UK variant update:

50% more contagious and the main difference is in the rate of infection in children up to the age of 9.

No significant difference found yet in clinical course, mortality within 28 days or chance of re-infection.

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https://t.co/D8DXVvBeew

50% higher infection rate

(Secondary attack rate 15.1% versus 9.8%)

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Main effect in children under 9 years old

(see age distributions, second image has overlay of reference onto UK variant)

3/

Essential to stop the UK variant: 50% higher transmission will lead to more cases, more hospitalizations, more ICU cases, more deaths, and greater economic costs.

Independent SAGE's plan for the UK variant

With the new Covid variant everywhere, it's not enough to just wait for the vaccine | Stephen Reicher

Here is a tweetorial from our latest publication in @Annals_Oncology about longitudinal tracking of esophageal adenocarcinoma. #OesophagealCancer #EsophagealCancer https://t.co/QWvrzBXmK7 1/8

We sequenced 245 plasma samples from 97 patients with oesophageal adenocarcinoma using a 77 gene pan-cancer ctDNA panel. 2/8

Variants derived from previously characterised driver oesophageal adenocarcinoma genes had a significantly higher VAF than variants from other genes, indicating selection. 3/8

Peripheral blood cell samples were also sequenced for 78/97 patients. CHIP mutations were identified in 23% of cases, longitudinal tracking of CHIP variants suggested these variants were dynamic over time. 4/8

We found patients that were ctDNA positive post-surgery had a significantly poorer survival than ctDNA negative patients, and the elimination of CHIP variants improved the positive predictive value. 5/8

I’m going to tag this as a little tutorial for @MichaelYeadon3 who keeps saying that there’s no problem from the suppliers of medical ‘gasses’

Most hospitals in the U.K. run their O2 supply from a Vacuum Insulated Evaporator (VIE)

https://t.co/Lu9ktGFSSm

1/n

This VIE is essentially a large thermos flask/ vacuum insulated cylinder at -180C
O2 is supplied from (typically) BOC in liquid form; when required, allowed to evaporate into gas, & supplied to hospital outlets.

Most hospitals have a VIE big enough to meet their needs

2/n

The problem is the pipes

Most ~12 bed ICUs have pipes that allow ~400L/min flow

This is Ok because most ventilators don’t use >20l/min; giving useful buffer capacity

Modern non invasive ventilation systems- CPAP, NIV, and High flow nasal Oxygen (HFNO), however, need more
3/n

A typical patient on HFNO will have 60-80Lmin flow. If they’re on 90% O2, that’s 60L O2 for 1 patient

6 of these patients will come very close to triggering the O2 flow alarm for this 12 bed unit.

4/n

Aside from breaking walls and re engineering the O2 supply for the whole hospital there’s no easy way of solving this problem
5/n

"Public health" isn't just about vaccinations, clinics and urgent care: it's a holistic discipline that encompasses all the contributors to health outcomes, which include things like housing, employment, transportation, pollution and more.

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A new working paper from @nberpubs estimates the number of US covid deaths that could have been prevented with a coherent, effective eviction moratorium and a ban on utility cutoffs:

The paper, written by a multidisciplinary group of Duke researchers from medicine and economics, found that housing precarity (a risk of losing your home) drove risky behavior that increased the spread of the disease and the resulting deaths.

3/

For example, it forced people to double-up on lodgings, making social distancing impossible, to say nothing of self-isolating after an exposure. It also drove people to tolerate high-risk workplace conditions, including illegal conditions.

4/

The authors used regression techniques to control for confounding variables, and used like-for-like counties with different utility and eviction policies to estimate the effect that these had on infection rates.

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What does it take to sustain screwiness in the way the world works? Mostly, it's just good people, trying their best to get us to a better place... within constraints which pretty much preclude us actually getting anywhere! A case in point with

These authors come across as hugely committed to something we might all agree upon: improving young people's experiences of physical education through better school-based-interventions. Sounds great? Agreed, & pretty much everything about their study models best practice 🥳

Sadly, established "best practice" involves further embedding the medicalisation of PE as if it should be about the potential contribution of physical activity to everything from quality of life, self-perception & cognition to the likelyhood of becoming healthy & active adults 🤯

We're reminded of the Chief Medical Officer's "recommended guidelines of 60 min of moderate-to-vigorous physical activity (MVPA) per day for healthy growth and development" 👇 This is a focus on what we can easily measure (generic) rather than on what we might value (individual).

