BC HEALTH
Saved by @CodyyyGardner

Essential reading for intensivists: things you didn't even dream were going on in your ventilated patients' lungs. With credit to @robertpdickson who does some very clever translational work on lungs

 Firstly, we are aware of the inherent badness of oxygen. Here is protein content in alevoli after 48 hours of FiO2 95% (i.e. oedema), delightful.
Secondly, all those VAP's we get cross with (can someone silver impregnante the ET tube or something) that we think is just orally communicating flora/immunosuppression? Mais non. High FiO2 all but destroys weakling bacteria, leaving the redox-armoured king, staph aureus, to rule
Unmitigated staph surges and produces a truckload of PAMPs (pathogen associated molecular patterns). Being redoxically armoured, it is fairly happy to thwart oxidative burst from neutrophils attempting to kill them too.
Indeed the lung flora changes prior to the alveolar protein content - like both a canary in the coalmine moment, and then contributing to pathology.
As you'd expect, the usual criminals are involved in whipping up lung injury by the 48 hour mark
So, we have been breeding oxidation resistant pneumonia, brilliant. Does that mean people above a certain FiO2 should get prophylactic antibiotics? I mean, germ free mice don't get the same severity lung injury...
Graphs below: show less alveolar protein/immunoglobulin after 48-72 hours of FiO2 95%, and more nicely retained alveolar histology in germ free mice
On the other hand, as if that wasn't confusing enough, there is also a problem with gut microbiome and lung injury. How upsetting.
The gut microbiome changes later than the lung.
If you do give systemic antibiotics (this study used ceftriaxone and vancomycin all of which we use in ITU in UK) you make things much worse :O
BUT WHY YOU JUST TOLD ME STAPH WAS TAKING OVER AND NEEDED KILLING. Well, when you give these antibiotics you especially get rid of clostridia species in lung and gut. In gut, clostridia provides butyrate for colonocytes. When they don't get butyrate
they start to respire anaerobically, leaving gut lumen oxygen higher, meaning enterobacteriae go whoosh, and take over gut. In lung, staph goes whoosh. And no doubt it's the ceftriaxone resistant version of staph that does.
As a side note, the mechanisms that staph use to resist oxidative damage are the ones we use - superoxide dismutase, thioredoxins, flavins, DNA protection. But we only have this sufficiently available during the DAY and we don't have good anti-ox at NIGHT
which is why bad idea to have big brain bleed full of oxygenated Hb at NIGHT because the heme and the oxygen mess you up, especially badly.
Original paper here https://t.co/za56C6ET0I
As usual, understand less than when I started, about good lung care in ICU.
starting point for circadian difference sub arach https://t.co/VkoLf4teK5
starting point for circadian difference in bleomycin toxicity https://t.co/F16IoZ4jpi

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The Tycoon Mindset
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@tycoonmindset05
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.
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(Cyriac) Abby Philips
(Cyriac) Abby Philips
@drabbyphilips
1/
Remember woman who tuk multiple @SriSriTattva products 4 range of problems frm diabetes 2 gas 2 liver disease & developed liver failure, listed for liver transplant?
Here is original thread:
https://t.co/PXxI1Slyv2
23 samples, Analysis results
#MedTwitter #livertwitter


2/
Before I go into results, I must say this was overwhelming. There was SO MUCH the lab identified, impossible to put everything here. So I made a summary. At the end of this thread, I have linked a full analysis described in Excel format. Some results were VERY concerning

3/
How did we analyse?
Here R links 2 methods
They R high end, done under strict protocols
Frm Ministry of Forest, Environment, Climate / NABL approvd Lab
ICP-OES https://t.co/O1CLhqVQAu
GC MSMS https://t.co/zRJoXyWQIr
FTIR https://t.co/goAembQ08p
Here is list V analysed 👇


4/
Sample names written on top (each column).
First 5 samples: C what we identified in #Ayurveda #medicines
Antibiotics
Steroids (anabolic/synthetic)
#NARCOTICS - LSD, Morphine
Blood thinners (possible reason Y bleeding tests were off the roof in the patient)
Heavy metals!


5/
Next 5 samples (total 10 now)
Mercury is clear winner. Almost all samples
See controlled substances - Butyrolactones https://t.co/CPz0FwPEOm, methylamine https://t.co/OZnXY7U9UQ
Alcohols, industrial solvents
Rare metals - cobalt, lithium
Again lots of blood thinners
#Ayush
HEALTH
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❄️ Mac n’ Chise ❄️...
@sailorrooscout
The importance of T-cell immunity!
A recent study has found that after one dose of Pfizer’s vaccine, patients had a strong T-cell response, and a boosted antibody response after their second dose. This is good news for many reasons so let’s read up.

This study found that people’s antibodies were moderately effective against the original strain after their first dose of Pfizer’s vaccine, less effective against the B.1.1.7 variant, and were unable to neutralize the B.1.351 variant. Read what I said, that’s only after ONE dose.

However, they had strong T-cell responses against ALL known variants after the first dose. So why is this important? To recap, T-cells stimulate B-cells to make antibodies. Antibodies are just your first line of defense which is what is initiated when you get a vaccine.

