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

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/

“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.…

New Cannabis Based Menu for Chao Phraya Hospital patients (service being rolled out to other hospitals too)
"This cannabis special menu is bringing different parts of the cannabis plant to use with leaves to cook as ingredients in food" #cannabis #Thailand

Whilst patients in the UK are still being denied with almost no progress with #NHS Amazing to see how much progress is being made with #cannabis as #medicine in #Thailand is the same 2 year period:

A Thread: 1/10 #Thailand allowed #cannabis #medicine in Jan 2019, 2 months after the UK.
NOW:
Is approved for 160+ conditions (everyone!)
Village doctors, clinics and hospitals can supply approved products or grow and produce their own, from nearly 100 approved formulas

2/10 - Average monthly prescription cost is £20-£30.
Educational programs started for the Medical Profession within 3 months, for many others at 6 months and school kids after a year. (Google Dr Ganja - see photo)

3/10 - Shortly they will launch a new policy for any individual or collectives to grow #cannabis for #medicine for themselves and any surplus material can be sold to the government for use in centralised production.

Okay, let's start this hypersomnia thread!

[note - I am not looking for unsolicited advice.]

Idiopathic hypersomnia or narcolepsy (not the same, but similar) is very hard to describe to people.

When I say "I slept 10 hours last night and I'm still tired" I'm not bragging. 1/16

For me, the accommodations I need are about time. My body doesn't care what I want to do - when I want to wake up or be asleep. My body wants to wake up at 10-11am, and go to sleep at 3am, always.

Just a one hour shift in my sleep schedule can screw me up for days. 2/16

When I tell people that I'd really "prefer it" if we could meet at 10am or later, it's because getting up before that has consequences for me. Big consequences. Most people won't see them. Sometimes I still give in and say it's fine. It ruins 2-3 of my days, sometimes more. 3/16

Let me explain. When I am required to wake up at 9am, esp. in covid times working from home, my body pays me back for it later.

I'm going to show you ways this happens. I can usually withstand 1 day of waking up early, with some consequences, but 2 days in a row kills me. 4/16

Let's say this graph represents Day 1, the first time I am required to get up early. The y-axis is my level of Sleepiness. Any symptom listed higher up includes that symptom + every other symptom below it. Getting up that early means I can't listen or concentrate all day. 5/16

ICYMI, public health officials fear community transmission of B.1.1.7 (the "UK variant") is underway in Ontario.

I'll dissect each piece of worrying news from this story.

1. Simcoe Muskoka has so far reported 3 positive tests in individuals *with no known links* to the massive B.1.1.7 outbreak at Roberta Place LTC.

Two of those are linked to separate outbreaks of their own (a different LTC and a mental health hospital). Testing underway.

2. Of the 225 cases at Roberta Place, 100+ are confirmed or preliminary + for B.1.1.7.

42 household contacts of ppl linked to the outbreak are also COVID+. Public health unit is worried about keeping cases (which are all likely B.1.1.7) from rippling further into the community.

3. A case in Kingston area who tested positive for COVID "several weeks ago" was just discovered to be B.1.1.7. That person travelled to Simcoe Muskoka, but had not travelled internationally, according to the local health unit.

4. Overall, Public Health Ontario counts 47 B.1.1.7 cases as of yesterday -- these are only the ones confirmed thru full genome sequencing. Preliminary screening tests not included (yesterday's 99 in Simcoe Muskoka, for example).

Here's a breakdown by health unit courtesy PHO: