I am totally content getting and spreading whatever germs come my way, it's healthy and a normal part of life. It's been happening for eons, it's nothing new.

1/23 We haven't had a lot to celebrate during this pandemic. But achieving the milestone of offering vaccine to the over 70s, health and care workers and the most clinically vulnerable just before target date is a huge cause for celebration, given the scale of the achievement.

2/23 When Margaret Keenan got her first jab in Coventry on December 8th last year, who’d have thought that, by Valentine’s Day, we’d have vaccinated over fourteen million people across the UK in just ten short weeks? Amazing, extraordinary and truly, really, world class!

3/23 I’ve been struck by how much joy and relief has been brought to those doing the vaccinations and those receiving them. A GP told me yesterday that nothing had given him greater pleasure in his long career. And that the patient's relief was sometimes overwhelming.

4/23 It's vital to recognise the extraordinary contribution of the staff and volunteers who have made this happen. One of my close family had their jab yesterday and was in awe of the volunteer standing outside in the freezing cold for a four hour shift meeting and greeting.

5/23 What I wanted to share in this thread was the slightly untold story of some of the extraordinary challenges the NHS has had to overcome to deliver this target. Requiring superhuman effort from NHS leaders and staff, way beyond the call of duty. Five challenges set out below.

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 —
•Having HIV/AIDS
•Smoking.
•Using Oral contraceptives (birth control pills) for a long time (5+ years)
•Having birth to many children (4+ yrs).
•Having many sexual partners

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

My uncle passed away from cancer when I was 16 years old.

I’ve since spent 100’s of hours researching how to avoid and fight cancer naturally.

Here’s what I found:

1) Boost your stem cells

Your body slowly regenerates using stem cells.

Foods that promote stem cell growth:

• Seafood & fatty fish
• Berries (black, blue, raspberry)
• Broccoli, cauliflower, brussels sprouts

More stem cells = lower chance of cancer

Fasting is also a viable option for increasing your stem cells.

You could do a 24 hour fast once a week.

Or go extreme like my business partner @taylinsimmonds

And fast for 4-7 days at a time.

I’ll stick with 24 hours tops ;)

2) Hack DNA repair for longevity

To amplify DNA repair:

• Sleep 7+ hours
• Exercise regularly
• Try intermittent fasting

Natural DNA repair prevents your cells from mutating.

Eat foods that amplify DNA repair:

• Greens
• Mangoes
• Greek yogurt

The best cancer cure is prevention.

APL Apollo conducted their earnings con-call today at 2:00 pm

"Vision of capacity of 4 Million Tone till 2025"

@hiddengemsindia @gvkreddi

Here are the key highlights 😀👇

Business Updates:

• Net Working Capital Remains under 10 days which is best in the building material
• Continue expanding rural region.
• Added 15 new distributors.
• Value added products contributed 50-60% of the topline.

Revenue breakup

• EBIDTA Margin Improvement: This was mainly because of cost structarize and better operational

• Working Capital Cycle as per mgmt should remain sustainable

• Blue Ocean: Company owns 100% subsidiary which contributes nothing but own property where corporate office is there

Improvement in Net Selling Realization:
• With expanding capacities at 2.6Million Tones and utlization of 75%, scalability has been affected.
• While the prices of steel has gone by by around 35%, due to shortage of steel.

• Apl Apollo being the dominant player past connection with steel companies worked well.
• Steel tubes supply from China is shrinking.
• Hence the discounting factor while selling the products has went away.