Cross-sectional imaging often reveals unexpected pancreatic cystic lesions, it is a frequent clinical problem, Should we observe or remove it? What's the diagnosis? Is our patient in danger of malignancy?
Don’t miss this @aegastro @my_ueg #EducAEG #UEGambassador twitter thread

Importance of Pancreatic Cystic Neoplasms (PCN):
Most are asymptomatic at diagnosis, frequency increases with age
Symptoms: acute pancreatitis (Wirsung obstructed by the cyst or mucus), pain, obstructive chronic pancreatitis, jaundice
> symptoms, >malignancy risk!

Classification of PCN:
Mucinous: intraductal papillary mucinous neop. and mucinous cystic neop.
Nonmucinous: serous cystic neoplasm, solid pseudopapillary neoplasm and cystic neuroendocrine tumours
Endoderm- derived columnar epithelium is characteristic for mucinous lesions
👇

Intraductal papillary mucinous neoplasms (IPMN)
Characterized by papillary proliferation+mucus production. It may involve Wirsung (becomes dilated) and/or branch ducts (cysts connected to the ductal system). It may evolve to pancreatic cancer particularly if Wirsung is involved

IPMN subtypes :
Intestinal: main duct, head, 40%->coloid/tubular adenoca
Pancreatobiliary: main duct,head, 68%->tubular adenoca
Oncocytic: rare, nodules,50%-> coloid/tubular adenoca
Gastric: most frequent, branch-type, uncinate, 10%->tubular

Every podcast, journal or book that I have read on health and upstream work boils down to these few steps. If u can get them right, u will be in great shape. A thread

1) Move. Though 10000 steps is just a number but a good goal to keep. This should be one keystone habit
2. Lift. Do strength training. Twice a week Four movements X 3-5 sets X 3-5 reps at 80% one rep max is good

3. Cardio - Not needed if u do 10000 steps but good to bring in for endurance and heart health.
4. HIIT once a week is good to improve anaerobic capacity
5. Sunlight - One of the most important thing that u can do for ur health is spending some time early in the morning

outdoors amidst nature
6. Protein- Make sure to get in 1.5-2gm protein per kg body weight.
7. Fibres - Aim to have 15 gms fibre per 1000 calorie. Half plate every meal preferably should be veggies.

8. Dietary fat is important for brain and hormone health.
9. Processed Sugar best avoided.
10. Fasting has its own advantage but u can do without it if u are managing ur calories. If u eat ur protein and fibre , u will not feel the hunger for rightly processed carbs

#SouthSudan #Sudan #SSOT

*Exposé of the Healthcare Sector in South Sudan*

Monday 4 January, 2021
(Washington DC; London)

*HIV/AIDS in South Sudan: The Diagnosis That Leads to the Murder of Doctors*

*Thon Wal* is an officer within the South Sudan National Police Service (SSNPS).

He was partly trained in Khartoum, Sudan, by the north Sudanese National Intelligence Security Service of the former Omar Hassan Al-Bashir and National Congress Party regime.

Aside from being a...

...policeman in the SSNPS, Thon Wal has also been operating in South Sudan for several years as a “private contractor” within the South Sudanese security apparatuses. Mercenaries who make themselves available for hire; and are sometimes more commonly called, the “Unknown Gunmen”.

So what is the relationship between Thon Wal and the former southern Sudan Inspector General of Police (IGP), *Makuei Deng Majuch*?

What is Thon Wal’s relationship with the key eye-witness, another policeman called *Mathew Aluong Makor*, in the murder of the British medical doctor, neuroscientist and academic, *Dr. Ding Col Dau Ding*? (1)

Essential reading for intensivists: things you didn't even dream were going on in your ventilated patients' lungs. With credit to @robertpdickson who does some very clever translational work on lungs

Firstly, we are aware of the inherent badness of oxygen. Here is protein content in alevoli after 48 hours of FiO2 95% (i.e. oedema), delightful.

Secondly, all those VAP's we get cross with (can someone silver impregnante the ET tube or something) that we think is just orally communicating flora/immunosuppression? Mais non. High FiO2 all but destroys weakling bacteria, leaving the redox-armoured king, staph aureus, to rule

Unmitigated staph surges and produces a truckload of PAMPs (pathogen associated molecular patterns). Being redoxically armoured, it is fairly happy to thwart oxidative burst from neutrophils attempting to kill them too.

Indeed the lung flora changes prior to the alveolar protein content - like both a canary in the coalmine moment, and then contributing to pathology.

