Name

medicine/gym/messi

[Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) @rkalyes1]

📚 This information could add a few more years to your life!

👉 Intermittent fasting to treat diabetes: time to update clinical practice guidelines - The Lancet Diabetes & Endocrinology

https://t.co/4nNRxqHE0W

[Name @32namez]

@xxChessMaster Black queen b6?

[Dr M Shujat Rasool @DrMShujat]

Among all migraine variants, the one that consistently fools clinicians the most is vestibular migraine. Not because it is rare but because it doesn’t behave like what we expect a “migraine” to look like.

No headache. Normal MRI. Normal ENT. Just recurrent dizziness that keeps changing labels.

[FRNK Asiimwe @RubabindaJr]

A lot of ill going on!

@TheUMAofficial @PharmacistsUg @agnmu_Ug @FUMI20232024 @OfficialFUMSA and now FEFERATION of UGANDA MEDICAL PRE-INTERN [FUMPI] reject and push back all the draconian shenanigans being metted on unsuspecting citizens that consume Healthcare in Uganda.

[Rt. Hon. Dr. Kirya Wilberforce @KiryaWilberfor1]

We're here for one reason and one cause

[FRNK Asiimwe @RubabindaJr]

WE REJECT AND PUSH BACK.

[Turkishh @TInyhunta]

Can't get enough of this Tal sacrifices 😳🔥🔥

Wtf was he on man????

[Ms. SUSAN KATAIKE @sussiekats]

🕕At 40, life stops being gentle.

Here's what nobody tells you:
1. Stay silent. Not everything needs to be said. Words lose power when wasted. Peace is chosen — not explained.

2. If someone's smarter than you, work with them. Competition is ego. Cooperation is intelligence.

3. The family you build matters more than the one you came from. Build forward.

4. Your job doesn't love you. It pays you to survive — not to dream. Never confuse income with purpose.

5. Free yourself from society's advice. Most people are lost — following the lost.

6. One real friend who celebrates your wins beats a room full of jealous acquaintances.

7. Blaming your parents keeps you weak. Taking responsibility sets you free.

8. Stop waiting for the right time. Waiting is how dreams die quietly.

9. No one is coming to save you. Your life is entirely your responsibility.

10. Your circle should talk about growth, money, discipline, and building. Everything else is noise.
11. You don't need another self-help book. You need action. You need discipline.

Adulthood begins the moment you stop expecting rescue — and start building. Silently. Patiently. Relentlessly.

#Copied

[FRNK Asiimwe @RubabindaJr]

Let talk about this Policy.
@TheUMAofficial,
@agnmu_Ug,
@OfficialFUMSA
@FUMI20232024
@PharmacistsUg
@faith_nabushawo

Tell a friend to tell a friend, to tune in.

The gloves will be off and words aren't going to be minced.

[FRNK Asiimwe @RubabindaJr]

I agree with your analysis Prof. @rkalyes1

But we are alert and very focused, secondly, we know these tricks, third time is on our side, and most importantly right is on our side too.

The draconian shambolic internship Policy is dead on arrival.

[Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) @rkalyes1]

🔥 Congulatulations Hon @CHRISBARYOMUNS1 🎉
🔥 We thank God for saving you last time, perhaps it was for a day such as this.
🔥 As Medical educators, we humbly ask that you address the plight of interns once and for all!
🔥 Medical Training/ Practice in Uganda needs a face lift.

[Dr M Shujat Rasool @DrMShujat]

🧠 FOR RESIDENTS | HOUSE OFFICERS | CONSULTANTS
(STROKE LOCALIZATION MADE SIMPLE)

When a stroke patient arrives, don’t start with scans first.

👉 First question at bedside: Which vascular territory is involved?
This single step predicts the full neurological deficit.

1️⃣ Middle Cerebral Artery (MCA) Stroke

📍 Most common stroke territory

Contralateral face & arm weakness > leg
Contralateral sensory loss

Dominant hemisphere → Aphasia

Broca: non-fluent speech
Wernicke: fluent but meaningless speech

Non-dominant hemisphere → Hemispatial neglect

💡 Key clue: Face + arm > leg = MCA

2️⃣ Anterior Cerebral Artery (ACA) Stroke

Contralateral leg weakness > face/arm
Sensory loss (leg predominant)
Frontal lobe features:
Personality change
Urinary incontinence

