BC HEALTH
Saved by @CodyyyGardner

26/42 Are there any national datasets that accurately capture what is going on? The brilliant @jburnmurdoch has highlighted number of admissions into ICU. The message from his animated chart (click on link) couldn’t be clearer – this winter is v unusual: https://t.co/76ZvHU2pmV.

 27/42 Some sceptics arguing covid-19 tests are inaccurate. PCR tests not 100% accurate but hospital inpatient testing accuracy much increased by frequency of testing (typically admission, days 3 & 6/7, then weekly). This means very low numbers of overall false positives.
28/42 Some sceptics argue that the published covid-19 positive inpatient numbers include both those admitted with covid-19 and those who acquired covid-19 in hospital. And that there are significant numbers of patients who have acquired covid-19 in hospital.
29/42 Covid-19 positive test data has always included anyone testing positive, irrespective of initial diagnosis. And the NHS has always acknowledged that hospital acquired (nosocomial) infection is a big issue. Hospitals are working incredibly hard to control it….
30/42 …The NHS regularly and completely transparently publishes nosocomial infection data, by hospital. But neither issue affects the degree of pressure that hospitals are under. Every inpatient, irrespective of initial diagnosis/infection source, occupies a hospital bed.
31/42 Some sceptics using regular @ONS & @PHE_uk mortality data to argue that current death rates are just reflecting ordinary mortality rates for this time of year. Or that the covid-19 mortality definition and diagnoses are mixing up ordinary respiratory illness and covid-19.
32/42 This excellent thread https://t.co/J3CMsFVogj looks at these issues in detail. It shows clearly why it is too early for the current sets of this data to be showing increased levels of mortality from the current, new variant driven, surge of covid-19 infection.
33/42 In the words of this thread: “If you are using the ONS + PHE data to assess excess deaths that are happening *now* you are using the wrong data because of lags. The impact of this surge will only become apparent in future data from the ONS + PHE”.
34/42 The current covid-19 death definition widely accepted across medical profession. Doctors are required by law to complete death certificate to the best of their knowledge and ability. Covid deaths are running at an alarming rate – currently over 1,000 a day.
35/42 Some sceptics are arguing that the failure to use Nightingales before now indicates that the NHS isn’t that busy. They are not purpose built hospitals and would require staff to be transferred from other settings. Systematic use was always a last resort insurance policy…
36/42 …The NHS was always going to use every ounce of permanent purpose built capacity first. The fact that the London Nightingale is opening next week is a sign of how pressured the NHS in London has become. Other Nightingales – e.g. Exeter and Manchester – already in use.
37/42 Particularly loathsome are the videos of empty corridors and hospital areas. There are lots of good reasons why some areas of hospitals will be much quieter than usual. No visitors due to infection control. Outpatient clinics moved online. Films being done at night-time…
38/42 …Waiting areas not in use due to social distancing. Reduced levels of ordinary planned surgery. Most activity and staff in hospitals will currently will be concentrated on covid, intensive care and emergency areas. Areas where illegal filmers can’t film.
39/42 And, as this thread from @dpjhodges - https://t.co/nP5ZkQ87Fu - argues. If the sceptics are right, those charged with nation’s health – CMO, CSA, Ministers, officials, NHS leaders – all have to be unaware of the data problems sceptics have "identified"...
40/42 …And despite their decades of cumulative experience, they are making major public health decisions totally oblivious to the catastrophic misreading of the data that the amateur lock-down sceptic sleuths have uncovered…
41/42 ...or they are unaware of these catastrophic misreadings. And, for reasons no one has yet rationally explained, they are all carrying on regardless, day after day, month after month, perpetuating one of the greatest public health hoaxes in history.
42/42 Worth adding that the more evidence & data driven sceptics now abandoning sceptical camp: https://t.co/CURsykctdu. Still time for rest to follow! Particularly since everyone in NHS from frontline staff and trust leaders to @NHSEngland CEO is heartily fed up of this cr*p.

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“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
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The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…
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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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lazy perfectionist
lazy perfectionist
@kazADHD
is ADHD a mental illness ?

a thread

ADHD is a neurodevelopmental disorder - people with it are born with it and it cannot be altered because it's part of their brain structure and is seen on brain scans. ADHD is also linked to premature births and hypothyroidism during pregnancy, among other things

from the WHO website: "neurodevelopmental disorders are disabilities in the functioning of the brain that can affect behaviour, memory and/or ability to learn."

neurodevelopmental disorders are not caused by external/environmental factors. you cannot *develop* these conditions

mental illness is a general term for a health problem that significantly affects how someone feels/thinks/behaves. mental illnesses cause suffering to those who experience them, as well as often their loved ones. ADHD does not directly cause suffering.

neurodevelopmental disorders are not mental illnesses. ADHD however, does make it more likely for a person to experience mental illness. ADHD can cause dysfunction and stress, but more often than not this comes from lack of accommodation rather than the symptoms themselves.
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Lindsey Fitzharris
Lindsey Fitzharris
@DrLindseyFitz
#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.
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matthew remski
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@matthewremski
A staple of anti-lockdown conspiracism in yoga/wellness is that public health measures are oppressive, authoritarian, and stifling what it means to be human. Masks suppress identity and speech. Vaccines assault the sovereign body. Influencers must rise up against tyranny! /1