We get recognition that PE "is not merely an opportunity for children to engage in PA" but that's linked to its role in "the development of knowledge & skills to foster their PA engagement throughout life" - so further focus on health outcomes. A long way from @meaningfulPE 🙄

Long THREAD :

Sources : A litigant named Dr. M. Geethanjali, approached the Madras HC, to redress her grievance wherein, she was denied an MD Opthalmology seat in PSG medical college whereas a candidate who got lesser rank than her was given the same seat. 1/n

The petitioner also alleged that while the initial fee fixed by government at the time of admission was Rs.3 lakhs, PSG college demanded 35 lakhs.

Justice Anand Venkatesh of Madras HC in an elaborate and detailed order, 2/n

went in-depth into the issue and found that, private medical colleges are making a killing in PG medical admissions using the pandemic. 3/n

The Court observed, _“The governments are grappling with the situation and the normal functioning of the society virtually came to a standstill and slowly attempts are being made to restore essential functions with sufficient safeguards. 4/n

Unfortunately, attempts are also being made to take advantage of this situation to justify certain actions. There is an attempt to put every blame on the Corona Virus even where it did not have a direct nexus to the action performed by an institution or any 5/n

1) Anyone injecting people with EXPERIMENTAL mRNA 'gene-therapy', FRAUDULENTLY labelled ‘vaccines’, WITHOUT informing them they're taking part in an EXPERIMENT with potentially very serious health risks, including death, IS BREAKING THE LAW. Nuremberg Code https://t.co/OY1Q3L3DwA

It's Monday AM post-@ASCO #GU21 & clinic starts in a couple of hours! Lots to process - I'll try to tackle optimal 1L tx for #kidneycancer. I'll make a case for cabo/nivo, leaning on the beautiful (& timely) tables below from @lalaniMD, @SoaresAndrey & @brian_rini (1/15)

What about IO/IO? We have long f/u w #CM214 data w nivo/ipi, no doubt (@AlbigesL et al in @myESMO Open). And treatment-free interval discussed by McDermott @BIDMChealth is no doubt impt. But we've known data not as impressive for favorable risk (2/15)

And furthermore, as @ERPlimackMD points out in another tweet, impt to look at primary PD rates (seen in @lalaniMD's table) - nivo/ipi at 19%!!! CR rate used to be something we highlighted w nivo/ipi, but now comparable across studies (3/15)

Okay now to the really tough stuff - comparing TKI/IO regimens. Something interesting I will add to @brian_rini @uromigos table above is the HR for PFS by INVESTIGATOR review. If the diff in HR for PFS by IND review caught your eye, this is even more striking (4/15)

I think INV-assessed PFS is impt, but if you're a skeptic, forget that argument. Turn instead to #QOL with axi/pembro. Kudos to @brian_rini @tompowles1 @ERPlimackMD et al for advocating for QOL in KN-426. @crisbergerot et al have taughts us the importance of these metrics. (5/15)

What reaching the peak means for the NHS: We're increasingly confident we have hit *a* peak and hopefully *the* peak of the second wave of coronavirus infections. Hospital admissions lag behind and will carry on rising for another week or so, but this is still a key moment… 1/10

I have talked before about how and why the healthcare the NHS provides right now is simply not as good as usual. We have protected emergency care but routine care for cancer, cardiac disease and so many other illnesses has been badly affected. Especially surgical treatments. 2/10

The surge in COVID patient admissions has a huge impact on other parts of the NHS. We see this pattern often in the winter flu season but it is far worse right now. The shortage of normal hospital beds and ICU beds makes in-patient work very difficult. 3/10

But the key issue is planning. The NHS was not designed to handle huge fluctuations in patient numbers over short periods. We need spare capacity to admit patients into. When the hospital is full, patients must wait to come in, creating serious problems in Emergency Depts. 4/10

Creating spare hospital capacity for a workload we cant predict is difficult. Solutions for small/medium/large patient numbers are all different. If we under-prepare, we cannot admit every COVID patient. If we over-prepare, we ring-fence beds we could use for other patients. 5/10

Spoke with my neighbour. A type 2 diabetic on medications and realized even now there is so much ignorance on this subject. I have done extensive research on this subject (was forced 2 after being diagnosed)

Here sharing it with you all. retweet it, it may save someone's life.

