Saturday, February 28, 2015

Study group discussion: Hyperuricemia

Why does pyrazinamide cause hyperuricemia?

I guess it competes with uric acid for excretion because it is a weak acid.

Ohh.. Didn't know this.

There's an interesting concept I heard learnt while studying the uric acid thingy - Why does alcohol ingestion have attacks of gout? Anyone wants to guess?

Consumption of alcohol produces gout because when alcohol is coverted to acetaldehyde, NAD is converted to NADH. More NADH causes conversion of pyruvic acid to lactic acid. Lactate is not metabolised and excreted to kidney... Increased lactic acid excreation causes decreased uric acid excretion and hence gout occurs.

Alcohol produces lactic acid which competes with uric acid.
Loop and thiazide diuretics also cause hyperuricemia through this mechanism.

Correct! We have a brilliant mind in the group! B)

A random review question from top of my head since its the topic of uric acid: Which ARB drug is a uricosuric?

Angiotensin receptor blocker, right?

Losartan.

Yup.

Low dose aspirin also competes with uric acid. High dose aspirin uricosuric by inhibiting absorption.

Wow..nice info!

Any condition causing inorganic phosphate depletion also causes hyperuricemia.

Why does phosphate depletion cause hyperuricemia though?

Hypophosphatemia leads to accumulation of AMP which is then converted into uric acid. Galactosemia fructose intolerance cause hyperurecemia through this mechanism.

Amazing concept!

I feel so jealous if you.. Biochemistry is like my biggest threat!

Updated later:
Recently, we had a discussion on hyperuricemia caused by diuretics. It was mentioned it is due to the resultant acidosis that causes hyperuricemia. I read something on those lines. Diuretics do cause acidosis cause of slight CA ase inhibitory action on the PT. Thus acidosis even caused is not very marked. They cause hyperuricemia primarily by competiting with uric acid to get secreted via the organic anion transporter in the PT. Plus as the E.C.F volume is depleted due to diuretics, there is also increased absorption of the secreted uric acid. That's what I read.

Study group discussion: 45 centimetres in length and tubes

What are structures in our body about 45 cms in length?

That's an odd question. As in why do we need to know / significance?

Just to remember! Examiner here asked us in viva.

The spinal cord, Umbilical cord, Femur, Thoracic duct.

I know the esophagus is 25 cm in length. And the length from the incisor is longer. Were you given a nasogastric tube in your viva?

No.

Nasogastric tube 104 cm I guess..?

Varies 105 cms or 75 cms Ryle's.

This is gonna sound really basic but umm.. Can anyone explain the difference between an infant feeding tube, nasogastric tube and a Ryles tube?

Ryles tube is nothing but nasogastric tube.. Used for both diagnostic and therapeutic purposes.

Ohh.. I thought nasogastric and Ryle's are different.

In infant feeding tube there are no lead shots like in Ryle's tube.. And it's 52 cm in length.

Infant tube is narrow.

Infant feeding tube is used in: Tracheoesophageal fistula
Choanal atresia
Imperforate anus
Poisoning
Upper GI bleed

Thanks!

Friday, February 27, 2015

Study group discussion: Cool fact about optic nerve

I just came to know that the optic nerve is not a true nerve! It's just the extension of diencephalon..

That's the reason, in devic's disease (neuromyelitis optica) the optic nerves are involved since they are a part of central nervous system!

Wow o.O

That's why, Optic nerve is involved in multiple sclerosis too! It's the only myelinated nerve, part of the cns!

Yup. Also since it contains the same cover of meninges.. In cases of raised ICT, you see papilloedema.

Study group discussion: Leriche syndrome

What is Leriche syndrome?

Claudication. Thrombosis of iliac veins in males, especially, in heavy smokers.

It's an Aortoiliac occlusive disease, a form of peripheral artery disease involving bifurcation of  abdominal aorta.

Triad seen in males as impotence, claudication, decreased or absent femoral pulse!

It's due to Atherosclerosis. Obesity, diabetes, smoking, age are risk factors.

Patients getting treated should be checked for CNS, CVS, 1st for any thrombosis and then go for the treatment of leg.

Doppler and USG is used to diagnose it.

Yup. Also Angiography, CT or MRI.

Study group discussion: What does emulsification mean in fat digestion

What does term emulsify mean in fat digestion?

