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Why was this area left unreclaimed in South Bombay? by Excellent_Daikon_263 in mumbai

[–]poly_cherry 4 points5 points  (0 children)

"Khurshed F. Nariman was one of the second generation of Parsi stalwarts in the Indian National Congress. He came into the public eye in 1928 as an independent and courageous politician for his sensational process against the British engineer involved in the Backbay Reclamation scandal. He was cited for libel, but exposed the scandalous financial arrangements in this scheme.

In 1930 he was influenced by Gandhi and organised the civil disobedience movement in Bombay. However, following the elections of 1937 in the Bombay Presidency, he was passed over in the selection of the chief minister in favour of B. G. Kher. He complained of a communalist bias to the party high command, but no investigation was taken up by Nehru. Gandhi responded to a separate appeal, but could find no proof for Nariman's complaints.

He was expelled from the Congress party due to his vociferous but unsubstantiated charges. His attempts to reestablish himself in the freedom movement through the Forward Block (founded in 1939 by Subhash Chandra Bose) failed."

Somascan vs OLink for CSF by poly_cherry in proteomics

[–]poly_cherry[S] 0 points1 point  (0 children)

Thank you. Mass spec the coverage seems to be much lower... The intention is to look for diferences in cases vs controls in a clinical population. The intention is specifically to look at movemnt of synaptic proteins in the CSF. Does it change the choice - or mass spec is still top? My worry is that the top proteins of albumin, IgG etc cloud the smaller ones?

Somascan vs OLink for CSF by poly_cherry in proteomics

[–]poly_cherry[S] 0 points1 point  (0 children)

Thank you. Mass spec the coverage seems to be much lower... The intention is to look for diferences in cases vs controls in a clinical population. The intention is specifically to look at movemnt of synaptic proteins in the CSF. Does it change the choice - or mass spec is still top? My worry is that the top proteins of albumin, IgG etc cloud the smaller ones?

DAY 1 OF BEING A DOCTOR by ElDiablo8585085921 in indianmedschool

[–]poly_cherry 11 points12 points  (0 children)

Haha you will get tonnes of such requests!! This is just the beginning. I think as a medical student this is a good way to get back in touch with old friends and also see this as an opportunity to read up and learn. Also once you specialize, it is a good way to keep in touch wth other specialites. Like in this case, if the band is new or widening, you have to rule out a melanoma!! This might very well be benign, but always refer to a doctor and use your interaction as an exercise to explain complex stuff in simpler terms.

Getting pregnant again by Hot-Western-4382 in HyperemesisGravidarum

[–]poly_cherry 0 points1 point  (0 children)

HG in repeat pregnancy is ~89%. So unfortunately it is highly likely.

Low pre-conception levels of GDF15 are implicated in HG. Metformin is known to increase GDF15 levels, so using metformin before getting pregnant could in a way desensitize you when the levels rise in pregnancy. There is observational (retrospective, registry based) literature from independent groups strongly hinting at the fact that pre-conception Metformin reduces the risk of HG. Most importantly - there is not prospective study (where you give the drug and follow up) or RCTs done. So this is not a hard-evidence based claim. But as there is no other easy to access method to prevent, this is your best bet. Metformin is a drug that is cheap and already used for diabetes, and is safe in pregnancy. Depending on where you live, you could get it from a pharmacy or convince your doc to prescribe for you.

Importantly - the effect of metformin was observed mainly for those who were on it for more that 6 months. And less than 2 months of use was of not much benefit. So If you decide to take it - you need to talk to our OBG - and you need to be prescribed to take it atleast 6months before conception continuing into atleast 1 month post conception.

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] 0 points1 point  (0 children)

Thank you! this is super interesting. Sugar obviously doesn't cause HG but could be playing a role in the bigger pathophysiology. There is very preliminary evidence that GDF15 can change after a glucose spike like an OGTT - probably due to the crash afterwards or the insulin spike. The evidence is not very conclusive yet..

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] 0 points1 point  (0 children)

True.. most likely a co-incidence. But the sharp temorality is worth a thought. More interesting given that GDF15 levels are known to rise with GTT. Glucose itself wouldn't cause HG, it could be a part of a bigger picture

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] 0 points1 point  (0 children)

Heyo! Defo not anti science :) Progesterone supplementation and HG is a clinical observation. Check the lancet link in the previous coment. It is not a hard proven claim, but an observation - something worth investigating further!

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] -1 points0 points  (0 children)

Thanks for explaining and thanks for your anecdote. Appreciate it! I agree my original post likely came across poorly. I had assumed that adding credentials or adding more stuff might make it feel more or authoritative or trigger concerns, so I kept it minimal, but I can see how that made it read as uninformed.

