Dr Divago

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Dr Divago

Dr Divago

@DivagoTM

stabbing people to life https://t.co/H8oflJaaNS

Se unió Nisan 2012
1.6K Siguiendo12.9K Seguidores
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Dr Divago
Dr Divago@DivagoTM·
A única forma de saúde é a saúde pública universal. Todo o resto é chantagem.
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Dr Divago retuiteado
JT
JT@jiratickets·
how it feels to drop a perfect arigato gozaimasu for the cute waitress at the hot pot restaurant (she’s latina and the place is korean)
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Dr Divago
Dr Divago@DivagoTM·
Que
Dr. Chacón-Lozsán F .'.@franciscojlk

💧 Hypertonic saline + furosemide in fluid overload. Fluid overload remains a major driver of morbidity and mortality in critically ill patients and acute decompensated heart failure. A systematic review and meta analysis evaluating the combination of hypertonic saline solution with intravenous furosemide provides important insights into a potential strategy to enhance decongestion. 🔑 Key findings: • 11 randomized controlled trials • 2987 patients with acute decompensated heart failure • Compared with furosemide alone, the combination therapy was associated with: Reduced all cause mortality Reduced heart failure related readmissions Shorter hospital length of stay • Improved decongestion profile: Higher daily diuresis Greater weight loss Increased natriuresis Reduction in serum creatinine • Physiological interpretation: Hypertonic saline may improve intravascular refill and renal perfusion Enhances diuretic response and sodium excretion Potentially overcomes diuretic resistance 👉 Clinical perspective: This strategy may be particularly useful in patients with diuretic resistance and severe congestion However, evidence remains moderate and should be individualized 👉 Bottom line: Not just removing fluid Optimizing the intravascular compartment is key 📖 Reference Liu C, Peng Z, Gao X, et al. Simultaneous use of hypertonic saline and IV furosemide for fluid overload. Critical Care Medicine. 2021. doi:10.1097/CCM.0000000000005174

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Dr Divago
Dr Divago@DivagoTM·
@rbarbosa91 @jdimick1 @ZhiVenFongMD It was all the rage in the Russian fishing boats in the 80s... Useful to get you to firm land, no reports - that I know of - on the recurrence rates they had as the goal wasn't definitive management, it was just "management".
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Ron Barbosa MD FACS
Ron Barbosa MD FACS@rbarbosa91·
@DivagoTM @jdimick1 @ZhiVenFongMD NOM makes sense in certain situations (frailty, hostile abdomen, etc.) though not for everyday routine management. I had one mild case where the patient was about 4 hr away from a flight home to the East Coast, and I said yeah, Abx will get you home and you can decide there.
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Justin B. Dimick
Justin B. Dimick@jdimick1·
The framing for this has always seemed strange to me. Surgery has a 0% failure rate at preventing recurrent appendicitis (yes if done well) and antibiotics a 44% failure rate. Unless surgery is strongly contraindicated, appendectomy seems like the right choice.
JAMA@JAMA_current

In adults with uncomplicated #appendicitis, 44% treated with antibiotics required appendectomy within 10 years, but complication rates were lower and quality of life similar to surgery. ja.ma/3NU446Z

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dermatoBarbie
dermatoBarbie@DermatoBarbie·
@lourentuza o TANTO de creme anestésico a desquerida correndo risco de ir de arrasta
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Dr Divago
Dr Divago@DivagoTM·
@rbarbosa91 @jdimick1 @ZhiVenFongMD Every now and again I'm faced with a very mild appendicitis in a very - otherwise - sick patient. Poor anaesthetic candidate, socially in a difficult situation, etc. I've been happy to, exceptionally, use the NOM option in those cases.
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Ron Barbosa MD FACS
Ron Barbosa MD FACS@rbarbosa91·
@jdimick1 @ZhiVenFongMD IMO there seem to be 2 ‘nonop’ camps with different motivations: Camp 1: academics that want papers Camp 2: systems that struggle to meet the existing workload, and need to decrease it somehow. If they can get rid of appendectomies, it would make a difference for them.
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Dr Divago
Dr Divago@DivagoTM·
@calkovik Pessoal fala de ganhar mais como se a profissão mais antiga do mundo não tivesse aí, pagando muito bem... Não querem fazer?
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CEO dos bebêzinhos
CEO dos bebêzinhos@calkovik·
@DivagoTM Penso a mesma coisa que você! Sei que vou ganhar menos mas jamais quero ficar o resto da vida como generalista ganhando mais, me matando e infeliz. Afinal, eu não estou fazendo pediatria por dinheiro, né? Kkkkkkkk Só achei engraçado o comentário dela, pqp! É foda.
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CEO dos bebêzinhos
CEO dos bebêzinhos@calkovik·
Hoje uma interna disse assim: ai pra que fazer uma residência se vai ganhar menos que um generalista depois? Me atacou por que?????
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Dr Divago
Dr Divago@DivagoTM·
@jdimick1 @GI_Pearls Not to say that, albeit all biased in selection, follow up etc, we should be doing better than Russian fisherman at sea in the 1980s by now
Dr Divago tweet media
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Dr Divago
Dr Divago@DivagoTM·
@biasoprolol Caiu demais qualidade esse ano, tão praticamente dando os ovos de páscoa deles e ninguém quer
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Dr Divago
Dr Divago@DivagoTM·
@mirimemiri Na BBC antigamente os caras sempre que mensagens uma marca (sei lá, coca cola) eles precisavam dizer "other brands are also available" pra não ficar subentendido que eles estavam promovendo o uso daquela marca específica. Talvez isso seja necessário no Twitter hoje em dia
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Vaciloscopia positiva
Vaciloscopia positiva@mirimemiri·
aqui nesse site se você comenta uma característica de A sem obrigatoriamente citar também a opção B as pessoas assumem automaticamente que você É CONTRA B é realmente o lugar onde a nuance vem pra morrer
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