2026-08-08T01:41:53Z https://nostr.now kamoweasel https://nostr.now/npub1jdvvva54m8nchh3t708pav99qk24x6rkx2sh0e7jthh0l8efzt7q9y7jlj https://m.primal.net/QZXK.png https://m.primal.net/QZXK.png https://nostr.now/nevent1qqsp6m5q970h7p7dpxvqw3zkceuy5x0p4q70qflr3gklfywjmmnu7yszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0chapupl GM and happy monday 😄☕ <br/><br/> 2026-10-26T11:44:50Z https://nostr.now/nevent1qqspxyhk4g5lg284hu7ley5amm6klayc6wsarpqy8v7tlruv6amlwhszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0crk9dvn GM and happy monday NOSTR ☕😸😄 <br/><br/> 2026-10-19T12:23:14Z https://nostr.now/nevent1qqsqhjvw3zeuq7g5ugqlq9nw6820m68l2g9xu3tc02h2wmkwvc6gg5szyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cc66pe0 In reply to <a href='/nevent1qqs8y7z97kxtwr56ncev95x8gm7h45tddyswum4fw0melkm9tk04uzgrpx9sl'>nevent1q…x9sl</a><br/>_________________________<br/><br/>I want those on my christmas tree 🎄🧡 <br/><br/> 2026-10-19T09:55:53Z https://nostr.now/nevent1qqsxsng8vm3hna2s5ekyn8mjsdh4ekz2jmcxj5wfyufzk22lpd49ndgzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cawsawd In reply to <a href='/nevent1qqsf3lra2qnzz3zmgff0cpaxwlv5dgfy00a78dppttk50sqn7frcjjskty0zw'>nevent1q…y0zw</a><br/>_________________________<br/><br/>GM Buddy <br/><br/> 2026-10-16T11:25:35Z https://nostr.now/nevent1qqs2r8g08j7gjxg7pqmqgmy4qwnjdysr30e84q0j7vup36dyc23jskqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c7wrhg3 GM. Pic of an argentine girl confronting police at massive march for public university funding. Epic 🫡🎓🧑🏻‍🎓🇦🇷 <br/><br/><br/><br/> <img src="https://blossom.primal.net/3caca2432b6ec41fea25518a701c94df17bbf783f1be9949fe76ce4d31e0888b.jpg"> <br/> <img src="https://blossom.primal.net/a6b16c18c5d750177fce40a8de0a03a35b1ddbcdc4e0cf77a2fc7b5e0a87633e.jpg"> 2026-10-16T10:47:02Z https://nostr.now/nevent1qqsx0ts6hggw79n6arc575nahrveerv0spprls2gmcspqcny4hahhkqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cjfrq6r In reply to <a href='/nevent1qqstc0rdgl274tr9zg6l0lzvn6hnsucj7zlny225cn4h02zpmk3s3gqaa7ekp'>nevent1q…7ekp</a><br/>_________________________<br/><br/>GM and happy wednesday Rasha <br/><br/> 2026-10-14T10:17:22Z https://nostr.now/nevent1qqsy2za780vedjp8lvcjzkhtq0e2xxfyx0wdcw2z88da4kma0k8f8tszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0ccr5ae5 GM and happy wednesday 😗☕ <br/><br/> 2026-10-14T10:15:52Z https://nostr.now/nevent1qqsteq5pn28d4chgx7y9vt7snkl07nt3ctz29nlakgzqn5dah83gztqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cwdm75e GM and happy tuesday 😄☕ <br/><br/> 2026-10-13T09:51:37Z https://nostr.now/nevent1qqs9p76r4e4s3ypw75p6f5tvc8vg8ylsgenwgmtfned6glt3p207yggzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cpjasuw Another day in the Argy Empire ♻️🇦🇷🏆😆 <br/><br/><br/><br/><video controls width="100%" class="max-h-[90vh] bg-neutral-300 dark:bg-zinc-700"><source src="https://blossom.primal.net/9728a7b3af70974bd956d4997c35279b80b7832e55bbbdc0ad24ae06250eb3fc.mp4"></video> 2026-10-12T19:55:00Z https://nostr.now/nevent1qqs2f2yqeykx5sxavgagxl402l0ynxwu70lfhxwwmk8u6fl6h7d4adgzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c0x2ewu In reply to <a href='/nevent1qqsqrcyccmyq60k338cnesdz8c26qcnqe75jsq7rz3n7myycrjzqgcspsl6lg'>nevent1q…l6lg</a><br/>_________________________<br/><br/>Happy GM then 😆☕ <br/><br/> 2026-10-12T18:36:15Z https://nostr.now/nevent1qqs0qnmlydcvy2vnpmwsyaj6jgctst7usz38asjqqtzpyc77ph0u80qzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c69y4xw