This is a limited point about availability of efficacy data for vaccines under development in the context of the approval for CovidShield and Covaxin in India.

There have been many so-called experts on the idiotbox opining about apparent availability of P III data which 1/n

“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.…

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.

Ankle joint is undertrained in a single joint means in both the frontal plane & in dorsiflexion 2 prevent lateral ankle sprains and shin splints. Single joint exercises allows you to evaluate the joint actions ROM & strength to understand injury risk & where development is needed

AJ Abduction (Cutting)

1. I pull the foot in2 dorsiflexion 2 stabilize the joint

2. I pull against the increasing tension of the band in2 abduction w/o losing dorsiflexion & also w/o externally rotating the thigh.

3. On the negative resist the bands pull eccentrically.

AJ Adduction (Cutting)

1. I pull the foot into dorsiflexion and I pull the foot into adduction against the tension of the band w/o medial rotation of the thigh.

2. I resist the negative movement of the band pulling the ankle into abduction eccentrically.

They called it elephantiasis
A disease said to be caused by a strange mosquito
I was at the Bible College at the time
I had been sent for my Teaching Practice at a church located at Ogudu Ori-Oke
The pastor of this church was a gentleman
He and his wife were chartered accountants

and they were blessed
I was a personal assistant to another pastor and the coordinator of the Bible College had to practically beg my boss to allow me to observe the Teaching Practice at another church (He had insisted I do it with him and I would have spent the time carrying his

Bible and practicing nothing)
When I reported for duty, I was assigned the duty of follow up and evangelism
My primary assignment was to liaise with the follow-up lady and visit all the members who have not been to that church in weeks
I was also given the altar to minister one

Sunday a month (sermon) and other Sundays in various capacities like leading the church in prayer, taking testimonies, and closing prayer
We met this brother on the way to a member's house early one Sunday morning
He was sitting outside a building, wearing yellow slippers and

looking hopeless
We had walked past him but my spirit reached out to me, so I asked the sister to turn around with me so that we can minister to this brother
He was happy we came around
He said he had spent everything he had on the leg and he was desperate enough to accept any

#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/