María Gabriela

[El CondeNado @elconde_nad0]

cuando finalmente llegas a tu "esto no vale mi energía" era

[Gastón🫀 @gastonfyp]

Yo fingiendo estar bien con una situación que claramente me está afectando

[dulce🍬 @dulcebarigonza]

Fui a ver Obsession y me parece una analogía perfecta de cómo los hombres literalmente te empujan a la “locura”, y luego te juzgan y te culpan por estar “loca”

[KriMeera Healthcare @krimeeraHC]

➰Lactulose

🤹Why Lactulose in Hepatic Encephalopathy (HE)?
🌀Hepatic encephalopathy is primarily caused by ammonia (NH₃) accumulation due to impaired hepatic detoxification.

🤹Lactulose – Drug of Choice :-
•🌀Non-absorbable disaccharide
•🌀Acidifies colonic contents → converts NH₃ (absorbable) → NH₄⁺ (non-absorbable)
•🌀Acts as an osmotic laxative → increases fecal nitrogen excretion
•🌀Reduces ammonia-producing gut bacteria

🤹Clinical pearl:-
🌀Target = 2–3 soft stools/day

🤹Why others are wrong?
•🪬Loperamide → slows gut → ↑ ammonia
•🪬Psyllium → bulk laxative, no ammonia reduction
•🪬Senna → stimulant laxative, not first-line for HE

🤹Mnemonic:-
🌀“Liver fails → Lactulose saves.”

#HepaticEncephalopathy #Lactulose #Ammonia #Cirrhosis #MedicinePearls #Pharmacology #KriMeeraPharma

[Rafael Sirera @ProfSirera]

Could you imagine that a hormone, invisible and intangible, can imprint itself as a visible geometric pattern in a bodily secretion — turning endocrine signalling into crystallised biology?

🌟 Oestrogen induces ferning patterns in vaginal (and cervical) secretions because it profoundly alters the biochemical composition and physical chemistry of the mucus, driving it towards a highly ordered crystallisation state upon drying.

▶️ Under high oestrogen levels — classically around the peri-ovulatory phase — vaginal and cervical secretions become rich in electrolytes, particularly sodium chloride, and relatively poor in proteins and mucins.

▶️ Oestrogen upregulates ion transporters and aquaporins in the epithelial cells, increasing water content and ionic strength while simultaneously reducing viscosity. The result is a fluid secretion optimised for sperm survival and transport.

▶️ When such a secretion is spread thinly on a glass slide and allowed to dry, salt crystallisation dominates.
Sodium and chloride ions self-organise as water evaporates, forming arborescent, fractal-like structures that resemble fern leaves.
This is not a biological structure per se, but a physicochemical phenomenon driven by ionic concentration, surface tension, and evaporation dynamics. The low concentration of macromolecules allows ions to crystallise freely, producing the characteristic dendritic pattern.

▶️ In contrast, during progesterone dominance (luteal phase, pregnancy), secretions are thicker, protein-rich, and mucinous.
Proteins disrupt crystal lattice formation, water content is reduced, and ion mobility is constrained. As a result, ferning disappears and the dried secretion appears amorphous or granular.

▶️ The ferning phenomenon is therefore a readout of oestrogenic action at the epithelial level, integrating hormonal signalling, ion transport, and fluid biophysics.
Its reproducibility made it a useful clinical tool long before molecular endocrinology existed, not only in gynaecology but also in obstetrics (e.g. detection of amniotic fluid leakage).

[Dr. AK 🇮🇳 @docakx]

🎄Christmas tree sign on ECG

What causes this❓️

Merry Christmas🎅

[Fénix Leviatán @OrionFenix7]

Vamos a explicarle a Nayib, por qué está prohibido en el país: la minería metálica es inviable en El Salvador por su poca extensión geográfica, su densidad poblacional y la inminente contaminación de aguas superficiales y manto freático.

Hay dos métodos de extracción: minería a-

[Epic Maps 🗺️ @theepicmap]

A thread of 23 Survival Tips And Tricks You Might Not Have Known Before.

1. How to break a door

[R E P L I C A N T @Roybattyforever]

Viajes en el tiempo, bucles temporales, universos paralelos, metalenguaje, argumentos complejos que te exigen reflexión y dar un paso más allá...

En este hilo os presento películas que os harán explotar la cabeza🤯

Comenzamos👇

[Epic Maps 🗺️ @theepicmap]

19. Did you know that 50 % of the Canadian population lives south of the red line?

[James Lucas @JamesLucasIT]

Thread of crazy painting details 🧵

1. It's all in the eyes

[Culture Explorer @CultureExploreX]

Italian churches captivate with their stunning architecture and timeless beauty.

These 24 sanctuaries are brimming with history and artistry. 🧵

[María Gabriela @MGSV98_]

X2

[Sertralina @electroboy97]

Compañeros caca residentes caca hospital caca medicos caca puta vale verga que año más mierda

Y el próximo que me diga "en el internado se sufre pero tiene cosas buenas" le parto su madre

[María Gabriela @MGSV98_]

@electroboy97 UCSFI Tonaca 💫

[María Gabriela @MGSV98_]

Thanks @kendricklamar for spending 428 minutes with me in 2022. I couldn’t stop listening to Money Trees. #SpotifyWrapped https://t.co/dNwNOLIpJF

[Macaco Louco M.D. ⚕ @Dr_VSalazar]

@arman_2 Lo que incluye la consulta, es la consulta y dí que te fue bien porque la toma de signos vitales va gratis culero. Sí no sabes como funciona mejor:

[María Gabriela @MGSV98_]

@electroboy97 10 cc de insulina :(

[María Gabriela @MGSV98_]

Y si

[Sertralina @electroboy97]

La verdad a mi no me gusta ser tóxico con mis compañeros...

Pero yo me tengo que cubrir las espaldas porque cuando algo pase nadie me va a defender así que lo siento