GM and happy monday 😙☕ <br/><br/> 2026-10-12T13:45:30Z https://nostr.now/nevent1qqsvc7dra6a8pha6qyypv90e3pfxser6y07njg5waph6pt9qckdg29gzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cyhs8aa After the attacks on Coldcard, Liquid, and Ledger, is there a place where I can safely store my Bitcoin other than my anus? #AskNostr 🍩🧡 <br/><br/> 2026-10-12T00:53:07Z https://nostr.now/nevent1qqs8fw2z02ayw4cl287ufdwu4hes63u0hsf3lk8skfk6gyw0w4ms72qzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cd9uytv GM and happy sunday. Asado incoming today... 🍖🍗🥩🔥🪵 <br/><br/> 2026-09-27T12:06:41Z https://nostr.now/nevent1qqs85wc3f9wgy8y8rad8vhsez7wy8wdyfymgcsemr88mwk5qt3jylmszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c8cw3xn Early Saturday GM ☕🐦 <br/><br/> 2026-09-19T08:44:32Z https://nostr.now/nevent1qqsdsk0xqjx0ru5u3hx6q05sddqfejsymec8yvl95z4aec0nkr2897czyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0chhlcd3 In reply to <a href='/nevent1qqsgfd73cpehwj94nhs7ugdhumwxh7ej2xrgk788fuz8xg74p43v7zs5ulxmk'>nevent1q…lxmk</a><br/>_________________________<br/><br/>🤌🏻 <br/><blockquote class="border-l-05rem border-l-strongpink border-solid"><div class="-ml-4 bg-gradient-to-r from-gray-100 dark:from-zinc-800 to-transparent mr-0 mt-0 mb-4 pl-4 pr-2 py-2">quoting <br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Article"><a itemprop="url" href="/nevent1qqsf4w37jnff5zedfz2x0tzaxzken7kwksy50ph23pnjzt4ydpz75gszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cqcyqqqqqqg6mt9ua" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1">nevent1q…t9ua</a></span> </div> Those of us born in Italy or Argentina are fortunate 🇦🇷🍕🇮🇹🤌🏻 #ZapCooking <br/><br/><br/><br/> <img src="https://blossom.primal.net/5a2fff56f10d849308564ed3a874c2dfbdfed498807df6067d1c4598c0d3e6d9.jpg"> </blockquote> 2026-09-18T01:05:23Z https://nostr.now/nevent1qqsf4w37jnff5zedfz2x0tzaxzken7kwksy50ph23pnjzt4ydpz75gszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cafp8ul Those of us born in Italy or Argentina are fortunate 🇦🇷🍕🇮🇹🤌🏻 #ZapCooking <br/><br/><br/><br/> <img src="https://blossom.primal.net/5a2fff56f10d849308564ed3a874c2dfbdfed498807df6067d1c4598c0d3e6d9.jpg"> 2026-09-18T00:43:32Z https://nostr.now/nevent1qqsfe24grjujzll7pm907cm9vvg77m2n0z620erkxf00g9st6et24fqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cdhayel In reply to <a href='/nevent1qqswru4fncky4ak2eqv8c0t0vm0rlk490ssu9lwe3shrmkp8u5ej69gknjgxh'>nevent1q…jgxh</a><br/>_________________________<br/><br/>😮 <br/><br/> 2026-09-17T01:02:18Z https://nostr.now/nevent1qqst25vxsgcxvnz6t7dvkj3cjv7a00xst0lmud5qas7snhfp328affqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c3ac6lc In reply to <a href='/nevent1qqsvn6vq04uka2zyxuhzvqmpa3vzmpd8njg7uz7tkwya5veyth0de0q8ykyym'>nevent1q…kyym</a><br/>_________________________<br/><br/>Are we talking about paying in SATs? 😗🧡 <br/><br/> 2026-09-17T00:17:15Z https://nostr.now/nevent1qqstpdu5z97hg66tjvyjasfqyn3fmyewtuc6mkkgyhmm0rsec0alxfczyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0ctt6908 We need Human Resources at NOSTR 📝🧑🏻‍💻 <br/><br/> 2026-09-16T13:42:45Z https://nostr.now/nevent1qqsr8exutrncdqhapl6cjy0gn0y89mdyf80g3rd05rvxpa8yvf0ptxqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c5vpu8w GM <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsr7acdvhf6we9fch94qwhpy0nza36e3tgrtkpku25ppuu80f69kfqpp4mhxue69uhkummn9ekx7mqpremhxue69uhkummnw3ez6un9d3shjtnyv4ex26mjdaehxtndv5va8f86" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Derek Ross</span> (<span class="italic">nprofile…8f86</span>)</a></span> and <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsrhuxx8l9ex335q7he0f09aej04zpazpl0ne2cgukyawd24mayt8gpz4mhxue69uhkyctnwdcxjum5dakzummjvuhszxnhwden5te0wpuhyctdd9jzuenfv96x5ctx9e3k7mf0dx3as9" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>fiatjaf</span> (<span class="italic">nprofile…3as9</span>)</a></span> 😬☕ <br/><blockquote class="border-l-05rem border-l-strongpink border-solid"><div class="-ml-4 bg-gradient-to-r from-gray-100 dark:from-zinc-800 to-transparent mr-0 mt-0 mb-4 pl-4 pr-2 py-2">quoting <br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Article"><a itemprop="url" href="/nevent1qqsqqqq9mkqpqlzrv4y9jrhpymnaqrjst6gpu92revdkhapv3cf8lhszyqlhwrt96wnkf2w9edgr4cfruchvwkv26q6asdhz4qg08pm6w3djgqcyqqqqqqgkr652u" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1">nevent1q…652u</a></span><br/> </div> What's the Bitcoin and Nostr version of this? #coffeechain <img src="https://blossom.ditto.pub/6b8aa0fb277ea1cd43df26dc9afb6238c28c1ba46fb997020563a6e4dc472c74.jpeg"> </blockquote><br/> <img src="https://blossom.primal.net/4f9590864b060473b73d27353a939250dd1a0adb8a88da12a68949676ca4c63c.jpg"> 2026-09-16T12:34:31Z https://nostr.now/nevent1qqsrruv4myfvln8yee37yey5fv6nlvrmes4q23kjrqqc5kdyxvgu7cgzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cxzzd02 In reply to <a href='/nevent1qqs0ppnp7xq6dwxxgfxmuqpxgd420rc04f6qw6uqahjy3fmpfm2dwrgeh75kz'>nevent1q…75kz</a><br/>_________________________<br/><br/>I think <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsxua0hju3e0j3jjhs0fjs0h3htnnreh6zm4lw4d0fhsgsv4rhwwnspp4mhxue69uhkummn9ekx7mqpz4mhxue69uhhyetvv9ujuerfw36x7tnsw43qu6ukjg" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>TheGrinder</span> (<span class="italic">nprofile…ukjg</span>)</a></span> is the right person to carry this project forward 😬👆🏻<br/><br/>I&#39;m IN <br/><br/> 2026-09-15T14:22:06Z https://nostr.now/nevent1qqsy7wg70sljmtl6xcndsyaw0a3t5wf7vnjntcy6d7qee6rmjpmhnnszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c40q6cz Expending some quality time with Toto in here ... 😸 #catstr <br/><br/><br/><br/> <img src="https://blossom.primal.net/10f96da211322b9a8d55a6fa647a42624c6d6b40893e1918d132957102cbc1b4.jpg"> 2026-09-15T14:19:58Z https://nostr.now/nevent1qqstt8s7wr5frwfd8tl04a6kpx9yatp74lelp8gxvmy9pgxfmfnkg5gzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0ch6ukfs In reply to <a href='/nevent1qqsqqqr9ud45nyccnc3f5mgh777jxaxcv5g235ehuevjlazklfaqfns6znzkq'>nevent1q…nzkq</a><br/>_________________________<br/><br/>Que suerte la tuya amigo 😄☀️ <br/><br/> 2026-09-15T13:42:46Z https://nostr.now/nevent1qqsdu8vc73x7e0kkyduzd6nvgmk52d47f9w8aqkyxfynduz3amvlntszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cfhdqpn In reply to <a href='/nevent1qqsy288q0g6ku65s3cxgt0pud83l4kg8pxfxzv2yfl7zd7vgdn4we0g9dl00m'>nevent1q…l00m</a><br/>_________________________<br/><br/>That&#39;s why we are lucky to have you and Mars in NOSTR 🫂😄 <br/><br/> 2026-09-15T13:41:36Z https://nostr.now/nevent1qqsdy0t8zhmk5jr4899h2lp4em33a6levu8hn96h92ujtlzsfxsp9lszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c44z3cg In reply to <a href='/nevent1qqs0ppnp7xq6dwxxgfxmuqpxgd420rc04f6qw6uqahjy3fmpfm2dwrgeh75kz'>nevent1q…75kz</a><br/>_________________________<br/><br/>I&#39;ve played WoW my whole