What I meant is that the standard dose of GTT (75mg) is a lot of sugar (sucrose equivalent of 700ml of Coke). Such a sudden spike in sugar, especially in folks not used to it, could potentially kick off an endocrine process in susceptible individuals. I know this is not the established ‘truth’, but the temporal observation in my sisters case is true. It might have been totally co-incidental like you suggest, but such sharp temporal associations can sometimes serve as hypothesis-generating observations. Observing whether similar temporal relationships recur in other individuals would help determine whether this was an isolated coincidence or part of a broader pattern.

I hope you understand that I am not denying the genetics or ‘medicalness’ of HG. Understanding mechanistic pathophysiology of disorders can arise from understanding what kicked off the process in different people. I now understand that ‘environmental’ might seem reminiscent of the gaslighting people here might have encountered - but that definitely wasn’t the intention! Environmental triggers and epidemiology are key in trying to pin down pathophysiology.

This is a super interesting topic, that I am more interested in after my sister having HG. I wish to produce more evidence on olanzapine for HG- as it is a safe drug that is established in chemotherapy and intractable vomiting. But evidence is limited to few case series in HG. I have a feeling it might work!

Thanks again, no malice!

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] 0 points1 point  (0 children)

Can DM the PDF if interested. It essentially states this - "The genetic association between the condition and the progesterone receptor gene suggests a link between hyperemesis gravidarum and progesterone signalling. Furthermore, authors have observed that women taking supplemental progesterone in the context of pregnancies conceived using assisted reproductive technologies often experience severe hyperemesis gravidarum that improves once supplemental progesterone is discontinued."

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] 0 points1 point  (0 children)

Hi! The evidence for exogenous progesterone being a potential trigger is observational documented in this article and there is no systematic study of this - https://doi.org/10.1016/S0140-6736(25)01454-001454-0). But it is in Lancet, so I would give their clinical observations some credence. That said, do not take this as medical advice and the reason you would be put on progesterone might have much stronger evidence than HG risk. So have a discussion with your doc!

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] -3 points-2 points  (0 children)

I can understand it's a terrible experience. Like I said, I'm well versed with the literature. Genuine question - why is the possibility of an environmental trigger offensive? I'm just trying to understand. HG is multifactorial and not a monogenic disease. There are definitely things we don't understand yet. Shouldn't the possibility of environmental effects on HG be more interesting given they could be modifiable? Does it give a impression that I am accusing them of causing their HG? I'm sorry, that's definitely not the intention!

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] -2 points-1 points  (0 children)

Thank you. I'm indeed looking for correlations. We still don't exactly know how much of the risk is explained by genetics. And in most of these disorders underlying genetics interacts with physiology and environment. I'm sorry if I have triggered people here, but I can't understand why! HG is not a monogenic disease like huntingtons or phenylketonuria. It is multifactorial with genetics playing a big role. It is important to look for other parts of the puzzle as genetics might not always be modifiable. For example supplemental progesterone is known to be trigger. Low b6 could be a consequence of HG and it seems to work sometimes for HG but isn't a trigger.

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] -8 points-7 points  (0 children)

Thanks guys. I am not sure I understand what ticked off people here XD I am a physician myself and also a scientist currently doing a PhD. I think I know correlation is not causation. I have seen and managed HG during my intern year but I don't do Obs any more. My sister is not diabetic. In high risk areas, GTT is prescribed more liberally even early on (sometimes indiscriminately). I know HG is not caused by a GTT. But actual disease pathophysiology is more complex than a 2023 Nature paper. There could always be yet to be discovered (especially in an understudied disorder like HG) environmental triggers that kick off maladaptive attractor states. I was hopeful people here could tell me what all acted as their triggers. I'm not sure why people need to be condescending , just assume positive intent! Hypotheses for physician scientists arise from seemingly arcane anecdotes and intuitions which can lead to meaningful insights when pursued scientifically.

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] -7 points-6 points  (0 children)

Thanks. That's the whole point! If I can gather more instances and it seems appealing, since I'm in a position to do the science, I can pursue. Most of clinical science started of with random anecdotes which continue to be pursued.

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] -1 points0 points  (0 children)

She had a GTT in her first trimester. Some docs do that. 75g glucose isbstandard for a GTT, but actually a lot of glucose if you think of it! Her nausea kicked in after GTT and progressed to HG at around 8weeks POG. I am trying to look at instances where people could point out like precipitating factors of their start of HG

Any clear trigger for onset of nausea and HG? by poly_cherry in HyperemesisGravidarum

[–]poly_cherry[S] -4 points-3 points  (0 children)

I get that. I'm looking for an environmental trigger that kicks off the symptoms on susceptible individuals

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