My Neighbour said his hba1c is 7. Everything is fine, he just needs to bring it below 6.9 and he would be fine.
That is just baloney! anything more than 5.6 will result in all kind of complications (Kidney failure,retina failure (blindness) amputations& heart attack etc etc

When i told him the benifits of intermittent fasting and fasting, My neighbour Nitin said, I cannot fast as doctor said i need to eat 5 -6 times a day.

FACT: If you are NOT on any insulin enhancing drugs. you can fast as much as you want. (metformin is OK)

to which he said These drugs r permanent & progressive, you can never stop using them.
FACT: if you can change your diet, you can change your sugar and insulin levels and no longer need these drugs. (advise not aplicable to type 1 diabetics, they wud always need insulin injection

Diet, I am on diet precribed by WHO.
FACT: Fuck WHO, and don't eat carbohydrates. infact another name of diabetes is carb intolerance. You can never acheive 5.6 or lower while eating your rice and roti.

Syngene & CRAMS are synonymous in the Indian stock market today.

From Early Discovery to Commercial Supply

NMEs cater to

~Pharmaceutical
~Biotechnology,
~Nutrition
~Animal health
~Consumer goods
~Speciality chemical

In this thread, let’s deep dive into their FY20 AR

1/
Syngene works with clients from around the world to find solutions to their research, development, and manufacturing challenges for small and large molecules while improving productivity, speeding up time-to-market, and lowering the cost of innovation.

Syngene At a Glance

2/

Plans

~Capacity Addition
~Capacity Expansion
~Partnering for Success

Vision: “To be a world-class partner delivering innovative scientific solutions”

3/

Kiran Mazumdar Shaw, Chairperson’s Message

4/

Jonathan Hunt, MD & CEO’s message

Folks, we need to talk about this Vitamin D trial. I have no stake in this game - take Vitamin D if you want but this pre-print is super sus.

The paper is presented as a randomized trial of vitamin D supplementation in hospitalized patients with COVID. Interesting and important question! And the results appear dramatic:

If true, this would be one of (if not THE most) effective treatments for COVID. But there are problems...

The first clue something is up is that the randomized groups aren't the same size:

It took me a while to figure out why this was, then I saw in the text that INDIVIDUALS were not randomized, WARDS in the hospital were.

I do want to talk a bit about connections, conflicts and information during a pandemic. Since @fordnation insinuated I have COI which I don't, let's take a look at a single instance where @fordnation and Hospital for Sick Children are both making interesting decisions.

Both share a powerful supporter in Peter Gilgan, who has been a great supporter of Sickkids

But his company, Mattamy Homes, has also substantially bankrolled Ontario Proud, which I have reason to believe pushed the Postmedia hit on my reputation.

Sickkids and Mattamy have very close ties. Here is Mary Federau, a longtime Sickkids exec who has moved to Mattamy but remains involved with the Sickkids foundation:

Mary's bio is too modest. It looks as though it has been scrubbed a bit over the last 72 hours. Here's the google cache from Jan 25:

Things look dire in SoCal hospitals. Check out these quotes!

“We’ve never had so many patients,” said Adrian Cotton, chief of medical operations at Loma Linda University Health in San Bernardino County.”
1/

(read to the last quote please)

“...at least one hospital has set up an outdoor triage tent to handle the overflow of people”

“In Long Beach, hospitals have started visitor restrictions. In the South Bay, a conference center has been transformed into an ambulatory clinic.”
2/

We have signage set up all over the hospital to inform patients that, if they have any family members with even signs of symptoms, not to visit”

“Loma Linda emergency physicians are seeing about 60 more patients a day than usual, Cotton said.”
3/

“About 150 patients have so far been treated in the tent, which is staffed according to the number of people inside. It’s expected to be up through March.”
3/

“As the main emergency room gets full, patients are moved to the tent. For example, a patient who comes in with a broken arm is likely to be treated inside the tent, he said. Visitor restrictions have also been implemented.”

