The minimum lethal dose of undiluted ethylene glycol is 1.4 mL/kg in cats, 4.4–6.6 mL/kg in dogs, 7–8 mL/kg in poultry, 2–10 mL/kg in cattle, 1.6 mL/kg in macaques, and 6.61 mL/kg in guinea pigs. Younger animals may be more susceptible. //

Once absorption has occurred, excretion of ethylene glycol is increased by fluid therapy designed to correct dehydration, increase urine production, and compensate for expected future losses. Fluid rates should be reassessed often to accommodate changes in hydration and status of ongoing losses. //

Cats require a higher (and extra-label) dosage 4-MP than dogs: 125 mg/kg initially, followed by 31.3 mg/kg at 12, 24, and 36 hours after the initial dose. Alternatively, ethanol can be administered, using a bolus protocol of 5 mL of 20% ethanol per kg body wt diluted in IV fluids and administered as a drip over 6 hours for five treatments, and then over 8 hours for four more treatments.

Lastly, for both dogs and cats, 30% ethanol can be administered at 1.3 mL/kg, IV bolus, followed by 0.42 mL/kg per hour constant-rate infusion for 48 hours. This approach may increase ease of monitoring and the maintenance of blood glucose levels. CNS signs may be less likely to wax and wane.

While teeth play a greater role in health than many realise, current dental solutions for tooth loss are temporary and subpar. What if we could regrow our teeth instead? //

Despite the demand, we're still years away from the first person to get self-filling cavities or a lab-grown tooth replacement. Before "we can begin to talk about" studying humans, experiments with non-human primates have to happen first, says Ruohola-Baker. That will take more research, time, and money. Plus, to get lab-grown teeth into human mouths, researchers need to create improved environments for tooth development.

In the meantime, the lessons learned in regenerative dentistry could help broader efforts to reproduce various parts of the body, such as organs and bones. Because teeth are "highly sophisticated living organs," says Yelick, efforts to replicate them in labs are teaching scientists how hard and soft tissues work together on a very basic level.

There’s still a slew of questions about why some people develop alpha-gal syndrome.

In some parts of the US, up to 30 percent of people may carry the antibody behind a red meat allergy spurred by tick bites, far exceeding the estimated number of people who actually have the allergy, according a study published in Morbidity and Mortality Weekly Report.

The findings suggest far more Americans than previously thought may be at risk of the allergy, which can make having a hamburger for dinner a potentially life-threatening choice.

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With the clearance, Cuprina appears to be the only company to have FDA clearance to sell two species of fly larvae—and it’s abuzz with the potential to dominate the global maggot market.

The new species is Lucilia cuprina, or Australian sheep blowfly. It’s a close relative of Lucilia sericata, or the common green bottle fly, which is the fly species most often used for wound therapy, often called biosurgery or maggot debridement therapy (MDT). L. sericata is the only other fly with FDA clearance, which the agency first granted in 2004 to Ronald Sherman, who is now Cuprina’s Medical and Scientific Director. //

The two Lucilia species used in MDT are not considered parasitic. They mainly feast on carrion—though L. cuprina can cause a parasitic infestation in sheep called flystrike. In well-controlled MDT use, they feast only on dead and decaying tissue in wounds.

Perhaps the biggest reason MDT hasn’t taken off is that it’s not backed by solid evidence. While small, low-quality studies have indicated that maggot therapy is safe and effective at wound debridement, robust trials and evidence are lacking. As such, the treatment remains niche and is sometimes seen as a last resort for patients who refuse or are poor candidates for surgical or other standard debridement methods.

The hypothesis behind MDT is appealing if the maggots aren’t. To treat chronic, unhealing wounds, such as diabetic ulcers in the feet and legs, sterilized maggots are placed in the wound and secrete enzymes to liquify necrotic tissue. They then wiggle around to consume the slurry from all the nooks and crannies of a wound, which may be less painful and more efficient than surgical methods that try to slice out necrotic tissue. The maggots are thought to secrete various antibacterial compounds to ward off pathogenic bacteria and block biofilms from forming, overall preventing secondary infection. Finally, the activity of the maggots may also stimulate tissue regrowth. //

While MDT is intended to be a well-controlled treatment with larvae closely monitored and carefully removed at timed intervals, accidental myiasis carries the risk of having the maggots run amok and becoming difficult to extract. When this happens, doctors in California provide a simple solution: using strips of uncooked bacon to entice the maggots out.

This strategy worked for a woman with a poorly managed wound around her ear. After bacon strips were wrapped around her ear for 5 to 10 minutes, the maggots clung to the bacon and could be removed. The doctors note that they aren’t sure why it works—the bacon may block air, forcing the maggots to surface; the fats from the meat may increase their mobility; or the maggots just like bacon.

Vaccines may be training a part of our immune system long thought to be untrainable.

For hantaviruses, human infections are accidental and almost always dead ends. Transmission to people generally happens when virus-laden rodent excreta gets stirred up in dust and inhaled—for example, a person sweeping out a shed or garage with a rodent infestation without a mask.

Such a scenario made headlines in the US last year when pianist Betsy Arakawa, who was married to actor Gene Hackman, was revealed to have died of hantavirus. A subsequent investigation found an extensive rodent infestation at the couple’s residence.

The one exception to this transmission route is from the Andes virus; ANDV is the only hantavirus that has been documented in rare instances to spread from person to person.

Based on that documented incidence, it is clear that person-to-person transmission requires close, prolonged contact. To date, though, it remains unclear whether breathing significant amounts of aerosolized virus from an infected person or exposure to an infected person’s respiratory droplets is behind the rare transmission. //

Whether from rodent exposure or the ultra-rare person-to-person transmission, the incubation period for hantaviruses—the amount of time between exposure and when symptoms develop—ranges from about 7 to 42 days.

The currently recommended quarantine and/or active monitoring period for potentially exposed cases is 42 days.

Researchers from Mass General Brigham tracked more than 130,000 people for over four decades and found that those who regularly consumed moderate amounts of caffeinated coffee or tea had an 18 percent lower risk of developing dementia compared to those who rarely touched the stuff. //

the apparent benefits weren't tied to heroic levels of caffeine intake, just to steady, mid-range consumption – roughly two to three cups a day – suggesting that consistency matters more than turning yourself into a walking coffee bean. //

The researchers are careful to point out that the findings are observational, meaning that they can spot patterns but can't prove cause and effect. //

Even so, the sheer length of the study – 43 years – gives it a bit more weight than the usual "scientists watched 12 undergrads for a fortnight" variety. Tracking habits over that kind of timespan is no small feat, and it offers a rare glimpse into how everyday behaviors play out over the long haul.

Some adults over 40 have shoulder pain, but nearly all have “abnormal” joints. //

The authors argue that the findings suggest clinicians should rethink MRI findings, changing not just how they’re used, but also how they’re explained to patients. The language in particular should change given that “abnormalities” are ubiquitous—thus normal—and shouldn’t be described in terms that indicate a need for repair, like “tear.”

“While we refer to these findings as abnormalities, many likely represent normal age-related changes rather than clinically relevant structural changes,” the authors write. “Adopting more precise and less value-laden terminology—such as lesion, defect, fraying, disruption, structural alteration, or degeneration—may help reduce patient anxiety and the perceived need to do something or fix something by avoiding language that implies trauma or a requirement for repair.”

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