@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.

“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.…

Mistakes natural lifters make

THREAD ⬇️

1) Bro Splits

Let's start off with the big one.

A natural lifter needs the actual training session to trigger the increase in anabolism that a steroid user will get 24/7.

After a workout, anabolism/protein synthesis is elevated for roughly 30-36 hours.

So training a muscle once a week is sub optimal as you're getting 30-36 hours of enhanced growth out of a 168 hour week.

Whereas if you train a muscle 2-3x per week this goes up to 60-72 hours or even 90-108 hours of enhanced anabolism, leading to faster growth.

Obviously there will be some individual differences here, but as a natural, if you only train a muscle once per week, you're leaving a good chunk of gains on the table.

It's optimal to spread your total weekly volume out across the week by increasing your frequency.

2) Not getting strong

If you get strong on the basic lifts and their variations such as the squat, deadlift, presses, rows and chins, I guarantee your physique will show it.

Take your squat from 225lbs x 10 up to 315 x 10 your legs will be bigger.

Stop fucking around!

I transformed my body in 6 months.

People charge INR 25,000+ for this information. It should be free.

Just follow these simple fat loss rules:

Exercise:
• 3-4x per week
• Weights > Cardio
• Compound movements first
• Cardio after weights

Don't focus on burning calories focus on getting stronger

Video

Nutrition:
• 20-25% calorie deficit
• 1.6-1.8 g/Kg Protein
• 2x fruits & veggies daily
• Limit eating out

Food quantity determines weight loss. Food quality determines health.

Video

Sleep:
• Fix wake up time
• Sleep 8 hrs
• No caffeine after 2 pm
• Dinner 2-3 hours before bed

Have a routine, and be consistent. Routines save your time and maximise your energy.

Video

Simple is beautiful.

Don't bookmark and forget.

• Commit to the end goal
• Disappear for 6 months
• Build yourself in private

Before you go, I would love to give you 10 bonus tips to make you unstoppable-

(with step-by-step video tutorials)

APL Apollo conducted their earnings con-call today at 2:00 pm

"Vision of capacity of 4 Million Tone till 2025"

@hiddengemsindia @gvkreddi

Here are the key highlights 😀👇

Business Updates:

• Net Working Capital Remains under 10 days which is best in the building material
• Continue expanding rural region.
• Added 15 new distributors.
• Value added products contributed 50-60% of the topline.

Revenue breakup

• EBIDTA Margin Improvement: This was mainly because of cost structarize and better operational

• Working Capital Cycle as per mgmt should remain sustainable

• Blue Ocean: Company owns 100% subsidiary which contributes nothing but own property where corporate office is there

Improvement in Net Selling Realization:
• With expanding capacities at 2.6Million Tones and utlization of 75%, scalability has been affected.
• While the prices of steel has gone by by around 35%, due to shortage of steel.

• Apl Apollo being the dominant player past connection with steel companies worked well.
• Steel tubes supply from China is shrinking.
• Hence the discounting factor while selling the products has went away.