Su

Labour is now saying taxes are going up on high earners. People who earn £100-125k are already effectively paying 60% tax in the UK, 50% if they earn above £125k. If taxes go up further, why stay? Seriously? Why support this utterly broken & unfair social contract?

@vtss_pl Just bought, thank you! ❤️

@schewtweet added 10 on ra now ❤️

doing a bday party with the London gang at venue mot 21/02

When you accidentally hit ‘lung window’ when reviewing a bone CT scan

@solardomusic what time does your Watergate set start tonight?

In medicine we don’t say “I love you” we say “that’s not unreasonable” and I think that’s beautiful

Sorry lads can’t come for a pint I’ve got to pick Be Sharp Say Nowt up from school

When the cardiologist repositions your stethoscope and asks you if you can hear the murmur now

@hannah_wants Set times for Night Tales? Thank you!

a career in medicine

@tofeelhealed @chloehornn1 😂

when you give him back his carhartt shoulder bag after he comes out of the pit and you reassure him that he looked cool

Amlodipine comes is three doses: placebo (2.5mg), treatment (5mg), and leg swelling (10mg).

Hello Amit, as a response to your question, I had asked you to stop all of these medications/supplements. I wanted to tell you why. I am sorry this is a long post, but you asked me a 20 mark General Medicine final exam paper question. So here goes. 1. Vitamin B is a complex of vitamins. They include, B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folic acid) and B12 (cobalamin). Each of these has its own benefits for the human body, each has its own sources from where you get them and also specific diseases associated with their deficiencies. Here is a simplified source on it: intechopen.com/chapters/78374 Some foods are high in several B vitamins, and certain foods are particularly high in specific B vitamins. Eating a balanced diet is key. Some groups of people are at risk for specific vitamin B. So they require supplementation - example pregnant women require folic acid, patients with Crohn's disease (inflammatory bowel disease) are deficient in vitamin B12 (because the part of intestine that absords vitamin B12, the ileum is affected in them). There are no people who require ALL vitamin B as supplements except those who are unable to take orally, bed ridden and on comfort care, like critically ill patients or chronically ill, disabled persons. You dont fall into any of these categories, so please stop Vitamins B. 2. Vitamin D. In 2015, The Endocrine Society of India recommended vitamin D supplementation for Indian people in a set of guidelines. They recommended 400 international units (IU) of vitamin D a day for infants, 600-1000 IU for children, 1000 IU for adolescents and pregnant women after 12 weeks’ pregnancy, and 1000-2000 IU for adults. bmj.com/content/351/bm… They recommended testing for vitamin D only in patients who have signs of osteomalacia, osteoporosis, musculoskeletal disorders, chronic liver or kidney disease, inflammatory bowel disease, or patients receiving drugs that raise the risk of vitamin D deficiency. In apparently healthy persons such as yourself, you need to improve dietary inclusion and if the diet is such that it is a vitamin D deficient one (such as vegan), then supplement is life long as per guidelines. 3. Omega-3 fatty acids (fish oil). The recommended omega-3 fatty acids intake is shown in Table 1 of this page: ods.od.nih.gov/factsheets/Ome…. Classical essential fatty acid deficiency in healthy individuals is virtually nonexistent. Clinical signs of essential–fatty-acid deficiency are usually only found in patients receiving parenteral nutrition (intravenous food) that lacks poly-unsaturated fatty acids. Omega-3 supplements for people who do not have a high cardiovascular disease risk is not recommended. Omega-3 supplements (1000mg per day) is recommended for only those with existing cardiac disease or high risk of cardiac disease and also to reduce triglycerides in those with high triglycerides. If your diet is one which is already deficient in omega-3 - for example no fish/seafood intake, then supplementation to target daily recommended intake is reasonable. ncbi.nlm.nih.gov/books/NBK56431… 4. Garlic supplements. A great deal of research has been done on garlic, especially on garlic’s effect on high blood lipid levels and high blood pressure. However the evidence is limited to recommend garlic supplements in general or in specific patient populations. No clinical societies worldwide recommend garlic supplements. Taking garlic supplements may increase the risk of bleeding. Using these along with other blood thinners is a strict no. Using garlic as a substitute for other blood thinners or anti-platelets is also not recommended as garlic is not proven to have equal efficacy or superiority compared to current standard medications. Garlic supplements may interfere with the effectiveness of some standard drugs that people are already on. nccih.nih.gov/health/garlic 5. Turmeric. Routine use of turmeric supplementation is not advised. Turmeric has only cellular and molecular level properties that has not been translated to humans through rigorous studies and has no clinically effective benefits in any of the quality studies conducted and has a lot of poor quality and methodically inept published works with impertinent cellular benefits. Turmeric supplements is also an upcoming cause for severe liver injury. Turmeric in curries and not in capsules. You can read more about it here x.com/theliverdr/sta…, here x.com/theliverdr/sta… and here x.com/theliverdr/sta…. 6. Tocotrienol - is a bioactive compound belonging to vitamin E family. Vitamin E supplements are richer in tocopherols than tocotrienols. There is no evidence that tocotrienols are better than tocopherols in any human condition. In adults, the recommended vitamin E intake is 15mg per day which is equal to 33 IU. Most vitamin-E-only supplements provide ≥67 mg (100 IU of natural vitamin E). These amounts are substantially higher than the recommended doses. This is comes above the vitamin E you are naturally getting from diet. Vitamin E supplementation in routine is not recommended. High dose vitamin E is used in specific patients, such as those with non-alcoholic steatohepatitis (NASH) or those who are on a very low-fat diet. A simple way to increase vitamin E in diet is to increase daily intakes of nuts, seeds, fruits, and green vegetables. ods.od.nih.gov/factsheets/Vit… Nutraceutical companies make tocotrienol rich vitamin E supplements which are far more expensive than plain vitamin E (tocopherol based) and has no known additional benefits. A good diet is all you need. Tocotrienol is a waste of your money. So, stop all of the useless supplements you are on, and stick to the aspirin only - only if even that is prescribed by your primary physician. Otherwise, ditch that too. "One of the first duties of the physician is to educate the masses not to take medicine." - Sir William Osler.

