Quick thread on what can happen if you hold your nose and mouth and then do a sneeze.

(Sources here: https://t.co/Ksy95o7im7)

You've probably heard the urban legend about what happens if you sneeze with your eyes open.

Well, you'll be pleased to have it confirmed that your eyeballs do not pop out of your sockets like champagne corks.
The air spaces in the nose and throat aren't connected to anything behind the eye, meaning that there's no way a sneeze can create pressure that would force your eyes to shoot out and dangle around like a game of swingball.
However, there are other dangers to sneezing that I wish I didn't know about but I'm going to tell you here because fuck you I guess.
Take for instance a perfectly healthy 34-year-old man who, for reasons unknown, decided to try and block a sneeze by covering his mouth and holding his nose at the same time.
I like to think that his wifi went down one day and in the boredom he merely thought "yeah fuck it I'll give internal sneezes a go then".
In a case written up in BMJ Case Reports under the rather distressing title "snap, crackle and pop: when sneezing leads to crackling in the neck", doctors write that the man showed up in the emergency department after an achoo gone wrong.
As the patient had pinched his nose and held his mouth closed when he sneezed - probably thinking he was about to make billions on his new invention of the silent sneeze - he had experienced a "popping sensation" in his neck.
As distressing as that sounds, it soon got worse when he experienced painful swallowing, pain in his throat and a "change of voice". Imagine sneezing, you feel a pain and ask for help and your colleague asks "why the fuck are you talking like Joe Pasquale".
Upon examination, it was discovered that his neck down to his ribcage made popping and crackling sounds, a sign that he either had air bubbles inside his deep tissue and muscles or was harboring two thirds of the Kellogg's Rice Krispies trio inside his chest cavity.
Which are equally distressing.
Figuring that it was more likely the former (known as Hamman’s sign, crackling can occur when the heart beats against tissue filled with air) they ordered a scan of his soft neck tissue and chest.
This soon revealed the problem: during the act of suppressing his sneeze he had ruptured the back of his neck.
The rupture - which is more often caused by blunt neck trauma, profuse vomiting and heavy coughing - had caused a collection of air to leak into the retropharyngeal region (see the arrow in the scan above), causing his pain and loss of voice.
Fortunately, the man was able to recover from the sneeze in hospital. He was given a feeding tube and monitored, and given intravenous antibiotics as a precautionary measure.
He was later discharged, but not before he was advised to avoid obstructing both his nostrils while sneezing, probably while muttering "you complete fucking pie" under their breath.
"Halting sneeze via blocking nostrils and mouth is a dangerous manoeuvre and should be avoided," the team note. "It may lead to complications such as pneumomediastinum, perforation of tympanic membrane and even rupture of cerebral aneurysm," the team write in their report."
Basically, sneeze like a normal person if you don't want to do a dead.
If you like this thread, my book is currently HALF PRICE
https://t.co/fZeogiAXy4
Wondering whether I should do a thread about what happens if you hold in a poo for too long

More from Health

I applaud the #EUCancerPlan *BUT* caution: putting #meat 🥩 (a nourishing, evolutionary food) in the same box as 🚬 to solve a contemporary health challenge, would be basing policy on assumptions rather than robust data.

#FollowTheScience yes, but not just part of it!
THREAD👇


1/ Granted, some studies have pointed to ASSOCIATIONS of HIGH intake of red & processed meats with (slightly!) increased colorectal cancer incidence. Also, @WHO/IARC is often mentioned in support (usually hyperbolically so).

But, let’s have a closer look at all this! 🔍


2/ First, meat being “associated” with cancer is very different from stating that meat CAUSES cancer.

Unwarranted use of causal language is widespread in nutritional sciences, posing a systemic problem & undermining credibility.

3/ That’s because observational data are CONFOUNDED (even after statistical adjustment).

Healthy user bias is a major problem. Healthy middle classes are TOLD to eat less red meat (due to historical rather than rational reasons, cf link). So, they

4/ What’s captured here is sociology, not physiology.

Health-focused Westerners eat less red meat, whereas those who don’t adhere to dietary advice tend to have unhealthier lifestyles.

That tells us very little about meat AS SUCH being responsible for disease.
1/15
Why can cefepime cause neurological toxicity?

And why is renal failure the main risk factor for this complication?

The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.

#MedTwitter #Tweetorial


2/
Let's establish a few facts about cefepime:

🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)

https://t.co/rjYG1BfGPR


3/
The first report of cefepime neurotoxicity was in 1999.

A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.

✅All symptoms resolved after hemodialysis.

https://t.co/u7JLVitQpp


4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).

💡The main risk factors = renal failure and lack of dose adjustment for renal function.

https://t.co/nxbnzSq8AR


5/
What about cefepime induces neurotoxicity?

One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.

This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).

https://t.co/Lf4BhON9IY

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