BC HEALTH
Saved by @Mollyycolllinss

🧵 on Importance of correct indication of colonoscopic surveillance studies (English 🇺🇸🇬🇧)
@KM_Pawlak @KMonkemuller @drkeithsiau @JacquelineChuMD @PerelmansPearls @stevenbollipo @SWexner @DrBloodandGuts @ebtapper @DCharabaty @RashidLui @AdvaniRashmiMD @AtoosaRabiee @DrMohdZein

 @SultanMahmoodMD @GI_Guy @RodriguezParra_ @DrHarryThomas @TennysonMD @AustinChiangMD @KralJan @thomaskroner @alinkmd #GITwitter
1/ The implementation of screening and surveillance programs can reduce the incidence and mortality of CRC
https://t.co/P0SCUGxmne
2 / But for these to be effective and to guarantee protection against CCR, they must meet a series of conditions. One of them is the correct indication for endoscopic studies for both screening and surveillance.
3 / According to a recent meta-analysis, the minority of patients who undergo colonoscopies have a correct indication, with less than 50% adherence to the surveillance intervals proposed by scientific guidelines.
https://t.co/ysjo3zRhXb
4/ In a survey of different clinical scenarios on CRC surveillance carried out in 1432 physicians by Patel et al., Only 37% correctly answered the questions according to the recommendations (CPG9)
https://t.co/RYPlT6hKnA
5/ This revealed that the knowledge of gastroenterologists about CPG was poor. Although there are many reasons for lack of adherence, adequate knowledge of their recommendations is essential to achieve an acceptable level of adherence.
6/ Lack of adherence can manifest itself in the form of overindication as well as underindication, and both can undermine the effectiveness of a prevention program.
7/ Regarding overindication, a retrospective study of 1500 patients showed a shortening of the surveillance interval in almost 30% of the sample and up to 50% in those patients who had adenomas detected in the index colonoscopy
https://t.co/gwxKqC6euL
8/ Although colonoscopy is a safe study, it is not exempt from complications such as perforation (0.05%), bleeding (0.25%) and death (0.003%), and its overindication generates a net increase in these adverse events
https://t.co/07geSpoUA2
9/ Overuse then generates an increase in costs with marginal benefits ...
https://t.co/ZBT321p0T9
10/ ... and only contributes to the overload and subsequent fatigue of endoscopy units that must attend a higher percentage of patients under unnecessary surveillance.
https://t.co/rIo3OLKFvT
11/ Overindication can also generate a delay in screening, follow-up, or surveillance studies in patients with the correct indication, threatening the effectiveness of CRC prevention.
12/ In order to incorporate new individuals into the programs and perform colonoscopies in this naive population, unnecessary repetition of studies should be avoided, the overuse of the practice should be minimized ...
13/ ... and put more energy into also identifying people at increased risk of CRC who have not yet performed screening procedures.
4/ On the other hand, underindication also carries significant risks, since we can delay the control of patients at high risk of developing metachronous lesions and cancer
15/ A longitudinal cohort study showed that 76% of deaths from CRC were due to failures in the indication of screening and surveillance studies, and that patients with delays in surveillance studies …
16/ .... showed up to 7 times increase the risk of developing CRC
https://t.co/JI4yU3NTbl
17/ For all the aforementioned, the adequate indication for colonoscopic surveillance is considered a quality marker of endoscopy units and represents a key element in achieving an effective prevention program.
https://t.co/90wfYZYUns
That's all folks!

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it seems to me that not many know that navalny is an avowed nationalist & racist and not just a blonde guy who likes to gently kiss his blonde wife before going to jail and watches “rick & morty”. so here’s a little thread and some of it is pretty personal.

here is navalny’s 2007 video. “a tooth without a root is called “dead”. a nationalist is someone who doesn’t want the russian root to be removed from the word “russia”. we have the right to be russian in russia, and we will defend it.”


i downloaded it to make sure it won’t disappear but it is still shared by navalny’s official youtube channel. btw, in this video, navalny is introduced in the caption as a “certified nationalist”.

here is another video navalny is not keen to share anymore, in which he compares muslims to cockroaches and flies and recommends shooting them with guns if swatters and shoes

here is a 2011 interview with navalny where he explains why he goes to the so-called “russian march”, a yearly nationalist gathering, and why he thinks it’s ok to collaborate with
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Chief Pharmacist 🗨️...
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All Women are at risk of getting Cervical Cancer. It often affect women over age 30.