life. I even have it tattooed on me &#34;Ani Belore Dela&#39;na&#34; (The sun guides us in Thalassian). I&#39;ve only ever played with the Horde. Only with the undead. Only under Sylvanas&#39;s command, only warlock. I&#39;ll quit my job whenever you want and we can begin 😁⚔️ <br/><br/> 2026-09-15T13:39:40Z https://nostr.now/nevent1qqsyuklqzd52dnnuz7v8xf5kljd55mzx0ycldtt6vhcjszcc636znlqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c6hzfd7 GM NOSTR. Have a beautiful day. <br/><br/> 2026-09-15T13:35:23Z https://nostr.now/nevent1qqsx42vaa2xlkhgqkg5ds9ugyly28xv4kk0xxemvy67fapv84yhknyqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c0lxc0c True 😅🤘🏻 <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsyawyrzrttfmv4cmtx5w2m85702kdct7hv3amfrkhagpdf9cz46mgprpmhxue69uhkv6tvw3jhytnwdaehgu3wwa5kuef0qy3hwumn8ghj7enfd36x2u3wdehhxarj9emkjmn99ulkwmr0vfskc0tpd3kqng2s9w" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Ava</span> (<span class="italic">nprofile…2s9w</span>)</a></span> <br/><br/><br/><br/> <img src="https://blossom.primal.net/db0be172e3218c3177c07749be0e83c8eb430cb3bda441e76be8cfc155b0e451.jpg"> 2026-09-11T15:21:47Z https://nostr.now/nevent1qqs0hg8kqtyfu00fxdwpn3mzq3exf9auzzt0fxthuv0a6l0ajc5l5hgzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cjkal6a I&#39;m worried that key stakeholders and organizations haven&#39;t commented on Liquid&#39;s situation in recent days on NOSTR. It is sad to me that the major #Bitcoin organizations aren&#39;t actively promoting in this community that is very committed to #Bitcoin and uses it every day. We must begin by valuing NOSTR from inside 💧🧡<br/><br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsfy229w70e8lgtxavlz9t78k06yrel6fxyhreteafqet8kfxhhwmgpr9mhxue69uhhqun9d45h2mfwwpexjmtpdshxuet59uq3vamnwvaz7tmjv4kxz7fwwpexjmtpdshxuet5uzhxm7" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Blockstream</span> (<span class="italic">nprofile…hxm7</span>)</a></span><br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsfjzteswm5cuyqpvvz40r0vszx4dcyql5u40xkeats5w9d48hht4guz0cnd" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>LiquidNetwork</span> (<span class="italic">nprofile…0cnd</span>)</a></span><br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsvnvvlln2ru6jlyweayugxecv7ftfdlzd6zqca63sh7x6ercggjegpp3mhxue69uhkyunz9e5k7qg4waehxw309ajkgetw9ehx7um5wghxcctwvszvprka" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Excellion</span> (<span class="italic">nprofile…prka</span>)</a></span> <br/><br/> <br/><br/> <br/><br/> 2026-09-10T21:51:58Z https://nostr.now/nevent1qqstxkv2detkezh2tjudgx86dl0k2fj483xe5esh3jqa5962rg8ez6czyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0ckjf6xm GM NOSTR. Do you feel like playing and win the zaps pool this sunday? B2 - C4. Because I have a sensitive stomach 😅☕🍞 #coffeechain <br/><br/><br/><br/> <img src="https://blossom.primal.net/8b0f589511f60ea782a320a01689203d5c4b48e5602451cb64101d739324f8fa.jpg"> 2026-08-30T14:18:42Z https://nostr.now/nevent1qqs92c9vm9wt6qj0gy4t2vzqae58vphx00vv9encz58qwmhj0z0a4eczyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c3rnjy0 In reply to <a href='/nevent1qqs9hespdp367xssfkaqlnpxz6ah9zzhx095snr6dhqceggprtty7kq6ur58v'>nevent1q…r58v</a><br/>_________________________<br/><br/>I&#39;m sure your client will be better. Please send me the link when it is ready and I will be happy to test it. 2026-07-09T15:17:23Z