Catherine Clase @cmclase@qoto.org

@jordy_bc @cmclase @LaurieTomlinson since I am on a roll 😎
What about flozins?
Yes you can see euglycemic DKA in a small number, but
- EMPULSE shows benefit starting with acute decompensated HF https://www.nature.com/articles/s41591-021-01659-1
- DARE showed no harm starting DAPA in peeps hospitalized with COVID

It’s not stop flozins for all when sick - we need nuanced guidance🤔

@cmclase @LaurieTomlinson @jordy_bc @hswapnil This is the way. The question is not how early benefit accrues from SGLT2i (or RASi) but when it is safe to start. I’ m a critical care #flozinator😅

@LaurieTomlinson @jordy_bc @cmclase @mike_johansen
Just like AKI and RASi, I agree euglycemic DKA is a real thing
But stopping all meds on admission (or if sick) seems too broad a stroke?

@yaneerbaryam
In fact, the same thing is happening in the southern hem. where we are in spring.
This graph is the last 10 years of resp. viruses infection rate, and we've never had a spike this time of the year. It's not seasonal.

Here is a chef with no sense of smell or taste, there are pilots and analysts with brain fog, athletes with heart and lung damage, healthcare providers and teachers with immune system damage, industries with disabled workers.

This is living with the virus.

/ht @enemyinastate

@yudisthra @jordy_bc @mike_johansen @hswapnil @LaurieTomlinson @cmclase As a HF doc I will say that we see euglycemic DKA pretty commonly in patients admitted frequently become NPO for cath, abdominal ultrasound etc. The issue here is not dehydration but rather that decreasing CHO intake and the glycosuric effect of SGLT2i lead to low serum glucose levels that fail to stimulate insulin release from the pancreas, hence the ketosis.

@jordy_bc @mike_johansen @hswapnil @LaurieTomlinson @cmclase in the absence of studies I withold it in patients with dehydration or a risk of dehydration which I may not be able to correct. (like Dengue). I tell my patients to withhold if they have diarrhoea or vomiting. And to avoid unnecessary referrals, I tend to tell surgeons to withhold SGLT2i at least 3 days before surgery

@mike_johansen @hswapnil @LaurieTomlinson @cmclase agree, though hard to do since holding them is almost ubiquitous unless someone forgets to (which implies other aspects of care may be similar) or the surgery is extremely quick/low risk/not requiring NPO status (e.g., bedside procedure?) which carries different risks than surgeries that typically “merit” holding

Never forget, a 13-year study of a dozen cities found that protected bike-lanes led to a drastic decline in fatalities for ALL ROAD USERS. And painted bike-lanes? No safety improvement at all. As for sharrows, it’s safer to NOT have them. Via #StreetsblogUSA, read their article. #bikelanes #bikes #cities #transportation #mobility #sharrows #infrastructure #urbanplanning
https://usa.streetsblog.org/2019/05/29/protect-yourself-separated-bike-lanes-means-safer-streets-study-says/

Hi #introduction from me..!
I'm a Prof of Operational Research at UCL & member of Independent SAGE.
As such, I've been tweeting about Covid for 2.5 yrs now so expect more of that here!
Plus occasional forays into politics, women in science, general science & stuff about London.
Hope I get the hang of it soon!

"So why are so many kids experiencing severe illness from seasonal viruses?

Emerging evidence suggests COVID-19 may be to blame, Furness says. “COVID, like many viruses, harms the immune system as part of its strategy”"

‘Immunity debt’ is ‘misinformation’

#covid

https://globalnews.ca/news/9272293/immunity-debt-covid-19-misinformation/

@cmclase @hswapnil @jordy_bc

What Swap said!!

#introduction #Nephrologist and #epidemiologist, Associate Professor at #UCSDNephrology 
Interested in #ADPKD, #biomarkers, #uromodulin, #FOAMEd, social determinants of health

Migrating over to #MedMastodon so don’t be alarmed if I re-follow you. 😀

90% of data science is data cleaning.

90% of data cleaning is data understanding.

90% of data understanding is figuring out the denominator.

Lecture by Harvard's Justin Feldman 🧠(https://scholar.harvard.edu/jfeldman)

How to Hide a Plague: How Elite Capture and Individualism Made Covid Normal

https://www.youtube.com/watch?v=OlFQ26SpGM0&t=1s

"This lecture will argue that the failures of the US pandemic response were mainly driven by economic elites who used their influence to undermine public health protections."

#Introduction #Nephrologist interested in all things Haemodilaysis especially vascular access and home HD. Also CKD epidemiology. Member and Past Steering Committee CKD Prognosis Consortium. Wannabe #Biostatistician. #Kiwi in Australia.

@cmclase @LaurieTomlinson on RASi - what I find fascinating is data from the COVID RAS studies, eg BRACE CORONA, REPLACE COVID @jordy_bc - and soon CLARITY
None of them show benefit of course, but it’s 🤯that continuing RASi in hospitalized COVID, or even starting RASi (CLARITY) didn’t cause harm.
We should really rethink sick day rules!