Long THREAD :

Sources : A litigant named Dr. M. Geethanjali, approached the Madras HC, to redress her grievance wherein, she was denied an MD Opthalmology seat in PSG medical college whereas a candidate who got lesser rank than her was given the same seat. 1/n

The petitioner also alleged that while the initial fee fixed by government at the time of admission was Rs.3 lakhs, PSG college demanded 35 lakhs.

Justice Anand Venkatesh of Madras HC in an elaborate and detailed order, 2/n

went in-depth into the issue and found that, private medical colleges are making a killing in PG medical admissions using the pandemic. 3/n

The Court observed, _“The governments are grappling with the situation and the normal functioning of the society virtually came to a standstill and slowly attempts are being made to restore essential functions with sufficient safeguards. 4/n

Unfortunately, attempts are also being made to take advantage of this situation to justify certain actions. There is an attempt to put every blame on the Corona Virus even where it did not have a direct nexus to the action performed by an institution or any 5/n

UK variant update:

50% more contagious and the main difference is in the rate of infection in children up to the age of 9.

No significant difference found yet in clinical course, mortality within 28 days or chance of re-infection.

1/

https://t.co/D8DXVvBeew

50% higher infection rate

(Secondary attack rate 15.1% versus 9.8%)

2/

Main effect in children under 9 years old

(see age distributions, second image has overlay of reference onto UK variant)

3/

Essential to stop the UK variant: 50% higher transmission will lead to more cases, more hospitalizations, more ICU cases, more deaths, and greater economic costs.

Independent SAGE's plan for the UK variant

With the new Covid variant everywhere, it's not enough to just wait for the vaccine | Stephen Reicher

Here's an interesting ncbi article on rage:

One of the claims argued, is that frustration triggers rage.

Either frustration from behaviour not producing expected outcomes, or frustration from someone not doing what one asks.

And, you can experimentally trigger rage by frustrating people sufficiently.

Get someone to do something in order to get a reward. Suddenly stop rewarding them for that. Bam, frustration and then rage.

Alternatively, pair your test subjects, ask them to cooperate to accomplish a task, and have your inside guy not listen.

Bam, frustration and then rage.

The thwarting of expectations is the common theme. Thwart someone's expectations, violate their model of how things work, and you frustrate them.

Keep at it, and you enrage them.

**Know your local vegetable : Ridge gourd**

This is must vegetables for people with

- pre diabetes and diabetes
- cholesterol
- strained liver and gland functions
- Improves eye vision

It's a good detox for your body and aids metabolism

-Many diabetic find Karela difficult to consume due to its bitter taste this is a equivalent beneficial

- This can be used even with skin as raw ingredient for your chutney with varied dals

- Can be used in Sabji as well

- It's a excellent vegetable to nourish your skin and enhance your skin tone

- It's given to people of all age from young children, old aged persons and even to expectant mothers

Per Ayurveda it's a must supplement for

– cleansing large intestine
– cleansing stomach and small intestines
– cough, cold
– chronic poisoning
- enlargement of the abdomen
– anemia
– inflammation

– Disease of the spleen
– Tumors of the abdomen
– haemorrhoids
– skin diseases
– Jaundice, Liver diseases

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.

My last #tweetorial focused on the GCS. Now let's look at another hugely important clinical window into the brain: the pupil. What does a 'blown pupil' really imply? What about small fixed pupils? To understand this, we need to see how pupil size is governed. #FOAMed 1/20

The pupil has two functions, constriction and dilation, both under autonomic control. Sympathetics dilate the pupil and open the eyelid - easy to remember, because in 'fight or flight' mode, maximum information needs to get in to keep you alive. 2/20

By contrast, constriction is parasympathetic. Its main function is to regulate the amount of light on the retina, so in response to high light intensity (like a pen torch), both pupils constrict. 3/20

These parasympathetics have a straightforward course (literally). They hitchhike on the third nerve, which runs forward from the midbrain to the orbit to supply most of the extraocular muscles and eyelid. As they're superficial, they're vulnerable to extrinsic compression. 4/20

Plenty of things can compress the third nerve and produce mydriasis (a dilated pupil) - most classically a posterior communicating artery aneurysm. But in the context of an acutely comatose patient, it suggests something worrying: 'uncal herniation'. Why is this? 5/20

1. What are stem cells? What are the various types of stem cells? How are stem cells being used in medicine today? Can stem cells be packaged into pills and taken orally?

