https://t.co/tGxQi7Rb8z
ONE FLU OVER THE CUCKOOS NEST. BORIS AND MATTS’ ECONOMY WITH THE ACTUALITE. NHS SPIN RUNNING ON LEAN #COVIDSTROIKA #WHATHAPPENEDTOFLU WHERE DID ALL THE BEDS GO? #EUROMOMO

🧵For months, healthcare professionals have been hanging on to the guardrails of the top deck of the Titanic.

We have been screaming at the top of our lungs that there is an iceberg dead ahead and begging the captain to turn the wheel.

We have had other passengers who are

in the food hall and can’t see the iceberg from where they are standing mocking us accusing us of lying about the iceberg.

“There is no iceberg. You’re seeing things”

“Even if there is an iceberg it is smaller than predicted based on available models”

“You’re getting paid

to claim there is an iceberg.”

We are on the ship too. So we are watching the ship approach an iceberg knowing full well that we are going down with the ship.

Do we keep screaming? Even though nobody is listening? Do we jump ship and save ourselves? The water is freezing

and we don’t want to desert our fellow passengers.

Do we gather up the other passengers who can see the iceberg and form a human shield to take the impact on ourselves? Do we bum rush the captain and demand he turn?

Or do we stand still, silent, frozen in a state of fight or

flight? Paralyzed with sheer terror.

Never in a 14 year career would I have imagined I would see this day.

How are we supposed to feel when a critically ill patient has survived cardiac arrest

Over the past few days I’ve been speaking to several frontline NHS staff working in hospitals in London and surrounding areas and it seems that the situation is incredibly dire

-- THREAD --

One doctor in a London hospital tells me that following a huge spike in cases their hospital is struggling to cope and they now have no choice but to ration Oxygen: “No beds, no space, minimal Oxygen supplies. We’re having to ration Oxygen.”

A senior doctor at one of the biggest London hospitals tells me that all elective surgery has now been cancelled and that roughly 80-85% of beds are currently being used for COVID patients.

At one hospital in London a specific team has been set purely to aid with the patient discharge process. Why? Simply to free up as much bed space as possible because demand is higher than it has ever been.

One medic tells me that the number ITU beds has increased at their hospital as they try and deal with extra demand but they only have staff to cover half of them: “Yes we have extra beds but what is the point if we don’t have any staff to actually work on them?”

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My last #tweetorial focused on the GCS. Now let's look at another hugely important clinical window into the brain: the pupil. What does a 'blown pupil' really imply? What about small fixed pupils? To understand this, we need to see how pupil size is governed. #FOAMed 1/20

The pupil has two functions, constriction and dilation, both under autonomic control. Sympathetics dilate the pupil and open the eyelid - easy to remember, because in 'fight or flight' mode, maximum information needs to get in to keep you alive. 2/20

By contrast, constriction is parasympathetic. Its main function is to regulate the amount of light on the retina, so in response to high light intensity (like a pen torch), both pupils constrict. 3/20

These parasympathetics have a straightforward course (literally). They hitchhike on the third nerve, which runs forward from the midbrain to the orbit to supply most of the extraocular muscles and eyelid. As they're superficial, they're vulnerable to extrinsic compression. 4/20

Plenty of things can compress the third nerve and produce mydriasis (a dilated pupil) - most classically a posterior communicating artery aneurysm. But in the context of an acutely comatose patient, it suggests something worrying: 'uncal herniation'. Why is this? 5/20

BURNING STUBBORN BELLY FAT

(A Thread)

Stubborn belly fat can be 'stubborn' for a variety of reasons.

- Your genetics
- Your calories aren't low enough
- Your hormones suck
- Your metabolism has dropped too much

A calorie deficit WILL eliminate this eventually, but often it's not realistic.

Let's get into this...

1. Your Calories

You may just be eating too much food.

If you're 160 pounds, yet you're averaging 2500 calories on most days while not doing any cardio, then it's just too much food.

There's nothing wrong with you, you just need to eat nutrient-dense, calorie-sparse foods.

2. Your Hormones

If you've got low T, you may reach a point in the diet where a calorie deficit just leads to further muscle loss, rather than fat loss.

To combat this:

+ OBVIOUSLY train hard with weights
+ Make sure you're sleeping properly

TBC...

+ Get your vitamin D
+ Get on TRT if the above doesn't work
+ Take 1-2 months at maintenance, if all the above doesn't work

Stress/cortisol is directly linked to low T and lack of sleep.

SO the solutions are the same for high cortisol.

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

#RunBetter👣
WHAT KIND OF KNEE PROBLEM DO YOU HAVE?

Does your knee hurt after a run or other workout? It’s not always runner’s knee; you may be suffering from jumper’s knee or pes anserinus syndrome.

Here you will find an overview of the three most common problems

A🧵

3 COMMON KNEE PROBLEMS:
#RunBetter👣

RUNNER’S KNEE:

If it hurts on the outside of the knee and extends toward the hip, it is runner’s knee.
#RunBetter👣

JUMPER’S KNEE

Isolated pain in the front of the knee on the lower pole of the patella is also called “patellar tendinopathy” (jumper’s knee).
#RunBetter👣

PES ANSERINUS SYNDROME:

If pain develops on the inner side of the shinbone directly below the knee joint, it is most likely pes anserinus syndrome.
#RunBetter👣

[THREAD] I saw a few of us saying that their 2021 resolution was to improve their mental health. So I decided to write this guide in terms of what steps we can take to improve our mental health for 2021 and beyond. The most important step is to start some form of treatment.

