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Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Dr Satoshi Akima FRACP 『秋間聰』
@ToshiAkima
Nephrology & Internal Medicine. Immunothrombosis incl DIC. @ISTH Member. No Conflicts of Interest. Views my own. Gone to 🦋
36 subscribers
Oct 19 • 6 tweets • 2 min read
I was always suspicious of the thousands of freshly minted clichéd Canadian trucker convoy and MAGA accounts pushing anti-vaxx propaganda. You'd block a thousand only to have a thousand more appear. They'd all repeat the same set of messages over and over. We clinicians are naive. All we could do in reply to the misinformation campaign was quote some RCT as though it were a scientific debate, when really it was an act of war. Yes, a proxy war waged by atypical means, but a war nonetheless.
Aug 29 • 7 tweets • 3 min read
The paper is now out in @Nature after I tweeted on this oral presentation @ISTH 2023 by @AkassoglouLab. Fibrin/fibrinogen may be a therapeutic target in СОVΙD neuropathology. Link in next tweet. “...results reveal a role for fibrinogen as a SARS-CoV-2 spike-binding protein accelerating the formation of abnormal clots with increased inflammatory activity”…“fibrin-targeting immunotherapy suppresses SARS-CoV-2 pathogenesis”.

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Aug 8 • 11 tweets • 3 min read
It's not so bad a comparison if you accept that to get a similar “depletion of the susceptibles” by a Darwinian evolutionary mechanism, you'd have to deplete 2-400M vulnerable pheno-/genotypes from the pool. It's always assumed that “evolve to become milder” means that the virus evolves, when it is just as likely that humans are “evolving” via a survival mechanism involving “depletion of the susceptibles”, leaving only those less prone to a lethal outcome. This, too, is evolution.
Aug 5 • 4 tweets • 1 min read
And this week's Grand Rounds “just a cold” is another young patient with enterovirus-induced fulminant myocarditis needing intubation, ECMO, and an Impella LVAD. I've never seen so many severe post-infectious complications presented in my life. Last week's Grand Round? Another “just a cold” with Mycoplasma in a paediatric patient who developed encephalopathy, needing IV pulse methylprednisolone and IVIg. It's like every week we see a new case of previously rare infectious complications in young patients.
Aug 3 • 7 tweets • 4 min read
Subjecting trial subjects to wearing surgical mаsks against an airborne virus is like running a bike helmet RCT with subjects in Tupperware helmets that weren't designed for that purpose. “But we don't know it doesn't work until we run an RCT” isn't good enough.
Image “But there was a 30% reduction in head injuries in the Tupperware group vs. placebo.” Not good enough! In a high-risk scenario for major head injury, a Tupperware helmet won't do. The magnitude of risk test subjects were exposed to needs investigation and quantification. Image
Jul 31 • 4 tweets • 2 min read
A reminder that there was once a titanic struggle between contagionists vs miasmatists over the mechanism of transmission of cholera before the need to cleanse the water of waterborne pathogens was accepted. We are going through a similar struggle today, fighting for clean air. abc.net.au/news/2024-07-3… If you want to read about how divisive the debates between the contagionists and miasmatists was, you should read “Death in Hamburg” by @RichardEvans36. They didn't need Twitter back then to be almost reduced to pistols at dawn.
Jul 25 • 9 tweets • 3 min read
This trial should have been reported as having an unacceptable 70% failure rate, showing that a surgical mаsk is grossly suboptimal in design and not fit for purpose as RPE. Engineered physical protective devices aren't drugs. bmj.com/content/386/bm… You wouldn't consider a parachute that failed to deploy 70% of the time to be an acceptable design to test by RCT, and neither should droplet protection against an inhaled bioaerosol be considered ethically acceptable for a study design.
Jul 24 • 7 tweets • 3 min read
Another factor is that children have been turned into let-it-rip vectors of forced mass infection who bring home diseases that debilitate the parents who are out of sick leave while killing the grandparents. sbs.com.au/news/article/a… And yes, children have been demonstrated to be key vectors of disease.
Jul 23 • 4 tweets • 2 min read
Another fact that people often don't know is that the yolk of the “fried egg” shape of a monocyte is chock-a-block full of coagulation proteins, like tissue factor (TF), which moves to the cell surface on activation. This drives various disease processes.
Image As for monocytes collaborating with platelets to bring about immunothrombosis, this occurs via monocyte PSGL-1 binding to platelet P-selectin. Image
Jul 23 • 4 tweets • 1 min read
There is no such thing as “just a cold.” In hospital grand rounds this week was a case of necrotising Staphylococcal pneumonia needing ECMO for ARDS in a fit young gym goer who was also Enterovirus PCR positive. All viral URTIs predispose to secondary bacterial infections. All viruses deploy host immune evasion strategies, which facilitate the pathogenicity of other organisms. If you isolate one viral URTI organism, you should be on the alert for the presence of other coinfections or to the future risk of 2ry suprainfection.
