DAY: APRIL 25 2024
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• 4-25-2024CANCER CASES IN YOUNGER PEOPLE ARE ON THE RISE In the United States this year alone, there will be an anticipated 2,001,140 new cancer cases—leading to an estimated 611,720 related deaths. That’s 5,480 new cases and 1,680 deaths every day. And, according to a recent CNN report, cancer cases among younger people are rising sharply. The American Cancer Society-reported cancer risks rise greatly with […] Read More
• 4-25-2024INHALED INSULIN COULD IMPROVE LIVES OF PATIENTS WITH DIABETES Millions of people around the world live with diabetes mellitus. Many of them have medication and specific dietary management approaches to help them maintain stable blood sugar levels. However, recent innovations, such as inhaled insulin, the hormone made by the pancreas, which controls blood sugar, have sparked hope for more […] Read More
• 4-25-2024HOW PHYSICAL ACTIVITY IN NATURE HELPS PREVENT SEVERAL DISEASES, INCLUDING DEPRESSION AND TYPE 2 DIABETES Physical activity in natural environments prevent almost 13,000 cases of non-communicable diseases a year in England and save treatment costs of […] Read More
• 4-25-2024STUDY REVEALS TAI CHI BENEFITS FOR SLEEP QUALITY IN ADVANCED LUNG CANCER PATIENTSA research found positive effects of tai chi and aerobic exercise on sleep quality, psychological well-being, physical function, and circadian rhythm in patients with advanced lung cancer. The study, conducted over a four-year period, discovered additional advantages in […] Read More
• 4-25-2024HOW DOES AGING START? SCIENTISTS EXPLAIN HOW IGG ANTIBODIES ARE A DRIVING FACTOR Aging, a phenomenon that affects every individual, is a natural part of the human condition but one that often induces anxiety. These feelings are paired with health conditions and illnesses that accompany the aging process, all of which decrease lifespan, the amount of healthy and active years, […] Read More
• 4-25-2024DO IMPLICIT BIAS TRAININGS ON RACE IMPROVE HEALTH CARE? There is increasing evidence that implicit bias—non-conscious attitudes toward specific groups—is a source of racial inequities in certain aspects of health care, and lawmakers are taking note. Since the tragic murder of George Floyd in May 2020, wherein a Black man was killed by police, several U.S. federal and state legislators have introduced proposals declaring […] Read More
• 4-25-2024VAPING NOW MORE COMMON THAN SMOKING AMONG YOUNG PEOPLE—AND THE RISKS GO BEYOND LUNG AND BRAIN DAMAGE Vaping is now more common than cigarette smoking among young people, according to a new report coordinated by the University of Glasgow and commissioned by the World Health Organization. This echoes research that has found the popularity of vaping among young people in the UK has surged in recent years. The number of children experimenting […] Read More
• 4-25-2024EXERCISE CAN EASE PERIPHERAL ARTERY DISEASE SYMPTOMS Patricia Creque describes herself as “one of those people who has music in my head and am always ready to dance.” Peripheral artery disease (PAD), however, had made it difficult for her to dance—or even walk. “For years I had such issues with my legs,” said Creque, 69, of Wyomissing. “I had no idea what […] Read More
• 4-25-2024NEW SCHOOL LUNCH RULES TARGET ADDED SUGARS, SALT School lunches will soon contain less added sugars and salt under new nutrition standards announced by the U.S. Department of Agriculture on Wednesday. “We all share the goal of helping children reach their full potential,” Agriculture Secretary Tom Vilsack said in a news release announcing the changes. “Like teachers, classrooms, books and computers, nutritious school […] Read More
• 4-25-2024RESEARCHERS CREATE AN AI-POWERED DIGITAL IMAGING SYSTEM TO SPEED UP CANCER BIOPSY RESULTS University of Waterloo researchers have invented a digital medical imaging system that significantly improves the cancer detection process to deliver immediate results and enable swift, effective treatment for all types of cancer. The Photon Absorption Remote Sensing (PARS) system, an innovative, built-from-scratch technology, is faster than traditional cancer-detection methods and […] Read More
• 4-25-2024SIMULATION OF INFANT GUT MAKES PREDICTIONS ABOUT OPTIMAL MILK FORMULA From top to bottom: bacteria, milk sugar, lactic acid, and acetic acid. Nutrients like milk sugar enter from the left and flow to the right. Meanwhile, bacteria convert them into substances like lactic acid. These substances also flow to the right and can be further converted by other […] Read More
• 4-25-2024HOW MEN’S GROUPS RESHAPE ATTITUDES Men are still often afforded a great deal of power and privilege in society due to their gender, however, they also experience disproportionate rates of negative psychosocial outcomes. Men, for instance, have higher mortality rates, lower life expectancy, and are more likely to die by suicide. Yet, despite those challenges, men are less likely than […] Read More
• 4-25-2024DIABETES DRUG SHOWS PROMISE FOR THE TREATMENT OF ACUTE HEART FAILURE A multicenter study has identified a potential new treatment for acute heart failure, a leading cause of hospitalization and death. The drug, dapagliflozin, was initially approved for the treatment […] Read More
• 4-25-2024STUDY FINDS BEING OVERWEIGHT IS ASSOCIATED WITH ALTERATIONS IN BRAIN PULSATIONS Correlation between body mass index (BMI) and very low frequency (VLF) amplitude of fluctuation (AFVLF) in brain regions. AFVLF was positively associated with BMI in brain regions Read More
• 4-25-2024USE OF ALCOHOL AND E-CIGARETTES AMONG YOUTH ‘ALARMING’: WHO The widespread use of alcohol and e-cigarettes among adolescents is “alarming”, according to a report released on Thursday by the World Health Organization’s (WHO) European branch, which recommended measures to limit access. Based on survey data from 280,000 young people aged 11, 13 and 15 in Europe, Central Asia and Canada, the WHO said it […] Read More
• 4-25-2024NOW HE’S TRYING TO CHANGE THE INDUSTRY For the past year, police Detective Tim Lillard has spent most of his waking hours unofficially investigating his wife’s death. The question has never been exactly how Ann Picha-Lillard died on Nov. 19, 2022: She succumbed to respiratory failure after an infection put too much strain on her weakened lungs. She was 65. For Tim […] Read More
• 4-25-2024TYPE OF SURGERY AND RISK LEVEL HAVE SIGNIFICANT IMPACT ON COMPLICATIONS AND DEATH IN ELDERLY PATIENTS Frailty is a well-established predictor of complications and death after surgery. However, patients over 65 who undergo a high-risk operation in the emergency room are at significantly increased risk of postoperative complications and death in comparison to the same patients who are assessed solely on their level of frailty, according to a study published in […] Read More
• 4-25-2024STUDY SHOWS HOW ADAPTING SUGAR METABOLISM STARTS IN THE BRAIN The mitochondria in the liver change their shape as soon as food is perceived. The image shows an electron micrograph of the mitochondria in liver cells. Credit: S. Henscke/Max Planck Institute for Metabolism Research What happens in the body when we are hungry and see and smell food? A team of researchers at the Max […] Read More
• 4-25-2024WHAT IS HEALTH EQUITY? HOW THE IDEA GREW—AND WHY IT MATTERS It’s an idea as old as modern medicine and as new as the latest medical research. No matter how you look at health equity, the conversation involves contradictions. But at its core are fundamental questions about illness and health, say experts who have watched the conversation move from the fringes of scholarly debate to the […] Read More
• 4-25-2024CREATINE FOUND TO IMPROVE COGNITIVE PERFORMANCE DURING SLEEP DEPRIVATION Creatine administration led to significant improvements in word memory task (WMT), speed in processing time in WMT, language, logic, and numeric tasks, […] Read More
• 4-25-2024MEAT AND DAIRY ALTERNATIVES SHOULD BE CLEARLY LABELED TO HELP CONSUMERS MAKE HEALTHY CHOICES, SAYS STUDY Consumers need clearer information about the nutritional content and processing of meat and dairy alternatives when they are buying food, according to a new study. Overall, the research from the London School of Hygiene & Tropical Medicine (LSHTM) found that plant-based alternatives are more environmentally friendly than animal-based products, and can be healthier. Read More
• 4-25-2024STUDY FINDS VITAMIN D ALTERS MOUSE GUT BACTERIA TO GIVE BETTER CANCER IMMUNITYResearchers have found that vitamin D encourages the growth of a type of gut bacteria in mice which improves immunity to cancer. Reported in Science, the researchers found that mice given a […] Read More
• 4-25-2024USING AI TO IMPROVE DIAGNOSIS OF RARE GENETIC DISORDERS Diagnosing rare Mendelian disorders is a labor-intensive task, even for experienced geneticists. Investigators at Baylor College of Medicine are trying to make the process more efficient using artificial intelligence. The team developed a machine learning system called AI-MARRVEL (AIM) to help prioritize potentially causative variants for Mendelian disorders. Read More
• 4-25-2024STUDY ARGUES TRAFFIC NOISE IS A NOVEL RISK FACTOR FOR CARDIOVASCULAR DISEASESAn international group of noise experts r have analyzed recent epidemiological data and found strong evidence that transportation noise […]
  
• 4-25-2024PERINATAL SUBSTANCE USE MAY SHAPE HOW STRONGLY MOTHERS FEEL TOWARD INFANTS
  
• 4-25-2024INTENSIVE BLOOD PRESSURE TREATMENT MAY HELP SOME MIDDLE-AGED WOMEN WITH TYPE 2 DIABETES, EARLY-ONSET HYPERTENSION
  
• 4-25-2024MORTALITY UP FOR BREAST CANCER DIAGNOSED FIVE TO 10 YEARS AFTER CHILDBIRTH
  
• 4-25-2024SHOULDER SURGEONS SHOULD RETHINK A COMMON PRACTICE, NEW STUDY SUGGESTS
  
• 4-25-2024STUDY REPORTS NEW COMPOUND THAT HALTS REPLICATION OF COVID BY TARGETING ‘MAC-1’ PROTEIN IN CELL MODELS
  
• 4-25-2024STUDY REVEALS RACIAL DISPARITIES IN COVID-19 TESTING DELAYS AMONG HEALTH CARE WORKERS
  
• 4-25-2024WATCHDOG GROUP SAYS US FOOD RECALLS ROSE AGAIN LAST YEAR
  
• 4-25-2024FDA APPROVES NEW ANTIBIOTIC AGAINST UTIS
  
• 4-25-2024AI’S PIVOTAL ROLE IN ERECTILE DYSFUNCTION MANAGEMENT
  
• 4-25-2024TO PROTECT HUMAN HEALTH, WE MUST PROTECT THE EARTH’S HEALTH
  
• 4-25-2024SWITCH TO ACETAMINOPHEN LEADS TO FEWER UNPLANNED INTUBATIONS AND IMPROVED MORTALITY IN THE NICU
  
• 4-25-2024MICROBIOTA B. FRAGILIS-SECRETED BFT-1 PROMOTES BREAST CANCER CELL STEMNESS AND CHEMORESISTANCE: STUDY
  
• 4-25-2024STUDY RECOMMENDS EXPOSING DEAF CHILDREN TO SIGN LANGUAGE BEFORE AND AFTER COCHLEAR IMPLANTATION
  
• 4-25-2024STUDY UNCOVERS DRUG TARGET IN A PROTEIN COMPLEX REQUIRED FOR ACTIVATION OF NF-?B
  
• 4-25-2024AI-POWERED ‘DEEP MEDICINE’ COULD TRANSFORM HEALTH CARE IN THE NHS AND RECONNECT STAFF WITH THEIR PATIENTS
  
• 4-25-2024HOLDOUT STATES CONSIDER EXPANDING MEDICAID—WITH WORK REQUIREMENTS
  
• 4-25-2024PERCEPTION OF SOCIAL ISOLATION AND LONELINESS CAN INCREASE DEPRESSIVE SYMPTOMS
  
• 4-25-2024LIVING AT HIGHER ALTITUDES IN INDIA LINKED TO INCREASED RISK OF CHILDHOOD STUNTING
  
• 4-25-2024ANTIMICROBIAL-RESISTANT HOSPITAL INFECTIONS REMAIN AT LEAST 12% ABOVE PRE-PANDEMIC LEVELS, STUDY FINDS
  
• 4-25-2024IMPROVING HEALTH COMMUNICATION TO SAVE LIVES DURING EPIDEMICS
  
• 4-25-2024RESEARCHER DISCUSSES IMPORTANCE OF COMMUNICATING TO THE PUBLIC DURING A PANDEMIC, AND THE PERSONAL RISK IT CAN ENTAIL
  
• 4-25-2024ANTIBIOTIC USE IN PATIENTS HOSPITALIZED WITH COVID-19 APPEARS TO HAVE NO BENEFICIAL EFFECT ON CLINICAL OUTCOMES
  
• 4-25-2024NEW RESEARCH FINDS PAID FAMILY LEAVE HELPS PREVENT CHILD ABUSE
  
• 4-25-2024CANCER SURVIVORS REPORTING LONELINESS EXPERIENCE HIGHER MORTALITY RISK, STUDY SHOWS
  
• 4-25-2024BETTER HEART HEALTH AT MIDLIFE LINKED TO LESS COGNITIVE DECLINE IN BLACK WOMEN
  
• 4-25-2024TARGETING SPECIFIC PROTEIN REGIONS OFFERS A NEW TREATMENT APPROACH IN MEDULLOBLASTOMA
  
• 4-25-2024WOMEN CAREGIVERS ARE STRESSED; TRANSPORTATION INFRASTRUCTURE COULD HELP
  
• 4-25-2024ALZHEIMER’S AND ARAB AMERICANS—MORE RESEARCH NEEDED
  
• 4-25-2024NEW TOOL HELPS IDENTIFY BABIES AT HIGH RISK FOR RSV
  
• 4-25-2024THREE MORE AFRICAN NATIONS ROLL OUT MALARIA VACCINE
  
• 4-25-2024A TURN-KEY BRAIN NETWORK AND GRAPH THEORY ANALYSIS PLATFORM BASED ON MRI DATA
  
• 4-25-2024STUDY REVEALS EMOTIONAL TURMOIL EXPERIENCED AFTER DOG-THEFT IS LIKE THAT OF A CAREGIVER LOSING A CHILD
  
• 4-25-2024ELUCIDATING THE COMPLEXITIES OF MATERNAL MICROBIOMES AND PREGNANCY DISORDERS
  
• 4-25-2024STUDY CONFIRMS EFFECTIVENESS OF BIVALENT COVID-19 VACCINE
  
• 4-25-20242 MILLION BOTTLES OF PERRIER ORDERED DESTROYED BY FRENCH AGENCY
  
• 4-25-2024STUDY REPORTS CHLAMYDIA AND GONORRHEA MORE LIKELY TO BE TREATED PER CDC GUIDELINES IN CERTAIN POPULATIONS
  
• 4-25-2024JOB LOSSES HELP EXPLAIN INCREASE IN DRUG DEATHS AMONG BLACK AMERICANS
  
• 4-25-2024THE ROLE OF RESIDENT MACROPHAGES
  
• 4-25-2024PUBLICLY FUNDED FERTILITY PROGRAM LINKED TO A DECREASE IN RATE OF MULTIFETAL PREGNANCY
  
• 4-25-2024PREMATURE MORTALITY HIGHER AMONG SEXUAL MINORITY WOMEN, STUDY FINDS
  
• 4-25-2024WITH HYBRID BRAINS, THESE MICE SMELL LIKE A RAT
  
• 4-25-2024NATIONAL TRIAL SAFELY SCALES BACK PRESCRIBING OF A POWERFUL ANTIPSYCHOTIC FOR THE ELDERLY
  
• 4-25-2024DIFFERENTIATING CEREBRAL CORTICAL NEURONS TO DECIPHER MOLECULAR MECHANISMS OF NEURODEGENERATION
  
• 4-25-2024NEW MOUSE MODEL ENABLES IDENTIFICATION OF CHEMOKINE PRODUCERS AND SENSORS
  
• 4-25-2024RURAL JAILS TURN TO COMMUNITY HEALTH WORKERS TO HELP THE NEWLY RELEASED SUCCEED
  
• 4-25-2024TOBACCO SMOKING REDUCES THE ODDS OF PSORIASIS IMPROVEMENT, STUDY FINDS
  
• 4-25-2024NEARSIGHTEDNESS IS AT EPIDEMIC LEVELS—AND THE PROBLEM BEGINS IN CHILDHOOD
  
• 4-25-2024NEW ZENDAYA TENNIS FILM REVIEWED BY AN EXPERT IN THE PSYCHOLOGY OF COMPETITION
  
• 4-25-2024JAPANESE STUDY FINDS INCREASE IN HOME DEATH RATIO DURING THE COVID-19 PANDEMIC
  
• 4-25-2024TREATMENT FOR DEADLY SUPERBUG C. DIFF MAY BE WEAKENING
  
• 4-25-2024CANCER DRUG TRIAL PROVIDES LESSONS FOR FUTURE
  
• 4-25-2024DRUG, ALCOHOL ABUSE GOES UNTREATED IN MANY EX-PRISONERS
  
• 4-25-2024SCIENTIST WHO HELPED DESIGN R21 ANTI-MALARIA VACCINE REFLECTS ON 30 YEARS OF RESEARCH, AND WHAT IT PROMISES
  
• 4-25-2024CD7 CAR T-CELL THERAPY, STEM-CELL TRANSPLANT BENEFICIAL FOR CD7-POSITIVE TUMORS
  
• 4-25-2024NANOMATERIAL THAT MIMICS PROTEINS COULD BE BASIS FOR NEW NEURODEGENERATIVE DISEASE TREATMENTS
  
• 4-25-2024STUDY FINDS RNA MODIFICATION IS RESPONSIBLE FOR DISRUPTION OF MITOCHONDRIAL PROTEIN SYNTHESIS IN ALZHEIMER’S DISEASE
  
• 4-25-2024GLP1 RECEPTOR AGONISTS DO NOT UP RISK FOR COMPLICATIONS AFTER EMERGENCY SURGERY
  
• 4-25-2024BLOCKING GENE MAY HALT GROWTH OF BREAST CANCER CELLS
  
• 4-25-2024FUTURE PARENTS MORE LIKELY TO GET RSV VACCINE WHEN PREGNANT IF AWARE RSV CAN BE A SERIOUS ILLNESS IN INFANTS: STUDY
  
