fernando cruz cooke

@hyderabaddoctor Preguntar si hace terapia de reemplazo hormonal con testosterona no estaría de más .

Case discussion for learning purpose Details of the case 🔸60-year old man presented with sudden onset speech impairment and right facial weakness. MRI brain showed features of acute left corona radiata infarct. 🔸Significant history included hypertension (well controlled on drugs), smoking (10 bidis per day for 30 years) and regular alcohol consumption. 🔸CBC reports are below- what is your inference?

@drabdulhameed07 Protusion L5-S1

Can you identify the foreign body?🤯

@JamesLucasIT Alguna vez alguien dijo del gran Lorenzo “ Cuando el genio se encuentra con la disciplina “.

This was carved from a single block of marble by a 23 year old in 1622. Bernini turned stone into flesh... The sculpture is called the Abduction of Proserpina, and it depicts the moment described in Ovid's Metamorphoses, when the goddess Proserpina was gathering flowers in a meadow and the earth opened beneath her. Pluto, king of the underworld, rose from the dark to take her. Out of every instant in that abduction, Bernini chose the one when her feet leave the ground. She is suspended in his arms. She is no longer in the world above, and not yet in the world below. Her left hand pushes desperately against Pluto's face. Her right is thrown back toward a sky she will never see again. And where the god's fingers close around her thigh, the marble surrenders to them, dimpling inward as living flesh would, as though Bernini had reached the deepest secret of stone and discovered that it had always been waiting to give in. He used to boast that in his hands, "marble became as impressionable as wax and as soft as dough." On her right cheek, a single tear has been running for four hundred years... The work was commissioned in 1621 by Cardinal Scipione Borghese, who wanted it as a showpiece for his own villa. He kept it for less than a year. In the summer of 1622, with a new pope newly elected, he gave it away as a political gift to the pope's nephew, Cardinal Ludovico Ludovisi. It disappeared into private hands for nearly three centuries. The Italian state bought it back in 1908 and returned it to the room it had been made for. It has been there ever since. I have stood in front of it, and I can tell you that nothing prepares you for the moment you actually see those fingers in her thigh. The marble seems alive and you forget, for a few seconds, that it is stone at all... -- -- -- If you enjoyed this, I write a weekly newsletter read by over 50,000 people who love rediscovering the beauty of the past. You can join us here: James-lucas.com/welcome If you'd like to support my work, a paid subscription is what makes it possible.

300 mg of NMN delivers the same nicotinamide exposure as 110 mg of plain nicotinamide (according to EFSA, at least) NMN loses its phosphate and ribose during absorption. What's leftover is niacinamide. EFSA's May 11 opinion approved β-NMN as a novel food and assigned a bioavailability conversion factor of 1. Note that this was based on an unpublished, unblinded study with a very small sample (n=10)....

Humilde consejo para el ciudadano de a pie: si quieren saber la verdad de las cosas, solo sigan a las personas adecuadas en las redes. Buen fin de semana!

There is an assumption with vitamin D that more is better, or that one dose works for everyone. Neither is true. The dose-response for vitamin D is curvilinear, and your starting level changes everything. Heaney et al. (2003) gave healthy men in Nebraska 1,000, 5,500, or 11,000 IU of cholecalciferol daily through winter. Achieved serum levels at steady state were approximately 30, 60, and 84 ng/mL. Ten times the dose did not produce ten times the level. It produced about 2.8 times the level. The body actively regulates 25(OH)D. As serum rises, hepatic hydroxylation, binding protein saturation, and catabolic clearance all increase. The curve flattens because the body is not passively accumulating vitamin D. It is throttling how much stays in circulation. There is a second layer. Garland et al. (2011, Anticancer Res) plotted the first derivative of that dose-response curve at different starting baselines in 3,667 adults. At baseline 10 ng/mL, +1,000 IU/day raises serum 25(OH)D by ~11 ng/mL. - At 30 ng/mL, ~8 ng/mL. - At 50 ng/mL, ~5 ng/mL. - Above 90 ng/mL, the response is nearly flat at ~1.6 ng/mL per 1,000 IU. The same pill does dramatically different things depending on where you start. Body composition shifts the curve further. Drincic et al. (2013) showed that in obese adults, the same 1,000, 5,000, and 10,000 IU doses produced smaller serum increments than Heaney saw in healthy-weight men. Vitamin D is fat-soluble and gets sequestered in adipose tissue. The Endocrine Society guideline acknowledges this and notes obese individuals may need two to three times the standard dose to achieve the same serum level. The guideline landscape has shifted on what "enough" means. The IOM defines 20 ng/mL as adequate and recommends 600 to 800 IU/day. The Endocrine Society's 2011 guideline set 30 ng/mL as sufficiency. Their 2024 update walked that back. They no longer endorse specific 25(OH)D thresholds for deficiency or sufficiency, and recommend against routine 25(OH)D testing in healthy adults under 75. The evidence did not support drawing precise lines at 30 ng/mL the way the field assumed for over a decade. If you are at 12 ng/mL, a moderate dose moves you a lot. If you are at 45 ng/mL on 5,000 IU/day, you are paying for a dose that barely moves the needle from where you already are. The dose that works is the one matched to your starting level, your body composition, and your individual physiology. Knowing your 25(OH)D level is the input that lets you choose the dose. Without it, you are guessing.

7 supplements with actual human trial evidence for aging, ranked by proof strength: 1. GlyNAC (Glycine + NAC), $0.50/day Baylor RCT, 24 adults, 16 weeks. Corrected 7 hallmarks of aging: oxidative stress down 70%+, mitochondrial dysfunction, insulin resistance, genomic damage, senescence. Glutathione up 164%. Gait speed improved. 2. Creatine, $0.10/day Meta-analysis of 22 RCTs (n=721 older adults): improved lean mass and muscle function. WHICAP cohort (n=2,900): dementia risk down ~30%. 3. Urolithin A (Mitopure), $2/day Nature Aging (Nov 2025), 50 adults, 28 days: expanded naive CD8+ T cells, reduced T-cell exhaustion, improved CD8+ fatty acid oxidation +14.7pp. Separate RCT: 12% muscle strength gain. 4. NMN, $1-2/day GeroScience 2023, 80 adults, 60-day multicenter RCT: blood biological age held flat across all doses while placebo aged (p<0.05). NAD+ rose (p≤0.001). Six-minute walk improved. 5. Spermidine, $0.30/day 20-year Graz cohort: lower mortality. 1-year pilot in MCI (n=100): 42% showed cognitive improvement vs decline in placebo. 6. Alpha-Ketoglutarate (Ca-AKG), $0.50/day 42-person study (2022): ~8-year biological age reduction on Horvath clock. ABLE trial (NCT05706389, 120 adults, 6-month RCT): results pending. 7. Taurine, $0.15/day Science 2023: 10-12% lifespan extension in mice and worms. Blood levels drop ~80% from youth to old age. Zero human aging RCTs completed. NCT05930210 ongoing. The honest ranking: creatine has the most RCT replications. GlyNAC has the most hallmarks corrected. Taurine has the most promising animal data and the least human evidence. I'd start with creatine.

@traumatogeek No se sabe aún lo que pasó . Es mejor ser prudentes . Acaba de morir uno de los rescatistas . También buzo expirementado .

Cinco profesionales del buceo. Una cueva. Una mezcla de gases que en superficie salva vidas y a 50 metros las quita Esto pasó esta semana en Maldivas. Monica Montefalcone era profesora de Ecología Marina Tropical en Génova. Su alumno Federico, que murió con ella, la había llamado “su guía” en los agradecimientos de su tesis. #LaTraumatologaGeek #Maldivas #buceo #Medicina

@gonzaloferreyr @manulaserna3 💪💪💪💪

Semana perfecta Match point sensacional Festejo tirándose al piso con toda la familia en la tribuna Inolvidable, @manulaserna3.