It’s our T-cells that are responsible for long-term immunity. When antibodies diminish after your initial inoculation, your T-cells-will tell your B-cells it’s time to produce more antibodies. As long as your T-cells still recognize this virus and inform your B-cells they need

to produce antibodies, the vaccine is still doing its job. Your antibodies will get built up over and over again. Just FYI your TCRs and your BCRs target different parts of the Coronavirus’ spike protein. Antibodies can prevent infection, your T cell-responses ensure that those
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Chris Yiu
Chris Yiu
@clry2
I think that, in the face of an ongoing global health emergency and a pressing need to reopen safely, some form of health pass is a reasonable option to consider. But debate is a good thing, so here are some brief thoughts on various concerns I've heard about them... [thread]

"A health pass discriminates against people who have refused the vaccine." No. A health pass should also support proof of test result for people who haven't been vaccinated, and exemptions for people who cannot be vaccinated (get vaccinated if you can though, for heaven's sake).

"A health pass is an invasion of privacy." No. A health pass should be privacy preserving, allowing you to prove your status to third parties without giving away personal data or letting them track you without your permission.

"A health pass is unfair to people without smartphones." No. A health pass should accommodate people without a smartphone, e.g. with a printable option as a fall-back (though for most of us, carrying a digital pass on our phone will be much more convenient).

"A health pass will become obsolete as the virus mutates." No. A health pass should actually give us more insight and flexibility to adjust our response as our knowledge of the virus, and the ways we test / treat / vaccinate for it, increases.
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NortherlyRose \U0001f308 \U0001f499
NortherlyRose 🌈 💙...
@NortherlyRose
#Thread

Living with meltdowns.

A personal, very late diagnosed, autistic perspective.

#autism
#AllAutistics
#ActuallyAutistic

1/

Before my autism diagnosis I had occasional emotional outbursts. These generally happened at home after a sustained period of pressure at school or at work.

When I discovered I was autistic I realised that these were actually what people call meltdowns.

2/

Getting intensely upset was a bit of a family thing. Sudden shouting and throwing of things, with resumption of peace and calm afterwards, wasn’t that unusual.

In fact we had a kind of mantra that it was much better to express our emotions than to keep them bottled up.

3/

It was hard to gauge my own emotions against other people’s but by any measure I felt things incredibly intensely.

As a child the injustice of being told off for something that wasn’t my fault burned into me. I sobbed until the tears stang my face and I could hardly breathe.

4/

But suppressing emotion was necessary for me to survive in the outside world. That’s partly what led to uncontrolled outbursts of feelings at home.

I melted down because there was no justice and I’d been misunderstood. I wasn’t using emotion as some kind of bargaining tool.

5/
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क्या आप जानते हैं कि क्या है, पितृ पक्ष में कौवे को खाना देने के पीछे का वैज्ञानिक कारण!

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कुछ लोग कहते हैं की व्यक्ति मरकर सबसे पहले कौवे के रूप में जन्म लेता है और उसे खाना खिलाने से वह भोजन पितरों को मिलता है

शायद हम सबने अपने घर के किसी बड़े बुज़ुर्ग, किसी पंडित या ज्योतिषाचार्य से ये सुना होगा। वे अनगिनत किस्से सुनाएंगे, कहेंगे बड़े बुज़ुर्ग कह गए इसीलिए ऐसा करना

शायद ही हमें कोई इसके पीछे का वैज्ञानिक कारण बता सके।

हमारे ऋषि मुनि और पौराणिक काल में रहने वाले लोग मुर्ख नहीं थे! कभी सोचियेगा कौवों को पितृ पक्ष में खिलाई खीर हमारे पूर्वजों तक कैसे पहुंचेगी?

हमारे ऋषि मुनि विद्वान थे, वे जो बात करते या कहते थे उसके पीछे कोई न कोई वैज्ञानिक कारण छुपा होता था।

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एक बात जो कह सकते कि हम सब ने स्वतः उग आये पीपल या बरगद का पेड़/ पौधा किसी न किसी दीवार, पुरानी

इमारत, पर्वत या अट्टालिकाओं पर ज़रूर देखा होगा। देखा है न?

ज़रा सोचिये पीपल या बरगद की बीज कैसे पहुंचे होंगे वहाँ तक? इनके बीज इतने हल्के भी नहीं होते के हवा उन्हें उड़ाके ले जा सके।
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Conservative Trader
Conservative Trader
@AnandableAnand
How to get rich trading (without getting lucky)

Complete beginner’s guide to wealth of Rs 10 Cr in 10 years

Step 1: start trading live

1/n

Nothing can substitute experience of live trading

No amount of back-test, studies or indicators can substitute training your mind with screen time

As a beginner, In live trading, you will make losses almost everyday

2/n

So here are the conditions which you can’t violate in first year
If you can’t follow these rules, this document is not for you

Start with trading capital of Rs 1 lakhs

Max loss per trade 0.25%, i.e. 250 Rs

Max loss for the day, 1%, i.e. Rs 1000

Max 6 trades in a day

3/n

I know, these conditions will cripple you in terms of what all you can trade and how

But just like any start up, trading is also about making it through initial gruelling constraints of life

You will also learn, how to turn these adverse rules to your advantage

4/n

Btw, you can sell directional banknifty options, obviously you can buy options, can do cash stock trading and much more under these conditions

Think about it, you will be do all kinds of instruments, just that PNL will not be roller coaster ride or exciting like a casino

5/n
TRADING , ALL