Long-lasting infection with certain types of human papillomavirus (HPV) are the main cause of cervical cancer.

HPV is a virus that is passed from one person to another during sex.

A Thread 🚺


More than half of sexually active people might have HPV at some point in their lives, but few women will get CERVICAL CANCER.

Early Screening tests & the HPV vaccine can help prevent cervical cancer.

When cervical cancer is diagnosed early, it is highly treatable &....

2/cont.

associated with long survival and good quality of life.

Most (almost all) cervical cancers are caused by HPV.

There are many types of HPV.
Some HPV types can cause changes on a woman’s CERVIX that can lead to cervical cancer as time goes on, WHILE other types can cause genital

or skin WARTS . HPV is so common that most people get it at some time in their lives.

HPV usually causes no symptoms so you can’t tell that you have it. For most women, HPV might be SELF LIMITING (ie it will go away on its own); However, if it doesn't, there are a chances that

over time it may result to cervical cancer.

OTHER FACTORS CAN INCREASE YOUR RISK of CERVICAL CANCER —
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#OurFavOnlineDoc 🩺🇳🇬🇬🇧...
@DrOlufunmilayo
HELLO: If you pee and every time you finish, your urine looks like this picture, you may have a serious medical illness.

Foamy urine especially if it is persistent and noticeable over time may mean you have a serious kidney problem.

Let’s talk about this today...
RT for others.


What are the features of a normal urine?

A normal urine should have a light yellow colour, painless, odourless (or faint smell), steady stream and should ideally not foam when you pee.

When there’s something wrong, then you see changes in all the above normal features of urine.

For instance if urine becomes very deep yellow, it may mean you are dehydrated;

If urine becomes painful or smells really really bad, it may mean you have an infection;

If urine has a poor stream, especially in a man, it may mean a prostate problem like cancer.

Do you get me?

So today let’s talk about Foamy Urine.

What are the things that can cause urine to suddenly be foamy. As I said in the first tweet, it MAY mean a serious medical illness like a serious kidney problem.

First things first- it does NOT always mean a problem but it may as well.

Now what are the causes of Foamy Urine:

1. SPEED-
If you pee really fast or with a lot of force, it may make your urine more foamy than usual. The speed and force makes the urine generate a lot of bubbles which tend to almost quickly disappear as it is formed in the toilet bowl.
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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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अस्य श्री गायत्री ध्यान श्लोक:
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• मुक्ता-विद्रुम-हेम-नील धवलच्छायैर्मुखस्त्रीक्षणै:।
muktA vidruma hEma nIla dhavalachhAyaiH mukhaistrlkShaNaiH.

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yuktAmindukalA nibaddha makutAm tatvArtha varNAtmikam.

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gAyatrIm vardAbhayANkusha kashAm shubhram kapAlam gadAm.

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shankham chakramathArvinda yugalam hastairvahantIm bhajE.

This shloka describes the form of वेदमाता गायत्री.

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दधीचि ऋषि को मनाही थी कि वह अश्विनी कुमारों को किसी भी अवस्था में ब्रह्मविद्या का उपदेश नहीं दें। ये आदेश देवराज इन्द्र का था।वह नहीं चाहते थे कि उनके सिंहासन को प्रत्यक्ष या परोक्ष रुप से कोई भी खतरा हो।मगर जब अश्विनी कुमारों ने सहृदय प्रार्थना की तो महर्षि सहर्ष मान गए।


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एक बार देवराज इन्द्र अपनी सभा में बैठे थे, तो उन्हे खुद पर अभिमान हो आया।


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1. PDC Acts as Support
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First off! We’ll start with the obvious things that constitute a possible connection.

They share the same Japanese Voice actress! Rie Kugimiya.
Usually this is a stretch reason, but considering everything else, it’s not unlikely that it’s the same character.

Secondly, their Appearances.
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Another notable thing is their eyes. They both have Glowing golden eyes with very similar appearances. They contain a ring, and a 4-point star pupil. Resemblant of a scope if you will. That’s The Herrscher of Void’s defining characteristic


If you’d even like to take a look at their outfits, there’s resemblances including the black fur collar, the designs on the torso and chest, and the use of something similar to coat tails/skirt. The Herrscher can change their outfit and they aren’t stuck with one. Sirin does this
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