https://nostr.now/nevent1qqs0ms0fmp04qy7ayqvmls70l5pxmnnhv7z06xdjp6ehhl6dgjycqfqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0ct4umvn Just purchased a <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qyvhwumn8ghj7urjv4kkjatd9ec8y6tdv9kzumn9wshsz9nhwden5te0wfjkccte9ec8y6tdv9kzumn9wsqzpy3fg4melylapvm4nug40c7elgs08lfycju09084yr9v7ey67amd8gg8xl" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Blockstream</span> (<span class="italic">nprofile…g8xl</span>)</a></span> Jade Plus from the store paying with L-BTC. I remember 2019 and now we are so advanced. This is fun! 🟢 🔐 ❄️ 2026-07-09T14:04:52Z https://nostr.now/nevent1qqswww6rwzanh0emptz332uct7c0mannxce7jg63f3rhn5nxe9t0g2gzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cv9jjf4 GM. Here comes the current champ 🇦🇷🐐☕ #WC2026<br/><br/><br/><br/><video controls width="100%" class="max-h-[90vh] bg-neutral-300 dark:bg-zinc-700"><source src="https://blossom.primal.net/fc2678f39c35cd00e2e3f00ed1451ae60d6670929c9e52de9792ea91641abf7f.mp4"></video> <br/><br/> 2026-07-08T10:20:42Z https://nostr.now/nevent1qqszhhlq09hc5ufxettgx6h3ynrsjj7j55lekmatq7lhh6q0j40ce8gzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0ctxyn62 In reply to <a href='/nevent1qqsfp565w4gr2vkkfpp6p356fq90fqedc3cm0sj20mrky8k6q3ul5zc5awyeg'>nevent1q…wyeg</a><br/>_________________________<br/><br/>And what do you think of something like <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqszw0ncsrfc6wd8lv3cal8cj4apkke8aqv3y75ys05h2st2p2g035spzamhxue69uhkzarvv9ejumn0wd68ytnvv9hxgtcppemhxue69uhkummn9ekx7mp06f6jvw" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>hodlhodl</span> (<span class="italic">nprofile…6jvw</span>)</a></span> friend?? <br/><br/> 2026-07-05T21:40:41Z https://nostr.now/nevent1qqsy4ndtadyln0uczj0t73a8kq9jnrrmdjpwa0xs2lx2jethydqzx6qzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c2080ps Watching Argentina vs Honduras. WC fever incoming 🤪⚽🇦🇷 <br/><br/> 2026-06-07T00:37:35Z https://nostr.now/nevent1qqsthvs099xuhwgxrlcd9fh0egvew2rukuy0c2nu3v297rd5g59wt6qzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cr0dswt GM and see ya&#39; in heaven CHAD 🥲☕ <br/><br/><br/><br/> <img src="https://blossom.primal.net/22cf74060b858be86856656ae2a740d7ab767f901a5d68db9d045c5845f898fc.jpg"> 2026-06-05T12:55:33Z https://nostr.now/nevent1qqsrzlk4lxv4m7pvqd9awqkca3tzvp0yr36u4vglwqqh3qr4p2apljqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0chrqynl Friends in New Zealand need their dog Marla to have surgery so she can walk again. <br/><br/>Unfortunately, they don&#39;t accept SATS on their payment platform. But all donations I receive via ZAPS in this note will be greatly appreciated and transferred ⚡🐶 #dogstr<br/><br/><a href="https://givealittle.co.nz/cause/help-marla-walk-again">https://givealittle.co.nz/cause/help-marla-walk-again</a><br/> <br/><br/><br/><br/> <img src="https://blossom.primal.net/eec03cba9efc65cd7c08945831d0b55a9a5c398720149f3a53cb53a0d3fd7662.jpg"> 2026-04-13T21:02:57Z https://nostr.now/nevent1qqs0pspffrv8y78s6qut4kvpazq5gdxys6v7gp4u0n468yxg6yva0xczyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c0dtqzj I&#39;m so sorry Italy... 🇮🇹😶🇦🇷 <br/><blockquote class="border-l-05rem border-l-strongpink border-solid"><div class="-ml-4 bg-gradient-to-r from-gray-100 dark:from-zinc-800 to-transparent mr-0 mt-0 mb-4 pl-4 pr-2 py-2">quoting <br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Article"><a itemprop="url" href="/nevent1qqsvzn5nf8c06h2fsfghmjh2my04f7njd9sgx6ulzfc5qm2frp544dgzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cqcyqqqqqqg2nqvlp" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1">nevent1q…qvlp</a></span><br/> </div> Making keto pizza ... 