Anecdotal reports pitched microdosing as a kind of psychedelic Swiss Army knife, providing everything from increased focus to a spiked libido and (perhaps most promisingly) lowered reported levels of depression. It was a miracle for many. Others remained wary. Could 5 percent of a dose of acid really do all that? A new, wide-ranging study by an Australian biopharma company suggests that microdosing’s benefits may indeed be drastically overstated—at least when it comes to addressing symptoms of clinical depression. //
This means, essentially, that a medium-strength cup of coffee may prove more beneficial in treating major depressive disorder than a tiny dose of acid.
Anecdotal reports pitched microdosing as a kind of psychedelic Swiss Army knife, providing everything from increased focus to a spiked libido and (perhaps most promisingly) lowered reported levels of depression. It was a miracle for many. Others remained wary. Could 5 percent of a dose of acid really do all that? A new, wide-ranging study by an Australian biopharma company suggests that microdosing’s benefits may indeed be drastically overstated—at least when it comes to addressing symptoms of clinical depression. //
This means, essentially, that a medium-strength cup of coffee may prove more beneficial in treating major depressive disorder than a tiny dose of acid.
Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence). Harms were rarely measured and poorly reported (very low‐certainty evidence). //
Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low‐certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low‐certainty evidence). //
The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory‐confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate‐certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low‐certainty evidence).
FranzJoseph Wise, Aged Ars Veteran
11m
1,581
DavidEmami said:
Hope the everything turns out well for the crew member. It does make me wonder, though -- how would they deal with something life threatening? And have any medical procedures been done in space before? Did some searching and the closest I can find is a post-splashdown injury on Apollo 12 that the crew treated before egress, but that wasn't in free-fall. In particular, I assume the medical concept of the "golden hour" has to be abandoned.
First, obviously IANAD, so take it with a big grain of salt.
"Golden hour" is usually talked in the context of massive traumatic injuries and/or massive haemorrhaging. Even there it's a bit controversial, as it might be more useful only in the context of triage of massively multiple casualties with limited medevac resources down here.
IOTW, if any massive traumatic injury happens on the ISS (say a micrometeorite going through an astronaut or a pressurised cylinder failure resulting in an open fracture and haemorrhaging), the casualty is likely to be fucked anyway.
For things that develop over a longer time (appendicitis ‑‑> septicaemia), the astronauts are hopefully so well monitored that it would be caught early on.
You can find a full equipment list in the CHeCS onboard here (PDF, 2011 link). https://ntrs.nasa.gov/api/citations/20110022379/downloads/20110022379.pdf
Includes BP/ECG, AED, basic dental & surgery stuff (nothing quite major, scalpel and forceps etc), detox kit, airways kit, ambu bag and low‑flow mask and endotracheal oxygen supply, IV with pump and IV solutions, chest drain valve for pneumothorax, dressings, sutures and splints. Plus medicines, obviously.
Not really sure what the survival rate of somebody with a tension pneumothorax would be, even if quickly drained with the drain valve and intubated. I presume NASA has some procedures for getting an intubated or IV'd astronaut back home, even if it might mean not wearing their suit?
What's the max acceleration experienced during re‑entry and chute deployment? Not Soyuz, hopefully something gentler like CrewDragon (I assume Soyuz's retrorockets are less gentle here)?
henryhbk Ars Tribunus Militum
12y
1,891
Subscriptor++
FranzJoseph said:
First, obviously IANAD, so take it with a big grain of salt.
"Golden hour" is usually talked in the context of massive traumatic injuries and/or massive haemorrhaging. Even there it's a bit controversial, as it might be more useful only in the context of triage of massively multiple casualties with limited medevac resources down here.
IOTW, if any massive traumatic injury happens on the ISS (say a micrometeorite going through an astronaut or a pressurised cylinder failure resulting in an open fracture and haemorrhaging), the casualty is likely to be fucked anyway.
For things that develop over a longer time (appendicitis ‑‑> septicaemia), the astronauts are hopefully so well monitored that it would be caught early on.
You can find a full equipment list in the CHeCS onboard here (PDF, 2011 link).
Includes BP/ECG, AED, basic dental & surgery stuff (nothing quite major, scalpel and forceps etc), detox kit, airways kit, ambu bag and low‑flow mask and endotracheal oxygen supply, IV with pump and IV solutions, chest drain valve for pneumothorax, dressings, sutures and splints. Plus medicines, obviously.
Not really sure what the survival rate of somebody with a tension pneumothorax would be, even if quickly drained with the drain valve and intubated. I presume NASA has some procedures for getting an intubated or IV'd astronaut back home, even if it might mean not wearing their suit?
