Dr Satoshi Akima, FRACP
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toshiakima.bsky.social
Dr Satoshi Akima, FRACP
@toshiakima.bsky.social
12K followers 1.9K following 940 posts
Nephrology & Internal Medicine. Immunothrombosis incl DIC. ISTH Member. No Conflicts of Interest. Views my own etc
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toshiakima.bsky.social
Note: it isn't necessary to always run an ionised Ca (needs to be on a fresh specimen collected in an ABG syringe, no ice) as the whole Ca is 80% accurate. But where accurate clinical confirmation is needed, run the iCa. Here's how to interpret the ionised calcium
November 22, 2025 at 12:32 AM
toshiakima.bsky.social
Debunking the myth of so-called “corrected” calcium. Use whole/uncorrected Ca as your screening test and confirm with an ionised Ca
November 22, 2025 at 12:11 AM
toshiakima.bsky.social
More flowers in the springtime
October 7, 2025 at 11:43 AM
toshiakima.bsky.social
Spring is bursting forth everywhere
Flowers blooming forth in spring
October 6, 2025 at 8:57 AM
toshiakima.bsky.social
Now, for something off-topic. Spring has brought forth bright yellow flowers of the Hymenosporum flavum tree, a native of New Guinea, Queensland and New South Wales. Although commonly known as the native frangipani, it is not related to the frangipani. #spring
Bright yellow flowers of the Hymenosporum flavum tree Bright yellow flowers of the Hymenosporum flavum tree, with red bottlebrush flowers in the background
October 6, 2025 at 6:53 AM
toshiakima.bsky.social
As stated about influenza in Harrison's Principles of Internal Medicine, 18th Edition (2011): “Most pathogens exit via the same route by which they entered: respiratory pathogens by aerosols from sneezing or coughing”.
October 4, 2025 at 7:50 AM
toshiakima.bsky.social
My dad today, aged 90. Used to jog daily along this beach. Caught COVID two years ago. Started to complain of back and hip pains. Slid out of bed and suffered a minimal trauma fractured neckof femur.
September 30, 2025 at 6:02 AM
toshiakima.bsky.social
What Brett Sutton is saying now is nothing new. He was one of the few CHOs who openly stated that #COVIDisAirborne even in the early crisis years of the pandemic. This is an official Victorian Dept of Health video from 21 Dec, 2021.
September 23, 2025 at 2:22 AM
toshiakima.bsky.social
What did you think of the 7-2-1 rule presented at ISTH this year? Fortunately for us, a $1 AU coin is similar in size to a 1 Euro coin
September 21, 2025 at 9:09 AM
toshiakima.bsky.social
Yes it is safe to wear a valves respirator as long it fits well (preferably fit tested) and the wearer isn't infected. If unsure re valve try a seal test
September 14, 2025 at 7:09 AM
toshiakima.bsky.social
It's a paper from last year, but it still pains me to think that we could have achieved elimination without resorting to lockdown, simply by implementing universal respirator usage alone. Not masks, respirators. It's still not too late.
Aerosol leak (left) from a mask is substantial, whereas with an N95 respirator (right), there is complete block of aerosol escape. That means zero transmission.
August 9, 2025 at 8:04 AM
toshiakima.bsky.social
My parents still have a cassette deck
August 3, 2025 at 11:38 PM
toshiakima.bsky.social
While a N95 respirator is better, even a plain mask is better than nothing to stop you coughing germs over others.
A mask reduces aerosol disperal An N95 respirator provides full source control whereas masks still leak
July 23, 2025 at 7:09 AM
toshiakima.bsky.social
Needless to say, as Harrison's Principles of Internal Medicine, 2011 Ed already stated: #InfluenzaIsAirborne. Wear a respirator!
July 16, 2025 at 11:26 AM
toshiakima.bsky.social
Clinicians often psychologize chronic symptoms away, but earlier in the same session at #ISTH2025, Dr Catherine Lemarié, PhD, INSERM Researcher, University of Western Brittany, gave a talk on the molecular underpinnings of post-VTE and post-PE syndromes that activate the inflammasome.
June 24, 2025 at 8:12 AM
toshiakima.bsky.social
I couldn't help but notice that the set of symptoms listed here is extremely similar to those experienced by #longCOVID patients, to which clinicians are similarly blind.
June 24, 2025 at 8:05 AM
toshiakima.bsky.social
Anette Arbjerg Højen, RN, MscN, PHD; Aalborg University Hospital, Denmark, gave an excellent talk at #ISTH2025 on how clinicians are blind to long-term sequelae suffered by patients after VTE (post-thrombotic and post-PE syndromes). The first slide summarises things.