Breakage of large fat globules into small ones by bile is called emulsification of fat.

Making the fat to be smaller particles, helps it mix in with the water. Eg. Milk is an emulsion of fat and water.

Yes.. just to make it easier to be digested and absorbed.

Like fat broken down into glycerol and fatty acid? Am I right?

Not really fat into glycerol and fatty acid. More to fat droplets mixing with bile. It increases the surface area to volume ratio.

More surface area : more sites for lipase to bind and digest

Thank you, guys!

Study group discussion: Neurological emergencies and isoniazid overdose

Tell me some neurological emergencies!

Status Epilepticus, Stroke, Guillain Barre syndrome syndrome, Myasthenia gravis, Neuroleptic malignant syndrome, spinal cord compression, subarachnoid hemorrhage!

Okay!

But why Guillain-Barré syndrome?

Respiratory paralysis. That's the reason they die, I guess.

Yep. Respiratory paralysis is the cause of death.

The same reason, respiratory paralysis, for myasthenia too?

Yep.

I read about one more - Overdose of isoniazid. That can be fatal too.

Isoniazid overdose depletes vitamin B6 in the brain. And B6 is a cofactor for the enzyme that convertes glutamate to GABA.
That causes decrease in the inhibitory neurotransmitter, GABA. That's why, the acute manifestation is seizures.

Commonly seen in rural areas because patients with TB neglect doses and consume all of them together.

Didn't know about this. We'll educate our patients better in the future! Thanks!

Study group discussion: Lemierre's syndrome

What can you folks tell me about lemierre's syndrome?

Caused by fusobacterium necrophilus.. Initial presentation is like Streptococcus pharyngitis but ASLO negative.

And rapidly transforms into complication - Intravascular clots, etc.
Metronidazole and high dose penicillin used for treatment. Not very common, I think.

Interesting.

Clots in the internal jugular vein.. is fibrynolitic therapy indicated?

Dunno.

It seems that the clot dissolves itself when the infection heals, so only antibiotic therapy is indicated.

Okay!

Study group discussion: Heyde's syndrome

66 year old male, painless bright red blood per rectum started this morning. Has pansystolic murmur in right 2nd intercostal space. What is the cause of bleeding?

Right side 2nd ICS, so it's aortic stenosis. Now the patient has bleeding. How do we put together AS with bleeding?

*after putting all sorts of differentials for bleeding per rectum, we finally gave up and asked for hints!*

Okie, hint.  It's a vascular malformation.

Angiodysplasia! What's the association but?

Heyde's syndrome - Aortic valve stenosis with GI bleeding.

Elderly people have AD due to age and strain but bleeding from it associated with AS is Hyde's syndrome!

Meaning normal people have less chances compared to the ones with aortic stenosis?
That explains it.

Wow! Didn't know this. Nice, thanks people!

Study group discussion: Fontanelles and thyroid hormone

Guys, remember we were talking about craniosynotosis? I think it was Pfeiffer syndrome we were talking about. So I found out about another condition that causes craniosynotosis in the new born which is acquired and can be prevented. Anyone wants to guess?

Is it due to some drug?

No. It's a hormonal imbalance!

Due to thyroid hormone?

Hyperthyroidism!

Correct!

Yaaay.

Hyperthyroidism in pregnancy can cause craniosynotosis in the neonate!

Oh oh.. Vice versa, what happens in hypothyroidism?

Macrocephaly? Mental retardation?

Umm yes. But delayed closure of fontanelles is what I was looking for!

Oh right.

Speaking of fontanelles.. Which condition causing bulging fontanelles and which conditions cause depression of fontanelles?

Hydrocephlus - Bulging.

Bulging Fontanelles in increased intracranial tension. Depressed in dehydration.

Correct!

When does the posterior fontanelle close?

At birth. Or right before birth or right after!

When does the anterior fontanelle close?

Anterior fontanelle 15-18 months.

Correcto!

It's fun when you know the answers :D

Haha true that!

Study group discussion: Varicocele

Some questions regarding varicocele. So what is varicocele?

The increase of the testicular venous pampiniform plexus. Gives the characteristic bag of worms appearance.

Yes! So there is dilatation of this pampiniform plexus!

If it occurs suddenly on the right side. It as an indicative sign of right renal cancer.