2. Stem cells are basically undifferentiated cells found in various organs of the body. Almost every organ has a reserve quantity of cells that are capable of maturing and replacing already existent cells in that organ.

3. There are different types of stem cells based on their origin and method by which they can be derived. There are embryonic, adult, tissue specific,multipotent, pluripotent, totipotent and induced pluripotent stem cells. See graphics below.

4. Stem cells are used in a variety of ways in medicine today. For instance, when a person has a blood or bone marrow disorder, they may receive a stem cell transplant. There is also a lot of work being done using stem cells on neurodegenerative disease research.

5. Stem cells, human stem cells need to be viable to be used in therapy. There is no way one can package then into capsules and administer them orally to a human being and immediately they find their way to a target organ 😂😂. Hakuna zvakadero. 6

You will find this interesting 🤯

Health Insurance premiums for a plan are as follows:
5 Lakh cover = Rs. 13410/-
25 Lakh cover = Rs. 24759/-
1 Crore cover = Rs. 18003/-
Wut? Yes. How? 🤔

Thread time 🧵:)

We checked if the plans were different.

What we found is that apart from the room eligibility there is no other significant difference between the plans.

This may have called for a lower “per lakh” premium, but it does not justify a discount of 37% for a 400% higher cover

So we dug deeper :)

We checked, rechecked, spoke to experts and the answer came down to simple market mathematics 🧮

Something you need to understand well.

Say you have a mobile plan with a quota of 3GB of data a day.

The average usage is say 2 GB a day.

Now if you apply for an upgrade to 10GB a day - the telco knowing this will rarely be utilised, can upgrade the plan at an extremely low cost, and not at the per GB rate.

Similarly, when you today buy a cover of 25 Lakhs. Since the average claims are say 3 Lakhs today, there are very tiny chances you will use the cover over 10 Lakhs in the short term.

So whatever amount the insurer charges today over 10 Lakhs is a bonus.

1. Some thoughts about picking over the bones of the referendum loss.

TLDR - get over it, move on, and most importantly, find a better strategy.

2. From an analytical perspective, I don’t think there’s much point in constantly assessing the referendum.

3. The answer is either so simple as to be banal (bad campaign etc) or too complicated (deep rooted societal roots etc) as not to provide any simple lessons. In any case, the result was very close.

4. Rather than dwell on the past, live in the future. Influencing what happens next is much more important than focusing on historic defeat.

5. You don’t see current Brexiteers lamenting the woeful state of their plans do you?

Many people meditating have felt this pulse, and it has brought instantaneous emotional and spiritual, and sometimes even physical healing to some people.

Something occurred to me yesterday morning. Decided to wait till today to post about it. It wasn’t very “Thanksgivingish”.

Are #vegan diets really the 'single biggest way' to reduce our carbon footprints & environmental impact on the planet? We argue that this is a highly misleading claim & that the evaluation of dietary change comes with a lot of context & complexity

🧐📑➡️: https://t.co/kYGeTpy8UP

1) Global data shouldn't be used to evaluate local contexts

Regional differences are important & due to very large variations in feed digestibility, slaughter age & weight, climate conditions, management, sociocultural factors, & nutrient security.

2) Further mitigation is possible

A lot of margin is left for higher productivity, feed strategies, veterinary care, smart use of manure, & herd management. A reduction of waste, the re-use of meat-processing by-products, & the valorization of biogas also hold potential.

3) Restricting animal foods only entails a small effect

For Westerners, the effect isn't only small on a yearly basis (1-6%) but especially so on a lifetime of emissions. Some vegetarians may even have higher impacts than some omnivores. Mock products do not solve the issue.

3bis) Aren't we scapegoating animal foods to downplay our non-dietary lifestyle effects?

Taking a flight, for instance, easily offsets one or more years of veganism. Yet, cars, tourism, pets, & smart phones receive little attention in comparison to the dietary quick-fix claims.

Some thought about DVT prophylaxis in ICU.
Part of my presentation on the same topic.

Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis?
#FOAMed

Question 2: How do you diagnose DVT in ICU?
▶️I think, the best evidence is available for CUS with limited scope for Venography.
And no role of D-Dimer.
#FOAMed

Question 3: Is there any evidence supporting Heparin thrombo-prophylaxis in ICU?
#FOAMed

Yes.
1⃣Number needed to prophylax to prevent 1 DVT - 20
2⃣Number needed to prophylax to prevent 1 PE - 52
3⃣Overall no major bleeding. But bleeding risk need to be individualised.

Question 4: Is there any evidence of LMWH over UFH in VTE Prophylaxis?
#FOAMeYes.
1⃣LMWH decreases DVT. But no difference in Proximal DVT.
2⃣No difference in PE.
3⃣No difference in major bleeding.
4⃣Lower incidence of HIT in LMWH (PROTECT Trial).
5⃣Overall advantage LMWH.

Question 5: Is there any role of Mechanical Thromboprophylaxis?
#FOAMed

💥 Role of Stents in Dialysis Vascular Access - Tweetorial

⚡️Indications for Stent Use

⚡️Recent Clinical Trials of Stents in Dialysis Vascular Access

⚡️Complications associated with Stent Use

1/
@ASDINNews
#VascularAccessPearls

⚡️Arterio-venous (AV) Access
causes significant morbidity & mortality in patients on hemodialysis

⚡️Most AV access associated complications are due to vascular stenosis👇🏽
2/

⚡️Vascular Access care has evolved over the past 60 years:

-Scribner’s Shunt in 1960 ➡️
-Brescia-Cimino AVF in 1966 ➡️
-1st Balloon Angioplasty in 1981 ➡️
-1st Bare Metal Stent in 1988 ➡️
-1st Covered Stent in 1996 ➡️
-DCB use in 2012
3/

⚡️Despite these innovations, AV access stenosis remains a big problem

-Percutaneous Balloon Angioplasty (PTA) remains the 1st line therapy for stenosis but it is NOT very effective

-AVF patency after PTA is only 50% at 6-months & it is worse for AVGs👇🏽
4/

⚡️Neointimal Hyperplasia (NIH) causes vascular stenosis & it is due to:

-Hemodynamic stress
-Surgical trauma
-Cannulation needle trauma
-AVG

‼️But balloon angioplasty, the treatment for stenosis, can itself induce NIH & cause restenosis👇🏽
5/

My name is Maryjane and the woman in the picture is Okolo Beatrice, my mother.

In August, my mom started having constant headaches. She went to the hospital, and was attended to by a doctor, but the headache persisted.

At a point, she started having loss of memory and disorientation.

We were asked to go to the Neuropsychiatric hospital to ask for a Neurologist.

She went, but did not see a Neurologist on seat, but met with another doctor there.

She was given some medications and asked to come back in a month. She returned to the hospital on the 29th of September with the same complaints. She was given medications again and was sent back home.

At a point I was no longer comfortable with the complaints.

I assumed it was a result of stress. So on the 1st of October, I went to my parents house, picked her up and went straight to the lab, where blood work as suggested by a doctor was carried out. From the lab, I took her to my house. My plan was for her to rest well.

The results of the test came back on the 4th of October, and the outcome prompted me to start looking for a Neurologist. I started making calls. Fortunately, we got a number and the following day which was the 5th of October, I took her to the doctor in Onitsha.

@jwdickerson Please no apologies, I meant nothing by it...I was just thinking out loud.... I'm sorry if it made you uncomfortable!

Many many clinicians, have difficulty distinguishing re: diagnosus between the three because it requires not only a great deal of indepth knowledge re: forensics and behavior, but experience as well. More, most of what people know about (ASPDp) criminal psychopaths comes 1/

from prison populations not the successful psychopaths that are functional enough to routinely get away with crime WITHOUT GETTING CAUGHT (these are you long running career Docs, politicians lawyers CEO'S who are typically caught late in life, if at all, and who shock everyone 2/

who thought they were pillars of society or admired for great skills and wealth--sound familiar?). Even folks who study prison populations have a difficult time identifying "successful criminals" out here in the world.
That's just the clinical axis.
We on the whole, 3/

we tend to automatically project our empathy, onto the behaviors of others in order to better understand them. When this occurs, it very often results in misdiagnosis. Then there's the pressure to constantly stay relevant, find new diagnoses and treatments re staying afloat 4/