June 24, 2025 at 8:03 AM
toshiakima.bsky.social
Take home slide. 5 x higher incidence of major bleeding on rivaroxaban #ISTH2025
June 23, 2025 at 2:20 PM
toshiakima.bsky.social
A revelatory presentation at #ISTH2025 by Luo Qi showing that blocking FXI reverses RAAS-driven #hypertension in a mouse renal ischaemia-reperfusion model. It also blocks the progression of kidney disease and onset of heart failure. Sorry #NephSky you're gonna have to figure out the contact system.
June 23, 2025 at 12:15 PM
toshiakima.bsky.social
Israel's Futile Air War: Precision Strikes Will Not Destroy Iran's Nuclear Program-or Its Government thegreekcourier.blogspot.com/2025/06/isra...
June 22, 2025 at 2:21 AM
toshiakima.bsky.social
Nor does immunity debt explain the rise in cases of other respiratory illnesses from TB to Mycoplasma. There is a better explanation. Namely, #ImmunityTheft jamanetwork.com/journals/jam...
ast fall, children in China were coming down with respiratory illnesses earlier and in greater numbers than usual. Ditto for respiratory syncytial virus (RSV) infections in the US and elsewhere in 2021 and 2022. And the current winter sea- son doesn't appear to be much differ- Medical News website ent as far as higher- than-usual case numbers, according to CDC surveillance data. The surging case numbers and their out-of-whack timing have fueled an ongoing debate about how the COVID-19 pandemic contributed to rates of other infectious dis-eases. No one yet knows for sure. "Right now, this is phenomenology," Wolfgang Leitner, PhD, chief of the Innate Immunity Section at the National Institute of Allergy and Infectious Diseases, told JAMA in an interview. "People are assuming a lot about the mechanism." Much of the discussion has centered around immunity debt and immunity theft, terms born of the pandemic and not found in textbooks. The former generally refers to the reduced spread of other pathogens because of nonpharmaceutical interventions (NPls) imposed to curb the spread of SARS-CoV-2, such as school closures and mask mandates. In early January of this year, a PubMed search for immunity debt resulted in only 22 hits, the earliest reference published online by French researchers in May 2021. "The lack of immune stimulation due to the reduced circulation of microbial agents and to the related reduced vaccine uptake induced an 'immunity debt' [that] could have negative consequences when the pandemic is under control and NPls are lifted," the authors predicted. Indeed, Chinese authorities have attributed the increase in influenzalike illnesses in their country to the lifting of COVID-19 restrictions and the circulation of known pathogens such as influenza and Mycoplasma pneumoniae, not some new JAMA February 6, 2024 Volume 331, Number 5 infectious agent, according to a November 22, 2023, statement from the World Health Organization. And as Leitner pointed out, echoing… It's unlikely that immunity debt, or immunity gap, as some prefer to call it, completely explains recent surges in respiratory infection, Leitner acknowledged. "Re-duction in immune status is contributing to rebound, but I don't think it's the whole story," he said. Population vs Personal Immunity When it comes to protecting against viral infections, people can't have their cake and eat it, too. "In 2020, we needed lockdowns absolutely desperately," epidemiologist William Hanage, PhD, associate director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health, emphasized in an interview. He takes issue with those who suggest "that we would have been able to somehow come up with an optimal solution that would have both minimized the pandemic and these consequences for other infections." That notion, he says, "is utterly, utterly false." The effects on other infectious diseases of implementing and then lifting COVID-19 mitigation measures are not at all surprising, Hanage noted "Do you expect fewer infections in this season to end up leading to more infections next season? Yeah," he said. "That's the way it works. The interventions that were put in place and were extremely effective in bringing [COVID-19] surges under control also stopped other things. It's basic infectious disease epidemiology." Just don't call it immunity debt, Hanage urged. "I dislike the term. It suggests you've been sort of profligate, that you have not been taking care of your immunological finances. Immunity gap. I think, is a less-loaded term." There's precedent for the concept. Although immunity gap and immunity debt hadn't yet been coined at the time, a dip in respiratory infections due to social distancing followed by a rebound when people resumed normal activities occurred in France nearly 30 years ago, Leitner pointed out. During a Paris public transport workers strike that began on November 30, 1995, many people in the region-including children who nor… deaths. For example, the Yamagata lineage of influenza B viruses, first identified in the 1980s, hasn't been isolated since March 2020, leading scientists to assume it is now extinct. And from 2019 to 2022, asthma attacks among US Black adults, who have higher rates than Hispanic or White adults, decreased from 29.3% to 22.1%, according to a national