What's the max acceleration experienced during re‑entry and chute deployment? Not Soyuz, hopefully something gentler like CrewDragon (I assume Soyuz's retrorockets are less gentle here)?
Click to expand...
IAAD, most of the survivable emergencies require only a critical but generally simple procedure to buy time. Often I am faced with surgical emergencies in the hospital overnight, and while on paper we have at least one trauma and one cardiac OR on hot standby, it's not like surgeons are standing there in stasis waiting to operate, and often will be several hours until they can formally operate on someone (or we need some test to complete). So for instance for the appendicitis above we use broad spectrum IV antibiotics, then figure it out later, Broken bones easy - splint and transport, pneumothorax (particularly tension) you can do a needle decompression (all it takes is a 20ga IV catheter and a stopcock) and again you've bought plenty of time for surgeons to get ready to do a definitive thoracostomy (chest) tube, most bleeding can be stopped with pressure.
Things where this isn't true would be a stroke or intracranial bleeding. Not 100% sure if the aircraft carriers that picked up Apollo astronauts even have the ability to treat that onboard. depending where the bleed is. If it is an epidural (in the skull, outside the brain but hydraulically crushing the brain) then the answer is simply we drill a hole and relieve the pressure (trepanning) and then some actual neurosurgeon can fix the issue, and when I was the intern, that's who did the burr hole, a 4 minute procedure that bought you hours to the OR. But if the bleed is deeper (such as a sub-arachnoid bleed or interparenchymal bleed) well not much you are doing outside an interventional neuroradiology suite, and those patients often have a poor prognosis on land. Not sure if they screen for berry aneurysms in the astronaut core with a head angiogram? Penetrating trauma management is battlefield medic level care to buy time to get to surgery, and a lot can be done to stall exsanguination within reason without much clinical skill or equipment. There are military medic deployed pro-coagulants that can be put into a wound to form instant clot, and of course the tried and true tampon in the hole. In a penetrating wound something like a tampon works by absorbing blood and expanding to put pressure on the bleeding vessels, which works surprisingly well in the absence of definitive medical care.
As for g-forces anyone who has ridden in an ambulance on our pothole strewn streets in the northeast knows you subject you patient to a surprising number of shock loads, but I worry more about needing to put a critically ill patient into a chair for the descent when bleeding has stopped while lying prone or on their back. Does crew dragon have a stretcher capability?
Desflurane is a common anesthetic used in hospital operating rooms worldwide. It’s also a climate super pollutant. Now, several decades after the drug was first introduced, a growing number of US hospitals have stopped using the anesthetic because of its outsized environmental impact. On January 1, the European Union went a step further, prohibiting its use in all but medically necessary cases.
Desflurane is more than 7,000 times more effective at warming the planet over a 20-year period than carbon dioxide on a pound-for-pound basis. However, curbing its use alone won’t solve climate change. The anesthetic contributes only a small fraction of total global warming, which is driven by far larger volumes of carbon dioxide and methane emissions.
Still, emissions from the drug add up. Approximately 1,000 tons of the gas are vented from hospitals and other health care facilities worldwide each year. The emissions have a near-term climate impact equivalent to the annual greenhouse gas emissions from approximately 1.6 million automobiles. //
Instead of desflurane, the Yale New Haven Health System now relies primarily on sevoflurane, an anesthetic that is 10 times less potent as a greenhouse gas and approximately half as expensive. The health care system saved $1.2 million annually on anesthesia medications after making the switch, Sherman said. //
USAP physicians and others are also using less nitrous oxide or “laughing gas,” a mild anesthetic and potent greenhouse gas. Nitrous oxide is commonly distributed throughout hospitals via a centralized, leak-prone pipe network. Pipe networks in US hospitals can leak up to 99.8 percent of the gas before it reaches patients, according to a study published in 2024 in the British Journal of Anaesthesia. Using small, portable tanks can reduce losses by 98 percent. //
A paper published in the academic journal Anesthesia & Analgesia in July argued that the climate impact of desflurane emissions was not significant and suggested that more harm may come from withholding the drug from patients. //
j5i7 Seniorius Lurkius
5y
2
As a anesthesiologist, a few points:
- Desflurane does have distinct advantages compared to sevoflurane or isoflurane. It's is faster acting, and faster to wear off. However, clinically, this doesn't matter too much if you adapt to the anesthetic you are using. But it could get a patient out of an operating room a minute or two faster. The more obese a patient, the larger a difference it could make.
- Due to its vapor pressure, Desflurane requires a powered vaporizer that uses electricity on top of its significantly higher CO2 equivilent.