“The county saw a 300-percent increase”
4/

@MSF was allowed to enter #Mekelle on 16 Dec & here is their account 👇

"no basic supplies. The local hospital was running at 30 to 40 %, with very little medication"

This is why one of the reason why we demand unfetters #HumanitarianCorridor
#TigrayGenocide

#Adigrat "The situation was very tense & its hospital was in a terrible condition. Most of the health staff had left, there were hardly any medicines &there was no food, no water and no money"
#StopWarOnTigray
#TigrayGenocide
#HumanitarianCorridor
#EritreaOutOfTigray

After 1 month since @AbiyAhmedAli declared victory

"#Adwa & #Axum. There we found a similar situation: no electricity & no water. All the medicines had been stolen from #Adwa general hospital & the hospital furniture & equipment were broken"

#StopWarOnTigray
#TigrayGenocide

"Beyond the hospitals, around 80 or 90 per cent of the health centres that we visited between Mekele and Axum were not functional, either due to a lack of staff or because they had suffered robberies"

#StopWarOnTigray
#TigrayGenocide
#EritreaOutOfTigray
@UN @POTUS @StateDept

"1 woman had been in labour for 7 days without being able to give birth. Her life was saved because we were able to transport her to #Mekele"

It is really heartbreaking to imagine how many of our mothers & sister have lost their lives.

#StopWarOnTigray
#TigrayGenocide
@UN

1. “Dr Tomas Ryan : Sociopath Or Psychopath : Or Both ?”

Answer = Both. Shortest Thread Ever. Only joking. Let’s jump in and try to see what makes Dr Tomas Ryan tick 🧵 1/21

2. Dr Tomas Ryan is a Neuroscientist at Trinity College Dublin. He has appeared on Claire Byrne Live, Prime Time & The Tonight Show in addition to radio appearances. He calls himself a Scholar on his Twitter bio.

3. He is part of the Zero Covid Cult Crew (ZCCC) out of that hallowed institute of learning, Trinity College Dublin. Other contemporaries of his in the merry little band are Luke O Neill, Kingston Mills & Aoife McLysaght.

4. Kingston Mills & Aoife McLysaght are staunch proponents of the Zero Covid strategy. Mills is an agenda contributor to the World Economic Forum and recently wrote an article for them entitled "Is reaching zero Covid-19

5. Did I forget to mention that TCD got funding from the Bill & Melinda Gates foundation for Vaccine development to the tune of $230,000. Tomas was also sponsored by Wellcome Trust Sanger Institute to complete his Phd in Cambridge. Let's just say he has connections to Big Pharma

There are some of us that don't have the pleasure of being able to consume milk products like we wish because when we do, it is accompanied by diarrhea, abdominal pains and bloating.

Sorry my dear friend, you're lactose intolerant. Let's talk about lactose intolerance today.

Lactose intolerance is a common disorder and is due to the inability to digest lactose into its constituents, glucose and galactose, secondary to low levels of lactase enzyme in the digestive tract.

So when you consume milk, it contains lactose. This lactose must be broken down.

Lactose in it's original form is a disaccharide, but for it to be absorbed by your small intestine, an enzyme called Lactase is required to break it down (hydrolysis) into a monosaccharide. In those with Lactose Intolerance, Lactase is absent. So Lactose remains a disaccharide.

The osmotic load or weight of this undigested lactose disaccharide causes secretion of lots of fluid and electrolytes into your digestive system, and that's where wahala starts. This leads to enlargement (dilation) of the small intestine that induces quick movement of the...

undigested lactose into the large intestine. Now when this lactose gets to the large intestine, it becomes fermented by bactaeria and this yields short chain fatty acids and gas. The combined effects of increased water in the feces, movement of the poorly digested lactose, gas...

Cipla concall was today at 10:40 pm (late night)

Here are the key takeaways 😃

@unseenvalue @darshanvmehta1 @AlgoBoffin @iramneek

Introduction

- Company being the first one to launch Remdesivir and the whole portfolio for covid 19

- Company is no.2 in lung leadership. Will try to unlock the complex generics in US.

- Growing faster than the average market growth.

- Trying to bring respiratory technology in China and in Brazil.
- There is a fair amount of unlocking through digitalization.
- ESG to improve in future. Becoming carbon neutral and water neutral.

US business
- Were able to add

- would be doubling the revenue in US.

- The pipeline is nicely diversified , now the products are diversified into respiratory + injectable around 30%

Indian market: One india strategy
- To cosumerize the business.

- Generic business is no.1 in india.

- Brand is moving from generic business to consumer business.

- Goal is to keep beating market growth by expanding the depth in portfolio.