Garyll Ryan ‏‎‏‎🍉

@TransferChecker Earlier this account was run by a Brentford die hard fan with value tweets. Seems he has sold the account to some random person who posts low value tweets aiming just for payout.

The Premier League became the biggest league in the world because of how good it is to watch. VAR is changing that feeling. It’s frustrating, it breaks the flow. It’s making fans lose interest.

I’ll start by saying that Aaron is a friend, a remarkable educator, & reliably wise. But here, as w/discussion of guidelines, nuance & context help. IMO, guidelines raise the bar if you don’t know enough to know when to deviate from them. I can’t imagine treating 10+ types of cancer every day, & if I’m outside of my limited range of expertise, following guidelines will help me deliver SOC in a competent way. But if you have deeper knowledge, you know that guidelines are a witch’s brew of strong evidence, weak data, & faith-based bias. Ideally, you won’t follow them slavishly & can deviate based on your good judgment & insight. I acknowledge that guidelines can lead ppl to be dissuaded from deviating, but I think you can effectively inoculate yourself from legal issues by documenting your sensible judgment well & communicating/aligning with the patient (I see tons of deviation from guidelines, data, & even optimal judgment that is sanctioned as a pact with the patient to justify irrational over-treatment; I’d even argue that it’s a cornerstone of practice at many centers). I think the problem of medicine is that it exults rule-following, & ideally people like Aaron can help keep physicians from just becoming sheep and absolving themselves of thought. I’ve also tried to do this over the years. I don’t think it’s a requirement that being a physician means subjugating judgment to rule-following.

💧 Albumin in the ICU: life-saving drug… or expensive myth? We’ve been using it since the 1940s. Yet in 2026 we still don’t fully agree when it actually helps. 🧠 First principle Albumin is NOT just a volume expander. It does much more: ▪️ Maintains oncotic pressure ▪️ Protects endothelium & glycocalyx ▪️ Modulates inflammation ▪️ Alters drug pharmacokinetics ➡️ It’s a biologically active molecule, not “fancy saline” ⚠️ The uncomfortable truth 👉 50-70% of albumin use is inappropriate 👉 In some studies: >90% misuse Yes… even in modern ICUs 🔥 Where albumin actually WORKS ✔️ Hepatorenal syndrome (HRS) → Albumin + terlipressin = better renal outcomes ✔️ Spontaneous bacterial peritonitis (SBP) → ↓ AKI + ↓ mortality ✔️ Large-volume paracentesis → Prevents circulatory collapse ⚖️ Where evidence is… mixed 🟡 Septic shock → No mortality benefit vs crystalloids → BUT better hemodynamics in some patients 🟡 ARDS → Improves oxygenation (if hypoalbuminemic) → No survival benefit 🟡 Major surgery → ↓ fluids, ↓ complications → BUT watch renal risk (especially 20%) 🚫 Where you should think twice ❌ Traumatic brain injury → ↑ ICP → ↑ mortality ➡️ Albumin crosses disrupted BBB → worsens edema 💡 Key ICU insight Albumin is NOT about: ❌ “giving protein” ❌ “correcting labs” It’s about: ✔️ hemodynamics ✔️ endothelial integrity ✔️ patient selection 📉 Hypoalbuminemia matters Every ↓10 g/L: ▪️ ↑ mortality ▪️ ↑ complications ▪️ ↑ length of stay ➡️ But correction ≠ automatic benefit 🎯 Clinical decision rule Use albumin when: ✔️ Cirrhosis-related complications ✔️ Refractory shock after crystalloids ✔️ Severe hypoalbuminemia with instability Avoid when: ❌ Routine resuscitation ❌ TBI ❌ “just low albumin” 🧠 Take-home ➡️ The question is NOT “Does albumin work?” ➡️ The real question is “In which patient, at which moment?” 📚 Rubio-Baines I et al. (2026) Journal of Clinical Medicine DOI: 10.3390/jcm15051981

Who called it pituitary stalk and not Strait of Hormones

2 weeks without smartphone internet significantly improved sustained attention. The effects were similar to being a decade younger.

@imYadav31 Is the presence of a secure platform like Knox an important factor when deciding a device to buy? Since we all use UPI and banking apps, does having Knox offer an advantage?

Let me know if you have questions....regarding the Oppo X9 Pro comparing the software feature of your current phone. I will try and answer it.

@encoword Should I get the OP15? Was waiting for the S26 series pricing and at those prices, doesn't seem to be a wise choice.

Currently top three flagship smartphones in battery life : (1) OnePlus 15 (2) OPPO Find X9 Pro (3) Realme GT 8 Pro Currently OnePlus 15 gives 15 mins approx more battery backup than my OPPO Find X9 Pro. This year OPPO Find X9 Pro, OnePlus 15 and Realme GT 8 Pro is giving fantastic battery backup. Fantastic optimization of battery.

@imYadav31 Is the presence of a secure platform like Knox an important factor when deciding a device to buy? Since we all use UPI and banking apps, does having Knox offer an advantage?

