BC HEALTH
Saved by @CodyyyGardner

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.
As you'd expect, the usual criminals are involved in whipping up lung injury by the 48 hour mark
So, we have been breeding oxidation resistant pneumonia, brilliant. Does that mean people above a certain FiO2 should get prophylactic antibiotics? I mean, germ free mice don't get the same severity lung injury...
Graphs below: show less alveolar protein/immunoglobulin after 48-72 hours of FiO2 95%, and more nicely retained alveolar histology in germ free mice
On the other hand, as if that wasn't confusing enough, there is also a problem with gut microbiome and lung injury. How upsetting.
The gut microbiome changes later than the lung.
If you do give systemic antibiotics (this study used ceftriaxone and vancomycin all of which we use in ITU in UK) you make things much worse :O
BUT WHY YOU JUST TOLD ME STAPH WAS TAKING OVER AND NEEDED KILLING. Well, when you give these antibiotics you especially get rid of clostridia species in lung and gut. In gut, clostridia provides butyrate for colonocytes. When they don't get butyrate
they start to respire anaerobically, leaving gut lumen oxygen higher, meaning enterobacteriae go whoosh, and take over gut. In lung, staph goes whoosh. And no doubt it's the ceftriaxone resistant version of staph that does.
As a side note, the mechanisms that staph use to resist oxidative damage are the ones we use - superoxide dismutase, thioredoxins, flavins, DNA protection. But we only have this sufficiently available during the DAY and we don't have good anti-ox at NIGHT
which is why bad idea to have big brain bleed full of oxygenated Hb at NIGHT because the heme and the oxygen mess you up, especially badly.
Original paper here https://t.co/za56C6ET0I
As usual, understand less than when I started, about good lung care in ICU.
starting point for circadian difference sub arach https://t.co/VkoLf4teK5
starting point for circadian difference in bleomycin toxicity https://t.co/F16IoZ4jpi

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Dr Catherine Pemble is #SocialDistancing
Dr Catherine Pemble is...
@CatherinePemble
Right, screw it. Here's a thread on *that* FBLive by Alex Cairnie about #Govanhill. Lets do a watch-through shall we? (Mind, I'm a resident of Govanhill, and a sociologist. I'm also 5'3, and a visibly queer woman so if half his claims are true I should be living in terror)

00:30: Welcomes viewers and uses points out that his videos are only getting attention b/c they're 'horrific'. Directs folk to his Youtube page. So already clout hunting.

1:08: "I've been warned to stay out of Govanhill. I'm a marked man" (proceeds to use a beanie as a disguise)

1:30 "Laughing and joking aside, here's somebodys front garden." Proceeds to show litter and claim its thrown from windows and this is 'common'. I know a handful of streets with litter issues like this, but its neither common nor unique to #govanhill and other deprived areas.

2:10 "Don't be under any illusion I'm only showing you the bad bits" - only shows you the bad bits.

3:45: He's had offers of help, but hes said no because hes not responsible for 'anybody elses safety' Good lord.

5:01: "Its not that bad. But its not all good either" -Correct

6:00: TW: child abuse - He starts claiming to have been contacted by a health professional and told about child abuse 'in the area'. Huge ethical issues here as the 'professional' who has 'been in the game a long time' is reporting to Facebook Dude and not authorities.
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Dinesh S. Thakur
Dinesh S. Thakur
@d_s_thakur
This is a limited point about availability of efficacy data for vaccines under development in the context of the approval for CovidShield and Covaxin in India.

There have been many so-called experts on the idiotbox opining about apparent availability of P III data which 1/n

2/n apparently the SEC had access to based on which it "supposedly" approved Covaxin. Another argument that is prevalent is other regulators (US FDA and MHRA) also approved vaccines based on P II data alone. Let me give you a few facts so that you can make your own decision.

3/n The protocols for both mRNA vaccines are publicly available. You can check. Both protocols *define* when the interim analysis will be done. This is not subjective. They clearly define how many infections need to be documented before the Data Safety Monitoring Board meets.

4/n Find the protocols for the bridging study for CovidShield and Covaxin and look for a similar milestone.

Here is one set of efficacy data post the interim analysis of a mRNA vaccine.

Source: https://t.co/BAPnP3PxEb


5/n This data was analyzed post the interim analysis where the blind was broken by the DSMB. Now ask yourself this question:
How does the SEC, or the sponsor of these studies, or the experts who are offering their opinion liberally on the idiotbox know what the efficacy is
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NotTheMacAnon
NotTheMacAnon
@NotTheMacAnon1
During a normal pregnancy, oxidative stress enhances antioxidant mechanisms that are capable of reacting by way of enzyme activity and non-enzyme free radical deactivators. However, pregnancy is also a state in which this adaptation and balance may be easily disrupted.

There is strong evidence that a chronicin flammatory reaction combined with the presence of a local oxidizing environment may play a vital role in the etiology and development of complications during pregnancy.

In late pregnancy, damage to DNA (especially when it is caused by oxidative stress) is associated with pre-eclampsia(PE), intrauterine growth restriction (IUGR), and the death of mothers in developing countries; it largely determines pregnancy – related susceptibility to diseases

The referential values of ROS and NOS and their minimal and safe concentrations or physiologically beneficial concentrations are yet to be determined.

The measurement of oxidative stress in vivo is perceived as controversial,

as the sen-sitivity and specificity of various oxidative stress markers is unknown.. .
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Ottawa Public Health
Ottawa Public Health
@OttawaHealth
THIS IS A CATCHY & ATTENTION-GRABBING TITLE

Today, the Province will likely announce what zone of the reopening framework we'll shift into as of Tuesday. Whatever is announced, though, doesn't change what we need to do. Why?

Kindly read these 14 tweets & we'll tell you. (1/14)

Fun fact: COVID-19 does not follow us on Twitter. COVID doesn't know, or particularly care, if we're in the Red or Orange zone.

The behaviours of the virus do not depend on the current ‘zone’ of public health restrictions. And, to be perfectly candid, neither should ours. (2/14)

Once upon a time we used to say #WeAreInThisTogether in our messaging. Here's the thing: we are, but we aren't. Not everyone is experiencing this pandemic the same.

Nurses, doctors, paramedics & healthcare workers have experienced things much differently than most of us. (3/14)

Some people have been home & isolated for months, while others haven't been able to stop working.

Business owners & hospitality workers have been on a rollercoaster of openings & closures.

Students, parents, teachers & school staff have had to adapt to going from online (4/14)

to in-person learning (and back again) numerous times.
And this virus has disproportionately affected some groups more than others.

But there's the thing: while our experiences of this pandemic haven't been shared, we do have a shared goal.

And we can reach it together. (5/14)
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Manish Dhawan.
Manish Dhawan.
@mysticfuture
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.
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Guruvayur Sri Krishna & Coconut with Horns.
#Krishnaleela
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🕉
We’ve all grown up listening to stories of Shri Krishna. This one is a famous story of Shri Krishna in Guruvayur Temple, also called Dakshina Dwaraka.


There lived a villager who planted coconut saplings and had promised that he would offer the 'first coconut' from each of his coconut trees to "Guruvayurappan". When the trees started to yield coconuts, he collected the first coconut from all the trees in a sack 👇


and set forth to Guruvayur.

On the way he was stopped by a robber who asked all the items in the sack. The villager told the robber that the coconuts in the sack belonged to Guruvayurappan and so he was unable to hand it over.
@SriramKannan77 @Jayalko1


The robber with anger asked the villager "Is Guruvaurappan's coconut any different? Does it have horns ?".
Saying so the robber pulled the sack forcefully out of the villager's hand, and coconuts came out..👇


To their astonishment each and every coconut in the sack had horns! Even today, the coconut with horns are displayed in the temple for devotees to see.

Below Picture is not original, as we cannot take photos inside temple.
Hare Krishna
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🕉🕉🕉🕉🕉
Shubham
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THE BATTLE OF PRATAPGARH (10 Nov, 1659)

Chhatrapati Shivaji Maharaj's impeccable military genius and matchless courage humbled the Adil Shahi Sultanate.

The beginning of what was to come later for the M0ghuls from one of the most indefatigable defenders of Dharma!

(Thread)


Shivaji’s growing influence in Maval region, made him a threat to the Adil Shahi ruler of Bijapur who sought to restrain him. The man who was given the responsibility of this mission, was their commander, Afzal Khan. Afzal was a formidable warrior known for his ruthlessness.(1)

His strategy was to bring Shivaji out into the plains, where he held an advantage, compared to the rocky Deccan terrain. Afzal attacked the holy town of Pandharpur, and later demolished the temple of Bhavani at Tuljapur to instigate Shivaji in a bid to bring him out.(2)

Shivaji was angry but remained patient. Knowing that he could not defeat Bijapuri Sultanate in an open battle, Shivaji moved to Pratapgarh fort, located on rocky heights, surrounded by thick forests of Jawali.(3)

This set the pattern for future Maratha attacks, using guerrilla warfare against larger invading armies rendering them ineffective in unfavorable terrain.(4)
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SHAKTA DHARMA AND THEIR ACHARYAS

Śhākta or Shakti or Devi pooja is not a new upasana. It is being carried out right from the time of Vedic period. Puran's tell us that Rishi Vashishth would worship Tara devi. Parshuram ji worshipped Tripura devi,


Agastya learned the secrets of Shri Vidya from Vishnu ji in Hayagriva avtaar. Bhagwan Ram, Laxman and Krishna too learned the tantrik vidya. Even Rig Ved 7.103.5 Sayan Bhasya also mentions about Śhākta/शाक्त(शाक्तस्येव शक्तिमतः).

Then we find that in the Harrappan excavations many figurines depicting Shakti were found. So in that age too, which was supposedly an urban city shakti was being worshipped. So naturally this tradition would be prevalent in rural areas too.

It is wrong to say that shakti puja originated from Bengal although it was popular there. Matsyendranath received this vidya from Maheshwari herself in Kamrup. We know that Shakti pooja is practised all over India.

Not much is known about the Śhākta saints in other parts of India in the middle ages.

Adi Shankaracharya wrote Pramanech saar named book on tantra and Anand lahri book on Devi strotras. Then there were Acharya Shankar, Bhaskar Rai, Laxman, Deshikendra, Raghav Bhatt, Krishnand,
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और देवर्षि नारद वहीं बैठकर तपस्या में लीन हो गए।इन्द्र नारद की तपस्या से घबरा गए।उन्हें हमेशा की तरह अपना सिंहासन व स्वर्ग खोने का डर सताने लगा।इसलिए इन्द्र ने नारद की तपस्या भंग करने के लिए कामदेव को उनके पास भेज दिया।वहां पहुंच कामदेव ने अपनी माया से वसंतऋतु को उत्पन्न कर दिया।


पेड़ और पौधों पर रंग बिरंगे फूल खिल गए और कोयलें कूकने लगी,पक्षी चहकने लगे।शीतल,मंद,सुगंधित और सुहावनी हवा चलने लगी।रंभा आदि अप्सराएं नाचने लगीं ।किन्तु कामदेव की किसी भी माया का नारद पे कोई प्रभाव नहीं पड़ा।तब कामदेव को डर सताने लगा कि कहीं नारद क्रोध में आकर मुझे श्राप न देदें।

जैसे ही नारद ने अपनी आंखें खोली, उसी क्षण कामदेव ने उनसे क्षमा मांगी।नारद मुनि को तनिक भी क्रोध नहीं आया और उन्होने शीघ्र ही कामदेव को क्षमा कर दिया।कामदेव प्रसन्न होकर वहां से चले गए।कामदेव के चले जाने पर देवर्षि के मन में अहंकार आ गया कि मैने कामदेव को हरा दिया।

नारद फिर कैलाश जा पहुंचे और शिवजी को अपनी विजयगाथा सुनाई।शिव समझ गए कि नारद अहंकारी हो गए हैं और अगर ये बात विष्णु जी जान गए तो नारद के लिए अच्छा नहीं होगा।ये सोचकर शिवजी ने नारद को भगवन विष्णु को ये बात बताने के लीए मना किया। परंतु नारद जी को ये बात उचित नहीं लगी।
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