Before play chess you should known the pieces, and I probably help in the basic.

    Magnesium ion has an ionized and intracellular fractions, being the 2nd largest intracellular cations in our body, critically important with potassium ions in most cell functions, as enzymes, at times being part of enzymes or protein structures. In fact, RBC magnesium is about 3 times of the plasma fraction. 

    In blood, similar to calcium, magnesium is found as bounded, ionized and intracellular fractions (RBC), in which bounded or Mg salt represents the reservoir to maintain ionized Mg, the only functional fraction, except when bounded to enzyme or proteins.

    In pharmaceutical form, we usually refers as 100 mg of magnesium oxide or 600 mg of magnesium sulfate. Unfortunately, in 500 mg of Mg sulfate there is only 5 meq (10 mg) of Mg. In other ions as calcium: 1 g of IV calcium gluconate (FDA: 8 mg of calcium), very effective but tiny fraction as compared with calcium chloride.

    Therefore, taking 800 mg of Mg sulfate = 6.4 mg (3.2 meq), half of RBC Mg/liter cell, is harmless from pharmacology and physiology aspects. However, 793 mg of oral sulfate after absorption may decrease blood ionized ions, thus cell function, while 793 mg of IV sulfate rapidly bounds ionized calcium leading to hypotension, seizures and bleeding in presence of surgery. 

    In brief, don't worry about our metal ions, our body has a lot, take care of the ionized and intracellular fractions (iron in Hb) which maintain us alive! 

  • Niroshan Sivathasan added an answer:
    Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
    Patient safety is high on the agenda both nationally and internationally.
    Niroshan Sivathasan · Australia

    Agreed, Anthony! A spin on the old adage, 'familiarity breeds contempt' - in this case, 'familiarity predisposes to oversight' - is something that all, including experts, should be aware of!

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