I never wanted to write a Prof thread here since I wanted this to be break.
But some comments regarding Dentistry is pushing me to be writing this, making me do what I have been trying to explain to people for a long time.
#Thread
#Dentistry
1)

The #RELAx trial has been published today in @JAMA. It was coordinated by Anna Algera. This thread is to explain the rationale, what we did, the findings and the meaning.
The rationale of #RELAx is based on the following

First, there is NO adequate evidence on the level of PEEP in non-ARDS patients. Most of the studies are old, conducted in post-surgical patients (short-term ventilation), and were not powered to detect differences in patient-centered

Second, despite the absence of evidence, the levels of PEEP used in non-ARDS patients increased over years, from 5 to 7/8 cmH2O, probably as a reflection of studies and practice in ARDS

Third, one IPDM showed that higher levels of PEEP could benefit more severe ARDS patients. However, opposite trends (higher mortality and longer ventilation) were found in mild ARDS with higher PEEP (despite not powered to be statistically

Fourth, most of the weaning protocols include PEEP ≤ 5 cmH2O as a criterion for readiness to wean. Theoretically, a standardized liberal strategy of higher PEEP could delay weaning in some

Eight years ago, Spencer Cox died of #AIDS. He had access to #antiretroviral therapy, but in his own struggles with #depression and substance use, he stopped taking them. 1/

Spencer left college, dropped out like me in the 80s, and we both found ourselves in @actupny where we joined the Treatment and Data Committee, doing battle with drug companies, the @US_FDA, the @NIH on a quest to save ourselves and our friends from near-certain death. 2/

Now everyone knows what those dark days before the advent of antiretroviral therapy were like. Waves upon waves of dying friends. A government who couldn't care less for the sick and dying. 3/

All this has happened before, and all this will happen again. AIDS. #COVID19. The next pandemic. The fire next time. 4/

And it changes you. Seeing so much death so young. Seeing those in power turn away from the catastrophe, even joke about it (find, listen to the tape of Larry Speakes in Oval Office w Reagan laughing about AIDS). 5/

#OTD 1901, Queen Victoria's funeral took place. Here's a little medical history THREAD (1/9) about one of Britain's longest reigning monarchs. 👇

"Queen Victorian on her death bed" by Emil Fuchs.

(2/9) On 7 April 1853, Queen Victoria became the first monarch to use chloroform to ease the pains of childbirth. Prince Leopold was born within 53 minutes of administration of the drug, which Victoria described as "delightful beyond measure.”

(3/9) The anaesthetic powers of chloroform was first discovered in 1847 by the Scottish physician James Young Simpson. He and his two friends experimented with it on the evening of November 4th. At first, they felt very cheerful and talkative. After a short time, they passed out.

(4/9) Impressed with the drug’s potency, Simpson began using chloroform as an anaesthetic. In December 1847, he delivered the first baby using it. Simpson nicknamed the girl “Saint Anaesthesia.” Her real name was Wilhelmina Carstairs, pictured here.

(5/9) During this time, Queen Victorian was pregnant with her sixth child. She heard of Simpson’s discovery and was keen to benefit from it, but royal doctors cautioned against it, claiming that painful contractions during labour were ordained by God.

ICYMI, public health officials fear community transmission of B.1.1.7 (the "UK variant") is underway in Ontario.

I'll dissect each piece of worrying news from this story.

1. Simcoe Muskoka has so far reported 3 positive tests in individuals *with no known links* to the massive B.1.1.7 outbreak at Roberta Place LTC.

Two of those are linked to separate outbreaks of their own (a different LTC and a mental health hospital). Testing underway.

2. Of the 225 cases at Roberta Place, 100+ are confirmed or preliminary + for B.1.1.7.

42 household contacts of ppl linked to the outbreak are also COVID+. Public health unit is worried about keeping cases (which are all likely B.1.1.7) from rippling further into the community.

3. A case in Kingston area who tested positive for COVID "several weeks ago" was just discovered to be B.1.1.7. That person travelled to Simcoe Muskoka, but had not travelled internationally, according to the local health unit.

4. Overall, Public Health Ontario counts 47 B.1.1.7 cases as of yesterday -- these are only the ones confirmed thru full genome sequencing. Preliminary screening tests not included (yesterday's 99 in Simcoe Muskoka, for example).

Here's a breakdown by health unit courtesy PHO: