ivan

Manejo de Cirrosis en hospitalizados. Tal vez no muchas cosas nuevas, pero importantes: 🟢El término histológico "cirrosis" se recomienda reemplazar por "enfermedad hepática crónica avanzada compensada" (cACLD). El estándar de diagnóstico ya no es la biopsia, sino elastografía y recuento de plaquetas. 🟢En Sangrado variceal: meta de hemoglobina de 7 g/dL. Transfundir plasma fresco congelado basándose en el INR... es mala idea, aumenta mortalidad. 🟢Todo paciente ingresado al hospital, con ascitis grado 2 o 3 debe someterse a una paracentesis diagnóstica, incluso en ausencia de síntomas. Si extraes >5 L: reposición con albúmina (6 a 8 g/L) 🟢La peritonitis bacteriana espontánea (PBE): >250 PMN. La utilidad de la profilaxis secundaria sistémica está en duda 🟢 Recuerden que ahora el síndrome hepatorrenal tipo 1 se actualizó a HRS-AKI (lesión renal aguda). La terlipresina (o norepinefrina) es el tratamiento de primera línea. 🟢El INR es inútil para medir el riesgo real de sangrado, ya que existe un reequilibrio simultáneo de factores procoagulantes y anticoagulantes. No lo usen para transfundir plaquetas ni plasmas, no no no. 🟢La restricción proteica está absolutamente contraindicada y se recomienda incluir snack nocturno con proteínas para evitar la cetosis. Medir el amonio venoso: innecesario. Está bueno para recordar generalidades. Pueden leerlo completo en el canal (t.me/memodiappartic…).

the worst part of being wasian is the other part of your family are republicans/MAGA and the other are DDS

Deaths from rectal cancer are rising rapidly among younger adults, an alarming trend that is confounding scientists trying to understand why millennials are so hard-hit. nbcnews.com/health/health-…

The Rome V updates to Bowel Disorders are now out! 🏟️🆕 Here is what’s new:

They veneered his lateral incisors. 😩

@joefranc Congrats na agad!

With this clientele, developing a luxury travel arm of Offduty Bucketlist is now inevitable

Equitable Bank was one of the banks involved in the Erap impeachment trial. It eventually merged with BDO, the bank now implicated in Sara impeachment hearing.

Ang SALN ay parang “litrato” ng yaman mo sa dulo ng taon, samantalang ang AMLC records ay parang “CCTV” ng galaw ng pera (pasok‑labas) sa bangko sa ibat-ibang petsa. Kaya: pwedeng malaki ang “galaw” sa CCTV pero pagdating ng pagkuha ng litrato, konti o zero ang natira. Kung ang claim ay “dumaan lang, wala natira,” ok - pero kapag milyon o bilyon ang dumaan, normal lang tanungin: Saan galing? Saan napunta? Bakit dumaan sa account mo? “Zero cash/bank deposits” sa SALN = ano ang sinasabi nito? Ibig sabihin: Ang dineklara ay wala (0) o hindi nagdeklara ng cash on hand at cash in banks as of December 31. Sa reports tungkol kay VP, lumabas na sa SALNs 2019 - 2024, walang declared cash on hand at bank deposits. Ano ang AMLC records at ano ang binibilang nito? Ang AMLC ay tumatanggap ng reports mula sa mga bangko, lalo na: • CTR (Covered Transaction Reports): karaniwang cash transactions > ₱500,000 sa isang banking day, automatic ang reporting. • STR (Suspicious Transaction Reports): kahit anong amount kung may red flags, tulad ng unusual, di tugma sa profile/capacity, walang malinaw na purpose, atbp. Sa House hearing reports, inilahad na may covered at suspicious transactions na naka-link kina VP Sara Duterte at asawa niya, at may total summary na umabot sa ₱6.77B sa mahabang period, kasama ang pasok-labas sa bangko. So ano ang relationship ng SALN, AMLC records, at “Zero cash”? Sa SALN: “Ano ang meron ka sa dulo ng taon?”. Sa AMLC: “Ano ang dumaan na pera sa accounts mo sa iba’t ibang araw?” Pwedeng sabay na totoo ang dalawa, malaki ang pasok-labas pero pagdating ng December 31, naubos/na-withdraw/na-transfer kaya zero ang ending cash/bank deposits. Pero kung malaki ang flow at may STR red flags, natural na tanong: “Kung ganito kalaki/ganito ka-flagged ang galaw, ano ang pinanggalingan at pinag-gamitan? Tugma ba ito sa legal income/capacity at sa dineklarang assets?” Dahil required sa SALN ang pagdeklara ng “cash on hand or in banks,” kapag zero ang dineklara sa maraming taon, at may indikasyon ng bank activity, may mismatch: “Zero ba talaga ang bank deposits as of Dec 31?” “Kung meron, bakit hindi nadeclare?” “Kung wala, bakit may ganitong pattern/volume ng transactions?” Ganito ‘yan: ang SALN ay litrato ng yaman mo sa dulo ng taon, kasama dapat ang cash at bank deposits. AMLC reports naman ay CCTV ng galaw ng pera - may CTR (cash > ₱500k/day) at STR (may red flags kahit anong amount) na nirereport ng mga bangko. Kaya kahit posible na malaki ang galaw pero zero ang natira sa December 31, normal lang tanungin: saan galing, saan napunta, at tugma ba sa disclosures? Yan lamang muna ang dapat alamin? Makatang Makwenta

Before meeting my partner, I’ve been in the dating arena. Dating tip: If first date pa lang, and ur date is already unloading problems & hinting you might be the financial solution… that’s not vulnerability—that’s a preview. Exit early. 🚩

A MUST-READ! This is probably one of my most important papers where I try to teach how to fish rather than offer fish. How I Read a Clinical Trial Report? BG’s primer for Busy Clinicians. Thank you @JCOOP_ASCO @EthicsdoctorP for the kind invitation. I hope the readers will find this useful. ascopubs.org/doi/10.1200/OP…

Ay bratinella

If you spend one million pesos every day, it will take you 18.5 years to spend all 6.77 billion. That’s how big the amount that flowed thru the Duterte couple’s bank accounts— with most of it undeclared in the VP’s SALN.

Joy Belmonte

🏥💉Usos y Contraindicaciones de la Albúmina Humana en Cuidados Criticos 🔰📚J. Clin. Med. 2026 doi.org/10.3390/jcm150… Enlace a Artículo Completo✅🆓👇🏻 t.me/SoMELaguna

💥🏥Manejo del Paciente con Cirrosis Hospitalizado 🔰📚Annals of Internal Medicine 2026 doi:10.7326/ANNALS-26-00513 Enlace a Artículo Completo👇🏻🆓✅ t.me/SoMELaguna

@easy_jonathan @akazukinchan2x True. The proper way was to withhold the entire results pending investigation.

He should sue the PRC for damages from undue mental torture. He’s been through a lot in life. Shame on the PRC for their KSP marites antics.

Leni offered everything in terms of public service as VP only to be ridiculed & rejected in 2022 in favor of 2 incompetent, corrupt nepo babies. Now that these two made a mess out of the country, we ask her to clean it up? The lady has pride & dignity. Hang your heads in shame!

We respect her decision even as we disagree with it and believe that the national interest will be best served if at some future time she changes her mind and heeds the growing clamor of the people for her to lead the nation's fight for genuine service and good governance. Today, given her rising poll numbers, I believe that Leni is in the best position to build the broadest and strongest unity not just amongst the ranks of the Liberal Party and our allies but to include all other groups and personalities outside our allied forces who are also looking to participating in the 2028 Presidential elections. As her poll numbers grow, so will the number of politicians and groups of various political colors and civil society/private sector groups throwing their support behind her. A snowballing of support behind her bid is quite possible. With her at the helm going into 2028 and given her current poll numbers that are much higher now than in the run up to the 2022 Presidential elections, a formidable coalition, far broader and more inclusive than the one we forged in 2022, can be cobbled together and lead us to victory in 2028. Now more than ever, having witnessed the largest corruption scandal in Philippine history, our people are crying out for good governance, and public accountability. Now more than ever, all those who believe in meaningful change and honesty and integrity in our public institutions must come together, sacrifice our time and effort for the sake of a better future for our children. I hope I am wrong but Leni's refusal to run, may create a leadership vacuum that I am afraid cannot be adequately filled by other contenders, this in turn could lead to disunity amongst our ranks and the splintering of not just our forces but of all potential allies outside our ranks. The net effect willl be the fielding of various political parties and groups of their respective Presidential bets, further weakening our chances and delivering victory to our adversaries. We must forge the broadest unity possible for the cause of good governance and win this for our people and work together for a better future for our children. Para sa bayan. 🇵🇭🇵🇭🙏🙏❤️❤️

Some notes on the said commissioned study on Monterrazas. Why insist on using the data of the “Mont Property Group” instead of the mandated agencies? Why modelled as “grassland”, instead of barren land?

Medical missions is a reflection of a failed healthcare system.