Papaya (Carica papaya) is a perennial fruit tree widely cultivated in tropical and subtropical climates for its nutritive and medicinal values. It is very popular in Kenya where it is grown for both local and export markets.
#MudavadiSpeaks #SundayMotivation #SundayThoughts #kot

Masks. A short thread. In June last year my GP advised me that wearing a mask even for a short space of time would be harmful for me on two fronts. One - I have painful rosacea on my face. It’s a horrible condition and it’s lifelong. I can at times look scary!

Putting on a mask simply makes it worse. Two - I have hypertension. Manageable and controlled. GP also advises that mask wearing even for short periods can raise cortisol levels and make them dangerous to me.

On that basis and given the dreadful treatment us non-maskers have to suffer and to appease the abusers I have three times asked my GP to issue me with a letter relating to my conditions.

On each occasion she has said that there is no need. Whilst she won’t admit it straight up, all conversations suggest she’s been told not to. I happen to agree that no-one should need to reveal their medical history to anyone other than medical professionals responsible for me.

I’ve researched mask wearing in relation to what they are supposed to be used for ref *Covid* - I’m no thicko - I prepare risk assessments (and I’m qualified to do so) every day (or did) - and the evidence *for* is weak. Very weak.

@73inlancs @janethooton_ @ErinInTheMorn @fifi_EY 1/ The 🏴󠁧󠁢󠁥󠁮󠁧󠁿 government decided pediatric gender care in England would be a monopoly contract (a Labour minister, in 2008), despite all other NHS patients officially being entitled to a choice of providers, & second opinions on diagnoses & treatment, & gave it to GIDS, which has…

@janethooton_ @ErinInTheMorn @fifi_EY 2/…always advocated that trans minors & their families must have no alternative source of care, & subsequent Tory ministers have personally put their signature on renewals of it, and even personally rejected proposals for improvement that have been put forward by NHS England…

@janethooton_ @ErinInTheMorn @fifi_EY 3/…as a result of wider & public consultation. They & their civil servants listen only to GIDS on trans minors - it was GIDS advised against <18s being allowed #GenderRecognition in 2004, & since, on the basis that no one under 18 can be certain of their gender identity, just…

@janethooton_ @ErinInTheMorn @fifi_EY 4/…as many other staff at their trust wrote⬇️ to the press in 2002 (when the first instigator of this case, psychoanalyst Susan Evans was on staff too) that no trans people should be allowed that recognition but needed

@janethooton_ @ErinInTheMorn @fifi_EY 5/…to "cure" us instead. Yet GIDS proved incapable of defending its super-conservative protocol in court - no doubt because GIDS has always expected challenges to be from patients seeking care more like that elsewhere, arrogantly ignoring that services in countries where the…

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)

#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.