https://t.co/RbqZKkUIjx
Controversial 3D. Probably none of you knows about Leber congenital amaurosis type 10, congenital blindness that affects 3 out of 100,000 children, condemning them to blindness for life. The only possible treatment is through gene therapy. 1/n
![](https://pbs.twimg.com/media/Ermmr-LXAAABmx2.png)
https://t.co/RbqZKkUIjx
https://t.co/iO2jqcIxU0
https://t.co/mG9lQoNCXI
![](https://pbs.twimg.com/media/Ermq1_sXAAAoEvg.png)
https://t.co/gnczyUWw9i
https://t.co/nYLR1Sq2BW
So take a small risk to protect the others and stop complaining. 9/n
#WearADamnMask #vaccinoCovid 10/10
More from Health
🚨New lockdown regulations just published, in force tomorrow
The Health Protection (Coronavirus, Restrictions) (No. 3) and (All Tiers) (England) (Amendment) Regulations 2021
https://t.co/L5jwlTDaIE
(Thread)
These are not a new set of regulations: they are amendments an old set of regulations
Which we thought were gone! But they are back
Welcome back No.3 regulations
A quick thing before we continue!
I have been analysing these laws for free for 9 months now - if you want to say thanks and have a few £ to spare please give to my @LawCentres fundraiser
They give free legal advice to people who need it
They also amend the All Tiers regulations
Oh god it's all amendments by paragraph references
Basically all of England now in Tier 4 and Tier 4 is amended but not by a huge amount
This really is a terrible way to make laws on the fly - who can possibly understand it?!
So, to explain, you need 2 documents open if you want to understand what is going on:
All Tiers regulations (Tiers 1-4, 2 December as amended) https://t.co/IraPQ112ak
And amendments https://t.co/L5jwlTDaIE
No sensible way of doing except by track changes, on it now, back soon
The Health Protection (Coronavirus, Restrictions) (No. 3) and (All Tiers) (England) (Amendment) Regulations 2021
https://t.co/L5jwlTDaIE
(Thread)
![](https://pbs.twimg.com/media/Eq_G2BHXUAEDrYW.jpg)
These are not a new set of regulations: they are amendments an old set of regulations
Which we thought were gone! But they are back
Welcome back No.3 regulations
A quick thing before we continue!
I have been analysing these laws for free for 9 months now - if you want to say thanks and have a few £ to spare please give to my @LawCentres fundraiser
They give free legal advice to people who need it
They also amend the All Tiers regulations
Oh god it's all amendments by paragraph references
Basically all of England now in Tier 4 and Tier 4 is amended but not by a huge amount
This really is a terrible way to make laws on the fly - who can possibly understand it?!
![](https://pbs.twimg.com/media/Eq_HkOFXIAUZfvB.jpg)
So, to explain, you need 2 documents open if you want to understand what is going on:
All Tiers regulations (Tiers 1-4, 2 December as amended) https://t.co/IraPQ112ak
And amendments https://t.co/L5jwlTDaIE
No sensible way of doing except by track changes, on it now, back soon
1/15
Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial
2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR
3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp
4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR
5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY
Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial
![](https://pbs.twimg.com/media/EsguIasVkAEbrgS.png)
2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR
![](https://pbs.twimg.com/media/Esgu6r8XMAAvxN2.png)
3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp
![](https://pbs.twimg.com/media/EsgvNjcVcAAO1q8.png)
4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR
![](https://pbs.twimg.com/media/EsgvuTOXcAIKQI6.jpg)
5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY
![](https://pbs.twimg.com/media/Esgw7RkW8AI37Oc.png)
You May Also Like
So the cryptocurrency industry has basically two products, one which is relatively benign and doesn't have product market fit, and one which is malignant and does. The industry has a weird superposition of understanding this fact and (strategically?) not understanding it.
The benign product is sovereign programmable money, which is historically a niche interest of folks with a relatively clustered set of beliefs about the state, the literary merit of Snow Crash, and the utility of gold to the modern economy.
This product has narrow appeal and, accordingly, is worth about as much as everything else on a 486 sitting in someone's basement is worth.
The other product is investment scams, which have approximately the best product market fit of anything produced by humans. In no age, in no country, in no city, at no level of sophistication do people consistently say "Actually I would prefer not to get money for nothing."
This product needs the exchanges like they need oxygen, because the value of it is directly tied to having payment rails to move real currency into the ecosystem and some jurisdictional and regulatory legerdemain to stay one step ahead of the banhammer.
If everyone was holding bitcoin on the old x86 in their parents basement, we would be finding a price bottom. The problem is the risk is all pooled at a few brokerages and a network of rotten exchanges with counter party risk that makes AIG circa 2008 look like a good credit.
— Greg Wester (@gwestr) November 25, 2018
The benign product is sovereign programmable money, which is historically a niche interest of folks with a relatively clustered set of beliefs about the state, the literary merit of Snow Crash, and the utility of gold to the modern economy.
This product has narrow appeal and, accordingly, is worth about as much as everything else on a 486 sitting in someone's basement is worth.
The other product is investment scams, which have approximately the best product market fit of anything produced by humans. In no age, in no country, in no city, at no level of sophistication do people consistently say "Actually I would prefer not to get money for nothing."
This product needs the exchanges like they need oxygen, because the value of it is directly tied to having payment rails to move real currency into the ecosystem and some jurisdictional and regulatory legerdemain to stay one step ahead of the banhammer.