Danish

Doctor. Cricket, Politics and Bitcoin.

[Jason Ryan @jasonryanmd]

Amazing podcast. Dr. George Tolis (@georgetolisjr) is chief of cardiac surgery at Brigham and Women’s and he does not hold back in this discussion about medical training and surgical decision making. Few surgeons are willing to speak so bluntly about these topics. A must listen.

[Arish @arishs24]

$4700 to hear your family never made sense to me, we changed that. Pre order now.

[David Keyes @DavidMKeyes]

When Pakistan requests something you really don't want to do

[Dr. Priyam Bordoloi @DocPriyamMD]

A student asked: "If sore throats are caused by a virus or bacteria, how come sleeping under the fan or drinking cold water gives it?"
I am surprised most people are not aware of the answer to this.

[Danish @thesignd]

@zfrmrza @GovtofPakistan @PM_PK_Shahbaz @WHOPakistan @UNICEF_Pakistan @UNAIDS_Pakistan @AwaamPakistan Politicians would only act if they get affected by it. Otherwise it is only the poor who will suffer.

[Zafar Mirza @zfrmrza]

We are sitting on a generalised epidemic of AIDS in Pakistan. UNAIDS estimates that Pakistan has the fastest-growing number of AIDS cases in Asia.

What BBC film has revealed in Tunsa THQ is a tip of the iceberg. Same practices are rampant in all districts of the country. All blood borne diseases as a result are on the rise in Pakistan due to absolutely irresponsible health care practices including, reuse of disposable syringes by health care workers and drug addicts; unscreened blood transfusions; unprotected sex; unhygienic use of shaving instruments and so on. We have the largest population with Hepatitis C infection in the world ie around 10 million.

After RatuDero outbreak of AIDS among young children, I sat up a Taskforce for safe injection which produced a National Action Plan for Injection Safety and we banned the import, manufacture, sale and use of reusable disposable syringes and we promoted their replacement with auto-destruct syringes. The breakdown of governance, lack of implementation of policies, and complete lack of accountability has not made the desired effect on the ground though local manufacture has shifted predominantly to auto-destruct syringes.

There are health budget issues, supply chain issues and unfilled posts in public sector health facilities where only poor and gullible people go for lack of affordability. Tunsa is a wake up call, like Ratu Dero (2020) outbreak was, like Jalalpur Jatan (2009) outbreak was, and many other outbreaks. After a spike in media discussions and governments defending the issue gradually dies down.

Our successive governments have failed to make health care their priority which is evident from the very low spending on health care. In this case, very young children are suffering and dying due to AIDS due to health care workers criminal behaviour of using same infected syringes on multiple children. Those who survive have to take lifelong medication - a life long suffering and liability on society. Look at the clip below. It is horrendous. This is scandalous.

For God sake take care of people’s health and make it a fiscal priority. We have to take a moral and financial responsibility for people’s health care, rather than continue to be dependent on Global Fund, GAVI and others. These are our children, our people and they are our responsibility.

[Anjana Sankar @Asankar]

The outcome of the talks in Islamabad could affect the stability of the Middle East, global energy security, and even the safety of millions of Indians who live and work in the Gulf countries.

These talks, if succeed, will essentially save the world from the brink of an economic disaster. It is actually good for India. It is good for the Gulf countries, good for the Middle East, and good for the world.

But Indian media is treating it almost like a cricket match between India and Pakistan. Every development is seen and discussed only through the lense of IndiaPak rivalry. They seem to be almost gloating over the prospect of its failure.

India’s foreign policy success should come from India’s own strength and diplomacy, not from celebrating Pakistan’s failure. Can’t we do it at least in this case??

[Ismailoğlu Pasha @IsmailogluF]

English is full of Arabic words from the Islamic Golden Age, yet this influence is hidden
“Experts” trace these words to other sources to downplay our achievements

Malcolm X said:if you believe you’ve never achieved anything you’ll never achieve anything

[Mushahid Hussain Sayed @Mushahid]

Brilliantly analysed by Prof. Pape: Iran has changed regional ‘rules of the game’ through CONTROL of Strait of Hormuz without CLOSING Strait! The War is, indeed, transformational for Global Order, as ‘Might is Right’ aggression by Trump-Netanyahu Bully-Boys duo miserably failed!

[Danish @thesignd]

Wow. So much hatred for your neighbor

[Fidato @tequieremos]

When Pakistan conducted nuclear tests in year 1998, the economy was in dire straits. Pakistan was down to only $600 million in foreign exchange reserves against an outstanding foreign debt of $38 billion. Pakistan would have defaulted under the economic sanctions imposed by the US before the Saudis chipped in.

To ease the economic pressure, Saudi Arabia agreed to a three year plan to accept deferred oil payments from Pakistan in 1998.

According to a western diplomat, the Saudis after three years of deferred payments practically wrote off the payments.

In 1998, according to Guardian when the Saudis bailed out Pakistan, oil prices had fallen to $10 a barrel and “the Saudis had an unprecedented budget deficit and even had to borrow money”

Prince Turki bin Faisal once described the relations between Pak and KSA as “probably one of the closest relationships in the world between any two countries”.