Atherosclerosis kills 20 million people a year. Statins slow plaque growth. Nothing approved today reverses it. Cyclarity just reported the first human evidence that oxidized cholesterol can be selectively removed from the body. Their drug, UDP-003, is an engineered cyclodextrin dimer with roughly 1,000-fold selectivity for 7-ketocholesterol (7KC) over normal cholesterol. In a Phase 1 trial of 72 healthy volunteers at Monash Victorian Heart Institute (NCT06813339), it showed dose-dependent urinary excretion of 7KC, a 3-hour half-life, no serious adverse events across all dose levels, and no bioaccumulation. 7KC is an oxidized form of cholesterol that accumulates in arterial plaque and converts macrophages into foam cells. Foam cells are the building blocks of plaque. In preclinical work, removing 7KC with UDP-003 reversed foam cells back to functioning macrophages in 15 minutes. This program grew out of @aubreydegrey's "damage repair" framework for aging. @vitadao, a decentralized science DAO, was one of 12 investors. The lead investigator, Stephen Nicholls, ran some of the largest cardiovascular imaging trials in the field. This is still Phase 1. Safety, not efficacy. The exact quantities of 7KC excreted weren't disclosed, and plaque regression hasn't been demonstrated yet, not even in animals. An ACS patient cohort with pre/post coronary CT imaging is enrolling now. Phase 2 (plaque regression as primary endpoint) is planned for late 2026. Historically, roughly 8% of Phase 1 drugs reach approval. If it works, this would be the first drug that removes the toxic material inside plaque rather than just slowing its accumulation. That's a different category of medicine.

@fernandamdo Amén.

Hay médicos increíbles y que no tienen cuentas grandes de redes sociales. Hay médicos buenisimos que no saben editar un reel, no tienen tiempo para publicar, no les gusta exponerse, trabajan en hospitales saturados, priorizan consulta, investigación, vida personal, etc. Un buen médico no necesariamente es un buen divulgador y viceversa. En mi opinión, el número de followers no debería ser importante para decidirte por un médico.

When can we say a cancer is curable? We want to cure all cancers. Some cancers are curable. Some are not. As oncologists, we all have individual patients with cancer who are cured. Even those considered incurable! Anecdotes abound. But when can we say a cancer is curable compared to saying an individual patient is cured. There is a critical difference. Let’s take myeloma, a form of blood cancer. With recent advances, some patients with myeloma are likely cured. But can we call myeloma a curable cancer? I am still reluctant. I still cannot look a young newly diagnosed patient in the eye and say that we are dealing with a curable cancer. I still cannot assure them like I do with diffuse large cell lymphoma or Hodgkins. Cure is a straightforward concept: -You need to be able to eradicate the disease. -You need to be able to stop all therapy. -You need to have a high probability that after a period of time of being disease free after stopping all therapy that patients have a very low risk (usually less than 5%) of recurrence. Some cancers are clearly curable, eg. many localized solid organ tumors. Some cancers are curable even in advanced stages. Eg., Hodgkins, acute leukemias, testicular cancer, diffuse large cell lymphoma. No one doubts that these cancers are curable. We confidently tell patients that. For some cancers, like myeloma we are now at the threshold of cure. We are debating whether it’s curable or not. (The fact we are wondering whether we can cure myeloma is in and of itself a monumental advance and reflects the fact that many patients can live 10-15 years or longer after diagnosis.) At present I am still not confident that we can call myeloma a curable disease because: 1) Most studies that show excellent disease free survival are in the context of continuous suppressive anti-myeloma therapy. Unlike curable cancers like diffuse large cell lymphoma, we don’t have studies that show a clear plateau in the disease free survival curve after stopping all therapy: the gold standard visual of a curable cancer. 2) The long overall survival we now see in myeloma reflects outcomes not just with frontline therapy but successful therapy of relapse with with sequential therapy of multiple relapses. The disease course of myeloma is still one of multiple remissions and relapses. 3) We don’t have sufficient follow up in patients with highly effective modern therapy. I’m hoping for example with ciltacel CART we can finally get there. Time will tell if we can fulfill requirement #1 above. But we are very hopeful. We want to cure both newly diagnosed and relapsed myeloma. We may already be achieving this, and all we need is time to demonstrate it.