• 4-25-2024THEY PARTLY DEVELOP FROM SAME GENE MODULE
  
• 4-25-2024ASTRAZENECA PROFIT UP ON STRONG SALES OF CANCER DRUGS
  
• 4-25-2024BIRD FLU IN HUMANS? EXPERTS SEE LITTLE RISK
  
• 4-25-2024US BIRTHS FELL LAST YEAR, MARKING AN END TO THE LATE PANDEMIC REBOUND, EXPERTS SAY
  
• 4-25-2024CLIMATE CHANGE IS BRINGING MALARIA TO NEW AREAS. IN AFRICA, IT NEVER LEFT
  
• 4-25-2024MALARIA IS STILL KILLING PEOPLE IN KENYA, BUT A VACCINE AND LOCAL DRUG PRODUCTION MAY HELP
  
• 4-25-2024GENETIC VARIATIONS MAY PREDISPOSE PEOPLE TO PARKINSON’S DISEASE FOLLOWING LONG-TERM PESTICIDE EXPOSURE, STUDY FINDS
  
• 4-25-2024EXPERTS CALL FOR GLOBAL GENETIC WARNING SYSTEM TO COMBAT THE NEXT PANDEMIC AND ANTIMICROBIAL RESISTANCE
  
• 4-25-2024WOMEN WITH HEART DISEASE ARE LESS LIKELY TO RECEIVE LIFE-SAVING DRUGS THAN MEN, RESEARCHERS FIND
  
• 4-25-2024VENEZUELA BROKE ITS HPV VACCINE PROMISES, AND THERE’S BARELY ANY SEX ED. EXPERTS SAY IT’S A PROBLEM
  
• 4-25-2024NHS BABY CHECK MAY MISS DISLOCATED HIPS IN NEWBORN BABIES
  
• 4-25-2024RESEARCHERS PUBLISH FINAL RESULTS OF KEY CLINICAL TRIAL FOR GENE THERAPY FOR SICKLE CELL DISEASE
  
• 4-25-2024UNDERSTANDING THE CELLULAR MECHANISMS OF OBESITY-INDUCED INFLAMMATION AND METABOLIC DYSFUNCTION
  
• 4-25-2024UVEITIS EXPERTS PROVIDE AN OVERVIEW OF AN UNDERESTIMATED IMAGING TECHNIQUE
  
• 4-25-2024STEM CELL TRANSPLANTS AND SURVIVAL RATES ON THE RISE ACROSS ALL RACIAL AND ETHNIC GROUPS
  

I've loved looking at chemistry on paper for a while now, but of course there's something missing. I'm pretty inexperienced, like I understand the basic concepts and premise, however there are still a lot of things that quite confuse me. I have heard people say that the best way to learn chemistry is to actually get out there and do some chemistry, work with your hands and all. So, I'd like to. I've always been interested the most in (organic) medicinal chemistry, but as I'm not too good at putting together synthesis (probably as a result of having never actually done chemistry), I have no clue how difficult some of the more common ones are, like acetylsalicylic acid and acetaminophen. So yeah, pretty much just looking for any good chemical synthesis (preferably organic) that would be reasonable for a first project to work on. Specifications of my work environment, equipment, and budget are below. Apologize if anything here is like not chemical lingo, my only interaction to the world of experienced chemists is through a staff member at my school who isn't even a science teacher.
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I'll be doing everything in an outdoor gazebo with mesh windows, most likely using an additional fan to remove undesired products. I have access to electricity there, however it's somewhat limited. For safety, I'll be using a standard lab coat, face shield and/or goggles, gloves, and a gas mask if I was to work with any acids. As long as the chemicals don't pollute the surrounding environment, pose a safety risk to my unprotected neighbors, or are difficult/expensive to dispose of, I'm fine working with them. My budget for equipment is probably around $200-300, however if I need to acquire a hot plate, I can work that in.
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Thanks!

I will start this off by saying I have zero medical qualifications and I am not a physician.
I put this list together for my own family because I realized that over time, we had a large collection of things in our medicine cabinet that we forgot what it was for. This list can be used to help describe the function of certain medicines that are common in medicine cabinets but might only be used for short terms. It may be useful as an offline quick reference in the event of grid down.
In all cases, you should consult a qualified medical professional. None of the content of this page should be considered medical advice. I am not a medical professional, and this information is summarized from the manufacturers and other medical websites.
Most of the medicines mentioned below is medicine that would not be for long term use, that's why it made it to this list. If you have a medical condition that is ongoing, it is best to ensure you have enough medicine to last you until at least the expiration date on the oldest batch, or for one year, whichever is sooner.

• Ear infection antibiotic ointments: Antibiotic ointments and creams can be used for external ear infections. One example is Neomycin/polymyxin B/bacitracin (Neosporin). Antibiotic ear drops can also be used to treat ear infections in children who have ear tubes due to frequent ear infections or swimmer’s ear. Ciprodex (ciprofloxacin/dexamethasone) and ofloxacin are two examples.
• Small antibiotic creams: Topical antibiotics can be applied directly to the skin. They work by destroying or inhibiting the growth of susceptible bacteria. Some examples include Bacitracin and Neosporin (also known as “neo-bac-polym” because of its combination of neomycin, bacitracin, and polymyxin B).
• Anti fungal creams: Antifungal creams are topical medications used to treat fungal skin infections such as athlete’s foot, ringworm, and jock itch. They work by attacking the fungi that cause fungal infections and are available over-the-counter or by prescription. Some examples include clotrimazole, miconazole, ketoconazole, and econazole.
• Iodine: Iodine is an element that is used by the thyroid gland to produce thyroid hormones. Humans cannot produce iodine so it must be consumed through food or supplements. It is added to some foods and also to salt. Iodine deficiency can lead to health problems such as goiter (enlarged thyroid gland) and hypothyroidism (low levels of thyroid hormones)
• Aspirin: Aspirin is a salicylate that works by reducing substances in the body that cause pain, fever, and inflammation. It is used to treat pain and reduce fever or inflammation. It is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina).
• Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that works by reducing hormones that cause inflammation and pain in the body. It is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps or minor injury.
• Acetaminophen: Acetaminophen is a pain reliever and a fever reducer. It is used to treat mild to moderate pain or to reduce fever. Common conditions treated include headache, muscle aches, arthritis, backache, toothaches sore throat colds flu and fevers.
• Naproxen: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that works by reducing hormones that cause inflammation and pain in the body. It is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout or menstrual cramps.
• Diclofenac: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammatory diseases such as gout. It can be taken by mouth or rectally in a suppository, used by injection or applied to the skin. This medicine works by reducing substances in the body that cause pain and inflammation.
• Ponstan: For menstrual cramps
• Paracetamol: Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. It is commonly included as an ingredient in cold and flu medications and is also used on its own.
• Codeine: Codeine is an opiate mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. Codeine works by weakly binding to a specific opioid receptor but with much less affinity than morphine which means its analgesic (pain-relieving effects) are much less.
• Morphine: Morphine is an opioid medication that works by blocking pain signals from travelling along the nerves to the brain. It is used to treat moderate to severe pain. The extended-release form of morphine is for around-the-clock treatment of pain.
• Oxycodone: Oxycodone is an opioid pain medication sometimes called a narcotic. It is used to treat moderate to severe pain. The extended-release form of oxycodone is for around-the-clock treatment of pain and should not be used on an as-needed basis for pain.
• Paracetamol: Paracetamol is an analgesic and antipyretic drug that is used to temporarily relieve mild-to-moderate pain and fever. It is commonly included as an ingredient in cold and flu medications and is also used on its own. Paracetamol is exactly the same drug as acetaminophen (Tylenol).
• Dexamethasone is a type of corticosteroid hormone that is very effective at reducing inflammation and suppressing the immune system.
• Voltaren oral tablets are used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis.
• Voltaren ophthalmic eyedrops are used to treat pain, inflammation, and light sensitivity after eye surgery or for certain eye conditions.
• Azithromycin is an antibiotic used to treat a variety of different infections. It has the distinct advantage of once-daily dosing; however, diarrhea is a common side effect.
• Normal saline: Used for fluid and electrolyte replenishment for intravenous administration. It can also be used to clean out an intravenous (IV) catheter.
• Rivanol: Also known as Ethacridine lactate, it is an antiseptic used in solutions of 0.1% for cleaning wounds and mucous membranes. It is effective against mostly Gram-positive bacteria such as Streptococci and Staphylococci
• Hydrogen peroxide wound treatment: Hydrogen peroxide (H2O2) is a topical antiseptic used for cleaning wounds. It kills bacteria by producing oxidation through local, nascent, free oxygen radicals. It also removes dirt from the wound due to its frothing action.
• Stomatidin: An antiseptic agent used for disinfection and prevention of bacterial, fungal and yeast infections of the oral and vaginal mucosa.
• Penicilin: Penicillin is an antibiotic used to treat bacterial infections caused by susceptible microorganisms. It works by inhibiting the growth of bacteria by interfering with their cell wall synthesis.
• Gentamicin: Gentamicin is an antibiotic used to treat several types of bacterial infections. This may include bone infections, endocarditis, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections and sepsis among others. It is not effective for gonorrhea or chlamydia infections.
• Lincocin: Lincocin (Lincomycin) is an antibiotic used to treat severe bacterial infections in people who cannot use penicillin antibiotics. It works by killing bacteria or preventing their growth.
• Antitetanic treatments: Anti-tetanus immunoglobulin (TIG), also known as tetanus antitoxin, is a medication made up of antibodies against the tetanus toxin. It provides immediate but short-term protection from tetanus in those who have a wound that is at high risk and have not been fully vaccinated with tetanus toxoid or have HIV/AIDS
• Diazepam: is a benzodiazepine that is used to treat anxiety disorders, alcohol withdrawal symptoms, muscle spasms and stiffness, or seizures. It works by enhancing the activity of certain neurotransmitters in the brain.
• Metamizole: Also known as dipyrone, it is a painkiller, spasm reliever and fever reducer. It has a potential for blood-related toxicity but causes less kidney, cardiovascular and gastrointestinal toxicity than non-steroidal anti-inflammatory drugs (NSAIDs)
• Metoclopramide: A medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people with delayed stomach emptying, and to help with gastroesophageal reflux disease. It increases muscle contractions in the upper digestive tract which speeds up the rate at which the stomach empties into the intestines.
• Ranitidine: A medication that belongs to a group of drugs called histamine-2 blockers. It works by reducing the amount of acid your stomach produces. It has been used to treat and prevent ulcers in the stomach and intestines.
• 5% Glucose (IV solution): Also known as Dextrose 5% in water, it is a form of glucose (sugar) that is injected into a vein through an IV to replace lost fluids and provide carbohydrates to the body. It is used to treat low blood sugar (hypoglycemia), insulin shock, or dehydration (fluid loss). It can also be given for nutritional support to patients who are unable to eat because of illness, injury, or other medical condition.
• Omeprazole: A medication used to treat excess stomach acid in conditions such as non-cancerous stomach ulcers, gastroesophageal reflux disease (GERD), active duodenal ulcer, Zollinger-Ellison syndrome and erosive esophagitis. It works by blocking gastric acid production and is from the group of medicines called proton pump inhibitor.
• Aminophylline: A bronchodilator that works by relaxing muscles in your lungs and chest to allow more air in, decreasing the sensitivity of your lungs to allergens and other substances that cause inflammation, and increasing the contractions of your diaphragm to draw more air into the lungs. It is used to treat symptoms of asthma, bronchitis and emphysema.
• Solu-Medrol: A brand name for methylprednisolone injection, a synthetic glucocorticoid primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is used to treat many different inflammatory conditions such as arthritis, lupus, psoriasis, ulcerative colitis, allergic disorders, gland (endocrine) disorders and conditions that affect the skin, eyes, lungs, stomach, nervous system or blood cells.
• Synopen: Contains chloropyramine which is a strong antihistamine that prevents the effects of histamine, a substance that is created in the body and participates in the development of allergic reactions.
• Spasmex: An antispasmodic, antimuscarinic agent indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency and urinary frequency. According to receptor assays, it displays higher affinity towards muscarinic receptors compared to nicotinic receptors at therapeutic concentrations.
• Adrenaline: Adrenaline (also known as epinephrine) is used to relieve respiratory distress due to bronchospasm and is the primary drug used in the emergency treatment of respiratory conditions when bronchoconstriction has resulted in diminished respiratory function. It is also used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs and other allergens. Adrenaline may also be used during cardiac arrest, croup and asthma when other treatments are not effective.
• Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings, some types of slow heart rate, and to decrease saliva production during surgery. It can also be used as an antidote for overdose of cholinergic drugs or mushroom poisoning.
• Dexamethasone is a corticosteroid that prevents the release of substances in the body that cause inflammation. It is used to treat many different inflammatory conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis and breathing disorders.
• Voltaren gel is used topically on the skin to provide temporary relief of joint pain. This pain remedy is recommended for treating pain and tenderness from osteoarthritis in the knees, hands and other joints. Voltaren pain-relieving gel may also be used to help ease aching joints due to rheumatoid arthritis.
• Lasix (furosemide) is a loop diuretic (water pill) that prevents your body from absorbing too much salt. This allows salt to instead be passed in your urine. Lasix is used to treat fluid retention (edema) in people with congestive heart failure, liver disease or a kidney disorder such as nephrotic syndrome. Lasix may also be used alone or with other medications.
• Tylex is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds and fevers. It relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of the joint. Tylex can be used in adults and children over 12 years of age for short-term relief of moderate pain that is not relieved by other painkillers such as paracetamol or ibuprofen alone.
• Voltaren is a nonsteroidal anti-inflammatory drug (NSAID) that contains diclofenac sodium as its active ingredient. It works by reducing substances in the body that cause pain and inflammation.
• Amoxicillin is a penicillin antibiotic that fights bacteria. It is used to treat many different types of infection caused by bacteria, such as tonsillitis, bronchitis, pneumonia, and infections of the ear, nose, throat, skin or urinary tract.
• Ciprofloxacin is a fluoroquinolone antibiotic that belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria and is used to treat different types of bacterial infections. Ciprofloxacin can also be used to treat people who have been exposed to anthrax or certain types of plague.
• Sulfadiazine cream is a topical antibiotic used to prevent and treat skin infections. It works by stopping the growth of bacteria.
• Enterofuryl contains nifuroxazide as an active ingredient. It is an antibiotic indicated in the treatment of susceptible gastrointestinal infections such as acute diarrhea, amoebiasis, amoebic liver abscess, colitis, giardiasis and trichomoniasis.
• Azithromycin is an antibiotic that fights bacteria. It belongs to a class of medications called macrolide antibiotics. Azithromycin is used to treat many different types of infections caused by bacteria such as respiratory infections, skin infections, ear infections, eye infections and sexually transmitted diseases.
• Multivitamin pills are supplements that contain a combination of vitamins and minerals. They are designed to lower your risk for vitamin deficiencies and bridge any gaps in nutrient intake due to increased needs (such as during pregnancy) or compromised absorption (due to digestive troubles or other medical conditions)
• Amoxicillin is a penicillin antibiotic that fights bacteria. It is used to treat many different types of infections caused by bacteria such as tonsillitis, bronchitis, pneumonia and infections of the ear, nose, throat, skin or urinary tract. It works by stopping the growth of bacteria.
• Linex Baby is a probiotic supplement intended for oral use only. It contains B. bifidum BB-12, one of the most clinically researched strains of bifidobacteria. Linex Baby can be used as a preventative and supportive treatment in diarrhea, distension and other digestive disorders caused by either a viral or bacterial infection or as a side effect from treatment with antibiotics.

First off I would like to dress up PSSD with some context. We currently do not know the root cause of it, be it auto-immune, mitochondrial dysfunctional or purely hormonal disharmony. We do what we can to spread awareness about it in the most civilized manner, completely enraged and crippled by having our very biological state torn apart. And that's where it hurts the most, which is also what I believe is the greatest suffering a human being can go through.

Philosophy

"The most common way people give up their power is by thinking they don't have any." -Alice Walker.
By having our own biology turned upside-down, having counter-intuitive self-destructive thoughts due to withdrawals/effects from government and academic endorsed substances, we form the belief we don't have any power and our future is to be bathed in complete and utter hopelessness. This is escalated due to experience as well which acts as a combustion. It is very possible, most of us if not all of us, are life-long sufferers of metabolic dysfunctions or similar, which are the root cause of our mental instability to begin with.
The primary key for a person to succeed in life is consistency. To be able to perform with consistence, means to be able to do the best progress possible. Stability. The combustion acts as a result of a complete unstable life-long experience which strengthens the substance-ignited belief of hopelessness. What is success to someone who has only experienced failure? Something that has never been done before.
In itself that has the potential to be the most fulfilling/beautiful despite being the most miserable. There's nothing as beautiful and as inspirational that compares to something that has never been done before, the act of creation/invention (i.e. treating an illness, having children, experiencing evolution, etc). There's nothing more miserable than a life-long experience of complete biological failure and suffering.

Psychiatry

99% of the psychiatrists are a threat to the human biology and well-being. They are taught to prescribe certain substances without questioning the science behind it, most of the times enforce them on people, based on certain behaviors and malicious research. They are anti-science. They do not act on fundamental scientific principles and they justify so due to their inability to successfully investigate what a mental illness is and how it can be treated to begin with. This is not just criminal, it's equivalent to a war-crime. Based on a purely scientific analysis on the substances they enforce along with the ways they operate, they frequently vandalize human rights and torture people. A casual visit on the psychiatry subreddit can enlighten you about how they form the so-called "moonlight" parties to prey on victims as a group with the human's family with only one goal: deceive, manipulate and administer the biology-poisoning substances.
Approximately 1% of the psychiatrists, actually care about exploring the truth and effectively helping people. Although they might themselves act like the rest of the 99% sometimes, they are slowly peeling into actual science. The lead and prime example is Dr. Chris Palmer, who wrote a book called "Brain Energy", who asserts human history dated a century ago up to this day, trying to successfully understand the problem. Metabolic dysfunction seems to be the most likely case of cause.
All psychiatric medications cause tremendous biological/mitochondrial dysfunction, and the only reason he won't publicly disclose and claim it is because he would go against psychiatry itself if he was to do so. A psychiatrist can never go against the biology-poisoning substances and has to defend them because that's how psychiatry works.