💡 Key clue: Leg > face/arm = ACA

3️⃣ Posterior Cerebral Artery (PCA) Stroke

Contralateral homonymous hemianopia
No motor weakness
Memory impairment (hippocampus)

💡 Key clue: Isolated visual field defect = PCA

4️⃣ Basilar Artery Stroke

⚠️ Neurological emergency

Locked-in syndrome
Conscious but quadriplegic
Vertical eye movements preserved only
Bilateral motor deficits ± cranial nerve palsies

💡 Key clue: Locked-in = basilar until proven otherwise

5️⃣ Lacunar Strokes (Small vessel disease)

Seen in HTN & diabetes
Deep brain involvement:

Pure motor hemiparesis (internal capsule)
Pure sensory stroke (thalamus)
Ataxic hemiparesis (pons)
Dysarthria–clumsy hand syndrome

❗ No cortical signs:

No aphasia
No neglect
No visual field defects

💡 Key clue: Pure motor OR pure sensory = lacunar

🔑 ONE-LINE PATTERN RECOGNITION:

Face/arm > leg → MCA
Leg > face/arm → ACA
Visual field cut only → PCA
Locked-in → Basilar
Pure motor/sensory → Lacunar

🧠 If you can localize, you can diagnose before imaging.

[Chess Master @xxChessMaster]

The Most DISRESPECTFUL Checkmate of the 1800s

Wow! Never saw that before! 😱🤯🔥🎯

William N Potter vs Frederick Matthews
London (1868) · 1-0

[Massimo @Rainmaker1973]

This artist bringing a painting to life

[📹 lesoulsart]

[Dr.Sridatta A.K.A Nephron_Endowment @SridattaPawar]

They have no strong guideline based evidence showing clear renal benefit in routine AKI or CKD care.

Many of the available studies are industry sponsored and usually compare:
Standard CKD care + “save drug” vs standard care alone.

The most important thing before treating CKD is understanding the pathogenesis behind the disease. Treatment should target the mechanism driving progression not just add “renal supportive” tablets to everyone.

Case 1:
CKD with serum creatinine 1.5–1.7 mg/dL,
No acidosis,
No hypertension,
Non diabetic,
Non anemic,
No proteinuria,
No heart failure.

What exactly is the disease modifying treatment here?

Often there may be no specific pharmacological therapy indicated beyond:

- lifestyle optimization,
- avoiding nephrotoxins,
- monitoring renal function,
- cardiovascular risk reduction,

I explained this honestly to the patient and advised good long term follow up.

The patient then went back to the referring doctor saying:
“Sir didn’t prescribe any kidney medicine. I wasted my visit.”

The referring doctor quite senior later called me and said:
“At least you could have written a ‘save tablet’.”

Case 2:
A patient already taking a “save drug” came with worsening proteinuria and rising serum creatinine but surprisingly was not even on RAAS blockade.

The patient said:
“This tablet is supposed to save kidneys, but my kidneys are still worsening.”

I initiated Renin Angiotensin System blockade after explaining the evidence in detail and stopped the “save drug.”

As expected, serum creatinine rose slightly initially after starting RAAS blockade.

The patient returned saying:
“You stopped the save tablet, that’s why creatinine increased.”

Despite repeated counseling about the expected hemodynamic rise seen with RAAS inhibitors, he discontinued evidence based therapy and switched to another brand of “save drug” after taking a second opinion.

He returned 6 months later with further worsening renal function.

I again reinforced the same advice. Eventually, he agreed to continue evidence based treatment, and renal function later stabilized, though not completely normalized.

Case 3:
One of my relatives who lives far away consulted a nephrologist friend of mine for CKD management.

Later my relative called me and said:
“Your friend is not a good nephrologist because he didn’t prescribe any ‘save tablet.’”

I guess many nephrologists add these “save tablets” only after initiating all evidence based therapies, and then use them as adjuncts mainly to satisfy patient expectations.

The reality is:
There is no strong guideline supported evidence showing major renal outcome benefits from these drugs in routine CKD or AKI practice.

At the same time, most of them are relatively safe, so many clinicians feel:
“May not benefit much, but probably won’t harm either.”

If you type “RAS blocker side effects” online, you immediately see: rise in serum creatinine

Patients naturally get frightened because these are measurable and visible effects.

But ironically, RAAS blockade remains one of the most evidence based renoprotective therapies .