survey study published recently as a research letter. The authors noted that decreasing chronic airway disease exacerbations have been attributed at least in part to reduced circulation of common respiratory viruses. A 2023 review article he coauthored concluded that some long COVID symptoms may be due to chronic immune activation and the presence of persistent SARS-CoV-2 A Thieving Virus? Since the beginning of the pandemic, many people have either dismissed COVID-19 as nothing worse than a cold or, at the opposite end of the spectrum, have referred to it as airborne AIDS. "We work with children with HIV, and it's just offensive to see people make those kinds of statements," Munro said of comparing COVID-19 with AIDS. Reality lies somewhere between those extremes, experts say. Almost all viral respiratory infections, especially when they are severe, cause imA small study published in Cell in August 2023 found that severe COVID-19 can cause long-lasting immune system changes, but the alterations were related to persistent ac-tivation, not suppression. The researchers compared blood samples from 57 people, some who were recovering from severe COVID-19 or other severe illnesses and some who were healthy. They found gene expression differences in hematopoietic stem and progenitor cells (HSPC- long-lived precursors to diverse immune cells-between the patients recovering from severe COVID-19 and the other study participants that persisted for up to 1 year after the patients became ill. In the recovering patients, those differences were associated with a higher production of white blood cells that seemed to produce more infla… Their study didn't answer the question of whether COVID-19 infections might be linked to increased susceptibility to less serious non-COVID-19 infections, Andersson acknowledged in the email. "We do not include milder infections seen in primary care or those not requiring medical attention, and, as such, we cannot exclude that the risk of these infections could be increased," he wrote. He and his coauthors did find that people who'd been hospitalized for COVID-19 were more likely to be hospitalized for another infectious illness than those who'd never had COVID-19. "Not surpris-ingly, those individuals who had been hospitalized for one type of infection would tend to have higher odds of later being hospitalized for another infection," Andersson explained. No question, SARS-CoV-2 "messes with your immune system," Leitner said. "It kills T cells...What I don't know, and it hasn't been shown, is how much does that contribute in what we're seeing in terms of outbreaks? My theory is it contributes, but it's certainly not the only reason." Published Online: January 10, 2024. doi:10.1001/jama.2023.26608 Conflict of Interest Disclosures: Dr Hanage reported serving as a paid scientific advisor to News & Analysis Merck Vaccines, Shionogi Inc, Pfizer, and Biobot Analytics, a company in which he holds stock options. Dr Erdmann reported serving as an investigator for the National Institute of Allergy and Infectious Diseases' Adaptive COVID-19 Treatment Trial and COVID-19 Prevention Network and the National Institutes of Health's Researching COVID to Enhance Recovery Initiative and COVID-19 Therapeutic Interventions and Vaccines public-private partnership. Dr Erdmann also reported receiving payment for serving as a member of Perspectum's Scientific Advisory Board and having a patent for human neutralizing antibodies against SARS-CoV-2 and COVID-19 that has been licensed to the PlantForm Corp. No other disclosures were reported. Note: Source references are available through embedd…
June 10, 2025 at 2:22 PM
toshiakima.bsky.social
As with most hypertension guidelines the EU guidelines say automatically treat HYPERTENSION if Office SBP ≥140 mmHg and/or DBP ≥90 mmHg. Drugs if confirmed
BP ≥ 130/80 mmHg
June 9, 2025 at 3:52 PM
toshiakima.bsky.social
Please boycott these games and prevent them from becoming a propaganda success like the 1936 Berlin Olympics.
LENI RIEFENSTAHL SCHÖNHEIT IM OLYMPISCHEN KAMPF
June 9, 2025 at 1:20 PM
toshiakima.bsky.social
All the more reason to be determined not to go licking Musk's boot at the land of the Twi⚡ted X.
Cover to a book by Doris L Bergen: Twisted Cross.
June 9, 2025 at 12:44 PM
toshiakima.bsky.social
I have bad news. There’s something else that accelerates inflammaging. COVID. johnsnowproject.org/insights/tex...
People are more likely to get cancer as they age. Dr. Miriam Merad has an unconventional idea of how that might be reversed: using allergy drugs and other seemingly unlikely medications to damp a condition known as "inflam-maging." The immunologist and oncologist has spent years examining malignant tumors to learn why people over age 50 account for nine in 10 cancer diagnoses in the U.S. She and her research team at the Icahn School of Medicine at Mount Sinai in New York City have homed in on an answer: the aging immune system. Their studies of individual immune cells in human lung tumors, as well as in old mice, have revealed how chronic, or pathogenic, inflammation in older people— dubbed inflammaging-interferes with the immune system and fuels cancer growth.
June 7, 2025 at 1:09 PM