The health-wealth tradeoff of lockdowns is still hotly debated. Here are some thoughts that may help untangle the issues. 1/17 #EconTwitter #EpiTwitter
Figure courtesy of @luismbcabral

Let's start with concept of tradeoffs. With aggregate societal wealth and health on the axes, we can show all combinations that we can achieve though different policies. All points in purple region are feasible, those outside it are not. Which point should we choose? 2/17

Since society values both health and wealth, from any starting point, we want to move in North-East direction. When making a move, we say that there is a tradeoff if gaining more health necessarily means giving up some wealth. 3/17

It can never be optimal to stay at an interior point like E, because we can get both more wealth AND more health by moving to points like G or F on the frontier. So at an interior point like E, there may be no tradeoffs at all. We can find policies to improve BOTH. 4/17

At extremes with 100% or 0% lockdown (like points A and C or nearby points), we're on frontier but again may be able to get both richer and healthier. But in intermediate cases, like G and F, there is necessarily a tradeoff. 5/17

"Dependency" and "personality disorder" in mental health services: a thread.

I'm thinking today about Courtney Porter who died earlier this year, just three days after being discharged from inpatient care against her wishes. 1/

She was 20 years old. At her inquest, @CNWLNHS defended their decision to discharge Courtney by stating that people with a diagnosis of EUPD could not stay indefinitely due to the "risk of developing a dependence on the service." 2/

"Risk of dependency" is a phrase used very commonly to deny or withdraw support and care from certain mental health patients - most often those bearing a personality disorder label. But why? Why are this huge heterogeneous group of people, labelled with PD, 3/

supposedly all at risk of developing dependency, more so than anyone else, and what is so terrible about dependency that it's actually preferable for people to die than to be dependent..? 4/

Mental health services in the UK reflect the western culture of viewing autonomy and independence as key to personal development and success. Since the rise of individualism and self-care in the NHS moved us away
5/

It's been 13 months since my craniocervical fusion surgery and 7 months since my tethered cord surgery. My diagnoses were craniocervical instability, tethered cord, ME/CFS, MCAS, POTS, and mold illness (which may or may be fully explained by MCAS). 1/n

Before my first surgery, I couldn't sleep inside a house b/c of mold illness/MCAS. I got paralyzed, unable to speak, and barely able to breathe, sometimes 8 or more times a day. This could result from tilting my head back, speaking too much, a loud sound, a tap on the head. 2/n

Traction (pulling my head away from my body) brought me back from these episodes. I couldn't ever be left alone. I wasn't bedbound, but I could do essentially nothing for myself. 3/n

By that point, my symptoms were extreme even for CCI, and they were quite unusual for ME/CFS. But I started out with classic ME/CFS -- PEM, POTS, unrefreshing sleep, cognitive impairment, low NK-cell function, wacky cytokines, sky-high IGGs for a bunch of viruses. 4/n

The last year has been HARD. These surgeries are brutal and hard to recover from. Needing a second surgery when I hadn't yet fully recovered from the first was emotionally and physically rough. 5/n

Dear #MedTwitter please, please, if you are a licensed medical professional and/or in school to be, do NOT delete your tweets or comply with anyone telling you to do so. It will harm you far more than leaving them up and explaining. Nothing is ever deleted. Can be used in court.

When I was at Harvard Med School and at an esteemed children's hospital, a case against an esteemed professor, that NO lawyer would touch cuz this was someone who had WRITTEN the textbooks and trained every expert, was won ..based on "a document was deleted" - creating suspicion

"Sunlight is the best disinfectant" you will hear me say OVER and OVER - wins & losses *should* be on data/standards but unfortunately wins & losses are in the court of public opinion. So be reliable, credible, and trustworthy. Transparency is one way to achieve that reputation.

The tweets I delete typically have a typo or the link did not populate the image as I wanted and I *immediately* repost THE SAME tweet, corrected. That way if anyone with "dark web" capacity were to try to "find dirt", ain't none. What you see is what you get.

I have been around the block enuf times, been a public servant w/ strict COI & scrutiny of my every word, & have been "in the room" when we have been deciding billions of dollars of state funding in Medicaid

You can decide whether you trust my

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.

👋I will literally volunteer to sit in on these vendor pitches and translate snake oil sales pitches to make sure the stakeholder/end user requirements and needs and priorities are clearly defined so shit like this stops being a viable business model that does nothing but harm.👋

Very few people in IT at any actual level that is being given respect right now out of dire necessity have the kind of training or experience to handle this shit. Few if any of the data models that have been accepted and are being used follow the HIPAA-grade science methodology.