My DMs are FLOODED with this same set of questions 👇 • How difficult is switching from Samsung → Oppo? • Alternative to Samsung Wallet? • Samsung Watch connectivity.....does it work smoothly? • How hard is it to adjust to the new UI / settings? I’m preparing a detailed thread (step-by-step) to make the switch painless. Drop your questions in the comments......I’ll try to answer every one. 👇📩📱

Something about this show feels so brilliantly different. Which is strange because it manages to recapture why made the original run so special. What once felt so fun and heartfelt in 2006 feels far more profound and powerful today.

@TechTurbanator Why is the storage upgrade offer applicable for 2 days only?

There are no full swipe card offers??????? Except for Samsung co branded cards. WTF 😒

@smasithick Why is the preorder period only for 2 days? In the UK it is for 2 weeks.

🚨 Samsung Galaxy S26 Series - India Pricing & Offers Galaxy S26 Ultra 256GB – ₹1,39,999 512GB – ₹1,59,999 16GB/1TB – ₹1,89,999 Galaxy S26+ 256GB – ₹1,19,999 512GB – ₹1,39,999 Galaxy S26 256GB – ₹87,999 512GB – ₹1,07,999 Galaxy Buds4 – ₹16,999 Galaxy Buds4 Pro – ₹22,999 🔥 Offers ✔ 512GB at price of 256GB (Limited time) ✔ Redeem Pre-reserve voucher – extra ₹2699 off ✔ Up to ₹3500 multi-buy benefit ✔ ₹3.5K off on Buds4 (bundle) ✔ ₹2K off on Buds if bought separately ✔ Up to ₹2799 Samsung Rewards ✔ 10% cashback with Samsung Axis Bank Card 📦 Deliveries start March 6. Ultra now starts at ₹1.39L. Thoughts on the Indian pricing this year? 👀💰 #GalaxyUnpacked @SamsungMobile @Snapdragon @Snapdragon_IN @SamsungIndia @gregcroc @SnapdragonCarla

bro’s standing like he’s checking the VAR😭😭

We are recruiting into "The I hate TRAMADOL Club". Read ahead and consider if you are willing to join! It has two Mechanism of actions, -reuptake inhibition of serotonergic and norepinephrine systems (predominant) -mu opioid receptor agonism Drugs it can potentially interact with and result in a Subacute/Chronic, mild to severe Serotinergic crisis: -SNRIs/ SSRIs, too obvious -Antipsychotics -Anticonvulsant -TCAs -Triptans -Parkinsonism drugs -MAO inhibitors -Cold and cough medication with Dextromethorphan!! It's a good drug when you know the patient profile. But in the hands of an Over-the-counter drug dispensing uncle, it's a catastrophe awaited! What's likeable about this drug: -Provides moderate analgesic affects -Anti shivering in the postoperative period, 50mg slow IV -A good adjust to Peripheral and Neuraxial blockade -Suitable for intraarticular administration for analgesia -Time dependent bactericidal activity, against S. Aureus, E. Coli, P. Aeruginosa !! So, to be more coherent, it's a "I hate TRAMADOL in the hands of unknown" club. Join us! #analgesia #opiods

Alcohol consumption amongst Indian men is decreasing

The idea that poor people shouldn't have nice things is pure classism. Poverty isn't a moral failure, and struggling shouldn't mean a lifetime of suffering. If you think a brand loses value because poor people buy it, you’re just a shallow person with no real substance.

@DocPeriop If the patient did not attain ROSC, this video would have been uploaded with a different caption altogether, and discourse would be different. Iykyk.

Stop glorifying this. No human can continue EFFECTIVE chest compressions for 30min. It would have helped if the person very passionately recording with his camera have joined the resuscitation. I shall never understand why anyone would think of filming a medical emergency/procedure (apart from educational purposes). You people do not understand consent. You all will never!! What's with the religious music? Why? Just why??

@TheReal_YRJ Which color would you recommend considering the materials are different?

It’s been five years since I last bought a phone on launch day 😄 Went for a quick store run to pick up a OnePlus 15 for my brother just before closing, and the flagship store in Bangalore was still packed with a long queue. Felt like a pop-up 😛

@encoword Which colour would you suggest for better long term durability?

▶️ Design OnePlus 15 design from front looks so much premium and one of my favourite design will the slimmest bezels currently. Black and violet color has glass back and metal frame. Sand stone color has another type of material which is hardened using Micro Arc Oxidation.

OnePlus 15 review - Performance redefined with fantastic UI but with a twist 👀 🧵 [ It needs a lot of hardwork to test and make review. Please quote / repost / like to support 🥰 ]

@trakinenglish @r3dash Is the presence of a secure platform like Knox an important factor when deciding which android device to buy? Since we all use UPI and banking apps, does having Knox or Motoshield offer an advantage over other android devices?

You’ve got questions. We’ve got @r3dash Drop your biggest tech doubts in the comments. Specs, comparisons, buying advice, hot takes… anything👇 Ershad’s Inbox – Episode 2 is here, and he’ll be answering all your questions on camera. #ErshadsInbox #TrakinTechEnglish