PSSD

PSSD is not just about sexual dysfunction. It's about the whole picture which is the whole biological ecosystem. Brain-fog, fatigue and other symptoms are equally crucial. When the ecosystem is so tormented and crippled, that itself is a huge reason to avoid by any means a substance that might induce so. Nobody seems to care however, and psychiatry is a root cause of that ignorance. They are doing their very best to conceal and make it pass. The recent BBC promotion is a good point to start with surely, but still, it doesn't address the root problem which is psychiatry and the FDA approving those substances.
Dr. Healy seems to be doing research and the PSSD network is raising a fund. That's good alright and hopeful. However, I wouldn't trust a single psychiatrist at this point and that's me. We need impact, scientific impact. This is extremely difficult to accomplish. And primarily, as I said, the root cause is psychiatry. It's not just SSRIs that induce PSSD, it's also dopamine antagonists. You can listen to everyone saying "we don't know how these substances work but if they can make you feel 15% better you should really do it". This is like, the pinnacle of insanity and deception. I do not, and will not, accept that the pharmaceutical companies are capable of such a tremendous feat. I firmly believe the picture is beyond those companies.
I am a long-sufferer of dopamine antagonism administration. The way my biological state has been damaged is inexplicable. The human brain is so complex and it heavily relies on the whole biological ecosystem harmony. To stand up from a chair and get a glass of water, there are some very serious and complex processes happening. My intuition, the subconscious processes of problem-solving and critical thinking are almost in-existent. The way those substances are disabling is unfathomable. I am still able to very slowly write a wall of text but for how longer I truly do not know. Forming thoughts and especially action in general feels like a marathon.

My routine

I wake up and take a shower. I slowly progress the water from hot to cold, carefully, making myself just uncomfortable with hyperventilation breathing and shivering but not too dangerous, for 20-60 seconds.

• Limbic friction: Increases neuro-chemical release of dopamine and norepinephrine which help you overcome limbic friction.
• Improves HRV (Heart Rate Variability) and reduces fatigue.
• Cold exposure can lead to the production of more mitochondria in adipose tissue, which can help burn glucose and fatty acids to produce heat. This process is referred to as browning of fat and can be activated by exposure to cold.
• The idea of mitohormesis, which is the activation of certain pathways that induce changes in mitochondria leading to increases in metabolism.

I then go out and take a short walk or just casually expose my eyes to direct-contact sunlight for ~20 minutes.

• Light exposure for regulating circadian rhythms.
• Elevated levels of baseline dopamine.
• The connections between melanopsin cells and the circadian clock are plastic throughout the lifespan, regular sunlight exposure can strengthen these connections, leading to better sleep and wake cycles.

I take my morning rotation of supplements which is the following:

• 1430mg EPA and 572mg DHA, pure fish oil: Consumption of omega-3 improved learning, memory ability, cognitive well-being, and blood flow in the brain. Omega-3 therapies are beneficial, well-tolerated, and very low-risk.
• 200mg CoQ10: Coenzyme Q10 (CoQ10) is required for adenosine triphosphate (ATP) synthesis and is therefore important for the conversion of carbohydrates to energy. By enhancing the functioning of the mitochondrial enzyme glycerol-3-phosphate dehydrogenase, CoQ10 helps with glycemic control.
• 2000mg Taurine: The median life span of taurine-treated mice increased by 10 to 12%, and life expectancy at 28 months increased by about 18 to 25%. A meaningful antiaging therapy should not only improve life span but also health span, the period of healthy living. We, therefore, investigated the health of taurine-fed middle-aged mice and found an improved functioning of bone, muscle, pancreas, brain, fat, gut, and immune system, indicating an overall increase in health span.
• 700mg Niacin: A growing body of evidence highlights the key role of vitamin B3 in neuronal health. What is emerging is that niacin bioavailability is crucial for neuronsurvival and functions: indeed, vitamin deficiency has been recognized as a pathogenic factor for neurological deficits and dementia, as well as for neuronal injury and psychiatric disorders.
• 200mg Magnesium Citrate: This is to cover my electrolytes with the dairy-free ketogenic diet I am going.
• 150mcg Iodine as Iodine Potassium: Iodine is an essential component of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Thyroid hormones regulate many important biochemical reactions, including protein synthesis and enzymatic activity, and are critical determinants of metabolic activity.
• 1600mg NAC (N-Acetyl Cysteine): It has been used as a beneficial drug treatment for some disorders such as poly cystic ovary syndrome patients with CC resistance, preterm birth, acetaminophen toxicity, RPL, chronic bronchitis, ulcerative colitis, liver cancer, muscle performance, hemodialysis, asthma, Alzheimer and Parkinson.
• 2000 IU Vitamin D3: I won't share any links about this one since it's so widely known it's a key element for central nervous system function. I am following the dosage of Bryan Johnson's blueprint project: https://blueprint.bryanjohnson.co/
• 500mg Vitamin C: Nothing to say here, numerous anecdotal reports it helps with psych poison. Besides that, I am following the dosage of Bryan Johnson's blueprint project: https://blueprint.bryanjohnson.co/

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I perform a work-out, be it weight-lifting or cardio (and it's a true damn struggle).

• Exercising early in the morning, within an hour of waking and no later than 3 hours after waking, can set a neuro-chemical context for heightened levels of arousal and mental acuity throughout the day. This can lead to feeling more biased for action and less lethargic, providing more energy throughout the day.
• Exercise can improve brain health by releasing neuro-chemicals such as dopamine, serotonin, noradrenaline, and brain-derived neurotrophic factor (BDNF). BDNF helps grow new brain cells in the hippocampus, which is important for memory and attention function. Exercise can help delay the onset of diseases like dementia and Alzheimer's, making it an important habit to cultivate for brain health.

After the work-out is done, I take my first cup of coffee for the day. Through-out I also smoke tobacco, since there's a huge possibility it counter-acts dopaminergic antagonists by inhibiting certain functions and preventing the full-on catastrophic effect of the poison. I also have decided to make an attempt and stay caffeinated for the whole of my day, since caffeine is an anti-oxidant and is the only thing along with tobacco I can think of to proactively counter a dopaminergic antagonism poison. I would use orange juice, but it's not possible on the ketogenic diet.
A few hours later, I have my first and only meal of my day. It consists of meat and greens and the primary focus is to stay under 20g carbs. When the meal is done, I take my second and final rotation of supplements for the day:

• 1600mg NAC (N-Acetyl Cysteine)
• 700mg Niacin
• 715mg EPA and 286mg DHA, pure fish oil
• 100mg CoQ10
• 200mg Magnesium Citrate
• 1000mg Taurine
• 5g Creatine: Creatine supplementation enhances immunological function of neutrophils by increasing cellular adenosine triphosphate. Seems to produce positive effects on strength, power, fat free mass, daily living performance and neurological function in young and older people.
• 100mg Vitamin B1: Thiamin (vitamin B1) is a precursor of thiamin diphosphate (ThDP), which is a known coenzyme of central metabolism... As a result, noncanonical thiamin-binding proteins emerge as important players in the thiamin bioactivity essential for human health, including pain relief, immunity, neurodegeneration, and cancer.
• 750mg L-Tyrosine: It's been reported that L-Tyrosine does help with dopaminergic activity and all. I follow a similar dosage of Bryan Johnson's blueprint project: https://blueprint.bryanjohnson.co/
• 1000mg L-Carnitine (Will switch to Acetyl-L-Carnitine for exploration): The role of L-carnitine and acetyl-L-carnitine in facilitating fat oxidation and increasing fat loss. Various positive effects of acetyl-L-carnitine on cellular metabolism, sperm quality, and exercise performance.
• 2 tbsp of bio-organic Apple Cider Vinegar: Helps with digestion/my medically induced diabetes and is rich in vitamins. Also following Bryan Johnson's blueprint project: https://blueprint.bryanjohnson.co/

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Through-out my day I will also walk 7000-10000 steps and will have a 10-minute stretch session. So far I am into 1 month into this strict and disciplined routine.

Growth and the future

This dopamine antagonism poison accompanied by benzos is the definition of hell. I am not under a CTO or similar -- everything has been done completely illegally and against the core of my well-being. My whole metabolism is at peak worse. I did lose ~40kgs of weight (within ~2 years) thanks to my long fasts, medically induced diabetes and daily walks, however I am still borderline obese thanks to the poison and diabetes. Everyday feels like a marathon. I am starting to think that these drugs permanently cause further metabolic dysfunction and dysregulation that needs an exclusive genome/epi-genetic analysis that will cost a 6 figure price to begin with. I did find a specific PhD nutritional who is interested in bizarre and exclusive metabolic dysfunctions, however I believe he is one of the very, very few in the world right now. I do not have that kind of money.
For now, my plan is to optimize my sleep while doing my best to defend my right to be human and eradicate the poison for the first phase. Eight-sleep cover pods are a very good tool to optimize sleep and make the best out of it to begin with -- which is a very powerful weapon of healing and recovery.
I want to stay strong. Some days are really, really difficult, in terms of fatigue, brain fog and in general biological failure. We need to be together in this fight against our health. We need to be powerful. We need power and that power is knowledge. We need to find a way to fix this hell and judging from the world, we are in the tightest spot possible.
I wanted to share all of this in hopes I inspire some people here and more importantly spread knowledge. Nobody knows how it is to be so crippled, tortured and out-casted.

Can someone please help me how to draw the mechanisms for the synthesis of acetaminophen from 4-aminophenol and acetic anhydride in water. I’ve got an assignment due and I just can’t figure out where to draw the curly arrows and what compounds to include

One of The popular methods of treating pain at home is taking pain relief tablets. We often use OTC painkiller tablets as soon as we feel uncomfortable or distressed. We may think we know painkillers and how they work, but are we sure? Let’s read further about the mode of action, side effects of painkillers and complete guide to buying the right ones from Online Pharmacy.
Types of OTC painkillers
The most commonly used over-the-counter painkillers are-
1) Paracetamol
Paracetamol is a pain-relieving medicine you can rely on. It’s used to treat menstruation discomfort, fever, tooth pain, back pain, headaches, and body pain. It is often effective for minor pains. It’s one of the pregnancy-safe drugs. But, its overdose can damage the liver, giving rise to a situation known as Hepatotoxicity.
Painkillers under this category – Acetaminophen, Calpol, Panadol, etc.
Paracetamol mode of action
Paracetamol can block the cyclooxygenase pathways and is frequently grouped with NSAIDs (nonsteroidal anti-inflammatory medicines). It is known to have central effects that eventually lessen the sensations of pain. Acetaminophen’s antipyretic effects are most likely due to its direct impact on the brain’s heat-regulating areas, which causes peripheral vasodilation, sweating, and a loss of body heat.
Side effects of Paracetamol
When you take Paracetamol, you should be aware that you may experience side effects like nausea, dizziness, and headaches. If these problems persist or get worse, stop taking medicine immediately and consult your doctor.
Things to consider
Fortunately, there aren’t many recorded clinically relevant medication interactions with Paracetamol. Due to differences between observational studies and those conducted on healthy volunteers, there is a great deal of debate over the potential interaction between warfarin (By using warfarin, blood clots in your blood and blood vessels are prevented from forming or growing larger) and its ability to boost its anticoagulant effects. Other than that, no significant medication interactions with therapeutic doses of paracetamol in humans have been confirmed.
2) Non-steroidal inflammatory drugs
Non-steroidal inflammatory drugs (NSAIDs) are painkillers that reduce inflammation (swelling) and pain, such as those used to treat arthritis. As the name suggests, they do not contain steroids.
Painkillers under this category– Ibuprofen, Naproxen, Diclofenac, Mefenamic acid, and Aspirin for pain relief (low-dose aspirin is not normally considered to be an NSAID).
NSAIDs mode of action
Nonsteroidal anti-inflammatory medications (NSAIDs) have historically been used to treat pain by inhibiting the production of prostaglandin-producing enzymes.
NSAIDs act as analgesics (pain killers) through a range of peripheral and central mechanisms, in addition to peripheral suppression of prostaglandin synthesis.
Side effects of NSAIDs
Currently, GI issues (Gastrointestinal), renal issues (Kidneys), and Cardiovascular (Heart-related) events are the most common NSAID adverse effects. All NSAIDs are not equally likely to cause renal and cardiovascular adverse effects, contrary to a widespread assumption.
Things to Consider
When aspirin, alcohol, some antihypertensives (Blood pressure medicines), antidepressants, and other frequently taken drugs are taken with NSAIDs, drug interactions have been documented. Healthcare professionals can help patients understand the importance of balancing efficacy and safety by advising them to use over-the-counter NSAIDs at the lowest effective dose for the shortest time possible.

Hi! I'm a chemical Engineering student, and I've been doing some research about uses of acetic acid, and i found a massive amount of information, but not too much for the pharmaceutical industry. I believe the most notable use is by indirectly making acetic anhydride, which is used for acetaminophen and aspirin. I also found it can be used to make acetanilide, which is a precursor for some sulfonamides. Do you know any other drugs that use acetic acid in their synthesis even if as a solvent? Also sorry if I'm asking in the wrong place, or if this question is not allowed. Thank you!