Why is left sided varicocele  more common than right?

Left side enters at right angle!

And I am confused.. Which testicular vein drains where?

Right goes in IVC, left in renal. So that's why left is more common
Mnemonic! http://medicowesome.blogspot.ae/2014/03/left-testicular-vein-drains-into.html

What to suspect when you see right sided varicocele which are not common though?

Obstruction of IVC

Brilliant!!!

The right spermatic vein drains at more obtuse angle to IVC. So more likely some obstruction in IVC.

*a debate went on whether varicocele cause sexual dysfunction, sterility, infertility or not. The one who posts the link to the research paper, typically wins*

*Key questions raised* What is the function of this plexus? What would happens if patient is not treated? The pampiniform plexus forms a counter current system with testicular arteries. Hence. Maintaining a low temperature. They take away the heat from the arteries. So azoospermia? The sperms won't survive in the increased temperature? Does the erectile dysfunction occurs in varicocele?

*Conclusion* Varicocele (grade 3) is associated with significant reduction in testicular function with significant increase in serum levels of FSH and LH, which may cause erectile dysfunction and male infertility.
Source: http://www.ncbi.nlm.nih.gov/pubmed/11111867

Study group discussion: Ligamentum venosum and ligamentum arteriosum

Can someone explain the formation of ligamentum venosum to me? I read up on it and re-listened to the lecture but I feel like I'm confusing myself :(

The formation or why it's there?

The origin.. As in what it is a remnant of and how?

It's the remnant of the ductus venosum which shunts blood away from the developing liver to go directly into the inferior vena cava. Since the developing liver doesn't need a huge amount of blood supply.

Oh...That makes sense.

Yup. So the umbilical veins brings nutrients and oxygen from the placenta, so we need to bypass the liver via the ductus venosus. Then when we are back in the Right ventricle, we don't need much blood into the lungs so we shunt it into the main circulation via ductus arteriosus.

Which later turns into ligamentum arteriosum! :D
Now everything is in place! Thank you so much!

No problem :)

Study group discussion: Parasites that cause carcinoma of the gall bladder

Which parasites are associated with gall bladder cancer?

Chronic schistosoma is associated with bladder cancer.

Flukes!

Fasciola!

Clonorchis sinensis.
Fasciola hepatica too.

Roundworms block the the CBD.

CBD?

Common bile duct.

But that'll be associated with jaundice. Not carcinoma!

Study group discussion: Hernia

What is Richter's, Littres, pantaloon hernia?

Ritchers is the one when part of circumference of intestine is involved, right?

Yup.

How do you remember this? Any mnemonic?

You can remember richters hernia as it has C-part of Circumference of bowel.

Pantaloon is when there is indirect plus direct hernia so two sacs are there.

In Littres, I think the meckels diverticulum is a part of the sac.

Which is the commonest type of hernia in females?

Inscional hernia is commonest in females.

Aren't femoral common in females?

The most common in females in indirect inguinal. But I guess you want to ask about femoral. Femoral hernia are overall commonest in females. But they are not the most common type in females.

Because of wider pelvis.

Thanks! Got it.

Some days back I had asked about the name of hernia that includes appendix.
Finally, got its name :D
It's amyand hernia,

Study group discussion: Pfeiffer disease and Pfeiffer syndrome

What's Pfeiffer disease and Pfeiffer syndrome?

Pfeiffer disease - Glandular fever -Infectious mononucleosis - Kissing disease.

Pfeiffer syndrome is craniosynostosis with hearing loss, a genetic disorder.

Craniosynotosis?
Early fusion of premature bones.

What type of craniosynotosis? There are several types!

Sutures fused and no place for growth of brain. Accordingly you get different shapes of skull - Coronal, cloverleaf shape or a boat shaped skull.

Type 1 is classic, with no neurological impairment.
Type 2 is clover leaf shaped head and retardation of growth with neurological impairment.
There's type 3 too.

Why do you have such an extensive knowledge on this rare syndrome?

Actually, there was an infant girl with craniosynostosis.
Her mother complained that she used to regurgitate the milk after each feed. (This was probably because of the raised ICT.)
The doctor's had to operate - Break the fused bones to provide space for the brain to grow.

Breaking up bones for the brain to grow, now that's something awesome!