As a cardiologist, every day I see 2-3 patients who need clearance for surgery 🔪 ALL of them are on blood thinners🩸 Every surgeon wants to stop these medicines💊 The patients ask: Is it safe? Should I stop? Let's see how to deal with blood thinners before surgery 🧵👇

CIRRHOSIS I urge every #MedTwitter student, graduate and young fellows of Gastroenterology and Hepatology to read this brilliant review on "Diagnosis & Management of Cirrhosis" in @JAMA_current by @ebtapper & @NDP1001 Here are some important & some additional points on cirhosis for non-medical people from the manuscript: 1️⃣ The major cause for cirrhosis is changing - alcohol use and non-alcoholic fatty liver [NAFLD] alone or in combination has surpassed hepatits C in the USA because hepatitis C infection is now curable. In India it is still alcohol, but NAFLD is catching up. 2️⃣ One does not NEED to be an "ALCOHOLIC" to develop cirrhosis. In the presence of other risk factors, such as diabetes, obesity and high blood pressure or even the presence of a specific gene mutation called PNPLA3, even mild to modest amount of alcohol use can promote cirrhosis. The amount of alcohol safest for your liver is zero ml. 3️⃣ The gold standard for cirrhosis diagnosis is a liver biopsy which is invasive, but confirmatory. But this is no more required as newer techniques such as Shearwave scan that measure liver stiffness (value >15) can do the same. 4️⃣ Cirrhosis is no more considered an irreversible disease. Early stages of cirrhosis and stable stages of advanced cirrhosis can undergo regression/reversal with correct treatment of its cause(s). 5️⃣ The major complications of cirrhosis include rupture of large veins (called varices) in the digestive tract that present as blood vomiting or black tarry stools; development of fluid in abdomen (ascites), brain dysfunction (from sleep disorders to confusion and coma, called encephalopathy), life threatening infections, kidney injury and liver cancer. 6️⃣ A large part of management of cirrhosis is still MEDICAL while major life threatening complications and those that are unmanageable with medicines & recurr require transplantation for cure. 7️⃣ Apart from major complications there are minor complications that are STILL major for the patient, resulting in poor quality of life. These need to be asked for, identified and addressed. These include: [treatments based on small, but good quality trials]👇 ➡️Severe recurrent itching ✅️Treatment: Moisturizers, hydroxizine ➡️Severe muscle cramps ✅️Treatment: Sipping pickle brine/juice at onset of cramps, vitamin E+carnitine, prevented using taurine 1000mg per day. ➡️Reversal of sleep, daytime sleepiness ✅️Treatment: Lactulose syrup. ➡️Sexual dysfunction in men, mostly among those who consume alcohol ✅️Treatment: Tadalafil. 8️⃣ Not all patients are diagnosed with cirrhosis at a stable stage. Approximately 40% are diagnosed during the time they present with a major complication. Some are even diagnosed with advanced liver disease and liver cancer on routine testing without any symptoms at all. 9️⃣ Remember alcohol use is an avoidable cause for cirrhosis. Alcohol in mild or modest amounts is also an avoidable cause for cirrhosis in those with additional risk factors and in those diagnosed with cirrhosis, no amount of alcohol is advisable. There should be lifetime abstinence. 🔟 Common concerns/myths⬇️ ➡️Low platelet counts in cirrhosis does not need any treatment and low platelet counts does not lead to any symptoms. A count above 50,000 is adequate in cirrhosis patients. ➡️There is no liver detox. Liver detoxes are wellness frauds that can in all likelihood, harm the liver. ➡️Swelling of the legs in cirrhosis is not a complication of cirrhosis, it is a feature of the disease due to multiple reasons such as low protein/albumin, varicose veins, slow lymphatic drainage from legs etc. ➡️There is no specific diet for liver health. Overall general health also includes good liver health. Any person who prescribes, advertises or sells specific liver health solution only wants your money. ➡️Whey protein does not damage the liver. It is safe for use. ➡️Fruits and veggies combinations as juices or blended infusions or as a predominant dietary component compromising protein in diet does not improve "liver health." There are no specific fruits or vegetables that specifically improve liver health. ➡️Processed and ultraprocessed foods, sugary diets, fructose-based foods (including an overconsumption of fruit in diet) are ours and our children's greatest enemies when it comes to fatty liver disease. FULL PAPER LINK HERE jamanetwork.com/journals/jama/…

Shout out to all the international NBA fans, I see you 🧡

meet me at the club 👀 @GreenVelvet_ @Patrick_Topping

This is Everyday But “It’s Ok not to be ok” Mental health awareness 🧠🤗