A paper published in the journal Psychological Medicine confirms the existence of neurobiological alterations in early stages of life in minors exposed to maltreatment. The study's first author is the researcher Laia Marqués-Feixa, from the Faculty of Biology, the Institute of Biomedicine of the University of Barcelona (IBUB) and the CIBER Mental Health (CIBERSAM), and it has been carried out in collaboration with the CIBERSAM EPI-Young Stress Group.
"Those children and adolescents who have suffered child maltreatment by adults show alterations, in early stages of life, in the hypothalamic-pituitary-adrenal axis (HPA), one of the main biological mechanisms of stress regulation", notes Laia Marques, member of the Research Group on Genes, Environment and Youth Development led by Professor Lourdes Fañanás Saura, from the Department of Evolutionary Biology, Ecology and Environmental Sciences of the Faculty of Biology of the UB. "Moreover –she adds–, we have observed a dose-response relationship, so that those children that have suffered serious maltreatment experiences show higher alterations in the functioning of this axis". https://www.news-medical.net/news/20210916/Childhood-maltreatment-causes-neurobiological-alterations-in-early-stages-of-life.aspx
Global studies on long Covid and children ‘unnecessarily worrying’, say researchers https://i.stuff.co.nz/world/australia/300409787/global-studies-on-long-covid-and-children-unnecessarily-worrying-say-researchers
Stressed out fruit flies could be dying sooner because their social lives affect their biology. Scientists have found that flies who experienced stressful social environments had the biggest change in the microbiome -- suggesting a biological link between social stress, immunity and longevity. https://www.sciencedaily.com/releases/2021/09/210908180721.htm
A Mozart sonata that can calm epileptic brain activity may get its therapeutic power thanks to melodies that create a sense of surprise, according to a study published Thursday.
The research on 16 patients hospitalized with epilepsy that did not respond to medication has bolstered hopes that music could be used for new non-invasive treatments.
"Our ultimate dream is to define an 'anti-epileptic' music genre and use music to improve the lives of those with epilepsy," said Robert Quon of Dartmouth College who co-authored the study published in Scientific Reports.
Mozart's Sonata for Two Pianos in D Major K448 is known for its effects on cognition and other brain activity, but researchers are still seeking to understand why. https://www.sciencealert.com/listening-to-mozart-somehow-helped-people-with-epilepsy
This might explain why the risk of certain neurological and psychiatric diseases varies depending on the seasonal time of birth. So far, this unexplained correlation have been observed in diseases such as Parkinson's, Alzheimer's, multiple sclerosis, bipolar disorder, autism, schizophrenia and epilepsy. That said, time of birth is only one of several risk factors for the diseases in question.
"Although more research is required before we can issue recommendations about specific light therapies for pregnant women, we are clearly on an exciting track that may eventually prove highly significant," says Lena Gunhaga.
While the new findings are based on observations of the brain and nervous system of mice, the function is deemed to be similar in humans. The researchers continue with more detailed studies of how Opsin 3 affects the development and function of the brain. https://www.sciencedaily.com/releases/2021/09/210920121749.htm
This spectacular event, considered the "Greatest Shoal on Earth," involves the movement of hundreds of millions of sardines from their cool-temperate core range into the warmer subtropical waters of the Indian Ocean, on South Africa's east coast.
The sardine run is triggered by the upwelling of cold water on the southeast coast and as they swarm north they get sandwiched between the coast and a southward-flowing hot current that exceeds the sardines physiological capacity. They are then predated by huge numbers of dolphins, sharks, seabirds and even whales, an event that has featured in many nature documentaries.
A new study in the journal Science Advances by South African and Australian scientists tested the hypothesis that the Sardine Run represents the spawning migration of a distinct east coast stock adapted to warm subtropical conditions. https://www.sciencedaily.com/releases/2021/09/210915161346.htm
Compared to the surface ocean, the deep ocean is even more acidic. CO2 that dissolves in. the surface oceandescends into the ocean's depth with dead biotic materials, and. accumulates there. Thus, oceanacidification is gradually happening from the bottom of. the ocean upwards. Ocean acidification is accelerating as a result of climate change. https://environment-review.yale.edu/acidification-deep-atlantic-ocean-accelerated-ocean-circulation-0
The new research found several peaks of cadmium, a deep-sea nutrient, in the penguin poo that corresponded to greater densities of penguin remains buried in the nesting area. This relationship suggests that deep, nutrient-laden ocean water was redirected to the surface several times in the past 6,000 years, allowing ecosystems at the surface to thrive. The method is a novel approach to reconstructing past ocean circulation. https://phys.org/news/2021-09-penguin-poop-reveals-antarctic-ocean.html
It would take confirming that the same link exists in humans before anyone can talk about new Alzheimer’s treatments. But Mamo suggests in the press release that specific drugs or even changes to one’s diet could reduce the amount of amyloid in the bloodstream, potentially helping to prevent or at least delay Alzheimer’s — and that’s big news in the fight against a particularly horrible disease. https://futurism.com/neoscope/scientists-cause-alzheimers-disease
"This research can help students realize that there is evidence behind how and why people are kind, and that kindness does impact health and wellbeing," says Dr. Stewart. "It also has an incredible impact for teaching in higher education as it provides insight into where students are at with their practice and understanding of kindness in order to build the groundwork for inclusion of this topic within educational practices and course content areas."
While there are on-campus wellbeing resources available to students at most post-secondary schools, this research demonstrates that by including wellbeing initiatives into coursework, it's easier for more students to engage in those activities and receive benefits without added effort. The study also demonstrated that a curriculum-based kindness intervention would be well received by students. https://phys.org/news/2021-09-explore-impact-kindness-campus.html
New research shows that exposure to PFAS chemicals is linked with decreasing nutritional value of breast milk. "It's nearly impossible for people to avoid these harmful chemicals. Therefore, we must show what effects they have and get such toxic chemicals banned," says Tuulia Hyötyläinen, professor of chemistry at Örebro University.
The Örebro study is the first to show that the chemicals change the composition of breast milk. https://medicalxpress.com/news/2021-09-breast-nutritious-due-chemicals.html
“Snakes are interesting because vaguely snake-like lizards evolved multiple times, but never became really successful,” said Longrich. The big difference is that they seem to have combined this elongated body with the ability to feed on large prey, by having incredibly flexible jaws, and then they lost their sternum, so the ribs could spread apart.”
With so much space and so many potential places to hide, snakes evolved by what Longrich calls “creative destruction”. After older species vanished, they left huge gaps in the ecosystem that snakes were all too eager to exploit, which is how the precursors of extant snakes diversified and ended up everywhere, from land to trees to water. Getting dinosaurs out of the way meant that snakes could find places to live where survival would have never been possible before. This explains why there has always been a burst of biodiversity after mass extinctions.
While it helped that snakes had a body plan that could adapt to almost anything, Longrich thinks their success did involve impeccable timing. The gaping niches left by the dinosaurs were filled in every sort of environment. There were no juvenile tyrannosaurs to grab a bite on land, nothing especially vicious climbing trees (though the avian dinosaurs that survived may have swooped in for a snake once in a while), and the seas were no longer treacherous with mosasaurs.
“Snakes were sort of in the right place, at the right time,” he said. “I think evolution is probably less about one key innovation than a suite of key innovations; you need to get a whole series of useful adaptations together, and once you do, the lineage becomes very adaptable." https://www.syfy.com/syfywire/snakes-slithered-out-of-the-dinosaur-extinction
It’s understandable if you’re skeptical of NFT collecting and wonder whether it’s merely a casino for the crypto elite. Why care about the challenges of NFT data management? Behind the hype, there could be something substantial taking shape. The protocol now widely used to mitigate these issues, called the Interplanetary File System (or IPFS for short), has broader applications, and could fundamentally reshape how all data is managed across the web.
When I recently spoke to Molly Mackinlay, who leads product and engineering at Protocol Labs—a company overseeing the development of IPFS—she suggested the protocol may affect a range of significant sociopolitical systems. IPFS-enabled file preservation and data authentication could impact judicial systems, historical archiving in the digital world, and even bolster the fight against “fake news” and misinformation when trust in journalism is declining. https://singularityhub.com/2021/09/19/how-to-embed-trust-into-the-foundations-of-the-internet/
Scientists from the University of Alaska Fairbanks are currently investigating which animals harbor the Alaskapox virus by trapping them to take blood and tissue samples to search for the virus. Samples collected last year showed evidence of the virus in squirrels, voles and shrews, but exactly how the virus gets from these animals to people remains unknown. https://www.forbes.com/sites/victoriaforste2021/09/18/new-virus-causing-alaskapox-found-in-two-more-people-in-fairbanks/?sh=3cae6b65be94
Life expectancy in America is tied to socioeconomic status—and that is not the case in Europe The working paper found almost no disparity in mortality rates between rich and poor European communities, meaning Europe's poorest residents roughly are living as long the wealthy. The same cannot be said for the United States, where a person's zip code "is much more likely to determine when you'll die," Thompson writes. For example, in the United States, Black teenagers in the poorest counties are about twice as likely to die before their 20th birthday when compared with teenagers in the richest counties. Meanwhile, in Europe, the mortality rate for teenagers is 12 deaths per 100,000—no matter how wealthy or poor the area.
The paper's authors attributed the difference between America and European countries to the way European countries implement health interventions. https://www.advisory.com/daily-briefing/2021/09/21/american-mortality
Whenever organic matter is burned, such as in a wildfire, a power plant, a car’s exhaust, or in daily cooking, the combustion releases polycyclic aromatic hydrocarbons (PAHs) — a class of pollutants that is known to cause lung cancer.
There are more than 100 known types of PAH compounds emitted daily into the atmosphere. Regulators, however, have historically relied on measurements of a single compound, benzo(a)pyrene, to gauge a community’s risk of developing cancer from PAH exposure. Now MIT scientists have found that benzo(a)pyrene may be a poor indicator of this type of cancer risk.
In a modeling study appearing today in the journal GeoHealth, the team reports that benzo(a)pyrene plays a small part — about 11 percent — in the global risk of developing PAH-associated cancer. Instead, 89 percent of that cancer risk comes from other PAH compounds, many of which are not directly regulated. https://www.eurekalert.org/news-releases/929233
Last year, computer engineers from Northwestern University and Delft University of Technology (TU Delft) introduced the world’s first battery-free Game Boy, which harvests both solar energy and the user’s kinetic energy from button mashing to power an unlimited lifetime of game play.
The same team now introduces a new platform that enables makers, hobbyists and novice programmers to build their own battery-free electronic devices that run with intermittent, harvested energy.
Called BFree, the system includes energy-harvesting hardware (the BFree Shield) and a power-failure-resistant version of Python, one of the most accessible and most used programming languages. All the user needs is a basic understanding of Python in order to quickly and easily turn any do-it-yourself (DIY) smart device into a battery-free version. With this technology, novice programmers can now turn their DIY battery-powered motion sensor, for example, into a solar-powered sensor with an infinite lifetime. https://news.northwestern.edu/stories/2021/septembenow-everyone-can-build-battery-free-electronic-devices/
has created an extremely energy-efficient optical switch that could replace electronic transistors in a new generation of computers manipulating photons rather than electrons. In addition to direct power saving, the switch requires no cooling and is really fast: At 1 trillion operations per second, it is between 100 and 1,000 times faster than today’s top-notch commercial transistors. The study comes out Wednesday in Nature.
“What makes the new device so energy-efficient is that it only takes a few photons to switch,” the first author of the study, Dr. Anton Zasedatelev commented. “In fact, in our Skoltech labs we achieved switching with just one photon at room temperature! That said, there is a long way to go before such proof-of-principle demonstration is utilized in an all-optical co-processor,” https://www.eurekalert.org/news-releases/929080
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Engineers behind the microfliers were inspired by the seeds of the maple tree They float through the air, catching the wind in order to spread out far and wide The new devices carry a range of equipment including sensors and power They can float through the air gathering data on pollution levels or look for signs of airborne disease after a major outbreak and send data back to scientists
A microchip the size of a grain of sand https://www.dailymail.co.uk/sciencetech/article-10016819/Winged-microchip-size-grain-SAND-smallest-human-flying-structure.html
The researchers used mass spectrometry to determine the concentrations of PET and PC microplastics in six infant and 10 adult feces samples collected from New York state, as well as in three samples of meconium (a newborn infant's first stool). All samples contained at least one type of microplastic. Although average levels of fecal PC microplastics were similar between adults and infants, infant stool contained, on average, more than 10 times higher PET concentrations than that of adults. Infants could be exposed to higher levels of microplastics through their extensive use of products such as bottles, teethers and toys, the researchers say. However, they note that larger studies are needed to corroborate these findings. https://www.sciencedaily.com/releases/2021/09/210922090835.htm
Any democratic nation in the world holding a legislative or presidential election in the late 1960s could expect around 77% of its citizens to turn up to vote. These days, they can expect more like 67% – a decline that is both problematic and puzzling.
Research shows that low turnout is bad for democracy. It usually means that socioeconomically underprivileged citizens vote less and, as a result, public policies benefit the rich. Politicians feel less under public scrutiny and turn a deaf ear to the needs of the wider public. Instead of formulating general public policies serving society at large, governments can more easily target benefits to their core supporters. https://phys.org/news/2021-09-global-voter-turnout-decline-1960s.html
Japanese knotweed.
The fast-growing plant, feared by homeowners for its ability to invade gardens and buildings, contains a chemical which could take the place of the nitrite preservative in cured meats such as bacon and sausages.
Diets high in nitrite have been linked to a higher risk of colorectal cancers – leading scientists, including at the University of Reading, to look for alternatives.
The PHYTOME project has developed processed red meat that includes added natural substitutes which reduces the carcinogenic compound nitrite added to preserve meats. The range of sausages and hams had a mixture of plants and fruits added to them which included rosemary, green tea, and resveratrol – an extract taken from Japanese Knotweed. https://scienceblog.com/525531/japanese-knotweed-extract-could-cut-cancer-risk-of-processed-meat/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+scienceblogrssfeed+%28ScienceBlog.com%29
Your immune system is as unique as your fingerprint – new study https://theconversation.com/your-immune-system-is-as-unique-as-your-fingerprint-new-study-168228
It’s easy to believe that if only we didn’t need to work, or we could work far fewer hours, we’d be happier, living a life of hedonic experiences in all their healthy and unhealthy forms. But this fails to explain why some retirees pick up freelance jobs and some lottery winners go straight back to work.
Striking the perfect work-life balance, if there is such a thing, isn’t necessarily about tinkering with when, where and how we work – it’s a question of why we work. And that means understanding sources of happiness that might not be so obvious to us, but which have crept into view over the course of the pandemic. https://theconversation.com/work-life-balance-what-really-makes-us-happy-might-surprise-you-168446
What the finding cannot tell us is why our ancestors lost their tails; that is, why this mutation was selected for by evolution. Most proposed explanations involve tails being a disadvantage when early apes started moving in a different way, such as walking upright on branches. But fossils suggest the first tail-less apes still walked on all fours, says Ward.
Xia and Yanai think there must have been a strong advantage to losing tails because this mutation does also have a disadvantage. Some mice developed spinal abnormalities resembling spina bifida. They speculate that the relatively high rate of spina bifida in people is a lingering relic of the loss of our tails all those millions of years ago. https://www.newscientist.com/article/2291130-how-our-ape-ancestors-suddenly-lost-their-tails-25-million-years-ago/
Self-awareness is key to helping kids cope with back-to-school stress https://phys.org/news/2021-09-self-awareness-key-kids-cope-back-to-school.html
Observations confirm that aerosols formed from plant-emitted compounds can make clouds brighter https://phys.org/news/2021-09-aerosols-plant-emitted-compounds-clouds-brighter.html
“The first thing for individuals to do is to understand that humans do not just affect the atmosphere,” Thomas says. “Human activity has an immense impact on ocean health, including ocean acidification, plastic and oil pollution, overfishing, and more. The more we understand our impact on these complex systems and how it will affect our livelihoods, the faster we can begin to find solutions.”
After you have a basic understanding of the issues at play, taking action can take several different forms.
“The ultimate key has to be reducing our carbon footprint,” Davis says. “Wherever possible, individuals should make more sustainable carbon conscious lifestyle choices, as well as work to lobby governing bodies, coastal decision makers, corporations, and institutions to take ambitious climate action on our behalf.” https://sustainability.yale.edu/explainers/ocean-acidification-explained
An 'evolutionary rescue route' towards coexistence of competitive plant species Researchers identify evolution of self-pollination as the promoter of coexistence of plant species that share the same pollinators https://www.sciencedaily.com/releases/2021/09/210921172723.htm
Refurb over rebuild
The Royal Institute of Chartered Surveyors (RICS) estimates that 35% of the lifecycle carbon from a typical office development is emitted before the building is even opened. The figure for residential premises is 51%.
The report has heartened the Architects' Journal, which has been campaigning against any unnecessary demolition.
It wants the government to change the VAT rules which can make it cheaper to rebuild than to refurbish a standing building.
Its managing editor Will Hurst said: "This staggering fact has only been properly grasped in the construction industry relatively recently. We've got to stop mindlessly pulling buildings down." https://www.bbc.com/news/science-environment-58667328
This illusion follows a simple principle: frequencies that are higher or lower than the most sensitive frequency -- 250 Hz for humans and 1000 Hz for mice -- are felt as more similar to this preferred frequency when their amplitude is increased. In this condition, a high frequency vibration (e.g. 500 Hz) thus appears to be lower than it really is, whereas a vibration whose frequency is lower to the preferred one (e.g. 150 Hz) appears to be higher. "Falling victim to this psychophysical illusion, the brain misperceives by refocusing on what it knows best" describes Mario Prsa. "Such phenomena are also characteristic of other senses, like audition, where our own perception can be fooled by very low or high volumes and rarely represents real physical attributes of sound, but rather a composite feature of several stimulus characteristics."
A still mysterious phenomenon
How and why is this illusion created in our brains? "This question is precisely the subject of our ongoing work," explains Daniel Huber. "At what moment exactly does the brain fail to correctly interpret tactile stimuli, and what happens at the neuronal level? And why do different species, like mice and humans, misperceive in the same way?"
The team of Daniel Huber dives even further into this topic: with the help of deaf volunteers and musicians they transpose pieces of music into the range of vibrotactile stimuli to study how deaf people can be able to perceive music https://www.sciencedaily.com/releases/2021/09/210923115648.htm
Experts say the now-waning delta surge may be the last major COVID-19 wave As the latest COVID-19 case surge winds down, predictive models say we may not see another one similar to it https://www.salon.com/2021/09/23/experts-say-the-now-waning-delta-surge-may-be-the-last-major-19-wave/
Acetaminophen is the active ingredient in more than 600 pain-relieving medications, including Tylenol.There is growing evidence that suggests exposure to acetaminophen can cause neurodevelopmental, reproductive and urogenital disorders.But experts caution that more research is needed to determine its exact effects. In the meantime, they say pregnant people should only take acetaminophen when medically indicated. https://www.usatoday.com/story/news/health/2021/09/23/tylenol-during-pregnancy-researchers-urge-caution-acetaminophen/5803379001/
Developing the advanced and powerful detection techniques to characterize as many endocrine disruptors as possible with ultra-sensitivity in the environment is still challenging, however highly demanded. Environmental estrogens (EEs), as typical endocrine disruptors, have been listed as one of the global environmental issues to be addressed through international collaboration by the United Nations. They are structurally diverse compounds that can interact with nuclear estrogen receptors and pose significant risks to ecological and human health.
In a new paper published in Light Science & Application, a team of photonics and environmental scientists, led by Prof. Tuan Guo from Jinan University and Dr. Xiaohong Zhou from Tsinghua University, developed a simple-to-implement plasmonic optical fiber biosensing platform for ultrasensitive detection of estrogenic endocrine disruptors https://www.eurekalert.org/news-releases/929381
: "Anecdotally people have reported changes in aspects of their mental lives brought about by the pandemic, such as changes in what occupies their thoughts or dreams. Our study is the first to actually document the systematic changes that have occurred in thinking patterns during this unprecedented time.
"Our findings are exciting because they show how important our external environment and social interactions are for shaping what is going on internally and suggest that changing our external world could be one way of changing the (mal)adaptive thought patterns that make up so much of our waking lives."
As well as changes to social and future thinking, they also found that older adults (55-78 years) experienced more detailed thoughts during their virtual social interactions compared to in-person ones during the lockdown. This increase in detailed thoughts for older adults during virtual interactions may be linked to the phenomenon of 'zoom fatigue'.
Researchers said the findings highlighted the important role our social and working lives play in shaping what we think, and how we think, as we go about our everyday lives. https://www.news-medical.net/news/20210928/COVID-19-lockdown-linked-with-important-changes-in-peoples-thought-patterns.aspx
The researchers say that the implications of their study could provide some reassurance for policymakers, but only if the trend towards increasing education levels continues.
Wolfgang Lutz, founding director of the Wittgenstein Centre and IIASA demography expert, says, "Population aging is unavoidable, but negative economic consequences of population aging are not inevitable. More than increasing fertility, ensuring that current and future generations receive a good quality education is the key to deal with challenges of population aging." https://www.news-medical.net/news/20210928/Chinas-declining-birth-rates-and-aging-population-may-not-hinder-future-prosperity.aspx
U.S. lawmakers and advocacy groups have urged Facebook to scrap the plan entirely for safety concerns.
"Today is a watershed moment for the growing tech accountability movement and a great day for anyone who believes that children's wellbeing should come before Big Tech's profits," said Josh Golin, executive director of Fairplay, an advocacy group focused on children.
"We commend Facebook for listening to the many voices who have loudly and consistently told them that Instagram Youth will result in significant harms to children."
Golin vowed to continue fighting against Instagram Kids “until they permanently pull the plug.” https://www.voanews.com/a/facebook-puts-instagram-kids-project-on-hold/6247440.html
Some 21 cartoons and TV dramas, including “Peppa Pig” and “My Little Pony,” were already flagged by authorities in April after parents complained they contained “inappropriate behavior,” as South China Morning Post reported at the time.
Unhealthy Content
Last week’s ban is part of a much greater cultural crackdown in China. The news comes after Chinese regulators tightened rules over what it called “unhealthy content” in TV shows earlier this month. Authorities also banned “effeminate” aesthetics, promising to promote more heteronormative images of masculinity while criticizing male celebrities who used makeup. https://futurism.com/the-byte/china-cracks-down-violent-cartoons
Study shows N95 respirators could offer robust protection from wildfire smoke https://phys.org/news/2021-09-n95-respirators-robust-wildfire.html
Protein formation is an error-prone process, and given that these mistakes have been linked both to aging and to a number of human diseases, these results focus attention on an under-researched area in the longevity space.
Explaining the study, lead author Dr Ivana Bjedov of the UCL Cancer Institute, said: “We commonly hear about DNA mutations, which can cause cancer, and are considered one of the underlying causes of ageing.
“However, mistakes in proteins which affect organismal health are largely neglected, despite the fact that errors introduced during synthesis of new proteins are much more frequent than mutations made during DNA replication. For this study we therefore focused on protein errors, and we questioned if fewer mistakes in proteins improve health [2].”
For the study, scientists investigated an evolutionary ‘hyper-accuracy’ mutation, known as RPS23 K60R, found in the ribosomes (cell’s protein-producing factories) of hyperthermophilic Archaea, a single-celled organism that can live at extremely high temperatures. https://www.longevity.technology/fixing-protein-production-errors-lengthens-lifespan/
The United States has made extraordinary progress during the past 50 years in reducing children’s exposure to lead. In the early 1970s, lead was ubiquitous in the US environment.1 It was marketed aggressively by the lead industry2 (Figure 1) and was used in paint, water pipes, and plumbing fixtures. More than 100 000 tons of tetraethyl lead were added each year to gasoline to improve automotive engine performance, and lead contamination of air, soil, and dust in urban centers and along highways was extensive.3 Scientists employed by the lead industry claimed that lead was an essential trace element, necessary for children’s nutrition.4 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2784262
Florida Gov. Ron DeSantis signed the bill into law in May but District Judge Robert Hinkle in June granted a temporary injunction preventing the governor from implementing the law after two Internet trade groups—NetChoice and the Computer and Communications Industry Association— filed a lawsuit.
The trade groups argued the law may violate the First Amendment by compelling social media platforms to host offensive speech they otherwise would not and by interfering with their editorial policies.
The coalition in its amicus brief said the district court’s First Amendment analysis is “riddled with errors.”
“It veered off course from the outset by concluding that S.B. 7072 regulates speech, when that law instead regulates conduct that is unprotected by the First Amendment: social media platforms’ arbitrary application of their content moderation policies,” the coalition wrote. https://mb.ntd.com/texas-attorney-general-leads-10-state-coalition-supporting-florida-ban-on-big-tech-censorship_681275.html
Chapter 17Herbs and Spices in Cancer Prevention and Treatment
Kaefer CM, Milner JA. https://www.ncbi.nlm.nih.gov/books/NBK92774/#!po=38.8393
Great for Privacy, Great for the Environment: DuckDuckGo Is Now Carbon Negative https://spreadprivacy.com/duckduckgo-goes-carbon-negative/?s=pr-hp