🍕🇮🇹🧑‍🍳🤌 <br/><br/> </blockquote><br/> <img src="https://blossom.primal.net/5e42f5f99bd5d794724f03358f24a25ec01ee68337b3a01e509839bb1c10fad7.jpg"> <br/> <img src="https://blossom.primal.net/699ef2173faff80a3319e7162e5f99cf6cef17163b73302dfe137404efd6cee8.jpg"> 2026-04-12T00:59:20Z https://nostr.now/nevent1qqs27a5ey9w5yprph5vnkqjk0ezr62z74jz8fcpw8a44uqzsmm472vszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c5969mr In reply to <a href='/nevent1qqspvtzs4te3482a5j8yv975un63pqgjy38wv87s0n5g9eapz59g5jq0r76lp'>nevent1q…76lp</a><br/>_________________________<br/><br/>But is it you or the agent right now? Or an actor paid by the agent? 🧐☕ <br/><br/> 2026-02-26T10:20:52Z https://nostr.now/nevent1qqs9vlhad4xenc6adsurpw9erjzjgr5hfrqg6nahlnuer87c9jdz3rczyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c2zsxqn In reply to <a href='/nevent1qqs85xqw7f22xmznjyqzr3rqfygs2ul88rtcp4d2s39p6mcfvh6zfqqsuefdu'>nevent1q…efdu</a><br/>_________________________<br/><br/>It&#39;s complicated, my friend. There are many accounts that slip through my spam filter. But there are also several npubs that are constantly adding you to their contacts and then deleting you to hunt for new sats.<br/><br/>They are also randomly liking and interacting, and their profiles are mostly reposts. Those are the bots that usually attack these campaigns.<br/><br/>Here&#39;s an example <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqspsvgetdyw5umnzc3me8vm48v8f2xkjjre7hmat79tdqfqmtlxcnqpzemhxue69uhk2er9dchxummnw3ezumrpdejz7qgmwaehxw309ankcetpwdhkuct5daezuer9wchhyetvv9usw8ff66" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Bob</span> (<span class="italic">nprofile…ff66</span>)</a></span> and <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsf24u42d2ltugavnwpcttazdk4syvsflw9j254pj6qj8g9g9llhgg898jnk" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>CosmicWhispers</span> (<span class="italic">nprofile…8jnk</span>)</a></span><br/><br/>As I see some slip through my blocking filter, I will keep you informed. <br/><br/> <br/><br/> 2026-02-17T14:19:58Z https://nostr.now/nevent1qqsgwuufd5avfy0kpx0937j9t8fuzdg36gpw5w3mhepdukg8xqkk8zczyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0ctpsgdu In reply to <a href='/nevent1qqsrkjps2grqqhzlx3rn6kn96dqry6fdahp54qac0339hpxqkx324zcpzemhxue69uhhyetvv9ujuurjd9kkzmpwdejhgn0fhvg'>nevent1q…fhvg</a><br/>_________________________<br/><br/>Google Search &#34;Why Tatum steals my poo 💩&#34; <br/><br/> 2026-01-14T00:13:08Z https://nostr.now/nevent1qqsxjkejv5r3gewdwa5h50flj7flzpxzd3h6pk83wszxwp8pqsjpskqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cya6rr0 GM. That&#39;s why we Bitcoin ☕🧡 <br/><br/><br/><br/> <img src="https://blossom.primal.net/6f64abe38d7d8f84424e04bb52ee50495fd4942a8c2dad3ee772fb1193e5287e.jpg"> 2025-08-09T14:02:10Z https://nostr.now/nevent1qqs9795mjwj8e0vdm25acyngdhk8n6u4r7uz0wmaty0uvkywfq60e2czyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c9788fc Luis Enrique&#39;s performance is incredible. Congratulations PSG! <br/><blockquote class="border-l-05rem border-l-strongpink border-solid"><div class="-ml-4 bg-gradient-to-r from-gray-100 dark:from-zinc-800 to-transparent mr-0 mt-0 mb-4 pl-4 