Wow.

She's safe now (:

Study group discussiont: Acute lymphangitis

This patient presented with rapidly progressive left arm pain and erythema. Physical examination revealed a small blister on his left third finger, which had been injured during a lacrosse game, with surrounding warmth, tenderness, erythema, and linear streaking to the elbow. diagnosis?

*a picture of acute lymphangitis was posted in the group, I can not upload it here because of copyright purposes*

Is it a lymphangitis?

Yes! acute lymphangitis!

Nice! Any further details regarding lymphangitis?

About lymphangitis.. It's inflammation of the lymphatics.

The most common cause of lymphangitis is streptococcal infection. The shape of the lesion is very caracteristic since it follows the lymphatic vessel path.

Thanks for the further information!

Or a sporothrix infection. Though the history doesn't suggest anything like it.

What history should the guy have to suggest a sporothrix infection?

The fungus can enter the skin through small cuts or punctures from thorns, barbs, pine needles, or wires. In rare cases, inhalation of the fungus can cause pulmonary infection.

Correct! Rose gardeners especially.

Thank you, IkaN, you are the best!

Haha. It's okay.

Study group discussion: Uncouplers of oxidative phosphorylation

In electron transport chain, cyanide inhibits the last step.

Even dicoumarol is an uncoupler.

There was another drug used for weight loss that's an uncoupler.. Which one was that?

Dinitrophenol?

Yes!

Review question: What do new borns have that is an uncoupler? Why is it important?

UCP 1

Brown fat

I had to Google UCP 1. The answer I was expecting was simple brown fat :P
For those who don't know, UCP 1 or thermogenin is uncoupling protein 1 present in brown fat.

UCP-1 (Thermogenin) - Non shivering thermogenesis in brown fat in

I think, these UCP play great role when polar bear comes out from hibernation and also in human infant.

Yes, the polar bear!

Speaking of bears - What will happen to you if you eat a polar bear's liver?

Vitamin A toxicity?

Yes! Vitamin A toxicity! Mostly, increased intracranial pressure.

Why given term thermogenin?

Generate heat. Uncouplers dont generate ATP.

Ya, ATP formation replace by heat releasing process.

Aspirin high dose also acts as an uncoupler. Hence, we get hyperthermia in it.

This is interesting because aspirin is used as an antipyretic and it's overdose, paradoxically, causes fever.

Yup.

What is an uncoupler?

Uncoupling protein also called ucp, cause leakage of proton from mitochondrial membrane.
This allows the proton to reenter the mitochondrial matrix without capturing ATP.
Uncoupler = Uncouples oxidation (ETC) from phosphorylation ie oxidation without phosphorylation.
So energy indtead of being trapped in ATP is displaced as HEAT (NON SHIVERING THERMOGENESIS)

Physiological uncouplers:
# UCP 1 thermogenin
# excess thyroxine
# unconjugated hyperbilirubinemia

Synthetic uncouplers:
# dicumorol (vit K analogues)
# asprin
# calcium
# valinomycin

Thanks!

Awesome!

A nice summary!

Study group discussion: To vaccinate or not to vaccinate

Something about influenza vaccine!
So 6yrs old child comes for influenza vaccine! Allergic to egg! Develops rash with the eggs! Will you give him the vaccine or not?

Why yes or why no?

Yes. Because the new ones are not produced in eggs, right?
They're subunit/recombinant/ts vaccines.

If it's an egg based vaccine, you can give a test dose and check keeping adrenaline ready.

My friend had allergy to egg. Last year when we went to take influenza vaccine, she wasn't given it.

Because it's not an important vaccine / you can do without it?

She has stomach pain on eating eggs..No rash or anything.

Yes, it's a controversial issue! Though earlier their used to be strict contraindication to egg allergy. But with the egg allergy with rash, they say it's ok to administer with an observation period of 30 minutes after the vaccine is given.
On the other hand if patient had anaphylaxis reaction then the vaccine can still be administed but under the consultation of the specialist in the allergies.
There is difference in the usage of live vs inactivated vaccine!
Egg allergic are given the inactivated one!
I found two papers let me send the links here
http://www.ncbi.nlm.nih.gov/m/pubmed/23805959/
http://www.ncbi.nlm.nih.gov/m/pubmed/23176882/

So you can give it (:

How about MMR vaccine should that be given in Egg allergy?