• ...blocked cities from advancing climate solutions

The natural gas industry was losing in cities across the US. Then came an obscure tactic called preemption. https://www.vox.com/22691755/gas-utilities-fight-electrification-preemption
China’s Cracking Down on Kids’ Screen Time, and the Implications Could Be Far-Reaching https://singularityhub.com/2021/09/29/chinas-cracking-down-on-kids-screen-time-and-the-implications-could-be-far-reaching/
The Biden administration said Wednesday it will draft rules to govern the killing of wild birds by industry and resume enforcement actions against companies responsible for deaths that could have been prevented, a longstanding practice that ended under President Donald Trump. The move came as North American bird numbers have plummeted drastically in recent decades. That decline was punctuated by news Wednesday that the famed ivory-billed woodpecker and 22 other species have gone extinct.
Conservation groups, which have urged President Joe Biden to take stronger action to protect wildlife, said the planned rules were urgently needed to hold companies accountable for bird deaths.
But the administration's announcement got immediate pushback from the oil industry, which has been subject to some of the most high-profile prosecutions under the Migratory Bird Treaty Act. https://www.kob.com/national-news/us-to-resume-enforcement-of-unlawful-bird-deaths-by-industry/6253816/?cat=602
The rise of dark web design: how sites manipulate you into clicking Because those additional cookies generate extra revenue for the websites we visit, cookie banners are often designed to trick you into clicking “accept all”.
The UK’s information commissioner recently urged G7 countries to address this problem, highlighting how fatigued web users are agreeing to share more personal data than they’d like. But in truth, manipulative cookie banners are just one example of what’s called “dark design” – the practice of creating user interfaces that are intentionally designed to trick or deceive the user. Dark design has proven to be an incredibly effective way of encouraging web users to part with their time, money and privacy. This in turn has established “dark patterns”, or sets of practices designers know they can use to manipulate web users. They’re difficult to spot, but they’re increasingly prevalent in the websites and apps we use every day, creating products that are manipulative by design, much like the persistent, ever-present pop-ups we’re forced to close when we visit a new website. https://theconversation.com/the-rise-of-dark-web-design-how-sites-manipulate-you-into-clicking-168347

“Krokodil” is the street name for the semi-synthetic opioid derivative desomorphine.
It's commonly claimed that Krokodil will make your skin fall off: https://www.drugs.com/illicit/krokodil.html

Those who inject these caustic agents into their veins can develop extreme skin ulcerations, infections, and gangrene -- a discolored (green, grey, black) scale-like skin

https://time.com/3398086/the-worlds-deadliest-drug-inside-a-krokodil-cookhouse/

Wherever on the body a user injects the drug, blood vessels burst and surrounding tissue dies, sometimes falling off the bone in chunks.

https://www.thesun.co.uk/news/2682111/pics-addicts-scaly-wounds-crocodile-injecting-drug-krokodil/

The drug turns a user's skin green and scaly around the area where they inject it as blood vessels burst and the skin rots away.

If properly prepared, the toxicology of desomorphine is similar to other opiates. However, contaminants which can be mixed in with the desomorphine due to lazy preparation can cause necrosis. Similar chemicals are used during mass production of heroin, cocaine, and methamphetamine, but they are more thoroughly removed before final packaging.
The claim that Krokodil makes people's skin fall off is no more accurate than a claim that heroin gives people HIV.
Source: https://sci-hub.se/https://pubmed.ncbi.nlm.nih.gov/24650492

Repeated administration of desomorphine can cause severe medical complications which include physical and psychological dependency, tolerance and a withdrawal syndrome if the substance is no longer taken, similarly to heroin (Grund et al., 2013; Erowid, 2013). The dependence potential of desomorphine was initially described by Eddy et al. (1957) and was verified later by Sargent and May (1970) during their study with monkeys. No further studies have been conducted after those concerning the dependence potential or its dependence liability of desomorphine compared to morphine. Other effects of desomorphine are similar to those of opiates, including miosis, flushing and paresthesia (neutral effects). Common negative effects are constipation and urinary retention, nausea and vomiting, as well as more serious medical implications, such as allergic reactions, seizures, and respiratory depression leading to death (Grund et al., 2013; Erowid, 2013). All the above effects are expected as they are inherent of an opioid like desomorphine.
The final product [of common street synthesis] is often contaminated with various toxic and corrosive by-products or residuals. Thus, synthetic analogues of codeine, other drugs such as tropikamide, ephedrine or acetaminophen (often found in codeine containing preparations), phosphorous, iodine or even heavy metals like lead can be found in the “krokodil” street samples, as a result of poor synthesis. All these substances are considered to be responsible for the most of the undesirable or toxic effects that appear after the repeated injections of “krokodil” which actually is a cocktail of all the above substances; desomorphine, by-products and residuals.
The toxicity of by-products and residuals of the manufacturing process along with dirty needles and poor injection technique can lead to a slew of horrific consequences that are not related to the opiate effects of desomorphine but to the toxic effects of impurities in “krokodil” (Grund et al., 2013; Gahr et al., 2012a). Indeed, the synthetic method followed for the production of homemade desomorphine yields an impure, orange-colored liquid contaminated with various toxic and corrosive by-products or residuals like paint thinner, lighter fluid, gasoline, lead, zinc, hydrochloric acid, iodine and/or red phosphorus that are used for its preparation (Erowid, 2013; Thoma and Lehmann, 2011). Since this homemade cocktail is routinely injected with little or no purification, it can cause immediate skin irritation and ulcers, a discolored (greenish) scale-like appearance, similar to that of a crocodile's, destruction of skin and severe muscle and cartilage tissue damage. Thrombophlebitis can also appear. The presence of gasoline and hydrochloric acid still in the finally injected liquid solution is considered responsible for these damages. Once the skin around the injection site is damaged, the area becomes a target of gangrene. This leads to skin and muscle decay around the injection site, and, in time, the skin sloughs off due to the rupture of the blood vessels, often exposing the bone below. The same effects are also caused by the presence of phosphorus that is usually scraped from matchboxes. The damaged tissues are susceptible to infections that may lead to inflammation, abscesses and rotting as this flesh-eating drug kills slowly from the inside out (Christensen, 2013; Grund et al., 2013; Erowid, 2013; TOXNET, 2013; Drug Enforcement Administration (DEA) Office of Diversion Control, 2013; Gahr et al., 2012a; Dinis-Olivera et al., 2012). In most of the cases, extensive amputation is the only solution.

Why do we get period pain?
So it’s that wonderful time of the month. But, have you ever took a second to think why am I actually popping ibuprofen for my period pain?! Well, read on to find out! During our period, compounds known as prostaglandins are released from the uterine lining (endometrium) which triggers uterine muscle contractions (in order to expel the lining). Furthermore, it is thought that higher levels of prostaglandins can cause more severe cramping in some women.
What is ibuprofen and what has it got to do with period pain?
Ibuprofen is a nonsteroidal anti-inflammatory drug, also known as an NSAID. NSAIDs are often used to treat period pain. Moreover, NSAIDs inhibit the production of prostaglandins (via the inhibition of COX enzymes), the compounds responsible for period pain in many women.
Ibuprofen lessens period flow?
There has also been talk about how ibuprofen can lessen menstrual flow; if Cardi B can use it to delay her period for two days it must be true right? It turns out there might be some truth to it. Interestingly, a study found that taking NSAIDs can reduce menstrual flow by 28% to 49%. Although you shouldn’t really be using this method to ignore a potential underlying problem, in that case, a doctors visit would be advised.
Alternatives to NSAIDs
‘Natural’ methods
Although it has been shown that NSAIDs can reduce the levels of prostaglandins, these anti-inflammatory drugs can cause stomach problems (amongst other unpleasant side effects) for some people (and isn’t such a good idea for those with stomach ulcers) – so where possible – it is always best to relieve period pains through ‘natural’ methods (easier said than done, I know), such as those below:
· Applying heat · Drinking more fluids · Massage · Exercise (I promise once you push past the pain it’ll help) · Or perhaps you have an increased sex drive right now? An orgasm can work wonders on your period cramps!
If you really can’t get on board with the more natural interventions then below are some potential ‘natural’ alternatives to NSAIDs that have a similar mode of action.
‘Natural’ alternatives to NSAIDs Turmeric
Firstly, who here is a fan of turmeric? Well, you’d be wise to consume the spice during menstruation; in a recent study the spice has been shown to abate menstrual pain (to a similar extent as mefenamic acid – a prescription NSAID). Whilst a combination of turmeric and mefenamic acid gave the best outcome, use of turmeric alone wasn’t far behind mefenamic acid (alone) in terms of pain relief.
Curcumin, the primary bioactive compound in turmeric has been shown to be the main culprit for the pain-reducing effects of turmeric. As we saw earlier, the source of period pain often stems from the metabolism of arachidonic acid to prostaglandins. Curcumin affects arachidonic acid metabolism by blocking the cytosolic phospholipase phosphorylation, reducing the expression of cyclooxygenase-2 (COX-2). Remember COX enzymes were responsible for the conversion of arachidonic acid to prostaglandins, so if we reduce the expression of them, we reduce prostaglandin synthesis.
Zinc There is evidence that zinc may also provide period pain relief – a study found that ingestion of zinc sulphate (a source of zinc) throughout the duration of menstruation reduced pain duration and severity (1.5 fold) by the third menstrual cycle, compared to the control group (placebo).
Disclaimer
This hopes to provide relief (and information) to those suffering with primary dysmenorrhoea (period pain when there is no underlying medical problem). If you think your pain is abnormal or it is too severe that you can’t carry out daily tasks then you should consult a doctor in order to see if there is an underlying cause.
References
Hesami, S., Nooshabadi, M. R., Yousefi, M., Lalooha, F., & Haghighian, H. K. (2021). Randomized, double-blind, placebo-controlled clinical trial studying the effects of Turmeric in combination with mefenamic acid in patients with primary dysmenorrhoea. Journal of Gynecology Obstetrics and Human Reproduction, 50(4), 101840.
Zekavat, O. R., Karimi, M. Y., Amanat, A., & Alipour, F. (2015). A randomised controlled trial of oral zinc sulphate for primary dysmenorrhoea in adolescent females. The Australian & New Zealand journal of obstetrics & gynaecology, 55(4), 369–373.
Eby, G. A. (2007). Zinc treatment prevents dysmenorrhea. Medical Hypotheses, 69(2), 297-301.
Dawood, M. Y., & Khan-Dawood, F. S. (2007). Clinical efficacy and differential inhibition of menstrual fluid prostaglandin F2alpha in a randomized, double-blind, crossover treatment with placebo, acetaminophen, and ibuprofen in primary dysmenorrhea. American journal of obstetrics and gynecology, 196(1), 35.e1–35.e355.
Mazaleuskaya, L. L., Theken, K. N., Gong, L., Thorn, C. F., FitzGerald, G. A., Altman, R. B., & Klein, T. E. (2015). PharmGKB summary: ibuprofen pathways. Pharmacogenetics and genomics, 25(2), 96–106.
Matteson, K. A., Rahn, D. D., Wheeler, T. L., 2nd, Casiano, E., Siddiqui, N. Y., Harvie, H. S., Mamik, M. M., Balk, E. M., Sung, V. W., & Society of Gynecologic Surgeons Systematic Review Group (2013). Nonsurgical management of heavy menstrual bleeding: a systematic review. Obstetrics and gynecology, 121(3), 632–643. https://doi.org/10.1097/AOG.0b013e3182839e0e

