虫咬，野外植物过敏现象 - bug bites and plant contact allergy

虫咬或被植物蛰了过后，

1. 用水和肥皂洗净
2. 可以考虑用上敷药品 - Astringents, Oatmeal baths (Aveeno), Calamine Lotion，此类产品可以使皮肤舒服一些，止痒，晾干。
3. OTC非处方 hydrocortisone 也可以使用，但效果并没有处方类药品理想。如果情况不严重，不需要用hydrocortisone, 情况严重的话，建议见医生开处方类上敷皮质类固醇。
4. 口服过敏药效果未必理想，应为痒的感觉不完全是由于histamine release. 口服过敏药效果平平
5. 上敷过敏药，麻醉药（止痛药）以及抗生素也不建议，应为会刺激皮肤。

hydrocortisone和其他上敷皮质类固醇需1-2日才能见效，保留此类药为中等-严重蚊虫叮咬现象。

Hypoglycemia

These has been a lot of talk about treating hypoglycemia/low blood sugar,

Remain calm, Suggested treatment include - 15g of simple sugar (glucose or table sugar, etc), use 20g of simple sugar to correct severe hypoglycemia. This is about 3-4 glucose tablets, 5-6 hard candy and 120mL of REGULAR soda.

Suggest retesting 15min after a hypoglycemia episode,

and suggest a small meal after blood sugar has been corrected.

treatment of diarrhea - children

Always rehydrate.

Rehydration solutions are available and if diarrhea is not severe, rehydrate as needed. DO NOT over rehydrate with plain WATER. This may cause eletrolyte imbalance which can be dangerous as well.

Rehydration solution calculation (with rehydration solution)

Home-made rehydration solution - 1 teaspoon (5mL) of salt AND 8 teaspoon of sugar (40mL) in 1 litter of water. DO NOT use pop or certain juice, due to large amount of sugar. 

for mild-moderate dehydration,

50mL/kg over the first 4 hours (NOT ALL TOGETHER in one dose) 

moderate-severe dehydration, (must seek medical attention)

100mL/kg over the first 4 hours

rehydration should continue beyond 4 hours if needed. 

Plain water is harder to absorb than rehydration solution in case of diarrhea and plain water has no eletrolytes to replenish the loss.

Drugs

In case of suspected infectious causes - ex. unsanitized food, house hold, school, work place outbreak. Some drug therapy may not be used.

DO NOT use,

bismuth subsalicylate - Pepto Bismo - contains salicylate, not recommended in children. In addition, efficacy data is not firmly established.

Loperamide, Imodium - not approved to be used in children <2. Must consult physician <12. Risk of mental side effects with Imodium. 

Psyllium, metamucil - can be used with physician's guidance. Do not use products with laxative. 

Attapulgite - not recommended. very weak efficacy data. 

not suggesting adding niacin to statins?

Recent meta-analysis this January, 2013 suggests benefit of adding niacin to existing therapy to further alter lipid levels looking at current data available (11 trials, n=~10000).

The AIM-HIGH (n=3500, established CV disease) showed no benefit for hard end points (ex. first event of the composite of death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for an acute coronary syndrome, or symptom-driven coronary or cerebral revascularization.)



Lavigne PM, Karas RH.The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013 Jan 29;61(4):440-6. doi: 10.1016/j.jacc.2012.10.030. Epub 2012 Dec 19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23265337?dopt=Abstract

The AIM-HIGH Investigators. Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy. N Engl J Med 2011; 365:2255-2267. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa1107579

an interesting article on myth about weight losing

Heard about this all over the media - sex only burns 21 Cal (or kcal) on average?
The original paper looks into different myths regarding weight losing. Part of this article touches on the subject of sexercise. It calculated the amount of energy needed for sex using the average energy expendature per hour times the average length of sex (only 6 minutes! - Bohlen JG, Held JP, Sanderson MO, Patterson RP. Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Arch Intern Med 1984;144:1745-1748) This gives the shocking number 21 Cal per sexual activity!

We might as well spend 20 minutes watching TV, we burn the same amount of energy...

Original source - http://www.nejm.org/doi/full/10.1056/NEJMsa1208051#t=articleDiscussion
published on new england journal of medicine.

Grapefruit & Drugs

It takes as little as 1 grapefruit or 1 cup of grapefruit juice to interact SIGNIFICANTLY with conventional drugs. Spacing apart drugs from eating grapefruit does NOT help the problem in any way. Grapefruit has the ability to inhibit enzyme (CYP3A4) in the gut that is responsible for some of the breakdown of certain drugs. Drugs are designed to take this effect into account. By eating grapefruit juice, you will have MORE (or less depending on which drug) drug in your system causing toxic effects. This effect can last 2-3 days due to permanent inhibition and time delay for production of new enzymes. Always tell your health care professional, esp pharmacist, that you are a grapefruit consumer!

more serious adverse reactions linked to energy drinks

Several new case reports of adverse reactions to energy drinks have been documented including 18 fatalities possibly linked to energy drink consumption. Caffeine content seems to be the cause. Mind the caffeine content and per serving size. (some brand contain multiple small servings per bottle). Stay within the daily limits.