If you can flu, you can obviously give MMR. Plus, measles is a severe disease so I think yes.

Yes, it is not a contraindication. Very low risk for anaphylaxis as these contain only small amount of egg cross reacting proteins!! These two are the ones commonly tested.

The quantity of egg protein in a dose of MMR vaccine is approximately 40 picograms (much lower than in influenza vaccine, which contains approximately 0.02-1.0 micrograms), and this is believed to be associated with a much lower risk.
Source: Wiki

What vaccine can have an inconsolable screaming reaction to it? (>3hours)

DPT ... Due to the pertussis component.

Aha. Okay.

I have another vaccine related review question!
If a child develops convulsions after receiving his DPT shot, what will you do? Will you give him the next shot?

I would say no! Anaphylaxis as well as encephalopathy are contraindications to the next shot?

This is a trick question - The convulsions occur due to the pertussis component of the vaccine.
So you will give the vaccine, but you'll give acellular pertussis instead or just give DT in the next dose.
They are life threatening diseases and it's important that the kids get vaccinated.

Ohhh!!!!

Was my viva question! (Also one of the rare instances when I knew the answer :P )

Study group discussion: Chagas disease

What comes to your mind when you hear of left ventricular apical aneurysm?

Two apical impulse.

Hint: Protozoa.

Chagas disease.

Brilliant!

Chagas disease causes destruction of the neural crest cells, right?
I know it causes Hirschprung disease. But how come apical aneurysm?

I think some parts of the heart are also formed from the neural crest cells.

The aorticopulmonary septum!

Chagas disease is associated with dilated cardiomyopathy.

I've heard of that.

Related fact: Chagas also causes achalasia.

Thursday, February 26, 2015

Study group discussion: How and when do children understand the concept of death

A six year old boy with neuroblastoma has a recurrence of the tumor despite aggressive treatment. The doctor discusses the patient prognosis with his parents and recommends palliative care. Parents ask how they should tell son the prognosis and possible death. Doctor advises parents to be honest and follow patients lead. Patient most likely has which understanding of death?

1- Being asleep
2- Being final
3- Being in a long journey
4- Being temporarily separated from parents
5- No understanding of death.

3 year olds think it's temporary separation. They keep asking whether their pets will come back.

At 6 years of age the child begins to understand that death is final and fears that his or her parents will die and leave.

It is not until about age 9, however, that the child understands that he or she also can die.

Since the child was diagnosed with neuroblastoma, he will be able to understand that death is final, but will be unable to understand his possibility of death.

The answer is 2. Death is final.

Additional info about normal child development discussed by an awesomite mother:

My 6 year old doesn't understand death much. 8 year old gets it.

6 year old knows, in the abstract, what death is, because we've had a dog die. But he never showed true grief in the understanding of it, asked where you go when one does, etc.

My daughter is 8.5 and is now questioning the afterlife. She's asking questions regarding what happens, really wanting to know, etc.

Hope that helps! 

Study group discussion: Alcohol and sex

This my viva question.. The boldest I have come across. The external asked me how does alcohol affect one's sexual performance. I went through 50 shades of red within a minute!

Haha. I think it decreases sexual performance.. As in erection. I'm not sure though. Heard it somewhere.

I said, it increases the desire but decreases the performance.
He quoted a line by Shakespeare then!

Alcohol causes loss of libido.

Sexual dysfunction in the alcoholic may be due to the depressant effect of alcohol itself, alcohol-related disease or due to a multitude of psychological forces related to the alcohol use. The spectrum of sexual dysfunction encompasses:
Decreased sexual desire—persistent or recurrent deficiency or absence of desire for sexual activity giving rise to marked distress and interpersonal difficulty;
Sexual aversion disorder—persistent or recurrent aversion and avoidance of all genital sexual contact leading to marked distress and interpersonal difficulty;
Difficulty in erection—recurrent or persistent, partial or complete failure to attain or maintain an erection until the completion of the sex act;
Difficulty in achieving orgasm—persistent or recurrent delay in or absence of orgasm, following a normal sexual excitement phase;
Premature ejaculation—persistent or recurrent ejaculation with minimal sexual stimulation, before, on or shortly after penetration and before the person wishes it, which causes marked distress.