@Tiempodetenis1 Danil tiene razón en esta .

😳 Daniil Medvedev se quejó por la asistencia médica que recibió Jannik Sinner. El ruso sostuvo que el italiano estaba acalambrado y que, según el reglamento, no debería haber recibido atención médica por ese motivo.

@gonzaloferreyr @manulaserna3 Vamos !!!💪💪

Así festejó @manulaserna3 la clasificación a su primera final en el circuito Challenger. Venció a Bauti Torres por 6-4, 6-2 e irá por el título mañana en Córdoba. Se mete 321 del mundo y comienza a soñar con llegar a la qualy de los Grand Slams en 2027.

@Arraya_Tennis @bgtennisnation Nalbandian es el argentino más talentoso que empuñó una raqueta y es mucho decir en una tierra de grandes tenistas .

Conversando con @bgtennisnation hablamos de Nalbandian y Gaudio Quien fue mejor y porqué

@thealepalombo Mérida es hermosa !!!!

I'm Italian, living in Portugal. From Lisbon, the Spanish border is two hours east. I'm in Extremadura more than I'm in Porto. Almost every foreigner who comes to Spain does the same trip: Madrid, Barcelona, maybe Sevilla, Granada or Valencia. The Spaniards I know don't spend their weekends there. They drive inland. To Castile, Extremadura, Aragón, Galicia. The interior that emptied out since 1950, what they call la "España Vaciada". That's where the country still lives. 10 places I've stayed in. Some many times. 🧵

@therealbuni Lo más grave que el rector es impresentable .

Rector UNR : las universidades no le cobran a los extranjeros porque son muy pocos, no mueve la economía 😭 -en tu universidad son el 32% Rector UNR: es que son tantos que si les cobramos no van a venir y nos quedamos sin economía 😭 Doctorado en psicopateo

@gonzaloferreyr @camilougo @ATPChallenger 💪💪💪

En su quinto match point, @camilougo cerró un triunfo importante en segunda ronda del @ATPChallenger 175 de Valencia. Le ganó a Matteo Berrettini por 7-6 (2), 6-4 y se enfrentará a Miomir Kecmanovic en cuartos. Tremendo el nivel de este torneo.

@RufiEnLancha Para analizar tenis seriamente muy importante dejar la bandera de lado . Jodar es muy bueno y va a ser aún mejor pero Darderi no es un pasabolas .

Me encanta Jódar y este partido le tiene que servir de aprendizaje. Lo tenía en su mano, ha sido muy superior y ha dominado. Pero se le ha alargado el partido innecesariamente y le ha metido 6-0 en el tercero un tío que se ha dedicado solamente a pasar bolas. Necesita más variantes en su juego para poder ganar a este tipo de jugadores en estas condiciones. Este partido si se juega de día lo gana 6-2 6-3, pero sin variantes no va a poder adaptarse. Torneazo aun así de Jódar. Qué suerte tenemos con él.

@gonzaloferreyr @Lucianodarderi_ Gran jugador y muy buen pibe . La gente critica muy fácil desde afuera .

En los Futures y en los Challengers no hay banderas, hay personas que juegan al tenis. Y Luciano Darderi siempre fue de los amables, de los más laburadores y genuinos. Uno de los que te trata de igual a igual. A esos siempre se los respeta sin importar el país que represente.