A mild creatinine rise after starting ACE inhibitors or ARBs is often an expected hemodynamic effect, not necessarily kidney “damage,” provided it stays within acceptable limits but even some times they go beyond limits and then again reduce

Meanwhile, when patients search side effects of many “save drugs,” they usually find:

- “well tolerated”
- “antioxidant”
- “renal protective”
So psychologically:
the evidence based drug appears dangerous,
while the weak evidence supplement appears safe and comforting.

This creates a major counseling challenge in nephrology practice, especially in India,

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🧠🌡️ Temperature control in acute brain injury is evolving and the paradigm shift is important

For years, neurocritical care focused heavily on therapeutic hypothermia.

Cool the brain. Reduce metabolism. Improve outcomes.

The physiology made perfect sense.

But modern evidence is forcing the field toward a far more nuanced and physiology based approach.

📉 One of the most important concepts from this review

Fever itself may be one of the most underestimated secondary brain injuries.

Not simply a symptom.

A pathophysiological amplifier.

Across:
• Traumatic brain injury
• Ischemic stroke
• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Post cardiac arrest encephalopathy

Hyperthermia consistently correlates with:
❌ increased cerebral metabolic demand
❌ excitotoxicity
❌ oxidative stress
❌ cerebral edema
❌ intracranial hypertension
❌ worse neurological outcome

The review highlights that contemporary practice is moving away from indiscriminate hypothermia toward:
✅ controlled normothermia
✅ continuous temperature monitoring
✅ early fever detection
✅ minimization of temperature variability

⚠️ Important clinical nuance

Hypothermia still has physiological effects.

It can:
• reduce cerebral metabolic rate
• lower intracranial pressure
• attenuate excitotoxicity

But physiology alone does not guarantee improved outcomes.

This is one of the central lessons from:
• EUROTHERM3235
• TTM2
• EuroHYP
• INTREPID

The review elegantly demonstrates the recurring disconnect between: 🧪 physiological success
and
👤 patient centered outcome improvement

🫀 Perhaps the strongest practical message

Temperature management should not be viewed as: “A standalone neuroprotective therapy.”

It should be viewed as: “A modifiable physiological domain within brain centered intensive care.”

That distinction matters enormously.

Because it reframes temperature control as part of:
• multimodal neuromonitoring
• cerebral metabolism optimization
• ICP management
• seizure prevention
• oxygen delivery matching

rather than simply “cooling patients.”

📊 The figure on cerebral metabolism is excellent

The review illustrates how:
• fever
• seizures
• ischemia

increase CMRO₂ and worsen metabolic perfusion mismatch.

Meanwhile:
• sedation
• controlled temperature management
• selective hypothermia

can help restore coupling between cerebral oxygen delivery and metabolic demand.

🤖 Where the future may go

The next frontier is unlikely to be “cool everyone to 33°C.”

Instead:
• Multimodal monitoring
• individualized physiological phenotyping
• continuous metabolic assessment
• adaptive temperature targets

may finally identify WHICH patients actually benefit from deeper cooling.

Precision neurocritical care rather than protocolized hypothermia.

📖 Reference
Lavinio, A., Intensive Care Medicine. Advance online publication. https://t.co/AvJ7xIXikr

[HustleBitch @HustleBitch_]

🚨 DOCTORS JUST “SWITCHED OFF” PARKINSON’S TREMORS IN REAL TIME — AND THE BEFORE/AFTER IS UNREAL

This video is going viral… because what happens doesn’t look possible.

One moment: uncontrollable shaking.
Moments later: complete stillness.

No open surgery. No implants.

Just MR-guided focused ultrasound targeting a tiny area deep in the brain.

• Hands that couldn’t hold still… suddenly steady
• Violent tremors… gone on the spot
• Patients testing movement immediately — and it actually works
• Doctors watching it happen LIVE inside the MRI

This isn’t gradual.
It’s instant.

And now people are asking the same question:

If this exists… why does it feel like no one’s talking about it?

📹: TikTok/tremor.care

[Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) @rkalyes1]

🔥 Now that Okello has been sentenced ( I think he is mentally ill) and the Sovereignty Bill is being messaged (the spirit and intent are still the same)!

🔥 Can we please take some time and focus on the plight of medical interns in Uganda? Can we first fix what is broken?

[Chess.com @chesscom]

chess is a game where everyone gets to play and then Magnus Carlsen wins in the end

[Chess Master @xxChessMaster]

An Unbelievable Checkmate Combination🔥🤯

Wood vs Devos 1948