Ironically, pandemic management in economies where yoga/wellness is lucrative has been a neoliberal, choose-your-own-adventure mess in which centre-right governments barter with public health to enact a patchwork of half-measures that punish the poor and marginalized. /2

The goal is not universal health rights, or protecting medical systems, or saving as many lives as possible. The goal is to return to business-as-usual, using public health as a pit stop on a productivity race off a cliff. The ice caps aren’t melting fast enough, I guess. /3

Right-leaning governments, like influencers, have assessed the COVID threat with the magical bias of limitless optimism. Then they work to normalize COVID casualties as a new cost of doing business. *This* is what alt-healthers and Qamoms call “socialist”, or “communist”. /4

Centre-right governments and wellness influencers share a goal: get back to the optimism of making productivity heroic and consumption virtuous, without any reflection on structural issues of injustice, or what universal health care funding and standards would look like. /5
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Antonio García Martíne...
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We're basically fucked.

The tech world has gotten so huge, self-reinforcing, and insulated from reality they can no longer even vaguely look at themselves (and their actions) as others do. They just live on a different planet than most people.

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To say more than generalities for a moment, here's what I think is likely the core problem.

Techies take weird, improbable visions, and make them realities: some BS pitch deck to a VC, mixed with money and people, really does turn into some novel thing.

Most people work inside a legacy industry that's evolved that way over time (usually for good reasons), and they think about the future via some analogy with their present (which is a function of a long-ago past). The interruption that tech will introduce is often hard to grasp.
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He's wrong to prioritise the public over Labour Party
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History Of Rajputana
History Of Rajputana
@KshatriyaItihas
**Thread on Bravery of Sikhs**
(I am forced to do this due to continuous hounding of Sikh Extremists since yesterday)

Rani Jindan Kaur, wife of Maharaja Ranjit Singh had illegitimate relations with Lal Singh (PM of Ranjit Singh). Along with Lal Singh, she attacked Jammu, burnt - https://t.co/EfjAq59AyI


Hindu villages of Jasrota, caused rebellion in Jammu, attacked Kishtwar.

Ancestors of Raja Ranjit Singh, The Sansi Tribe used to give daughters as concubines to Jahangir.


The Ludhiana Political Agency (Later NW Fronties Prov) was formed by less than 4000 British soldiers who advanced from Delhi and reached Ludhiana, receiving submissions of all sikh chiefs along the way. The submission of the troops of Raja of Lahore (Ranjit Singh) at Ambala.

Dabistan a contemporary book on Sikh History tells us that Guru Hargobind broke Naina devi Idol Same source describes Guru Hargobind serving a eunuch
YarKhan. (ref was proudly shared by a sikh on twitter)
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Stambheshwar Mahadev Temple, Kavi Kamboi, Bharuch, Gujarat

Stambheshwar Mahadev is a Hindu Temple dedicated to Bhagwan Shiva, located in Kavi Kamboi in Bharuch District District of Gujarat, India. The Temple is about 150 years old. 1/n


The Temple is also known as the Submerging temple. The Temple is flanked by the Arabian Sea on one side and the Bay of Cambay on the other side.

As per legend, Tarakasura troubled the common people, sages and devas a lot. 2/n


Hence, Bhagwan Kartikeya k!lled him, but later he felt guilty for killing a demon who was a great devotee of Shiva. He went to Prabhu Vishnu and told about his guilty. Bhagwan Vishnu advised him to install a Shiva Linga to get relief from the sin. 3/n


As advised, he installed the Shiva Linga in this place and prayed to Bhagwan Shiva to forgive his sin.
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Every day, during the high tide hours, the temple submerges, and when the tide level becomes normal, the temple reappears again. The Temple houses a 4 feet high Shiva lingam. The Lingam can be seen during low tide. The visit to the temple should be planned in such a way that..5/n
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Anu Satheesh 🇮🇳...
@AnuSatheesh5
Thirumalai Murugan Kovil
#Panpoli
#TamilNaduTemples 🚩

Thirumalai Murugan Temple is located in Tenkasi district of Tamil Nadu. Muruga is worshipped as Thirumalai kumarasamy. Temple is situated near Kerala border and known to be where Shri Murugan gave darshan to Rishi Agasthiar


Devi is worshipped in the temple as Thirumalai Kaali amman

Sthala Puranam says that, there was a priest named Poovanbhattar of Thirumalai Kaali amman. Murugar appeared in a dream of the bhattar and said to find a Vigraham, lying in particular place which is of Thirumalaikumaran


Bhattar conveyed the news to the Pandalam Raja and they went to find out the vigraham. Surprisingly ants showed the way to find the Vigraham. Thus Murugan vigraham was found and Prathista was done here. There is a lake with pure water on the top of the hill


which is said to be created by Agasthiyar. It is believed that kannaki of
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Om Muruga
Muruganukku Harohara
🙏🕉🙏
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