Alcohol abuse is the leading cause of impotence and other disturbances in sexual dysfunction.

Thanks!

Study group discussion: Chain messages

There was a chain message being circulated on Whatsapp which started our discussion. The discussion gave me a new perspective on things.

I never read chain messages because I find them stupid. But one awesomite pointed out on how we must be aware of chain messages, since as a doctor, we'd undoubtedly run into patients who've read things like that and we should be able to talk to them about those things.

Also, tell us about stuff you've read on the internet that had no proved scientific basis, incidents of people who have believed such messages and outcomes associated with them. I'm interested and open to these things now as I feel there is value in knowing them.

I'm posting the discussion we had here for ya'll to read -

This was the "Prevent Swine Flu" message forwarded on our study group:
1. Frequent hand-washing (well highlighted in all official communications).
2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).
3. * Gargle twice a day with warm salt water (use Listerine if you don't trust salt).
* H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.
4. Similar to 3 above, * clean your nostrils at least once every day with warm salt water.
* Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but * blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.
5. * Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits).
* If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.
6. * Drink as much of warm liquids (tea, coffee, etc) as you can.
* Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

Is this actually good medical advice (Except for the sensationalist language...)?
1 and 2 definitely sound like good advice, but 6 sounds a little bit questionable to me.

Forwards always sound questionable to me! I've never heard about "Drinking warm liquids to prevent viral proliferation" though.. I'll look it up!

I tried Googling all sorts of stuff for the warm tea bit and found nothing on the 6th point.
Then finally, I Googled, "Reverse Gargling" and the forward created by the same guy comes up! There is no such thing!

It seems like a publicity move by the doctor who wrote it. (Why would any one list the names of hospitals they visit in an educational advice?!)

I'm interested in understanding the yoga for nasal cleansing!?

You can Google for videos. And do not try unless you are confident enough that you can do it. Sometimes the water goes in the wrong pipe!

I didn't mean interested as in wanting to try it :P
I'm from Britain so these sort of techniques are rare to say the least.

Yoga for nasal cleaning is simply putting water in one nostril and getting it out through other nostril. Simply irrigation and drainage.

Nasal yoga reminds me of Neti pots. Anyone wants to weigh the scientific evidence of that?

I wouldn't really trust this advice. I speak this from personal experience. Some guy who used to believe in these things told my grandpa to do some of these practices. He told my granddad to basically eat upwards of 6 lemons a day and also convinced him that the lemons would reverse effects of hypertension and diabetes. It didn't work, my grandpa passed away. I know this isn't relevant to the group, but I'm always wary of advice such as this.

That sounds so much like bad advice...  Everything in moderation. Six lemons a day is not moderation. Also, lemons have so much sugar in them, wouldn't that exacerbate the diabetes?

It's so sad that people believe such things and over do it causing more harm than good.

I didn't read after I looked at the last line - "Forward this to everyone and 20 might live cause of this." :/
It's when you guys got it to my attention that I actually read the whole thing!

I'm pretty wary of any kind of chain email advice. I think there's value in discussing them and critically analyzing them from a more scientific point of view, though. Especially since as a doctor you'd undoubtedly run into patients who've read things like that, and you'd need to be able to talk to them about those things.

I agree with that!

I once read of a case where a young girl was told to rub almonds on her face to clear acne, but her "acne" just kept getting worse. Turned out she was allergic to almonds.

Our residents had a discussion on how each and every relative was asking about Ebola because of the forwards they were receiving!

My aunt is very into chain emails.   I usually try to find time to point out all the scientific inaccuracies in them.

I don't trust anything.. Except soup for cold and honey for soothing the throat!

Soup works wonders!

See some things do no harm, like old wives tales of rubbing a potato on warts then burying the potato... But others are strange and potentially harmful.

There is some good science in some of these chain emails. But there is so much bad science.
Like the one that recommended aspirin to prevent heart attacks.   I mean, yes, it can certainly help, but it can also kill you if you have certain health conditions or if you try to overdo it.   Eating as much aspirin as you possibly can is also very much a bad idea.

The one I enjoyed most was the one that said cancer cells can't grow in alkaline environments so people should eat alkaline foods! I worked in a cancer research lab.  We grew cancer cells in alkaline medium!