This is a very long post with multiple sources. I link below the treatment for viral bacterial infections in people with cystic fibrosis, because I couldn’t find any other non-censored protocols involving viral bacterial lung infections. Just to give you a quick rundown of cystic fibrosis, it is a genetic disease which affects the sodium channels, making our mucus very thick. Because of this, we get lung infections quite frequently. You’ll see a lot of “suppressed and unsafe” treatment, according to the mainstream narrative, when you arrive at the cystic fibrosis treatment plan at the end of this post. I am going to include the covid protocol, how to identify viral bacterial infections vs regular bacterial infections, and cystic fibrosis treatment plan for viral bacterial infections. I hope this post helps some of you out there, because the standard treatment in patients with cystic fibrosis has saved lives. I also want to note that not one person with cystic fibrosis I ever knew went on a ventilator unless they got a lung transplant or went into lung failure. Why? Because the doctors say getting off the vent is lethal. I hope that you all find this post helpful and enlightening.
Upper respiratory tract infections:
Upper respiratory tract infections are often the result of the common cold or the flu. Both develop due to viruses. The common cold and the flu share a number of common symptoms, including: * a productive or nonproductive cough * chest discomfort * sore throat * a runny or stuffy nose * sneezing * muscle aches and pains * weakness * fatigue The flu may cause some additional symptoms Trusted Source , such as: * headaches * fever * chills Diagnosis A doctor can diagnose Trusted Source the common cold by assessing a person’s symptoms. In order to diagnose the flu, they may take a swab from the person’s nose. Treatment Symptoms of the common cold typically clear up within 7–14 days. In the meantime, the following over-the-counter (OTC) medications can help reduce the symptoms: * pain relievers, such as acetaminophen and ibuprofen * decongestants * cough suppressants Doctors may prescribe antiviral therapy for the flu. Antiviral therapy is more effective if people begin taking it within 48 hours Trusted Source of developing flu symptoms.
Lower respiratory tract infections:
Lower respiratory tract infections are those that affect the lungs or airways. There are two main types: bronchitis and pneumonia. Bronchitis is the medical term for inflammation of the bronchi in the lungs. The bronchi are the airways that enable airflow into the lungs. Bronchial inflammation can occur as a result of a viral infection or irritation from allergens or pollutants. The symptoms of bronchitis include: * a cough that produces clear, white, or yellow mucus * wheezing * difficulty breathing * sore throat * a runny nose * fever Pneumonia is the medical term for infection and inflammation of one or both lungs. Pneumonia can occur as a result of infection with any of the following pathogens: * bacteria * viruses * fungi * parasites The symptoms of pneumonia may include: * a nonproductive cough or a productive cough that brings up blood tinged mucus * chest pain * shortness of breath * headaches * muscle and joint aches and pains * fever with chills * fatigue Diagnosis When diagnosing bronchitis or pneumonia, a doctor will ask about the person’s symptoms and examine their chest using a stethoscope. They may also order one or more of the following diagnostic tests: * pulse oximetry, to evaluate blood oxygen levels * blood tests, to check for signs of infection * a sputum test, to help identify the pathogen responsible for the infection * a chest X-ray, to check for signs of inflammation in the lungs Treatment If a person has bronchitis, a doctor may prescribe codeine to help suppress coughing. They may also prescribe beta-agonist medications to prevent wheezing and steroids to reduce inflammation. The treatment for pneumonia depends on the type a person has, as well as its severity. For example, a doctor may prescribe antibiotics to treat bacterial pneumonia and antiviral medications to treat viral pneumonia.
https://www.medicalnewstoday.com/articles/cough-with-mucus#upper-respiratory-tract-infections
Productive Cough (Wet Cough with Mucus):
Posted by Dr. Chris Most of us classify different types of coughing by simple terms. One such term is a ‘wet cough’. This means that mucus is either coughed up or can be heard in the airway and lungs when coughing. A wet cough is a common occurrence in life, often following a cold or the flu, but usually clears up within a few days or one to two weeks at most. Nevertheless, it is important to understand the diseases that may be linked to a wet cough as some of these conditions can be very serious. What is a productive cough? A productive cough is a cough where mucus is produced and is either coughed up into mouth or can be heard in the airways. It is commonly known as a wet cough or chesty cough. This is in contrast to a non-productive cough where no mucus is present and is therefore referred to as a dry cough or sometimes even a barking cough. There are two terms commonly used with a wet cough – sputum and phlegm. These terms are essentially the same referring to mucus in the airways. Phlegm is the broader term that is used to refer to respiratory mucus in the airways or coughed up into mouth. Sputum specifically refers to the mucus that is coughed up into the mouth and can be passed out of the mouth by spitting.
Productive Cough Meaning:
A productive cough means that there is mucus in the respiratory passages. This can be in the upper passages like the nose and throat or the lower passages like the trachea (windpipe), bronchi, bronchioles or lungs. Sometimes blood or fluid may be in the lungs and can be expelled with the mucus. Most of time this mucus production is a result of inflammation of the respiratory passages and often due to an infection.
https://www.healthhype.com/productive-cough-wet-cough-with-mucus.html Identifying a wet cough
Mucus in the Airways and Lungs:
The respiratory passages are lined with a mucus-producing lining known as the respiratory mucosa or epithelium. Mucus is produced constantly to keep the linings moist since the moving air can quickly dry it out. Furthermore this mucus acts as a ‘sticky’ medium to trap dust and germs that may be entering with the air. Tiny hair-like projections known as cilia push these small amounts of mucus towards the throat. Here it is swallowed and travels down the esophagus (gullet) and passes down into the stomach. We never know that this process is occurring because of the very small amounts of mucus involved. Occasionally we may sneeze out some of the mucus or cough it out with saliva. Excessive Mucus in the Respiratory Tracts Excessive mucus in the respiratory tracts are mainly a consequence of inflammation of the respiratory lining. Sometimes this occurs with minor irritation like inhalation of dust or smoke. It quickly settles once the offending agent is removed. At other times it tends to occur with allergies and infections. Here it can last for much longer and sometimes becomes a persistent problem in life. As with the small amounts of mucus produced normally, this excessive mucus can pass out through the nose, mouth or be swallowed. However, it often lingers in the passages where it causes significant discomfort, affects the movement of air in and out of the lungs and irritates the lining thereby causing coughing. Expelling Mucus with Coughing The cough reflex is as initiated when there is any irritation in the respiratory tract. Tiny pulmonary irritant receptors, commonly known as cough receptors, react to any irritant – either mechanical or chemical. It is found in the lower respiratory tract. Similar receptors in the nose initiates sneezing. When the cough receptors are triggered, impulses are sent to the medulla of the brain and initiates the process of coughing. With certain conditions where there is ongoing inflammation of the respiratory tract, these receptors are constantly triggered. Therefore a cough occurs throughout the day and may last for weeks. Excessive mucus is therefore expelled by the constant act of coughing. The coughed up mucus in the mouth can then be spat out or swallowed.
Wet Cough Causes:
The most common causes of a productive cough are infections, particularly viral infections that last for just a short period of time. However, allergies, cancer and other diseases that causes excessive mucus in the respiratory tract may also be responsible. Infections * Acute bronchitis * Common cold * Influenza (seasonal flu) * Lung abscess * Pneumonia * Tracheitis * Tuberculosis (TB) Allergies * Asthma * Allergic rhinitis (hay fever) * Post nasal drip Inflammatory Lung Diseases * Chronic obstructive pulmonary disease (COPD) – emphysema and chronic bronchitis * Anthracosis – coal worker’s pneumoconiosis * Byssinosis * Silicosis Other Causes Some of the causes below may cause mucus, blood and/or fluid accumulation. * Lung cancer * Cystic fibrosis * Pulmonary aspiration * Heart failure – fluid in the lungs, not mucus * Near drowning * Acute respiratory distress syndrome (ARDS) * Smoke and toxic gas inhalation * Adverse drug reactions * High altitudes
Productive Cough Symptoms:
Productive cough is a symptom of some underlying disease. It may be accompanied by other symptoms such as : * Coughing up blood (hemoptysis) * Difficulty breathing (dyspnea) * Fluid in the lungs (pulmonary edema) * Wheezing * Chest pain * Hoarse voice There may be various other symptoms such as fever, malaise (generalized feeling of being unwell), sore throat, headache, changes in appetite and weight loss which are also present. These symptoms are part of the underlying disease and can vary depending on the cause. Wet Cough Diagnosis A productive cough needs to be assessed in conjunction with all other signs and symptom as well a patient’s medical history to reach a differential diagnosis. Specific tests for the suspected caused may then be conducted to confirm or exclude the disease. Sputum collection and analysis is one of the diagnostic tools that may be used.The following features of sputum and tests conducted on the sputum sample may be helpful in isolating the cause : * Sputum color and consistency – macroscopic examination of the sputum specimen. * Sputum cytology where the specimen is examined under a microscope and cells and microbes within it are identified. * Sputum culture where microbes are grown on specific media for conclusive identification and testing of drug sensitivity. * * Clear, white and gray mucus are normally seen when there is excessive mucus. It does not clearly indicate a cause. It can be seen with asthma, infections, may be pulmonary edema or chronic obstructive pulmonary disease. * Yellow to light brown mucus is more likely to be due to an acute bacterial infection of the airways or lung. It may also be seen in asthma where it is usually thicker in consistency. * Green sputum is an indication of a long standing infection (chronic) like some cases of pneumonia, chronic bronchitis with acute infections and lung abscess. * Dark brown to black mucus is usually this color due to the presence of certain dusts like coal or blood that has degraded. It may be seen with chronic infections including tuberculosis (TB), coal worker’s pneumoconiosis (CWP), lung cancer and pulmonary embolism (blood clot in the lung). * Pink, red or rusty colored mucus is most likely an indication of blood in the mucus but some microbes like pneumococci can cause a rusty red color even without the presence of blood. Pink to red mucus should always be taken serious as it is seen with the more severe causes like serious and life threatening infections or lung cancer. Productive Cough Treatment Productive cough is not a symptom of a specific disease. Therefore there is no specific treatment just for the cough. Instead the underlying cause needs to be identified and treated. The cough should subside with time. Some of the common drugs used in the treatment of a productive cough includes : * Antibiotics for bacterial infections. * Antiviral drugs for viral infections although most are self limiting and resolve on its own without treatment. * Bronchodilators and inhaled corticosteroids for chronic inflammatory diseases of the airways and asthma. * Antitussives to depress the cough reflex and protussives to stimulate a cough in conditions like cystic fibrosis. * Expectorants to help make the mucus less thick thereby assisting with its expulsion from the respiratory tract with coughing.
Signs and Symptoms of Pneumonia:
Pneumonia symptoms and their severity vary depending on the type of pneumonia you have. There are several types of pneumonia, but the most common include bacterial and non-bacterial. Bacterial Pheumonia Bacterial pneumonia is the most common type of pneumonia. A bacterial infection often follows a viral infection that causes a cold or the flu. If you have bacterial pneumonia, your symptoms will be more serious and noticeable than non-bacterial pneumonia. Symptoms include: * Fever (usually above 101F) * Cough that produces discolored mucus and continues to get worse * Chills * Rapid breathing * Pain when coughing or breathing deeply * Shortness of breath * Muscle or joint aches * Confusion (in older adults) Non-bacterial or “walking pneumonia” Walking pneumonia usually indicates a more mild pneumonia caused by a bacteria called mycoplasma pneumoniae. If you have walking pneumonia, your symptoms will be mild and you’ll probably function normally. Walking pneumonia symptoms include: * Dry cough that’s persistent and typically gets worse at night * Low-grade fever * Fatigue * Shortness of breath * Chest pain when you breathe deeply or cough * Loss of appetite Viral Pneumonia Many viruses can lead to pneumonia, including the flu virus or RSV. These diseases don’t respond to antibiotics and treatment is usually helpful, although anti-virals may be required. Symptoms are similar to bacterial pneumonia but may also include headaches, extreme fatigue, or decreased appetite. When to call your doctor Call your doctor if you have: * Difficulty breathing * Chest pain * Persistent fever of 102F or higher * Persistent cough (especially if you cough up mucus or pus) Who’s at risk Although pneumonia is dangerous for anyone, it can be deadly for: * Children younger than 2 * Adults over age 65 * Individuals with weakened immune systems * Individuals with heart conditions * Individuals with chronic lung problems * Individuals undergoing chemotherapy or taking medications that suppress the immune system If you’re at risk, contact your doctor right away if you start showing symptoms of pneumonia. Diagnosing pneumonia You might have a difficult time determining if you have a simple cough or if you have pneumonia. Thankfully, your doctor should have a better idea. To diagnose pneumonia your doctor may perform: * Blood tests to confirm an infection * A chest x-ray, which will help your doctor determine where your infection is located and how bad it is * A sputum test that takes a sample of fluid from your lungs after a deep cough * Pulse oximetry, which measures the oxygen level in your blood Getting treatment for pneumonia Once you’ve been diagnosed, your doctor can begin treating your pneumonia. In most cases, you can be treated at home. However, your doctor may choose to hospitalize you if you’re risks of getting worse are high or your symptoms are severe. Common treatment for pneumonia includes: * Antibiotics, which target and treat bacterial infections. More than one type of antibiotic may be needed to treat your pneumonia. * Cough medicine to help reduce coughing and allow for more rest. * Pain relievefever reducer to help bring down your fever and pain symptoms. Most over-the-counter medications should work, but your doctor may recommend specific medications. If you have pneumonia signs or symptoms, don’t wait too long before you contact your doctor. Getting the right treatment will help you feel better more quickly.
https://intermountainhealthcare.org/blogs/topics/live-well/2018/03/when-does-a-cough-turn-into-pneumonia/
Laboratory Diagnosis:
Guidance on specimen collection, processing, transportation, including related biosafety procedures, is available at: https://www.mohfw.gov.in/pdf/5Sample%20collection_packaging%20%202019-nCoV.pdf Sample collection Preferred sample Alternate Throat and nasal swab in viral transport media (VTM) and transported in cold chain. Nasopharyngeal swab, BAL or endotracheal aspirate which has to be mixed with the viral transport medium and transported in cold chain. General guidelines • Use appropriate PPE for specimen collection (droplet and contact precautions for URT specimens; airborne precautions for LRT specimens). Maintain proper infection control when collecting specimens • Restricted entry to visitors or attendants during sample collection • Complete the requisition form for each specimen submitted • Proper disposal of all waste generated Page 10
Respiratory specimen collection methods:
A. Lower respiratory tract • Bronchoalveolar lavage, tracheal aspirate, sputum • Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container. B. Upper respiratory tract • Nasopharyngeal swab AND oropharyngeal swab Oropharyngeal swab (e.g. throat swab): Tilt patient’s head back 70 degrees. Rub swab over both tonsillar pillars and posterior oropharynx and avoid touching the tongue, teeth, and gums. Use only synthetic fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with wooden shafts. Place swabs immediately into sterile tubes containing 2-3 ml of viral transport media. Combined nasal & throat swab: Tilt patient’s head back 70 degrees. While gently rotating the swab, insert swab less than one inch into nostril (until resistance is met at turbinates). Rotate the swab several times against nasal wall and repeat in other nostril using the same swab. Place tip of the swab into sterile viral transport media tube and cut off the applicator stick. For throat swab, take a second dry polyester swab, insert into mouth, and swab the posterior pharynx and tonsillar areas (avoid the tongue). Place tip of swab into the same tube and cut off the applicator tip. Nasopharyngeal swab: Tilt patient’s head back 70 degrees. Insert flexible swab through the nares parallel to the palate (not upwards) until resistance is encountered or the distance is equivalent to that from the ear to the nostril of the patient. Gently, rub and roll the swab. Leave the swab in place for several seconds to absorb secretions before removing. Clinicians may also collect lower respiratory tract samples when these are readily available (for example, in mechanically ventilated patients). In hospitalized patients in Dedicated Covid Hospitals (severe cases with confirmed COVID - 19 infection, repeat upper respiratory tract samples should be collected to demonstrate viral clearance. Recommended Test Real time or Conventional RT-PCR test is recommended for diagnosis. SARS-CoV-2 antibody tests are not recommended for diagnosis of current infection with COVID-19. Dual infections with other respiratory infections (viral, bacterial and fungal) have been found in COVID-19 patients. Depending on local epidemiology and clinical symptoms, test for other potential etiologies (e.g. Influenza, other respiratory viruses, malaria, dengue fever, typhoid fever) as appropriate. For COVID-19 patients with severe disease, also collect blood cultures, ideally prior to initiation of antimicrobial therapy Page 11