- Anesthesia machines use a circle breathing system. There is no way to strictly deliver anesthetic gases only when a patient is breathing in, but you can get very close.
Anesthetic waste gases are generally vented through a roof vent in the hospital. There are technologies out there to recapture the anesthetics, but I don't believe any are commercially common. - A lot of nitrous is lost due to leaks in the pipes. Generally nitrous isn't that useful in anesthesia for adults, but it does have its place in pediatrics.
- You can do anesthesia without any gases and just using medications that go through an IV. These are slightly more expensive, but better from a climate perspective. However, there are medical reasons to choose inhaled gases verses IV anesthetics.
- Finally, commonly used anesthetic gases are NOT flammable. However, oxygen is a great oxidizing agent...
To go along with that recent CETP trial news, here's another one for the "We don't know much about human lipid handing" file. A dietary study originally done back in the 1960s and 1970s has been (almost literally) resurrected, with data pulled out of yellowing stacks of paper, old cardboard boxes, and ancient-format computer tapes.
What it shows is that, under about the most controlled conditions possible in a large human trial (institutionalized patients being served standard meals), that replacing saturated/animal fat in the diet with vegetable-derived fats and oils provided. . .no cardiovascular benefit whatsoever. In fact, the lower the cholesterol levels of the patients, the higher their death rates. This was in over 9,000 subjects over five years, probably the largest study of its kind ever conducted, and it had only produced one (not very thorough) paper in 1989 that didn't make much of an impression. ///
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In the past 20 years, there have been only nine anthrax cases in the US.
However, B. anthracis is part of the larger Bacillus cereus group, which also includes B. cereus and B. tropicus, a newly recognized species. And these species can also carry and produce anthrax toxins. Both can be found in soils, and B. cereus is considered ubiquitous in the environment.
In 2022, CDC researchers found an unexpected pattern. Since 1997, there had been seven cases of infections from Bacillus group bacteria producing the anthrax toxin—all in metalworkers. Six of the seven were welders, hence the term “welder’s anthrax,” with the remaining case in a person working in a foundry grinding metal. Of the six cases where a specific Bacillus species was identified, B. tropicus was the culprit, including in the newly reported case.
Speculating risks
It’s unclear why metalworkers, and welders specifically, are uniquely vulnerable to this infection. In their 2022 report making the connection, CDC experts speculated that it may be a combination of having weakened immune responses in the lungs after inhaling toxic metal fumes and gases created during metalwork, and having increased exposure to the deadly germs in their workplaces. //
Environmental sampling of his workplace found anthrax-toxin-producing Bacillus in 28 of 254 spot samples. //
The experts also speculated that iron exposure could play a role. Bacillus bacteria need iron to live and thrive, and metalworkers can build up excess iron levels in their respiratory system during their work. Iron overload could create the perfect environment for bacterial infection. In the teen’s case, he was working with carbon steel and low-hydrogen carbon steel electrodes.
For now, the precise risk factors and why the healthy teen—and not anyone else in his workplace—fell ill remain unknown. CDC and state officials recommended changes to the workplace to protect metalworkers’ health, including better use of respirators, ventilation, and dust control.
agt499 Ars Tribunus Militum
13y
2,148
So, about the way Cholesterol guy ...improved his “mental clarity.”
I had a cardiac event in 2010, recovered fine with a bunch of meds, but found that I felt substantially diminished mental reasoning.
I went through a pile of tests, MRI, expert neurologists and cognitive testing, which all amounted to "you're pretty smart", but I just couldn't think like I used to.
In 2018 I got a new general practitioner and mentioned this, and she instantly suggested my cholesterol was too low, that the brain needs a level of cholesterol to function well and she'd seen it repeatedly before that cardiologists "overcook" cholesterol management.
Over a few months she reduced my lipid dosage to a quarter of what it had been, with fairly immediate mental improvements and cholesterol readings still in safe bounds.
I'm pleased to have my brain back despite the experts missing it all, and now I know I can go on the "nine pounds of cheese" diet for a brain boost...
Rhabdomyolysis, often shortened to rhabdo, is a condition in which your muscles get damaged and break down, which can lead to muscle death.
That muscle death releases toxins into the body, which can cause kidney damage.
There are lots of potential causes, including medications like statins, antidepressants and antivirals. It can also happen as a result to dehydration and overheating, drug abuse, certain underlying medical conditions, injury or trauma. //
But becoming more common is exertional rhabdo, which is caused by high-intensity exercise like marathons, CrossFit and yes, spinning. It’s especially a threat for people attempting these tough workouts with inadequate training, or those who push themselves too hard.
