We've looked at bats for a long time.... #SOA21 They have strong interferon responses, but not strong inflammation....
So what happens instead? #SOA21 They will tolerate high levels of viraemia with little symptoms. Bats are old... 65million years ago - they appeared at the end of the dinosaurs! They are far longer lived that other mammals. Senescence is late - more towards end of life.
They use 4x as much oxygen and have a high Hb level. #SOA21
Very social and circadian animal - thus, high viral transfer.... #SOA21 Social behaviour drives a lot of immune response. Circadian and seasonal variation....
Interesting we're seeing genetics potentially coding for increased risk? #SOA21
How have bats overcome viral problems? A delicious diagram.... :P #SOA21 Bats have downplayed toll-like receptors, unlike humans. Interestingly playing around with TLR's also can induce AKI in rats.
ALSO of note, TLR 7 may code for a poorer outcome in some young men with COVID-19 versus females. Females have a backup copy of these crs... #SOA21
Bats have a lot of transposons... this probably gives them a mutating immune system. #SOA21 Vampire bats need a lot of anti-clotting ability because they suck blood (anticoag in their saliva!)
10-15% of lethal COVID has autoantibodies against type 1 inferons... so bats? Yes - well, the RIG set up and the JAK-STAT pathway in bats code for protection against COVID. #SOA21
The inflammasome! It's inhibited by metformin (of interest). Messing around with circadian rhythm also annoys the inflammasome (new fave word here). #SOA21
Flying, hypermetabolic, warm - does this kill viruses in bats? Hmm - may help. But this hypermet status = robust against oxidative stress. They don't functionally age early and they tolerate mitochondrial DNA from dmg cells well (which shouldn't be in the blood stream) #SOA21
Bat v Human.... bats never really achieve high inflamm state. They have high interferon, but no large inflamm response... Humans heavily invested in adaptive immune system, bats in their innate.... #SOA21
65 million years of bat evolution allows for their adaptations. Some history repeating itself, with words from Defoe in the 1600's.... how have/will adapt? #SOA21
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What were the most impactful non-COVID papers over the past 2 years? Let's delve in and take a look. #SOA21
Finally an opportunity to not talk about COVID! #SOA21
TOMAHAWK - immediate vs delayed/selective angio. 3 years to conduct the trial in 31 ICUs. 554 patients. 'Worse' survival in immediate angiograph? Not SS, but close... #SOA21
Organophosphate poisoning, toxicology, dengue, snake bites and malaria.... sure what could go wrong? #SOA21@ICS_updates Drs. Chacko, Yacoub, Bhaumik and Dondorp tell us more.... 🧵👇😘
Biomarker guided abx treatments in sepsis. We catch up with Drs/Profs: Paul Dark, Stacy Todd, Enitan Carrol, Jonathan Sandoe and Matthew Stevenson on this large area of research @ICS_updates#SOA21
So, do biomarkers have any utility in guiding abx use in sepsis? We can measure, usually, these ones fairly easily: #SOA21
In around 2014, commissioned review in PCT. Seemed to suggest a shorter duration in abx use when PCT used.... tenuous data though. #SOA21 Low quality. Little evidence from UK... how does this fit into NHS practice in the realms of stewardship?
There's been a lot that's gone on over the past few years that's exposed the well known 'darker' side of social media. Traditional paradigms of knowledge dissemination have changed (if not disappeared). Much higher tech-savy population. #SOA21
This has democratised the discussion space to an extent. It allows for *anybody* (lit. anybody) to get involved. #SOA21
Is COVID-19 hyperinflammation, or a cytokine storm in a teacup? @DrPujaMehta1 's fab talk from #SOA21 today!
Main Q = "Hyperinflation contributing to worse outcomes for some patients with COVID-19" - clinical similarities to sHLH seen. Viruses are the most common trigger of sHLH. Early reports from China suggested cytokine profile was similar to sHLH in terms of COVID severity. #SOA21
We now know some things work and some things don't.... in certain populations. #SOA21