1. Management of COVID-19: symptomatic treatment:

10.1. Management of Mild Cases In the containment phase, patients with suspected or confirmed mild COVID-19 are being isolated to break the chain of transmission. Patients with mild disease may present to primary care/outpatient department, or detected during community outreach activities, such as home visits or by telemedicine. Mild cases can be managed at Covid Care Centre, First Referral Units (FRUs), Community Health Centre (CHC), sub-district and district hospitals or at home subject to conditions stipulated in the home isolation guidelines available at https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresympto maticCOVID19cases10May2020.pdf Detailed clinical history is taken including that of co-morbidities. Patient is followed up daily for temperature, vitals and Oxygen saturation (SpO2). Counsel patients with mild COVID-19 about signs and symptoms of complications that should prompt urgent care. Patients with risk factors for severe illness should be monitored closely, given the possible risk of deterioration. If they develop any worsening symptoms (such as light headedness, difficulty breathing, chest pain, dehydration, etc.), they should be immediately admitted to a Dedicated Covid Health Centre or Dedicated Covid Hospital. Caregivers of children with mild COVID-19 should monitor for signs and symptoms of clinical deterioration requiring urgent re-evaluation. These include difficulty in breathing/fast or shallow breathing (for infants: grunting, inability to breastfeed), blue lips or face, chest pain or pressure, new confusion, inability to awaken/not interacting when awake, inability to drink or keep down any liquids. Mild COVID-19 cases may be given symptomatic treatment such as antipyretic (Paracetamol) for fever and pain, adequate nutrition and appropriate rehydration. Tab Hydroxychloroquine (HCQ) may be considered for any of those having high risk features for severe disease (such as age> 60; Hypertension, diabetes, chronic lung/kidney/ liver disease, Cerebrovascular disease and obesity) under strict medical supervision. 10.2. Management of Moderate Cases Patients with suspected or confirmed moderate COVID-19 (pneumonia) is to be isolated to contain virus transmission. Patients with moderate disease may present to an emergency unit or primary care/outpatient department, or be encountered during community surveillance activities, such as active house to house search or by telemedicine. The defining clinical assessment parameters are Respiratory Rate of more than or equal to 24 and oxygen saturation (SpO2) of less than 94% on room air (range 90-94%). Page 12
Such patients will be isolated in Dedicated Covid Health Centre (DCHC) or District hospital or Medical College hospitals. The patient will undergo detailed clinical history including co-morbid conditions, measurement of vital signs, Oxygen saturation (SpO2) and radiological examination of Chest X-ray, Complete Blood Count and other investigations as indicated. Antibiotics should not be prescribed routinely unless there is clinical suspicion of a bacterial infection. Clinical Management of Moderate cases Oxygen Support: • Target SpO2: 92-96% (88-92% in patients with COPD) • The device for administering oxygen (nasal prongs, mask, or masks with breathing / non-rebreathing reservoir bag) depends upon the increasing requirement of oxygen therapy. If HFNC or simple nasal cannula is used, N95 mask should be applied over it. • Awake proning may be used as a rescue therapy. (Protocol at Annexure-I) • All patients should have daily 12-lead ECG • Follow CRP, D-dimer & Ferritin every 48-72 hourly (if available); CBC with differential count, Absolute Lymphocyte count, KFT/LFT daily • Tab. Hydroxychloroquine (400mg) BD on 1st day followed by 200mg 1 BD for 4 days. (after ECG Assessment) • Consider IV methylprednisolone 0.5 to 1 mg/kg OR Dexamethasone 0.1 to 0.2 mg/kg for 3 days (preferably within 48 hours of admission or if oxygen requirement is increasing and if inflammatory markers are increased). Review the duration of administration as per clinical response. Anticoagulation • Prophylactic dose of UFH or LMWH (e.g., enoxaparin 40 mg per day SC) • Control of co-morbid condition • Monitor for: • Increased work of breathing (use of accessary muscles) • Hemodynamic instability • Increase in oxygen requirement If any of the above occurs, shift to Dedicated Covid Hospital
10.3.4. Other therapeutic measures:
For patients with progressive deterioration of oxygenation indicators, rapid worsening on imaging and excessive activation of the body’s inflammatory response, glucocorticoids can be used for a short period of time (3 to 5 days). It is recommended that dose should not exceed the equivalent of Methylprednisolone 1 – 2mg/kg/day OR Dexamethasone 0.2-0.4 mg/kg/day. Note that a larger dose of glucocorticoid will delay the removal of coronavirus due to immunosuppressive effects. Prophylactic dose of UFH or LMWH (e.g., enoxaparin 40 mg per day SC) should be given for anti-coagulation. Control of co-morbid conditions should be ensured. For pregnant severe cases, consultations with obstetric, neonatal, and intensive care specialists (depending on the condition of the mother) are essential. Patients often suffer from anxiety and fear and they should be supported by psychological counseling. Note – An algorithm for clinical guidance for management of COVID-19 suspect/confirmed case is placed at Annexure-II. 11. Investigational Therapies4 At present, use of these therapies is based on a limited available evidence. As the situation evolves, and when more data become available, the evidence will be accordingly incorporated, and recommendation upgraded. Further, use of these drugs is subjected to limited availability in the country as of now. Currently, these drugs should only be used in a defined subgroup of patients: i. • • • • Remdesivir (under Emergency Use Authorization) may be considered in patients with moderate disease (those on oxygen) with none of the following contraindications: AST/ALT > 5 times Upper limit of normal (ULN) Severe renal impairment (i.e., eGFR < 30ml/min/m2 or need for hemodialysis) Pregnancy or lactating females Children (< 12 years of age) Dose: 200 mg IV on day 1 followed by 100 mg IV daily for 5 days 4This document will be updated as more data emerge. The document contains some potential off label/investigational use of medications and is based on a consensus of experts along with the available evidence. An informed and shared decision making is essential before prescribing any of these therapies. Page 17
ii. • • • • Convalescent plasma (Off Label) may be considered in patients with moderate disease who are not improving (oxygen requirement is progressively increasing) despite use of steroids. Special prerequisites while considering convalescent plasma include: ABO compatibility and cross matching of the donor plasma Neutralizing titer of donor plasma should be above the specific threshold (if the latter is not available, plasma IgG titer (against S-protein RBD) above 1:640 should be used) Recipient should be closely monitored for several hours post transfusion for any transfusion related adverse events Use should be avoided in patients with IgA deficiency or immunoglobulin allergy iii. • • • Tocilizumab (Off Label) may be considered in patients with moderate disease with progressively increasing oxygen requirements and in mechanically ventilated patients not improving despite use of steroids. Long term safety data in COVID 19 remains largely unknown. Special considerations before its use include: Presence of raised inflammatory markers (e.g., CRP, Ferritin, IL-6) Patients should be carefully monitored post Tocilizumab for secondary infections and neutropenia Active infections and Tuberculosis should be ruled out before use. Dose: Dose is variable ranging from 4 to 13 ml/kg (usually 200 ml single dose given slowly over not less than 2 hours Dose: 8mg/kg (maximum 800 mg at one time) given slowly in 100 ml NS over 1 hour; dose can be repeated once after 12 to 24 hours if needed
https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19dated27062020.pdf
Here is how they treat viral bacterial infections in cystic fibrosis. Now, I know most (if not all of you) have cystic fibrosis. But I couldn’t find a regular protocol since everything is being censored. This has been successful in treating viral bacterial infections with those who get consistent lung infections. I believe this protocol can save lives, but unfortunately they are not being implemented.
Respiratory Viruses in CF:
Acute Respiratory Viral Infections in CF Pediatric and adult CF patients experience frequent acute respiratory virus infections. Specific respiratory viruses responsible for infections are identified when patients present with symptoms indicative of a viral infection, leading physicians to take a viral swab from which genetic material is extracted for PCR, and a viral panel is performed consisting of primer sets specific to common viral culprits. The true incidence of viral infections is likely under-reported for several reasons, including infrequent use of viral swabs and incomplete PCR panels to detect viral infections, as well as the fact that not all patients present with symptoms during a viral infection (33, 34). The most commonly identified viral pathogens in CF populations are respiratory syncytial virus (RSV), human rhinovirus (RV), Influenza types A and B, and parainfluenza, all belonging to families of RNA viruses (34–36). It has been reported that close to 40% of children with CF are hospitalized at some point for severe respiratory infections, and of these hospitalizations, respiratory viruses were identified in 50% of patients, with RSV predominating (33). While in non-CF populations RSV is thought to be almost exclusively a pediatric pathogen, RSV infections are frequent in both adult and pediatric CF patients, and can result in severe symptoms. RSV infection may result in upper respiratory disease, including rhinitis, cough, fever, and acute otitis media, or progress to the lower respiratory tract, resulting in bronchiolitis or pneumonia in children, and exacerbate existing chronic airway disease in adults (37). RSV infection is especially aggressive in young infants with CF, leading to significant respiratory morbidity (38). Links Between Viral Infections and Exacerbations CF patients frequently experience periods of rapidly worsening respiratory symptoms, termed pulmonary exacerbations (39). Pulmonary exacerbations are typically defined by a decrease in lung function or increases in patient symptoms, however symptoms and severity of exacerbations vary from patient to patient and can be triggered by a multitude of causes (40). Exacerbations are often treated by initiating courses of additional antibiotics, increasing airway clearance therapies, or hospitalization in severe cases (41). Many clinical studies have now linked viral infections with pulmonary exacerbations (33, 35, 36, 42). Respiratory viral infections account for at least 40% of pulmonary exacerbations of CF adults (38, 43) and are linked to pulmonary function decline, antibiotic use, prolonged hospitalizations, and increased respiratory symptoms in CF patients (44–46). Respiratory viruses most frequently cultured during periods of exacerbation include the major viral pathogens appreciated in CF: influenza A and B, RSV, and RV (47–50).
Severity of Viral Infections in CF:
CF patients are known to be pre-disposed to chronic bacterial infections, and several groups have examined whether CF disease also leads to more severe respiratory viral infections. In vitro studies evaluating CF vs. non-CF primary human bronchial epithelial cells in culture found that RV replication was increased in CF cells (51). Enhancement of viral infection could be attributed to a diminished innate antiviral response in CF cells, which showed weaker induction of interferon and expression of some interferon-stimulated genes, as compared to non-CF controls (52). A clinical study evaluating severity of RV infections in CF children compared to non-CF pediatric patients with asthma, non-CF bronchiectasis or healthy controls found CF patients had a higher prevalence of RV, and higher viral load in bronchoalveolar lavage (BAL), both when patients were stable and at even higher levels during pulmonary exacerbations (53). Higher RV load correlated with worse lung function scores in CF children, and RV infection in CF resulted in lower levels of inflammatory markers than in non-CF children, again indicating a dysregulated innate immune response in CF patients could be responsible for increased severity of viral infections (53). A longitudinal study reported that RV was identified more frequently in CF children than non-CF subjects, and RV infections in CF children persisted longer (54). These studies suggest inherent properties of CF airway cells may make the CF airway epithelium more prone to viral infection, and together with what is known regarding links between airway physiology and bacterial respiratory infection in CF, these factors could have important implications in cases of viral-bacterial co-infections.
Viral-Bacterial Co-Infections in CF
CF patients are commonly chronically infected with bacterial pathogens and maintain a high abundance of microbes in the respiratory tract, including pathogens, and commensal organisms. These same patient populations also experience frequent acute respiratory viral infections. There are numerous ways in which infection with a viral pathogen can alter the host response, impacting previously existing chronic bacterial infections and microbial communities, potentiating secondary bacterial infections, and/or permitting the acquisition of new bacterial species in the airways (summarized in Figure 1). In this section, we evaluate insights from clinical studies of CF patient populations and mechanistic in vitro studies that inform us of viral-bacterial interactions occurring in CF during co-infections.
Impact of Therapeutics on Co-Infections:
Antimicrobial Treatments for Viral and Bacterial Infections As we've observed with the host immune response, attempts to clear one type of pathogen may have unintended effects on other microbes in the CF airways. The same may be true for cases of antiviral or antibacterial treatments administered to CF patients. It is appreciated that despite intense antibiotic therapy and even with alternating antibiotic courses, chronic infections with bacterial pathogens established as biofilms in the CF airways resist clearance through multiple mechanisms reviewed in Høiby et al. (92) and Lambert (93). Several therapies are now shown to impact both viral and bacterial pathogens, potentially leading to new therapeutic options for polymicrobial infections. We recently reported that an engineered antimicrobial peptide therapy, WLBU2, reduced both bacterial biofilm, and RSV titers in a mixed infection model in vitro (94). In addition
This part is the most important part of all I have linked and sourced in this entire post
members of the macrolide class of antibiotics, including erythromycin, azithromycin, and bafilomycin, which are known to effect antibacterial activity by binding to bacterial ribosomal subunits to inhibit protein synthesis (95) were also found to have anti-inflammatory effects. By blocking production of the pro-inflammatory cytokines IL-6 and IL-8, macrolide antibiotics reduced neutrophil recruitment to sites of injury, and infection (96). In non-CF bronchial epithelial cells, azithromycin (97), bafilomycin (98), and clarithromycin (99) treatments were found to reduce RV replication by increasing induction of interferon-stimulated antiviral genes, demonstrating that in addition to its anti-inflammatory, and anti-bacterial properties, azithromycin has anti-viral activity. In CF airway cells, azithromycin also reduced RV replication and increased RV-induced expression of interferon and interferon-stimulated antiviral genes; however, azithromycin did not prevent induction of IL-6 or IL-8 during RV infection, suggesting that the anti-inflammatory effects of azithromycin are diminished during a virus infection (51). Administration of azithromycin as an antiviral or anti-inflammatory agent could provide a potential therapeutic option for CF patients, yet as macrolide resistance is known to be widespread in clinical isolates from chronic airway infections (100), it is important to keep in mind the broader effects antibiotic administration may have on the CF microbiome. As viral infections can lead to severe respiratory morbidity and are linked to exacerbations in CF populations, there is a demand for effective anti-viral therapies, especially for major CF pathogens like RV and RSV for which no successful vaccine exists. RSV immunotherapy was shown to be effective at preventing lower respiratory tract infections and reducing symptom severity in high-risk infants, and young children (101). A humanized monocolonal antibody treatment for RSV, palivizumab, was developed (102) and prophylactic treatment with palivizumab significantly reduced hospitalizations (103), and incidences of respiratory-related illness (104) in CF children compared to untreated control groups. While potentially effective at preventing RSV infection, palivizumab prophylaxis is costly and has shown limited benefits for populations that do not regularly have high incidence of RSV-related hospitalizations (105), leading some to propose that anti-RSV therapy would be best-reserved for treatment during infections, not as prophylaxis, or for fall, and winter seasons when probability of virus-related illnesses and hospitalizations typically increases (106). As it has been observed that virus co-infection promotes P. aeruginosa colonization, a secondary benefit of antiviral therapies could be a delay in acquisition of bacterial pathogens in CF children. However, a recent study found that prophylactic treatment of CF infants with palivizumab to prevent RSV infection did not delay acquisition of either P. aeruginosa or S. aureus (107). A separate retrospective study found that although palivizumab reduced RSV-related hospitalizations and overall P. aeruginosa chronic colonization rates did not differ between treatment and control groups, the time to first P. aeruginosa isolate was significantly earlier in palivizumab-treated CF children (108). Many factors could have affected these outcomes, including patients' genetics, environmental exposures, and differences in clinical care quality and access. Broader studies evaluating the impact of palivizumab on the CF microbiome, including changes in abundance of commensal and pathogenic bacterial species, could shed light on how anti-viral therapies affect viral-bacterial-host interactions.
members of the macrolide class of antibiotics, including erythromycin, azithromycin, and bafilomycin, which are known to effect antibacterial activity by binding to bacterial ribosomal subunits to inhibit protein synthesis (95) were also found to have anti-inflammatory effects. By blocking production of the pro-inflammatory cytokines IL-6 and IL-8, macrolide antibiotics reduced neutrophil recruitment to sites of injury, and infection (96). In non-CF bronchial epithelial cells, azithromycin (97), bafilomycin (98), and clarithromycin (99) treatments were found to reduce RV replication by increasing induction of interferon-stimulated antiviral genes, demonstrating that in addition to its anti-inflammatory, and anti-bacterial properties, azithromycin has anti-viral activity.
https://www.frontiersin.org/articles/10.3389/fimmu.2018.03067/full
And thus includes this post. I apologize if some of this is copied and painted twice!

Chronic Pelvic Pain in Men Guidelines

Updated: Mar 17, 2020

• Author: Richard A Watson, MD; Chief Editor: Edward David Kim, MD, FACS more...
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Guidelines Summary

In 2015, Prostate Cancer UK released consensus guidelines for the diagnosis and management of chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The guidelines define early-stage disease as persistent, recurrent symptoms for < 6 months in antibiotic‐naïve men. In later-stage disease, patients experience persistent, recurrent symptoms for >6 months that are refractory to initial lines of pharmacotherapy. The recommendations for evaluation include the following [1] :

• Use of reliable instruments, such as the National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI), International Prostate Symptom Score (IPSS), and UPOINT system, should be considered to assess initial symptom severity, evaluate phenotypic differences, and monitor patients' response to therapeutic intervention.
• Patients should be screened for psychosocial symptoms (eg, anxiety or stress) using either the psychosocial yellow flag system and/or Patient Health Questionnaire–9 (PHQ‐9) and/or Generalized Anxiety Disorder–7( GAD‐7) scales.
• Referral to a mental health specialist (eg, psychiatrist, clinical psychologist) should be considered if clinically relevant levels of psychosocial symptoms are present.
• Other concerns or differential diagnoses, including urological cancers and infertility, should be discussed with the patient to establish a full patient history.
• Patients should be informed of the underlying causes of CBP and CP/CPPS to help improve their understanding. This may include an explanation of basic pelvic anatomy, the chronic pain cycle, and potential routes for pain (neuropathic vs nociceptive).

The guidelines include the following recommendations for treatment of CP/CPPS [1] :

• Consider α‐adrenergic antagonists as an initial treatment option, although there is a lack of evidence to inform best practice for the use of these agents and they have a modest treatment effect regarding total, urinary symptom, pain, and quality of life (QoL) scores.
• Treatment with α‐adrenergic antagonists should be considered in patients who present with significant voiding lower urinary tract symptoms (LUTS; eg, slow urinary flow, hesitancy); if no relief from voiding LUTS or other symptoms is achieved within 4–6 weeks, treatment should be stopped and a different pharmacotherapy considered. Patients should be referred to specialist care if other approaches have been exhausted.
• Due to the adverse effect profiles, consider uroselective α‐adrenergic antagonists (eg, tamsulosin, alfuzosin, silodosin) as first‐line treatment in patients who present with voiding LUTS.
• Antimicrobial therapy may have a moderate effect on total, urinary, pain and QoL scores and should be considered as an initial treatment option
• Antimicrobial therapy should be guided by bacterial cultures and sensitivities, taking into consideration any drug interactions and/or contraindications
• For patients with early‐stage disease, a quinolone (eg, ciprofloxacin or ofloxacin) for 4–6 weeks may be offered as first‐line therapy.
• A repeated course of antibiotic therapy (4–6 weeks) should be offered only if a bacterial cause is confirmed or if the patient has a partial response to the first course.
• If a bacterial cause is excluded (eg, via urine dipstick or culture) and symptoms do not improve after antibiotic therapy, a different treatment method or referral to specialist care should be considered.
• Multimodal/combined therapy should be individualized for each patient; depending on the symptoms at presentation; possible additions to first‐line antibiotic therapy include an α‐blocker and/or a nonsteroidal anti-inflammatory drug (NSAID), an agent targeting neuropathic pain (eg, pregabalin), or a 5-α‐reductase inhibitor (predominantly for patients with coexisting LUTS and benign prostatic hyperplasia).
• Patients whose condition is refractory to treatment should be questioned about the possibility of any past trauma (including physical, emotional, or sexual abuse)
• A multidisciplinary team should be utilized for treatment of refractory symptoms, with pharmacotherapy, physical, and psychosocial approaches integrated into an individualized treatment plan.
• The multidisciplinary team may include urologists, pain specialists, nurse specialists, physiotherapist, general practitioners, cognitive behavioral/psychological therapists, and sexual health specialists.
• There is insufficient evidence to recommend surgical techniques, including radical prostatectomy, transurethral resection of the prostate (TURP), high-intensity focused ultrasound (HIFU) or prostatic massage, except in the context of a clinical trial.
• If non‐physical causes for symptoms have been excluded, physiotherapy may be considered.
• After referral, a full assessment (eg, symptom score scaling, examination of the pelvic floor muscles) should be completed to guide the subsequent sequence of physiotherapy treatments.

The following physiotherapy treatment options may be considered:

• Pelvic floor re‐education
• Local pelvic floor relaxation
• Biofeedback
• General relaxation
• Deep relaxation/mindfulness
• Trigger point release
• Myofascial release
• Stretches
• Exercise for pain management
• Transcutaneous electrical nerve stimulation (TENS)
• Acupuncture for trigger point release and pain management
• Bladder retraining

The guidelines also include the following recommendations for pain management [1] :

• In patients with early‐stage disease, regular paracetamol (acetaminophen) may be offered for management of pain symptoms.
• NSAIDs should be offered only for short‐term treatment of pain, to patients with early‐stage disease whose symptoms are suspected to be due to an inflammatory process, or those judged to be experiencing an inflammatory flare.
• To prevent unwanted adverse effects, NSAIDs should be stopped within 4–6 weeks of treatment initiation if they do not reduce symptoms.
• In patients with early‐stage disease, use of opioids for pain management should be avoided.
• If pain is considered to be neuropathic in origin, consider treatment with a gabapentinoid (eg, pregabalin or gabapentin), a tricyclic antidepressant (eg, amitriptyline, nortriptyline, trimipramine) or a selective serotonin‐noradrenaline (norepinephrine) reuptake inhibitor (eg, duloxetine).
• Consider referral to a pain specialist when pain is severe and refractory to treatment or is significantly impairing the patient's lifestyle and ability to participate in daily activities

Chronic Pelvic Pain in Men Medication

Updated: Mar 17, 2020

• Author: Richard A Watson, MD; Chief Editor: Edward David Kim, MD, FACS more...
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Medication Summary

By definition and exclusion, nonbacterial prostatitis, or chronic pelvic pain syndrome (CPPS), is without a documented bacterial origin. Antibiotics should have a very limited role in therapy for this condition. However, in desperation to do something for the patient, physicians frequently prescribe multiple courses of antibiotics, often for extraordinarily protracted periods.
Keep in mind that no antibiotic regimen has been proven to be efficacious in the treatment of chronic nonbacterial prostatitis. According to Meares, "Antibacterial agents are neither effective nor indicated in the treatment of nonbacterial prostatitis." [39, 40, 41] If Ureaplasma urealyticum or Chlamydia trachomatis infection is suggested, however, a trial treatment of antibiotics may be considered.
In bacterial prostatitis, antibiotic therapy may be guided by culture findings from the prostatic secretions, from the ejaculate, from a urethral swab, or from the spun sediment of a final voided urine specimen (VB3). Even in this scenario, choosing the antibiotic is confounded by the fact that the organisms cultured from these sources may reflect urethral contaminants rather than a true pathogen.
In an aggressive attempt to clarify the presence of bacteria in the uncontaminated prostate tissue of men with CPPS, researchers in Seattle concluded that, while bacterial colonization within the prostate is not uncommon, particularly in older men, prostatic bacteria are probably not etiologically involved in the symptoms of most men with CPPS. The investigators performed digitally guided transperineal prostate biopsies in 118 subjects with CPPS and in 59 control subjects. They found no significant difference in the rates of positive cultures (38% vs 36%). [42]
Some patients with CPPS are maintained on long-term, low-dose regimens, such as one tablet of trimethoprim-sulfamethoxazole (Septra DS) daily. In some cases, patients experience symptomatic relief while on these regimens. Whether this is a reflection of the strong placebo effect associated with treatment of this condition or the result of suppression of an undetected pathogen is purely a matter of speculation. Studies suggest that, beyond the placebo effect, certain antibiotics may actually be providing an objective anti-inflammatory and/or analgesic benefit to these patients.
In screening for a bacterial etiology, the finding of gram-positive organisms has often been dismissed as a contaminant. However, small studies have found evidence to suggest that anaerobes and gram-positive aerobes, even coagulase-negative staphylococci, may in fact be pathogens, and appropriate antibiotic therapy has proven effective in select cases. [43]
In approaching the antibiotic option, remember that no antibiotic is free of complications. Regarding a blinded trial of antibiotics for CPPS, many have commented that the antibiotics cannot hurt. As a grim reminder of the rare, but devastating, consequences attendant to the casual use of such antibiotics, the primary author consulted on the treatment of a patient who experienced life-threatening complications following livekidney transplantation that was necessitated by his extremely adverse reaction to a course of trimethoprim-sulfamethoxazole. Tragically, the symptoms of chronic prostatitis (CP), for which this antibiotic was prescribed, were later proven to be manifestations not of prostatitis, but of a bladder neck contracture.
It should also be kept in mind that the expense of antibiotics is not negligible, particularly when multiple prescriptions are provided for the newest, most expensive wide-spectrum antibiotics.
The Urologic Diseases in America Project, reviewing Veterans Health Administration datasets, found that men with CP/CPPS were seven times more likely to have received a fluoroquinolone than were men without this condition. An increased use of other antibiotics was also observed. Despite the evidence that antibiotics are not effective in most men with CP/CPPS, they were prescribed in 69% of men with this diagnosis, suggesting that strategies to reduce unnecessary antibiotic use in these patients are warranted. [44]
In an editorial published in the Journal of Urology, Professor Richard Berger speculated that while considerable evidence suggests that antibiotics are no more effective than placebo in the treatment of CP/CPPS, this finding may be contrary to common experience, as the success rate associated with placebo has been approximately 50%. Thus, half of these men fare better whenever they are given something. It would not be surprising if the most common cause of inappropriate antibiotic prescriptions by urologists were for CP/CPPS type III, and if it were a major contributor to fluoroquinolone antibiotic resistance. [45]
Berger observes, "Because of our inappropriate nomenclature of 'prostatitis,' (when it is neither an infection nor an inflammation) and the message given by our antibiotic treatment, many men end up thinking they have an incurable but unknown infection. Old habits are hard to change, but need to be replaced by patient education, and perhaps by physical education and pain-directed drug therapy." [46]
In a controlled, randomized investigation by the Chronic Prostatitis Collaborative Research Network-2, pregabalin (Lyrica) failed to show an advantage in relieving discomfort, as measured by the NIH Chronic Prostatitis Symptom Index. The problem was that while 47.2% of the men experienced significant (> 6-point) relief when taking pregabalin, 35.8% of the men who were taking a placebo also experienced relief. Patients taking pregabalin fared better on the McGill Pain Questionnaire. Despite these findings, clinicians still hold that pregabalin may have a role in pain relief for select CP/CPPS patients. It is important to bear in mind that use of pregabalin is not US Food and Drug Administration approved for the treatment of CP/CPPS pain. [47]

Antibiotics

Class Summary

Chronic pelvic pain syndrome (CPPS) in men should, by definition, exclude men with a proven bacteriologic etiology. Therefore, antibiotics should not be deemed appropriate for the treatment of this condition. However, most practitioners are inclined to attempt at least 1 trial of long-term antibiosis.
Clinical evidence upon reviewing the results of all available clinical trials indicates limited validation for the use of antibacterials, even in the face of chronic bacterial prostatitis. The cure rates for sterilization of prostatitic secretions, even for this more specific indication, ranged from 0-90% and correlated poorly with symptomatic responses. Limited evidence from retrospective studies suggests that quinolones (eg, ciprofloxacin [Cipro], levofloxacin [Levaquin]) may be more effective than trimethoprim-sulfamethoxazole (Bactrim, Septra).