While finances can be a huge barrier to getting treatment, there are a few things around that. Medications (especially those that have been around for a while) are generally much cheaper because they exist in generic form. They are safe, have decades of research behind them.

Antidepressants are not addictive at all and while there are a few side effects at the beginning, they tend to go away after the first few weeks. While it is hard to get rid of superstition and myths around meds, taking that first step of just taking it will help so much.

For therapy, there are always some free or low cost options. Sometimes, there are students about to graduate from their post grad who offer free or low cost therapy as experience (under the supervision of a fully licensed psychologist and legally).

They are the equivalent of a resident doctor, meaning they have the knowledge and expertise but lack the experience and both of you can benefit from working with each other. I remember when I was in that position and worked, I had my supervisor guide through every client.

How do remedies work? Gemstones/ yantrās /Effectiveness / examples / astrological causes

Remedies for karmic debts can work effectively but they have to be exercised in certain manner. For example in case of certain rogā, the medicine cannot be given in raw form while in others

medicine should only be given in raw form only.

Therefore, the modus operandi of remedies is very important.
The quantity of japa, Pooja, homam, ḍeepa etc. has to be decided for their effectiveness. For example, a childless couple suffering from Sarpa dośa cannot have a child

by mere lighting a lamp in front of ṇagas. In other cases where case is small, the remedies are also small. Some remedies are expensive and strong but they have to be followed in same manner. Some remedies requires expert tantric etc. without which they cannot be done. The ten

Mahāvidhya requires a proper initiate or sadhak of mahāvidhya which is rare to find. Only he/she can solve the problem.

Mantras taken from book have no power either because they are nailed or because they lack the power of the Guru or initiate who lives with the mantra. That

power is transferred to student when the mantra is whispered in his/her ears. The mantra, homam, prayers etc requires expert mantraśastri or tantric who can do the Poojas. Ordinary purohits are not aware of the proper ritualistic procedure so their Poojas might not work.

The cor*na hoax thread. How and why, best as I can tell. First, how does the new virus work? The vast majority of cases are asymptomatic or indistinguishable from the common cold. A small minority of cases affect the lungs. But how it does should be clarified...

The virus doesn't cause pneumonia. Was often mistaken for pneu. at first, but doesn't cause the lungs to fill with fluid. Nor does it cause the failure of the lungs to pump; rather, it impairs the lungs' ability to absorb oxygen on a cellular level...

It also seems like it never fully destroys the lungs' ability to do this. From personal friends who've developed severe illness, like "having someone sitting on your chest". But I've never heard of a single cor*na death attributed to brain death due to no oxygen...

Rather, the stress caused by low oxygen makes some other organ "pop" first. The media is very vague on how it kills you, because you might start to put two and two together. That organ is almost always the heart. Lowered oxygen causes elevated heart rates. Sound familiar?

Yeah. The effects of the new virus on the body are indistinguishable from... moderate aerobic exercise. The only people who've died from the virus are -those who a light jog would kill-. What category is that? Does the data bear me out?

The story of Smallpox and how it was conquered....

A thread

12,000 years

That's how long Smallpox had been around, decimating whole civilizations and even wiping out others completely...the fall of the Roman empire was partly due to Smallpox

For years, this disease kept popping up and killing millions without a cure in sight

But it was until the 6th century that the disease really started making mad moves when it landed in Europe which was becoming a highly populated continent. That was when smallpox started doing big league numbers

This was later spread to other continents like Africa, Asia and the Americas, taken there by European traders and religious missionaries who wanted to spread the gospel to the "savages" who were doing very okay

We have all read, or at least some of us, about how smallpox was the major reason why conquering North America was easy, the white missionaries gave out blankets deliberately infected with smallpox to the native Indians and the disease took out 90% of indigenous people

Mega thread on seismic few days of the pandemic in Ireland.

📍The govt implemented level five.

📍More info about the UK variant.

📍And NPHET held one of the most important briefings in months on New Years Eve.

What's happened and where does it leave us now?

If you've understandably avoided news for the last week or more this should bring you up to date:

First:📍Stay home unless you have to leave, no visitors bar support bubbles, exercise within 5km. Essential shops only to open.

Full info:

How did we get here? The current restrictions were introduced on Dec 30 by An Taoiseach.

Prior to that it was to be 'level 5 with adjustments'. Non-essential retail, gyms, tennis and golf clubs were to remain open, schools were to return on Jan

The 'level five with adjustments' plan was only introduced on Dec 23. It was supposed to be reviewed on January 12. Yet it was quickly overtaken, and superseded with stronger measures on December 30.

What happened that it was needed, and needed strengthening?

Background first: Cases flatlined into Dec around 300.

The hope was they'd fall further in the early weeks due to a lag effect from the previous level five of Oct-to-end-Nov, but they didn't. The baseline was about 300. In Oct, NPHET's aim was <100.

#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)

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

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).