@keka Patient autonomy, end-of-life discussions and advanced care planning should play a role in the decision whether to operate or not in this selected group of patients

@patralekha The prototype study, a randomized controlled trial called TRUST, as reported by Medscape in 2017, looked at the effect of using levothyroxine to normalize a minimally elevated TSH among a geriatric cohort of about 700 participants. The study found no symptomatic benefit, primarily on quality-of-life measures. A further subgroup analysis of participants who had assessments of depression pre- and post treatment focused more specifically on whether mild depression could be alleviated with TSH correction with levothyroxine. Use of antidepressants was not an exclusion criterion. No effect was found on depression scores, using two different scales depending on the geographic location of the participants.

Hungry mosquitoes use several cues to target who they bite and are particularly drawn to the color red, according to researchers at the University of Washington. There are four cues that attract mosquitoes to humans: your breath, your sweat, the temperature of your skin, and the color red. When a mosquito smells specific compounds like CO2 from our breath, their eyes react and seek out specific colors that can help them target a potential host to feed on. The common mosquito species Aedes aegypti ignores colors such as green, purple, blue and white, but targets red, orange, black, or cyan. Human skin, regardless of overall pigmentation, gives off a long wavelength of light that sends a red-orange "signal" to a mosquitoes eyes.

@deepankar For decades, clinicians used a two-step screening approach: a nonfasting 1-hour glucose challenge test and a longer 3-hour fasting oral glucose tolerance test to diagnose GDM; roughly 20% who test positive on this glucose challenge test require the second step. Results of a large study led to new diagnostic criteria on a one-step 75-g oral glucose tolerance test (Diabetes. 2009;58[2]:453-9). The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study "found a linear relationship with hyperglycemia and outcomes – the higher the glucose, the worse the outcomes," said Teresa Hillier, MD, MS, an endocrinologist and investigator with Kaiser Permanente Center for Health Research Northwest and CHR-Hawaii. The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) made a clinical recommendation on the one-step approach, now a common screening tool in the United States.

@manami Hypo-osmolality (serum osmolality < 280 mOsm/kg) always indicates excess total body water relative to body solutes or excess water relative to solute in the extracellular fluid (ECF), as water moves freely between the intracellular and the extracellular compartments. This imbalance can be due to solute depletion, solute dilution, or a combination of both.

Under normal conditions, renal handling of water is sufficient to excrete as much as 15-20 L of free water per day. Further, the body's response to a decreased osmolality is decreased thirst. Thus, hyponatremia can occur only when some condition impairs normal free water excretion. [Generally, hyponatremia is of clinical significance only when it reflects a drop in the serum osmolality (ie, hypotonic hyponatremia), which is measured directly via osmometry or is calculated as 2(Na) mEq/L + serum glucose (mg/dL)/18 + BUN (mg/dL)/2.8. Note that urea is not an effective osmole, so when the urea levels are very high, the measured osmolality should be corrected for the contribution of urea.

Chronic mucocutaneous candidiasis (CMC) refers to a heterogeneous group of disorders characterized by recurrent or persistent superficial infections of the skin, mucous membranes, and nails with Candida organisms, usually Candida albicans. These disorders are confined to the cutaneous surface, with little propensity for systemic dissemination. CMC does not represent a specific disease, but rather a phenotypic presentation of a spectrum of immunologic, endocrinologic, and autoimmune disorders. The unifying feature of these heterogeneous disorders is impaired cell-mediated immunity against Candida species.

@sumana If you feel sick after eating full-fat coconut milk or snacking on fresh coconut meat, that could be because the high fat content in coconuts is upsetting your stomach. You could also have fructose intolerance, gallbladder issues or irritable bowel syndrome. Coconut milk is typically available in two different forms. There's canned coconut milk, intended for cooking, and refrigerated coconut milk, used as a beverage. Coconut beverages are increasingly popular as a tree-nut-free vegan alternative to dairy milk. You can use whipped coconut cream as a vegan dessert topping. Additives in refrigerated coconut milk may affect your digestive system due to thickening and gelling agents that can cause gas, bloating and diarrhea. Sugar alcohols like sorbitol, mannitol, lactitol, isomalt and maltitol, used for sweetening, can cause bloating and diarrhea

Hello, my friend is a vegetarian. She does drink milk. Recently she has been diagnosed with lack of calcium. Consequently, she is suffering from joint pains also. Does milk intake replenish the calcium demand of body?

@dhara There’s no one treatment for yellow nail syndrome. Treatment addresses specific symptoms of the condition and may include: topical or oral vitamin E for nail discoloration
corticosteroids
oral zinc
antifungal medications
antibiotics in the case of bacterial sinusitis, lung infections, or excess mucus production
diuretics, which remove excess fluid
tube thoracostomy, a procedure to drain fluid from the pleural space.
If yellow nail syndrome occurs with an associated disease like cancer, arthritis, or AIDS, symptoms may improve after treating the underlying disease. To treat lymphedema-distichiasis syndrome, your doctor may recommend manual lymph drainage, which is a specialized massage technique to improve circulation and reduce puffiness. You can also reduce lymphedema at home by wearing elastic compression garments. Compression encourages better lymph flow through your lymphatic vessels.

Hello, a 54-year-old postmenopausal woman is having a very painful left breast ulcer of 2 weeks' duration. The ulcer started as a small boil with yellow discharge and then increased gradually in size. She has no history of recent gastrointestinal or other systemic symptoms and had not previously undergone any surgery or biopsy of her left breast. How to treat breast ulcer?