Medical/Science Twitter - Do not trust IT hotshots with actual science data unless they have been trained in the real processes, know scientific method and their account/project/product managers approach with an established and medically respectable kind of taxonomy, plan, etc.

“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.…

#Thread on Tantra

The word ’Tantra’ literally means ‘loom’ in Sanskrit. There are several differing explanations as to what this word means. According to one source, this name is supposed to be a pun, and in order to understand it, one has to first understand the word ‘sutra’.

The key texts of Hinduism are known as sutras, a word which also means ‘formula or thread’. Therefore, if a sutra is a single thread of thought, then Tantra would be the loom that produces these threads of thoughts into a whole system of thoughts.

As a comparison, another source suggests that Tantra is a combination of two words, ‘tattva’ and ‘mantra’, which mean the science of cosmic principles and the science of mystic sound and vibration respectively.

In other words, Tantra may be regarded to be “the application of cosmic sciences with a view to attain spiritual ascendancy.”

In the beginning of Satyuga, Lord Shiva appeared in the form of Swacchandanatha, with his five mukha(mouth), namely Ishana, Tatpurusha, Sadyojata,

Vamadeva & Aghor. These mukhas represent his 5 energies, namely, Consciousness, Bliss, Will, Knowledge & Action. He manifested Tantras through his 5 mukhas (energies), some given by each of his mouth while others recited by him through two or more than two mouths simultaneously.

I’m deeply saddened to learn that Dr Joseph Sonnabend, one of the most important figures in the history of AIDS, died yesterday. I spent time with him in 2018 for one of the last interviews he ever gave. Let me tell you about this man and what he did:

Sonnabend was one of the first doctors to raise the alarm. In 1979, while running a sexual health clinic in Greenwich Village, he wrote to the NY Health Dept to warn them of the symptoms he was seeing: low white blood cell counts, enlarged lymph nodes. He didn’t get a reply. 2/

So he kept speaking out. When a patient of his developed a very rare cancer – Kaposi’s Sarcoma – he linked up with a dermatologist at NYU who said that over a dozen gay men had it. Sonnabend knew there was something very wrong. He started working at the lab at NYU — for free. 3/

It was soon after this in 1981 that the New York Times famously reported “Rare Cancer Found In 41 Homosexuals”. The next decade would kill most of Sonnabend’s patients and friends — and all of his lovers. What Sonnabend did was to fight for every single of them. 4/

Want to know who was the first to publish advice to wear a condom? That was Sonnabend. In 1983 he co-authored the first safe sex leaflet to fight AIDS: “How To Have Sex In An Epidemic”. 5/

@sbarnettARK Epigenomic biomarkers are becoming more established for #LiquidBiopsy and #CancerScreening, and we have seen the big players positioning themselves in this #epigenomics race recently.

Catching signs of #cancer early is crucially important to the disease management and survival rates, so the question is: how can we find out if there is something wrong going on early enough?

The first generation of high-throughput technologies was predicated on finding mutated (tumor) DNA in the individual's body (somatic), different from their (normal) DNA. Tumor/Normal (T/N) comparisons of the individual's samples, biopsies or ctDNA will indicate if there

are signs of cancer already underway. So why do we need #epigenomic profiling if we can do all this with the detection of mutations? Well, the argument is that if you can see sufficient mutated copies of DNA, cancer may already have progressed beyond the initial stages.

Then people asked the question: is there an earlier mark that we can detect for earlier stages of cancer before the Tumor/Normal mutations signal amps up? Here is where #epigenomics profiling took hold.