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Joel Topf, MD FACP
@kidney_boy
, 3 tweets, 1 min read Read on Twitter
Joe Mamlin has two rules:
1. It is ethically okay to lie, cheat, and steal on behalf of HIV-infected Kenyans

2. If people aren’t sharp enough to help you, they’re not smart enough to sop you
Joe was chief of Wishard County hospital when I was a med-peds resident. He is a legend
Try to be like Joe.

medicine.iu.edu/magazine/joe-m…
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More from @kidney_boy see all

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Joel Topf, MD FACP
@kidney_boy
This algorithm gives 12-24 grams of magnesium sulfate a day for 3 to 4 days! Anyone ever do that? Anyone ever see that?

Treatment of Hypomagnesemia. American Journal of Kidney Diseases, 63(4), 691–695. doi.org/10.1053/j.ajkd…
I get static from pharmacy if I try to give 8 grams in 24 hours, which I think is what UpToDate recommends (expired subscription).
I think the image is a typo, here is what the article says, “however, consensus statements recommend administering 8-12 g of magnesium sulfate in the initial 24 hours, followed by 4-6 g/d for 3 or 4 days to replete body stores.”
Read 3 tweets
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Joel Topf, MD FACP
@kidney_boy
Internists know that eGFRs can not be used in AKI, that the formula requires the patient’s being in steady state. But fewer internists (and fellows) know that also applies to the protein to creatinine ratio (PCR). (1/10)
Over and over again, I see protein to creatinine ratios ordered in the midst of AKI to “quantify the proteinuria”

The protein to creatinine ratio depends on the patient excreting their daily creatinine load and patients in the midst of AKI (either worsening or improving) do not.
When the creatinine is worsening, the urinary creatinine is less than the daily creatinine load. This decreases the denominator and can inflate the PCR. In my experience this is particularly evident in cardiorenal syndrome type 1. (3/10)
Read 10 tweets
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Joel Topf, MD FACP
@kidney_boy
A med student answered a question and was very nervous to say he learned it from UpToDate. He wasn't sure how I felt about UpToDate. He then pointed to this exchange from @OnlineMedEd where one of the teachers disparages UpToDate onlinemeded.org/spa/surgery-tr…
I hold UpToDate in high esteem. I think the authors tend to be top people in their field. I think it answers questions as good as any medical source.
An what is that about getting authors that couldn't get chapters in real text books. What the hell is a real text book?
Read 5 tweets

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GalacticRedPill
@GalacticRedPill
@RepJerryNadler is a poor strong man. He tries to wield power like he wields his massive gut -- and fails.

He's not a serious person. But corruption and graft has gotten him far in life.
@RepJerryNadler @RepDougCollins opening statement now... and he goes hard against the premise of the hearing itself.

And he's not wrong.

Get 'em, Doug.
@RepJerryNadler @RepDougCollins "They weren't made up rules when @BarackObama used them, were they? Just asking for a friend."

@RepDougCollins
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World Health Organization (WHO)
@WHO
Since the beginning of the AIDS epidemic, more than 70 million people have acquired the infection, and about 35 million people have died.
Today, around 37 million worldwide live with #HIV, of whom 22 million are on treatment ⬇️ bit.ly/2QwO8HW
The #HIV virus 🦠 was first isolated by Dr Françoise Barré-Sinoussi and Dr Luc Montagnier in 1983 at the @institutpasteur.

➡️ bit.ly/2QwO8HW
At the beginning of the 1980s, before #HIV had been identified as the cause of AIDS, the infection was thought to only affect specific groups, such as gay men in developed countries and people who inject drugs
➡️ bit.ly/2QwO8HW
Read 21 tweets
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Sunshiny
@sunnshiiny
Please read this NYT article about Israel. It’s like reading Canadian history and the result of 2019 future election.

Netanyahu’s Likud party doesn’t have enough seats to form a majority.

nytimes.com/2019/05/29/wor…
Netanyahu is unable to broker an agreement to get the required seats. So he tabled legislation to dissolve Parliament and arrange new elections.
No big deal. The parallel: there were rumblings about parliament opting to ask another party to try to build a majority government. Netanyahu panicked and quickly arranged an election in what seems like the Israeli version of proroguing parliament. A rhyme with Canadian history.
Read 68 tweets
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World Health Organization (WHO)
@WHO
Since the beginning of the AIDS epidemic, more than 70 million people have acquired the infection, and about 35 million people have died.
Today, around 37 million worldwide live with #HIV, of whom 22 million are on treatment #WorldAIDSDay bit.ly/2QwO8HW
The #HIV virus 🦠 was first isolated by Dr Françoise Barré-Sinoussi and Dr Luc Montagnier in 1983 at the @institutpasteur #WorldAIDSDay bit.ly/2QwO8HW
At the beginning of the 1980s, before #HIV had been identified as the cause of AIDS, the infection was thought to only affect specific groups, such as gay men in developed countries and people who inject drugs #WorldAIDSDay bit.ly/2QwO8HW
Read 21 tweets
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Ireland / Will
@ireland
Good Morning. I'm guessing we all want to enjoy good sex? So today, I want to share with you the many ways that you can minimise negative outcomes that can happen when people have sex -
First of all, I think we should acknowledge that in Ireland, our historical and cultural attitudes towards sex and sexual health have not been always healthy ones. I think many of us experienced shame and judgement for wanting intimacy and desire.
Let's look at having agency over your own body, the right to choose a sexual health strategy that works for you. There's no 'one size fits all' when it comes to looking after your sexual health, each person is different.
Read 23 tweets
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Ireland / Will
@ireland
When I first heard that people living with HIV on effective treatment cannot pass on #HIV to sexual partners. I had trouble trying to get my head around it. Because it challenged the status quo and decades of beliefs I had about #HIV
I read up on the science behind the claim. In the PARTNER study, there were ZERO transmissions out of 58,000 condomless sex acts between people with HIV on effective treatment who had undetectable viral loads and their HIV negative partners. Undetectable equals Untransmittable
In the PARTNER 2, which was the extension of PARTNER and studied men who have sex with men, there were ZERO transmissions out of 77,000 condomless sex acts between people with HIV on effective treatment with undetectable viral loads and their HIV negative partners. #UequalsU
Read 7 tweets

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