Catherine Clase @cmclase@qoto.org

@alexchangmd @hswapnil I guess I'd call this tertiary hyperparathyroidism, because of the hypercalcaemia. PTH should be suppressed for any other cause of hypercalcaemia, though that isa pathophysiology argument not one I can support with evidence. I think you've done due diligence for now diagnostically. Are you thinking of using bisphosphonate IV or only of hypercalcaemia worsens?

PS for others to have a chance of seeing and weighing in, which would be great, would value other #nephpearls #kidneyverse opinions, on Mastodon you have to reblog/boost. Unlike the birdsite, there's no algorithm that responds to likes, it just tells the person posting that you liked it.

Very nice to meet you and what an interesting post!

@alexchangmd

All just opinions and thoughts

Total zebra, but pheo is sometimes associated with orthostasis and with hypercalcemia through PTH-dependent and independent mechanisms.

Much more likely I would think would be secondary hyperpara from diabetic kidney disease (which is severe, evidenced by the proteinuria, though his GFR is well preserved). PTH 40 is WNL in your units, is that right? Should be suppressed by hypercalcemia and isn't.

Practically, 13 (3.24) is around the zone where i might consider empirically using a bisphosphonate for control. Or sensipar if it is covered for him, based on the hyperparathyroid idea.

What are you thinking? I'll boost in the hope of getting other people's ideas.

PS do an intro tweet and write your bio. Lots of hashtags so you start seeing what you love. Welcome to mastodon!

@dan613 @michael @trendless @ProjectN95@mastodon.social

Flomask isn't certified either, by the way.

They did their testing according to the F3502/N95 standard (community masks and respirators are tested by the same method, though with very different bars for passing)

And the results are compatible with N95s.

This standard tests masks glued around the edges to a flat plate.

How it would do on a NIOSH panel of people we don't know, but again, there are multiple reports on social media of good subjective fit.

Again, I'd predict from the data, the design, the overhead elastic, the anecdotal reports of good fit, that this would test in the same range as an N95.

As they point out on their super-transparent webpage, there are no N95s for children. NIOSH doesn't certify children's masks. It is a workplace standard.

https://flomask.com/pages/flo-mask-test-report

Well, people following me here know what is going on.

https://public.tableau.com/app/profile/bill.comeau/viz/AnnualCovid19deathrates/Dashboard1

Deaths per million in Canada:
2020: 409
2021: 379
2022: 492

Canada has a population of about 38 million, so this translates into 18,700 deaths from Covid in Canada in 2022.

For 2023, as far as we know for now, suggests a similar death rate this year.

IHME predicts that 80% mask use in public spaces (ie, a mask mandate) would reduce deaths by two-thirds within 2 months. That's 12,500 preventable deaths in Canada, over the course of a year. Much more in larger countries or countries with higher current death rates.

https://covid19.healthdata.org/canada?view=daily-deaths&tab=trend

@dan613 @michael @trendless @ProjectN95@mastodon.social

Good question. First to say, it's not claiming to be certified. The material in the filter is excellent, they have data on their website showing ASTM level 2/3 performance (tested by the medical mask standard - which is a flat material standard). I have one, the silicone seal is comfortable and well designed, makes a good seal on my N-of-1 face.

The material is good and subjectively, fit is good. It's comfortable. It can be worn with the straps overhead or earloops - I'd recommend overhead. I'd predict when worn on overhead elastic that it would perform in the same range, on a human, as a non-fit-tested N95/FFP3:

https://maskevidence.org/mask-types

I can't fit test it on a human without destroying it, and I would need several to test on different people.

Double masking:
✅Cloth over medical
-the filtration of the medical mask material plus the edge seal of a good-fitting cloth mask is a great combination

❌Anything over N95
-interferes with fit
-do this only if because of resource constraints, you have to wear your mask repeatedly or for long periods, and you also need to shield your N95 from external splashes. Recognize that with a mask over it, even if you were fit tested for that mask, you might not pass a fit test. However, still much better than a medical mask alone. Just not as good as an N95 alone.

More and references:
https://maskevidence.org/double-masking

@Pat We don't promote those over N95s because in the community people are wearing #bettermasks and #n95s without fit testing, where we have data to show results in >90% fitted filtration efficiency in most.

AFAIK, not known if we get additional gains from N99 or elastomerics without fit testing - let me know if you have a reference on this.

For others reading this, the numbers @Pat is quoting are for the masks tested on a machine, glued to a plate around the edges. Fit testing N95s on people in occupational health and safety protocols require >99% protection as fitted filtration efficiency (ie, fit factor >=100). A large proportion of people will achieve this, particularly with novel designs of #BetterMasks like Vitacore's CaN99 and the 3M Aura. Average filtration not-fit-tested is usually reported >90% in lab studies. Studies summarized at https://maskevidence.org/mask-types