Minocycline (Dynacin, Minocin)

• View full drug information

Minocycline helps to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible chlamydial, rickettsial, and mycoplasmal organisms.

Erythromycin (E.E.S., E-Mycin, Ery-Tab)

• View full drug information

Erythromycin is a macrolide antibiotic with the theoretical advantage of penetrating the blood-prostate barrier, but it carries an increased incidence of gastrointestinal (GI) intolerance.

Ciprofloxacin (Cipro)

• View full drug information

Ciprofloxacin is a fluoroquinolone with activity against Pseudomonas species, streptococci, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, and most gram-negative organisms, but no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.

Muscle Relaxants

Class Summary

Tension myalgia of the pelvic floor muscles, combined with overall stress-related tension, can be partially relieved with muscle relaxants. [39, 40, 41]

Diazepam (Valium, Diastat)

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Diazepam is a benzodiazepine derivative indicated for short-term relief of anxiety and adjunctive relief of skeletal muscle spasm. It depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing the activity of gamma-aminobutyric acid (GABA). Individualize the dosage and increase it cautiously to avoid adverse effects.

Alpha-Adrenergic Blockers

Class Summary

These agents have become a mainstay in the symptomatic treatment of chronic pelvic pain syndrome (CPPS) in men. [39, 40, 41] These agents, by relieving the secondary smooth muscle spasm within the bladder neck and prostatic urethra, afford the patient greater comfort in voiding. The dosage should be titrated progressively and administered at night to minimize the main adverse effect of orthostatic hypotension. The final dose must be individualized to meet the patient's needs.
While the antihypertensive agent has been administered to patients already taking other blood pressure medications, coordinating the addition of this medication with the primary care physician or cardiologist who is prescribing the patient's other antihypertensive medications is wise.
Again, as with other medications, such as antibiotics, remember that the use of alpha-adrenergic blockade is not approved by the US Food and Drug Administration (FDA) for the treatment of prostatodynia. One study suggested an advantage to the use of alpha blockers in combination with antibiotics over antibiotic therapy alone in the treatment of chronic bacterial prostatitis. [45]

Doxazosin (Cardura)

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Quinazoline compounds counteract alpha1-induced adrenergic contractions of the bladder neck, facilitating urinary flow in the presence of benign prostatic hyperplasia (BPH).

Terazosin (Hytrin)

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Terazosin is a quinazoline compound that counteracts alpha1-induced adrenergic contractions of the bladder neck, facilitating urinary flow in presence of BPH. Reporting at the annual convention of the American Urological Association, researchers confirmed a significant, albeit limited, value for alpha1-blockers in the management of CPPS. Patients with CPPS treated with terazosin showed a 56% improvement in their NIH-CPSI scores; however, placebo controls showed a 36% response rate.
In a parallel report from Finland, using the selective alpha-blocker alfuzosin, modest improvement again occurred. After 6 months, 19 patients on alfuzosin showed significant reduction in pain scores but not in voiding or quality-of-life scores. This finding seems counterintuitive in that one would expect an alpha blocker to have its most dramatic effect on voiding performance. Moreover, unlike BPH treatment, in which a response to alpha blockers is prompt, the symptomatic response in patients with CPPS can take 6 months or longer to mature.
These studies raise the question of whether the expense and nuisance of these long-term medications are warranted for this modest response, which is in close competition with the placebo effect.

Tamsulosin (Flomax)

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Tamsulosin is an alpha-adrenergic blocker that specifically targets A1 receptors. It has the advantage of causing relatively less orthostatic hypotension and requires no gradual up-titration from the initial introductory dosage. On the other hand, the rate of ejaculatory dysfunction is higher with this medication (8.4-18.1%).
​
FOR MORE INFO REVIEW ARTICLE ONLINE
https://emedicine.medscape.com/article/437745-overview#a5

I found very little information about acetyl chloride or other compounds being used in acetylation of 4-aminophenol. So I assume it is the method with acetic anhydride that is mostly used in commercial production of paracetamol. But what’s the reason behind it? Thank you! Edit: I think that esters can be used to acetylate 4-aminophenol as well. Is it correct? If yes, the question is again why it is not used in commercial manufacture.

https://onlinelibrary.wiley.com/doi/10.1111/eip.13149

N‐acetylcysteine for depression and glutamate changes in the left prefrontal cortex in adolescents and young adults at risk for bipolar disorder: A pilot study

Fabiano G. Nery Maxwell J. Tallman Kim M. Cecil Thomas J. Blom Luis R. Patino Caleb M. Adler Melissa P. DelBelloFirst published: 01 April 2021 https://doi.org/10.1111/eip.13149
Funding information: University of Cincinnati Gardner Neuroscience Institute – Neurobiology Research Center Pilot Award
Read the full text📷PDFTOOLS SHARE

Abstract

Aims

To investigate the mechanism of action of N‐acetylcysteine (NAC) in depressive symptoms in young individuals at familial risk for bipolar disorder.

Methods

We conducted an 8‐week open label clinical trial of NAC 2400 mg/days in 15–24 years old depressed offspring of a bipolar I disorder parent, with baseline and endpoint proton magnetic resonance spectroscopy acquired within the left ventrolateral prefrontal cortex (VLPFC).

Results

Nine participants were enrolled and finished the study. NAC significantly improved depressive and anxiety symptom scores, and clinical global impression (all p < .001). There was a non‐significant reduction in glutamate levels in the left VLPFC. Reduction in depressive symptom scores was positively associated with reduction in glutamate levels in the left VLPFC (p = .007).

Conclusions

This pilot study suggests that NAC might be efficacious for depressive symptoms in at‐risk youth, and that its mechanism of action involves the modulation of glutamate in the left VLPFC.
​
L-cysteine is an optically active form of cysteine having L-configuration. It has a role as a flour treatment agent, a human metabolite and an EC 4.3.1.3 (histidine ammonia-lyase) inhibitor. It is a serine family amino acid, a proteinogenic amino acid, a cysteine and a L-alpha-amino acid. It is a conjugate base of a L-cysteinium. It is a conjugate acid of a L-cysteinate(1-). It is an enantiomer of a D-cysteine. It is a tautomer of a L-cysteine zwitterion.
ChEBI
Cysteine is a non-essential sulfur-containing amino acid in humans, related to cystine, Cysteine is important for protein synthesis, detoxification, and diverse metabolic functions. Found in beta-keratin, the main protein in nails, skin, and hair, Cysteine is important in collagen production, as well as skin elasticity and texture. Also required in the manufacture of amino acid taurine, Cysteine is a component of the antioxidant glutathione, and plays a role in the metabolism of essential biochemicals such as coenzyme A, heparin, and biotin. (NCI04)
NCI Thesaurus (NCIt)
Acetylcysteine, also known as N-acetylcysteine (NAC), is a modified amino acid that is used as an antidote for acetaminophen overdose to prevent hepatic injury. Acetylcysteine is a hepatoprotective agent and has not been linked to significant serum enzyme elevations during therapy or to instances of clinically apparent acute liver injury.

tl;dr - Tramadol is promising as a treatment for pain and other symptoms with far fewer negative side effects. Co-administrated with Paracetamol shows best results so far. Overall, combining painkillers allows using less of each and thus enjoy synergy while reducing the negative effects for each.
Warning! Never take prescription drugs without doing research and consulting a doctor you can trust. Interaction with other certain medications can lead to dangerous adverse effects30402-9/fulltext) and in rare cases, severe allergic reactions occur. Seek immediate medical help you suspect an allergic reaction.
​
What we know
Tramadol is a centrally active analgesic of special interest that is recommended by the EU and American guidelines for the treatment of fibromyalgia. By inhibiting the reuptake of norepinephrine and serotonin, it exerts an analgesic effect with minimal activation of the opioid receptors and, therefore, it is not usually considered a “pure” opioid. In particular, tramadol targets certain FMS symptoms, such as asthenia, paresthesia, headache and restless legs, which are sustained by altered serotoninergic and noradrenergic neurotransmission within the CNS (Central nerve system). Tramadol is therefore often used in combination with paracetamol, which works by reducing nitric oxide synthesis and prostaglandin release from the CNS.
Tramadol functions as an opioid, and a serotonin and norepinephrine reuptake inhibitor. Tramadol is a prodrug, and the efficacy and adverse effects are mediated by cytochrome P450 metabolism.
Research conclusion
A tramadol/acetaminophen combination tablet was effective for the treatment of fibromyalgia pain without any serious adverse effects, as it exploits different mechanisms of action on pain and on the associated symptoms, such as asthenia, sleep disturbance, paresthesia, headache and restless legs.
Another study has found that co-administration of Ibuprofen and Paracetamol had an identical to better effect in comparison with 3 different opioids - 4.3 points reduction in pain vs 4.4, 3.9 and 3.5 on a scale of 0-11.
Interesting read - Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department - Thanks, u/inspectorhuman!
​
Sources:

1. Article: Effects of a Paracetamol and Tramadol Fixed-dose Combination on Pain, Asthenia, Cognitive Disorders and Sleep Quality in Fibromyalgia
2. Article: Tramadol for the treatment of fibromyalgia
3. Article: Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain00116-5/fulltext)
4. Article: Fibromyalgia - A Clinical Review
5. Article: Combination analgesia in 2005 - a rational approach: focus on paracetamol-tramadol
6. Article: Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures30402-9/fulltext)

1. The argument for PUFA being essential is not only wrong, it is obsolete. New evidence has accumulated since the 1930s when the single study "proving" PUFA being essential was conducted. I am not even mentioning the fact that basing public health/nutrition policy on a SINGLE study almost 100 years old is highly irresponsible, even if that study was legit. Many other studies have come out since then that invalidate much of the original claims of PUFA being "essential". PUFA is at best semi-essential and its daily dietary "requirements" come down to no more than 0.5% of calories. So, at the very least we have an upper bound on how essential PUFA is - i.e. if you are eating more than 1g-2g of PUFA daily at best you are not getting any benefit and at worse you are increasing the risk of cancer.
   
2. PUFA and its derivative eicosanoids and leukotrienes, are the major pathway to inflammation. There is no "healthy" level of inflammation, contary to dogma.The lower the inflammation the healthier the organism. As such, restricting PUFA (and depleting iron, tryptophan, etc) is perhaps THE definitive approach to controlling inflammation rather than rely on later factors in the cascade such as taking aspirin to combat inflammation. The eicosanoids/leukotrienes are the major trigger of histamine/serotonin/estrogen synthesis and release and without them, histamine/serotonin/estrogen become a much smaller burden on the organism.
   
3. PUFA directly inhibit cytochrome C oxidase, unlike SFA and MUFA. In addition, PUFA are directly estrogenic by activating aromatase, again, unlike MUFA and SFA.
   
4. PUFA are a major inhibitor of the protective steroid pathways, especially 5-AR, but at the same time are activators of 11b-hydroxylase and aldosterone synthase. So, PUFA tend to shift the steroid pathway towards the end products cortisol, estrogen and aldosterone.
   
5. PUFA activate TPH, which synthesizes serotonin from tryptophan. As such, PUFA are a major metabolic inhibitor. Combined with the fact that they also promote estrogen and cortisol I am not sure there is another substance that can rival PUFA in terms of metabolism inhibition with the possible exception of ionizing radiation, which mimics PUFA effects on the body remarkably well. So, maybe the next time somebody wants to make an argument in favor of PUFA, try to think of a way to frame radiation in a positive light. If you can give me an argument for radiation, then I will listen to the argument in favor of PUFA.
   
6. Animals depleted in PUFA have uncoupled respiration and their metabolism and their oxygen consumption is about 70% higher than "normal" animals. The same effect was observed with people who got accidentally depleted in PUFA. You may argue for PUFA all you want, but even mainstream medicine wisened up to the fact that uncouplers are a viable treatment of several (maybe all) degenerative diseases. Go to www.clinicaltrials.gov and search for "uncoupler" or "uncoupling" and you will see for yourself. So, if having super fast metabolism is viable treatment for many diseases of old age and maybe aging itself then why on Earth would anybody want to consume a well-known metabolic inhibitor.
   
7. PUFA are immunosuppressive. This is such common knowledge that there are even several established products on the medical market based on a combination of linoleic and linolenic acid that is given IV to organ transplant patients. As far as I know the daily dose is 20g, and even though it is given IV the effects from oral intake are very similar. This should not come as a surprise given how much PUFA boosts cortisol production. Anything that suppresses your immune system chronically is likely to result in cancer in the long run.
   
8. PUFA is one of the main inhibitors of endogenous cholesterol synthesis. In fact, to this day this is one of their main selling point, especially the EPA/DHA kind. Anything that suppresses your cholesterol synthesis increases the risk of cancer. Statins are major carcinogen, not to mention their link to diseases like ALS and other muscular distrophies. If statins and PUFA work similarly on cholesterol and muscle then I am not sure what person in their right mind would want to load up on PUFA given the several class action lawsuits against statins and their connection to ALS, dementia, liver failure, etc.
   
9. PUFA is insanely hepatotoxic. I must have posted at least 10 studies on this one. Saturated fat is so far the only known substance shown to reverse chirrosis in both humans and animals. High dose vitamin K2 (MK-4) and caffeine have similar effects but probably can't fully match effects of saturated fat on fibrotic tissue. Not even acetaminophen comes close to the toxicity of PUFA to things like cytochrome P450 and glutathione reserves.
   

Finally, if you have read enough studies, and especially if you have worked with some sick people to see what got them better and what got them worse, then you should have enough information to decide if you want to deplete PUFA or not.

We all know paracetamol (acetaminophen/Tylenol/Panadol). Synthesised first in 1877 by Johns Hopkins alumni Harmon Morse via the reduction of p-nitrophenol. It wasn't until 10 years after its synthesis, however, that human testing of the drug began. This came at a time where scientists were already heavily researching the possibilities of aniline derivatives, and knew of their potential for analgesia. As a result, paracetamol faced some stiff competition in the market against more established aniline based analgesics, such as phenacetin and antifebrin. Paracetamol did later become slightly more sought after following problems with antifebrin.
Paracetamol was first tentatively introduced to market in combination with phenacetin. Phenacetin was already an extremely popular drug in its own right; playing a big role in Bayer's successes. This combination was short lived, however, as consumers tended more towards phenacetin in isolation or with other constituents. While paracetamol consumption did eventually rise, phenacetin remained popular until the 1970s, when it was found to do some really bad things.
Because of the widespread popularity of anilines and other drugs such as aspirin, paracetamol was often the less preferred of the analgesics. It wouldn't be until the 1950's when it was essentially rediscovered as a metabolite of antifebrin that it would gain the popularity it currently has today.
In 1950, paracetamol hit the US market substantially; being sold as 'Triagesic'; also containing aspirin and caffeine. While this launch was briefly hampered after three consumers were found to have agranulocytosis, this later proved to be unrelated to the drug. Its popularity stemmed from its relative perceived safety, along with its few interactions with other medications. It also came in conjunction with the demise of phenacetin.
As well many of us know; despite its proliferation, paracetamol carries many risks and a tainted modern history. The effects of paracetamol overdose have centred it as the greatest cause of acute liver failure in the developed world by a significant margin. Paracetamol also carries the mark of being one of the most used drugs in attempting suicide by overdose. Its proliferation likely plays a large factor in this. It's almost certain that a majority of people on this sub-reddit working both directly and indirectly in poison control have a plethora of experiences on this matter.
Sadly, I can also attest to having third hand experiences of paracetamol's use in attempted suicide; it was one of the reasons I took so long to get this post out to you all. I debated sharing the story behind this, but decided not to. Instead know that this person is now doing well, and I'll share with you the transcription of a small musical idea I improvised at 01:00am at a donated hospital piano while waiting for news of their health. If anyone wishes to share their experiences more explicitly, please note that I'll be heavily monitoring this post in order to ensure the utmost respect is upheld. I have faith in you all though.
Questions and challenges are constantly being raised over the dangers of its availability, but another factor in its devastation is its use within other opioid medications. Opioid misuse in products containing paracetamol are a key cause of accidental overdoses.
Despite paracetamol being so widely used and available, it's not quite clear how the mechanism of action actually works. It does not act like normal Non-Steroidal Anti Inflammatory Drugs (NSAIDs), but one of its metabolites is thought to act as a reuptake inhibitor on the endocannabinoid neurotransmitter.
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Here's the link to the voting information, but don't click it if you don't want spoilers for next week; it's a tie!
I'm looking forward to hearing everyone's thoughts and discussion on this.
How should we behave and legislate around this drug? What easy steps can be taken to educate people on its dangers? How preventable are overdoses? What should be done about paracetamol use within opioid preparations?
As always; be kind, be respectful, cite your sources, and let me know ASAP VIA DM if I've made any errors and I'll endeavour to correct as soon as possible. It's very late where I am though.
Sorry it took so long,
Solomon x