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

A week ago I voluntarily admitted myself to the hospital to get help bc I am losing weight as a result of increased food intolerances, secondary to my very severe #MECFS. A psychiatrist here decided that im mentally ill, 1/

purely on the basis that the medical workup was unable to explain my food intolerance. My psych eval only found mild anxiety and depression. 2/

They have put me on a 72hr psych hold while they work to get the county courts to commit me to a psych ward. This is a nightmare. They have taken away most of my belongings, put me in a new uniform, and are keeping me under 24/7 video surveillance. 3/

In the middle of the night last night when I sat up to use the urinal loud alarms sounded, as though I was trying to escape. I can’t even walk and hadn’t even left my bed. 4/

If they succeed in having me fully committed I will lose ability to communicate with the outside world except for an occasional phone call. I will lose all agency, and will very likely have treatments forced upon me. 5/

@br0oklynzo0 @KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg Okay, so you haven't read the study in the British Journal of Sports Medicine, you've read a Guardian story about it.

I have now read the study, and I teach critical appraisal as part of my job, so let's dive into it a bit.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg First things first, the sample size in this study is tiny. 46 people. Plus, the point of comparison was "all women and men under the age of 30 in the Air Force between 2004 and 2014" rather than a longitudinal group.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg So no matching for age, background, or physical condition. The result of these is that you're going to get a lot of statistical artefacts.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg Second of all, there were three points of comparison here and you're ignoring two of them. The researchers measured for push-ups and sit-ups as well, both of which showed physical advantage removed entirely by hormones. Which means you're cherrypicking.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg So what do you get when you have a tiny sample size and cherrypicked results? That's right, you get noise in the data. Take a look at the results graph from this paper you haven't read.

“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.…

8 superfoods that will 10x your body mass:

1. Red Meat

Red meat is an excellent source of protein that aids in weight gain and muscular development.

It has leucine and creatine, which are substances important for increasing muscle building.

Protein and fat found in steak and other red meats contribute to weight gain.

2. Starchy Foods

Potatoes, sweet potatoes, corn, whole grain bread, oatmeal, whole wheat pasta, and brown rice are high-carbohydrate foods.

Carbohydrates, which have a protein-sparing effect, are essential for muscle growth along with proteins.

3. Eggs

Eggs are a powerhouse of protein, zinc, vitamins A, D, B 12, phosphorus, and folate.

Egg protein has a high biological value, which makes it the ideal post-workout snack.

There are 90 calories, 6.7 grams of fat, and 6.1 grams of protein in one large scrambled egg.

4. Fatty Fish

Essential fatty acids and proteins are abundant in fatty fish like salmon.

They aid in weight gain and immune boosting.

The finest source of omega-3 which is important for weight gain is found in these fish.