And spinning might just be the worst culprit. One 2021 study found that people who suffered exertional rhabdo caused by spinning actually had more severe cases than those who had exertional rhabdo from other causes.
The study authors also noted that the condition predominantly strikes young, healthy women — and wanting to keep up with your fellow SoulCyclers could be increasing your risk. //
Top symptoms to look out for are the “classic triad” of muscle pain, muscle weakness and dark urine the color of tea or cola.
But not everyone gets all three symptoms — in fact, only about 10% of people with rhabdo only experience one or two, according to the American Academy of Physical Medicine and Rehabilitation.
Other potential symptoms include fever, nausea, vomiting, malaise, dehydration, infrequent urination, confusion and loss of consciousness. //
if you do spin class, make sure to properly hydrate, avoid any medications or supplements that can increase your risk, and gradually build up exercise volume and intensity.
Disorders and Diseases of Hamsters
Electroconvulsive therapy, or electroshock, has a bad reputation, but medically its efficacy is well documented, even if nobody knows how it works. //
In electroconvulsive therapy (ECT), an electrical current is used to induce grand mal seizures as a treatment for psychiatric patients. Some hundred thousand Americans receive the therapy every year, a statistic comparable to the number of appendectomies or hernia surgeries performed. When drug alternatives prove ineffective, it’s considered safe and effective for people suffering from schizophrenia, depression, mania, catatonia, and other psychiatric diseases. As these BMJ authors note, its value is undoubted even if we don’t know how it actually works
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POTS
The man’s family told doctors that, up until a few months prior, he had been taking three different types of herbal supplements that claim to treat joint pain. The man had taken the supplements for four years, and sometimes as often as four times a day, but he had stopped using them in the lead-up to his illness.
Deadly doses
The supplements were: Artri King, Nhan Sam Tuyet Lien, and Linsen Double Caulis Plus. All are known to contain unlisted glucocorticoids, according to the Food and Drug Administration. And testing of two of the man’s supplements by the hospital confirmed the presence of the steroids.
Doctors determined that the man had essentially overdosed on the glucocorticoids—he had taken doses that exceeded the normal levels of glucocorticoids in the body. The steroids likely suppressed immune responses, leading to his infections and GI ulcers. But, more significantly, the excess steroid levels also caused his HPA axis to essentially shut down. While it’s possible to get the HPA axis back up and running after withdrawal from excessive steroid use, the amount of time that takes can vary. Further, if a person stops taking large doses of glucocorticoids abruptly, rather than gradually—as in the man’s case—and particularly after chronic use—also as in the man’s case—it can lead to an adrenal crisis. In retrospect, the man had all the signs of a crisis.
If we ID the DNA for a great antibody, anyone can now make it. //
knowing what antibodies we’d like to see people making while having no way of ensuring that they do.
One of the options we’ve developed is to just mass-produce broadly neutralizing antibodies and inject them into people. This has been approved for use against Ebola and provided an early treatment during the COVID pandemic. This approach has some practical limitations, though. For starters, the antibodies have a finite life span in the bloodstream, so injections may need to be repeated. In addition, making and purifying enough antibodies in bulk isn’t the easiest thing in the world, and they generally need to be kept refrigerated during the distribution, limiting the areas where they can be used.
So, a number of companies have been looking at an alternative: getting people to make their own. This could potentially lead to longer-lived protection, even ensuring the antibodies are present to block future infections if the DNA survives long enough.
take a deep butt breath….
Ig Nobel-winning research could one day be used to treat people with blocked airways or clogged lungs.
Last year, a group of researchers won the 2024 Ig Nobel Prize in Physiology for discovering that many mammals are capable of breathing through their anus. But as with many Ig Nobel awards, there is a serious side to the seeming silliness. The same group has conducted a new study on the feasibility of adapting this method to treat people with blocked airways or clogged lungs, with promising results that bring rectal oxygen delivery one step closer to medical reality.
, thanks to having lots of capillary vessels in its intestine. The technical term is enteral ventilation via anus (EVA).
Would such a novel breathing method work in mammals? The team thought it might be possible and undertook experiments with mice and micro-pigs to test that hypothesis. They drew upon earlier research by Leland Clark, also of Cincinnati Children’s Hospital, who invented a perfluorocarbon liquid called Oxycyte as a possible form of artificial blood. That vision never materialized, although it did provide a handy plot point for the 1989 film The Abyss, in which a rat is able to “breathe” in a similar liquid.
And Oxycyte was ideal for the group’s 2021 Ig Nobel-winning efforts. The experiments involved intra-anally administering oxygen gas or a liquid oxygenated perfluorocarbon to the unfortunate rodents and porcines. Yes, they gave the animals enemas. They then induced respiratory failure and evaluated the effectiveness of the intra-anal treatment. The result: Both treatments were pretty darned effective at staving off respiratory failure with no major complications.
In 2021, she came across a notice in the Federal Register recruiting participants for a double-blind clinical trial led by Dr. Richard Frye.
“It was like something clicked. He went from one or two words to full-on sentences within six months.” -- Kathleen Schnier
The pediatric neurologist was studying whether leucovorin could help autistic children with cerebral folate deficiency — or a shortage of vitamin B9 in the brain.
Researchers believe up to 70% of autistic children have antibodies that block the transport of folate into the brain, leading to these deficiencies and contributing to speech delays and behavioral challenges. //
With his new ability to speak, Nathaniel finally found a way to express what had been locked inside for years.
“The TV in my brain, I can say it in my mouth,” Kathleen remembers her son telling her. “It was always there, he just couldn’t say it.”
A 36-year-old man showed up to the emergency department of the Massachusetts General Hospital, severely unwell from a puzzling set of conditions. He had abnormalities in his lungs, intestines, blood, liver, and lymphatic system—and, of course, no single clear explanation. His case was such a riddle that a master clinician with an expertise in clinical reasoning was called in to help unravel it.
Patients with complex wounds need elevated care. So, we designed the Hillrom Envella Air Fluidized Therapy (AFT) Bed as our most advanced wound care surface to date. The Hillrom Envella bed can help with pain management and supports wound healing.1
The pressure redistribution surface pushes air through millions of tiny beads, creating a fluid-like environment that feels similar to floating on water. This action boosts immersion and envelopment, minimizes shear and pressure, and helps control the skin’s microclimate.2
Regardless, the editorial authors signal that Coca-Cola has become a first-line treatment for bezoars, and several case reports and studies support its use. A 2024 randomized controlled trial involving 160 patients in China with phytobezoars concluded that "Timely ingestion of Coca-Cola yields significant benefits, including a complete dissolution rate of 100 percent, a low incidence of gastric ulcers, no need for fragmentation, and reduced expenses."
While it's unclear what the woman's bezoar was made of—she didn't report eating an excessive amount of persimmons—it was most likely some type of phytobezoar. As such, doctors put her on a plan to drink 3,000 milliliters (about 8.5 cans) of cola in 12 hours. Given that the woman also had Type 2 diabetes, they prescribed diet cola. //
The next day, the woman "reported a sudden tugging sensation in her abdomen, followed by a prompt decrease in her nausea and abdominal discomfort." Taking another look with an endoscope, the doctors confirmed that the bezoar was gone.
As to how it formed in the first place, the doctors tied it to her use of semaglutide. As a GLP-1 weight-loss drug, one of its effects is slowing down stomach emptying. That in turn can create conditions for a bezoar to form.
I had been taught in school that scurvy had been conquered in 1747, when the Scottish physician James Lind proved in one of the first controlled medical experiments that citrus fruits were an effective cure for the disease. From that point on, we were told, the Royal Navy had required a daily dose of lime juice to be mixed in with sailors’ grog, and scurvy ceased to be a problem on long ocean voyages.
But here was a Royal Navy surgeon in 1911 apparently ignorant of what caused the disease, or how to cure it. Somehow a highly-trained group of scientists at the start of the 20th century knew less about scurvy than the average sea captain in Napoleonic times. Scott left a base abundantly stocked with fresh meat, fruits, apples, and lime juice, and headed out on the ice for five months with no protection against scurvy, all the while confident he was not at risk. What happened? //
One of the most striking features of the disease is the disproportion between its severity and the simplicity of the cure. Today we know that scurvy is due solely to a deficiency in vitamin C, a compound essential to metabolism that the human body must obtain from food. Scurvy is rapidly and completely cured by restoring vitamin C into the diet.
Except for the nature of vitamin C, eighteenth century physicians knew this too. But in the second half of the nineteenth century, the cure for scurvy was lost. The story of how this happened is a striking demonstration of the problem of induction, and how progress in one field of study can lead to unintended steps backward in another. //
Finally, that one of the simplest of diseases managed to utterly confound us for so long, at the cost of millions of lives, even after we had stumbled across an unequivocal cure. It makes you wonder how many incurable ailments of the modern world—depression, autism, hypertension, obesity—will turn out to have equally simple solutions, once we are able to see them in the correct light. What will we be slapping our foreheads about sixty years from now, wondering how we missed something so obvious? //
But the villain here is just good old human ignorance, that master of disguise. We tend to think that knowledge, once acquired, is something permanent. Instead, even holding on to it requires constant, careful effort.