Apr 30 • 4 tweets • 2 min read
Malaria is vector-borne. How would you hasten the spread of malaria? By telling people to protect themselves against malaria by handwashing instead of using mosquito nets. HIV is body-fluid-borne. How would you hasten the spread of HIV? By telling people to protect themselves against HIV by handwashing instead of using condoms (or PEP/PrEP)
Mar 10 • 4 tweets • 2 min read
Despite ancient origins, “contagionism” remained deeply unpopular because it implied the need for lockdowns to contain spread. Libertarian miasmatists claimed diseases weren't contagious. They regarded themselves as too modern for nasty Medieval lockdowns. That's why when Semmelweis came up with the contagionist concept of handwashing to reduce disease spread, the whole libertarian medical world gasped in abject horror.
Feb 23 • 6 tweets • 2 min read
This article on the outbreak of Cryptosporidium infections in Queensland is riddled with problems and contradictions. abc.net.au/news/2024-02-2… It states: “Health officials say the spread of the illness can be controlled by proper hygiene and hand washing.” Yet, it also says, “You don't need to get much water in your mouth to potentially get a case.” How does handwashing stop that?
Feb 21 • 7 tweets • 2 min read
Statements claiming that SARS-CoV-2 can't possibly be airborne because that would imply it is frightfully contagious, with an R0 more like measles, reminds us of how divisive a concept contagionism has been through the centuries. 🧵 Miasmatists held that miasmatism was more modern and libertarian, as opposed to contagionism, which had been used since the Middle Ages to justify quarantines and lockdowns to contain person-to-person transmission.
Feb 15 • 6 tweets • 3 min read
A nice photo illustrating why surgical mаsks don't work as respiratory protective equipment. You can see big gaps at the top, sides, and bottom. All the air you breathe in goes through the gaps and enters your lungs unfiltered. Photo from a respirator ad by Koken. Image But—you may object—surgical mаsks have excellent particle filtration efficiency (PFE). So they must work…right? A high PFE means nothing if the air you breathe in sneaks past unfiltered through these gaps rather than going through the filter. armbrustusa.com/pages/mask-tes…
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Feb 13 • 9 tweets • 3 min read
A bit of commentary on this @JAMANetworkOpen paper. It just means that HCWs should get a fresh respirator after they remove their respirators for a meal break mid-shift. Simple. 🧵 jamanetwork.com/journals/jaman…
Image The mechanism of fit failure is uncomplicated. It is strap fatigue. The reason trifolds didn't last as long is that they were Auras, which have super thin straps. This is not the case with Trident trifolds. It has nothing to do with the facepiece design (cup, duckbill, trifold).
Feb 3 • 11 tweets • 3 min read
This is a tale of two earloop respirators. The Q100 is from Canada, and its antipodean twin, the AMD T4, harks from Australia. They are almost identical in look, feel, and fit test results.🧵
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Image The CanadaMasq Q100 respirator has Canadian CA-N95 certification. The AMD T4 has Australian P2 and EU/UK CE 2233 FFP2 certification. Both were tested during certification to show that a small group of subjects passed fit tests in them according to the AU and CAN protocols. Image
Jan 31 • 9 tweets • 4 min read
Not bad. Wearing your respirator is about living fearlessly. If it's good enough, your trusted respie is a time machine that transports you back to 2019—as long as you wear it. But we need a few corrections.🧵 thespinoff.co.nz/society/31-01-… The technical OH&S terminology is that маsks are for droplets/splashes. Respirators are for the prevention of inhalation injury. Μаsks don't protect against viral aerosol inhalation. So make sure your respiratory protective equipment is a certified respirator.
Jan 19 • 12 tweets • 4 min read
We look upon the treatment of Semmelweis with horror, but there were political forces at work here that we do not appreciate. In particular, handwashing implied contagionism.🧵 If handwashing worked, that meant the removal from the hands of a contagious medium. In an age when contagionism was considered an archaic Medieval theory inconsistent with modern progress, this didn't go down well, especially without a sound germ theory mechanism to explain it.
Jan 14 • 7 tweets • 4 min read
A reminder that if you purchase 3M products from Amazon, make sure they are BOTH sold AND shipped by Amazon (a 3M authorised seller). NOT from a third party (unless you are CERTAIN they are an authorised seller). Shipped by Amazon is NOT good enough.

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Image If you want to hear this directly from 3M safety division vice president Dr Nikki McCullough, here is the relevant excerpt of this video interview.
Dec 19, 2023 • 11 tweets • 4 min read
This is a mаsk. It does not protect you against СОVΙD. because it has a fit factor and filtration efficacy of zero. Mаsks don't work.🧵 This is a mаsk. It doesn't protect you against CV19. It has a fit factor of near zero. It has good filtration efficacy, but none of the inspired air goes through the filter. Mаsks don't work. It's physically impossible for them to work. You might as well be wearing a batman mask.