Hahaha! This one is hilarious.

I was about to ask for hilarious incidents and here we have one!

Hahahaha my mum believed the alkaline treatment for cancer and my expression was basically: T_T
But there seems to be substantial information on alkaline treatments for cancer. Apparently, it's all over Google.

My aunt and mother believed it too.   But then I told them about the fact that we cultured cancer in alkaline medium with great success and they decided to believe me instead.

So umm what's alkaline food anyway?

Fruits are the main source of alkali in our diet. - Ganong

I tried looking up alkaline foods...  Orange was listed as one of them...

All I can think of is.. Food that alkalinizes urine. Cause citrus fruits do that!

Ah, that makes sense!

Hmm. I wonder if perhaps the foods that alkalinize urine can prevent cancer.  I doubt that causing the body to be more alkaline (Can that even be done?) would help with cancer, but perhaps the thing that makes foods alkalinize urine, or something else those foods have in common, also helps with cancer.

The only benefit alkalinizing foods can offer is prevention of kidney stones and maybe overdose of a few drugs, scientifically.

But then surely we would circulate "Food that contains this compound..." Rather than food that alkalised. If there was a common anticancer property that wasn't anything to do with alkaline food.

Hmm...  I'm disinclined to believe that The importance of knowing chain messages in modern Medicine it has any genuine anticancer properties, but I'm equally disinclined to reject the possibility.  I would like to see scientific evidence before forming an opinion either way. Medical research is constantly happening.  Just because we haven't discovered something doesn't mean it doesn't have merit.

I think the creator of the chain message (Considering he considered anything!) wanted to highlight that we should consume fruits to prevent colon cancer - so they used words like alkaline and stuff to make it all science-y and legit to the lay man?

That makes some sense, although I don't know why on earth they couldn't just use legitimate science.   It's possible to use fancy science words to make even basic science seem legitimate to people.   Especially with medicine where all the parts of the body can be expressed in fancy Latin.

But it spooks the lay-man into overdoing it. It's potentially harmful.

I agree so much. That's a very genuine concern. Even too much water can kill you, and I think that's a thing people fail to appreciate.

Yes, but in a perfectly healthy individual - Fruits would do no harm.

I must say, it's those who are affected by chronic diseases are more inclined to believe "Anything that could be of potential help" to them in curing their sickness.

*We discussed water intoxication syndrome. Since it's irrelevant to this post, I wrote a separate blog post on it here --> *

Woah. There are always some messages circulating on whatsapp regarding some wonder drug with a 100% guarantee.

My father gets influenced too. Due to some video.. I spent 15 mins explaining that white bread is bad for health and brown bread is good.

But but...Aren't the benefits of fiber well known?

White bread is simple nonsense.. It's bad for your intestines.. Plus no real nutrient benefit. It is refined wheat.. So there is hardly and fibre property to it.

How is it bad for the intestines?

I had come across a patient who had an intestinal onstruction. She was denied eating white bread. It reduces bowel movements.

“The Whiter The Bread, The Sooner
You’re Dead.” I've heard the phrase somewhere!

Exactly.

Wow. Seriously.

Whole wheat is all good. Except in patients suffering from celiac disease..I haven't come across any other condition where they shouldn't be eaten.

Gluten freeee.

Yup.

My mother was convinced that she should go on a gluten free, casein free diet even though she isn't diagnosed with celiac disease or anything like that. Someone told her that going GF, CF was good for everyone regardless of medical history.

It's not a bad idea per se, but I reckon patients who are not trained or well informed about nutritional science are at higher risks of deficiencies especially if they restrict their food choices. I think as physicians we should inform them of the possible risks and still provide them the autonomy and explain how to alter their diet to prevent deficiencies. Like vegetarians basically.

I guess I minded more that she wanted me to go on a GF CF diet and I enjoy too many gluten and casein containing foods for that to make sense for me.

Lol. Well I feel the same way. But we shud be realistic about the risks and not overexaggerate the dangers of gluten free diet because then the Coeliac's society might be affected as well.

But vaccines on the other hand, I'm sorry but we need to jab everyone possible because it's a public health issue.

Yes. Vaccines causing autism is utter bull. People are forgetting how bad the vaccine preventable diseases are (Since they don't see them anymore, thanks to the vaccines) and are being ignorant!