[Al Jazeera English @AJEnglish]

Pakistan sees fuel prices soar nearly 77% in a month, driven by government taxes that nearly double global rates. Rising inflation sparks criticism of politicians accused of ignoring citizens’ struggles.

Al Jazeera’s Osama bin Javaid reports from Karachi.

[Handre @Handre]

Americans fly to Turkey for $3,000 dental implants that cost $40,000 in Manhattan. They drive to Tijuana for $800 MRIs priced at $12,000 in San Diego (literally 15 minutes north). Medical tourism revenue hit $100 billion globally in 2023 while US healthcare spending broke $4.5 trillion.

The market speaks louder than any policy wonk ever could. When you can get the same cardiac surgery in Bangkok for $15,000 that costs $200,000 in Boston—using the same equipment, often better facilities, and surgeons trained at Johns Hopkins—the pricing isn't reflecting scarcity or quality. It's reflecting capture.

Insurance companies created this beautiful racket where they negotiate "discounts" off artificially inflated prices, hospitals play along because the government backstops the whole charade through Medicare reimbursements, and pharmaceutical companies... well, they just price whatever the market will bear (which turns out to be everything you own plus your firstborn).

Austrian school economists predicted this decades ago. When you remove price signals and direct payment, costs explode. When Americans rediscover actual market prices by flying to Mumbai for heart surgery, suddenly they remember what healthcare actually costs when providers compete for cash-paying customers instead of...

[N @_viperone]

If UAE had demanded this loan repayment from Imran Khan, we would see books written on how he damaged our foreign policy.

[Sultan @Sultan__Shehri]

High yield and compact lecture for neuroanatomic localization. Highly recommend for junior residents and interns interested in neurology

https://t.co/Es1csYUgan

[Brandon Luu, MD @BrandonLuuMD]

Doctors take more high-stakes exams than virtually any other profession.

Over 10+ years of this, I became obsessed with one question: which study techniques actually work?

Here's how I learned to study less and score higher
🧵1/11

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

🫀Heart failure in 2026: we are no longer treating symptoms. We are redesigning the disease.

The latest evidence update reminds us of something profound:

Heart failure is no longer a single entity.
It is a spectrum, and now, finally, we are treating it as one.

Several paradigm shifts stand out.

1. SGLT2 inhibitors are no longer “add-on” therapy.
They are foundational across the entire EF spectrum.

From HFrEF to HFpEF, the data are now consistent.
Not just symptom improvement, but hard outcomes.

This may be the most important unifying therapy in modern HF.

2. HFpEF is no longer a therapeutic desert.

For the first time, we have real disease-modifying options:

Finerenone → outcome reduction across EF ranges

GLP-1 / dual incretin therapies → targeting the obesity phenotype

Structural and metabolic mechanisms are finally being addressed

We are moving from “HFpEF frustration” → HFpEF phenotyping.

3. Acute heart failure is no longer about stabilization.
It is about early transformation.

The new paradigm:

Start GDMT in-hospital

Optimize rapidly

Treat beyond congestion

Decongestion is still important, but it is no longer the goal.
Disease modification starts on day 1.

4. Decongestion is becoming precision medicine

Urine sodium-guided therapy

Early escalation of loop diuretics

Sequential nephron blockade

Not just “give furosemide”, but measure, adjust, and target response.

5. Devices are no longer rescue therapy, they are integrated care

TEER expanding from mitral → tricuspid

Pulmonary artery pressure monitoring reducing hospitalizations

Remote hemodynamics shaping outpatient management

The boundary between ICU, ward, and home is dissolving.

6. The biggest problem is no longer evidence.
It is implementation.

We already have:

Quadruple therapy

Proven outcome benefits

Yet many patients never reach target doses.

The gap is no longer science.
It is execution.

🤓Final message

Heart failure care has entered a new era:

Mechanism-based therapy

Early aggressive optimization

Phenotype-driven treatment

And perhaps most importantly:
We are no longer chasing symptoms.
We are altering the trajectory of the disease.

📃Reference
Liori S, et al. Heart failure evidence update 2026. Heart Failure Reviews. 2026. https://t.co/T4MVjK0vGd

[عبداللہ @Blahhhhhh34]

Imagine writing a whole character assassination essay about a person, then you ask for their source and they proudly say social media. One more question and they start overheating like an old laptop 😭

[PTI @PTIofficial]

The world is watching as #AsimLaw is enshrined in the constitution by an illegitimate parliament led by the Sharif-Zardari partnership, acting as proxies of a brutal military dictator.

These are just some examples of how global media is covering the 27th Constitutional Amendment:

Sweeping authority...
Democratic erosion...
Unprecedented powers...
Lifelong legal immunity...
Collapse of judicial independence...
De facto ruler...
Mockery of civilian supremacy...
Lifelong dictatorship...

#ایسے_دستور_کو_میں_نہیں_مانتا

[The New York Times @nytimes]

Breaking News: Pakistan’s army chief secured expanded powers over the military and lifelong immunity after lawmakers approved a constitutional reform. https://t.co/ERYDNXi7Xh