I only know this stuff because I built and managed informational and compliance portals for a pharmacy chain's operations team and designed/built/launched a ton of stuff for uses with ACA. And my best friend from home is doctor who keeps me in medical research journals if I ask.

But the need to approach this virus as a true unknown with constant expected variable shifts and false positives and correlating behaviors that may or may not even be related to each other as the real research work is being done is imperative. Don't buy IT's easy answers to this.

Dental news you’ve missed this week.https://t.co/9KB8gbT2W8 healty for you.

CDO Sara Hurley speaks out after change in COVID-19 alert level

1/ The classic presentation at morning report for hypercalcemia starts with polyuria, constipation and confusion. #UncleBob wanted to understand why - stimulated by @CuriousClinPod ? @HannahRAbrams @tony_breu @AvrahamCooperMD

2/ Let's start with confusion. Finding information on this is very non-specific but I think this quote helps: High calcium levels can be a catalyst for neuronal demise, possibly due to glutaminergic excitotoxicity and dopaminergic and serotonergic dysfunction.

3/ But colleagues and learners know that I am most interested in the polyuria. I have taught that hypercalcemia can cause nephrogenic diabetes insipidus, but the mechanism was unclear. Let's review how ADH works and then look at an interesting study that suggests an answer.

4/ Antidiuretic hormone stimulates water reabsorption: stimulating insertion of "water channels" or aquaporins into kidney tubule membranes which transport solute-free H20 through tubular cells & back into blood, -> decrease in plasma osms and an increase urine osms.

5/ Thus we need to stimulate ADH production and have aquaporins (specifically aquaporin-2) available for transport. In general nephrogenic DI occurs because of the lack of aquaporin-2(AQP2).

Hot take: optics are better abstraction than lenses, in *all* use cases. Why? They make explicit all the things you're implicitly thinking about anyway when using lenses. I think they are really important in shaping how we think about bidirectional maps. A short thread. 👇 1/9

Optics make explicit 1) the internal state (residual) and 2) the fact that you need to have the base category either be Cartesian, or at the very least have the "get" maps be comonoid homomorphisms. Let's look at the state/residual.
2/9

In lenses, this state is always the same as the input and is implicit. This can be seen by repackaging the get map from get: X → Y to Δₓ;(get×X):X e→ Y×X. Now our new get map (in addition to computing the output) passes through the input. This is good for a few reasons. 3/9

First, this pleasantly symmetric with the put:X×Y'→X'. But also, this new map is now exactly the "left" map of an optic too. (It turns out put was all along the "right" map). This tells us that the passed-through input is actually the state we're remembering. 4/9

But most importantly, this formulation is now explicit in the use of the copy map Δₓ:X → X×X, which you might have not realized is needed if you were just thinking about the standard get-put formulation. Furthermore, when you were composing lenses, ... 5/9

Exactly 5 years ago today, Dafna Meir, a 38 year old nurse, wife, and mother of 4, was brutally murdered at her home in front of 2 of her children, by a 15 year old Palestinian.

Two days later, the murderer was arrested by Israeli security forces.

Here is his testimony >>

“She struggled”, the 15 year old murderer told the investigators.
“I stabbed her until I couldn’t pull the knife out of her body” >>

“Why did you kill her?”
he was asked by the investigators.

“Israel is killing our youths. That’s why. I decided to do the same as other young Palestinians do...I realized I might get hurt but I had faith in god” >>

“I was hiding and watching a settler lady with two small kids. She had that Jewish head scarf. She was speaking on her cellphone...I waited until she stepped outside so I can murder her” >>

“She stepped outside, I ran 5 meters towards her and stabbed her in the stomach...she began screaming...her children saw me stabbing her and began screaming”

The present iteration of conspirituality is defined by its online mediation. Frictionless space allows for unbounded charismatic reach and absolute, transcendent evasion of accountability. /1

Conspirituality themes of heroic individualism versus the cabal of control merge seamlessly with personal branding that pretends to outshine consensus reality. /2

Conspirituality and social media are now materially and economically parallel. In their first-order impacts, both monetize attention and emotional manipulation. But in the next ring out, both impact the material world in life-and-death ways. /3

Conspirituality can shift vaccine hesitancy, for example, while social media generally can disrupt IRL relationships and provoke addiction cycles and mental health crashes. And a thousand other things. /4

As with most online political activism, conspiritualists believe they are accomplishing something through that first-order dopamine loop. They’re not really building a world with posts, but social proof tells them they are. /5