pr-2 py-2">quoting <br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Article"><a itemprop="url" href="/nevent1qqs29wen6l8dcwtt23rledpjr5gfruaaca5khz0gj2pva783s7ru6agpzemhxue69uhhyetvv9ujuurjd9kkzmpwdejhgq3qjdvvva54m8nchh3t708pav99qk24x6rkx2sh0e7jthh0l8efzt7qxpqqqqqqzkljmlf" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1">nevent1q…jmlf</a></span> </div> PSG is making Inter dance #UCL #football </blockquote> 2025-05-31T20:58:33Z https://nostr.now/nevent1qqs29wen6l8dcwtt23rledpjr5gfruaaca5khz0gj2pva783s7ru6agzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c34hp58 PSG is making Inter dance #UCL #football 2025-05-31T19:32:57Z https://nostr.now/nevent1qqsfuqpp2n469su0yu9w2kewm5nrfackqmnwcu52gxw8gwlafnng5eqzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cmw34xj In reply to <a href='/nevent1qqsvk6dujtyu7nggwzxax26z276njear7g3zu662l6z4srd9fqn3hqgpzemhxw309ucnjv3wxymrst338qhrww3hxumnwddhfhr'>nevent1q…hfhr</a><br/>_________________________<br/><br/>Voy por un buen descanso amiga 😅🎽🛌🏻💤 2025-04-15T10:36:40Z https://nostr.now/nevent1qqsgwgfkzxqmsl5zu599jcawnyhm48kykq859nysa9ykantqyzza3wszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c79r55x #500kmchallenge It&#39;s over. I want to thank all the runners who have supported and run with me in this project 👇🏻<br/><br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsv3hm2azrvwydsapad7fx6qxql2zql9djn5cdz8vg9tgmqyg5n5pspvemhxue69uhkv6tvw3jhytnwdaehgu3wwa5kuef0dec82c33v4erq6e5xeuhscm4vakhqdnjxekh26nyx4chvuphx4uhqdejd5unsennxeuhwcmnxf4nx6m3vuekvwr8wfckgwts0yek60mzwfhkzerrv9ehg0t5wf6k2qgswaehxw309ahx7um5wgh8w6twv567u0fd" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>alejandro</span> (<span class="italic">nprofile…u0fd</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqs9ql7zpg9fcmrxrd9n5cqw7ne9g56elgzz26yej8uwm6awwnqd6qspp4mhxue69uhkummn9ekx7mqpzpmhxue69uhkummnw3ezumrpdejqwa5qkk" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Anix</span> (<span class="italic">nprofile…5qkk</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqswgvmv65ja7706f5a0xe8ajcqdfvgdeeppt2jvx0kh06sggg6ykyqpp4mhxue69uhkummn9ekx7mqpr3mhxue69uhkummnw3ezucnfw33k76twv4ezuum0vd5kzmqceeen8" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>dluvian</span> (<span class="italic">nprofile…een8</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqszv6q4uryjzr06xfxxew34wwc5hmjfmfpqn229d72gfegsdn2q3fgpz9mhxue69uhkummnw3ezuamfdejj7qgjwaehxw309ahx7um5wf6k2tnrdakj7r0afcs" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>hzrd149</span> (<span class="italic">nprofile…afcs</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsr7acdvhf6we9fch94qwhpy0nza36e3tgrtkpku25ppuu80f69kfqppemhxue69uhkummn9ekx7mp0qy0hwumn8ghj7mn0wd68yttjv4kxz7fwv3jhyettwfhhxuewd4jj7lal3ny" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Derek Ross</span> (<span class="italic">nprofile…l3ny</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsg8qaafrtvhgkrc8ry7j0kzxhhd9xpjw3rtsx0n58uls6s74wjmgqpp4mhxue69uhkummn9ekx7mqpzpmhxue69uhkummnw3ezumrpdejq223cfm" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>BitcoinRunner</span> (<span class="italic">nprofile…3cfm</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsrpn4kfee3j7s9jkxghkf2kpuus9dmgnalhvlttktkd3fq0uytmagpz3mhxue69uhkzmr8duh82arcduhx7mn99uq32amnwvaz7tmyd968gmewwp6kytmjv4kxz7g689stz" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>TheWildHustle</span> (<span class="italic">nprofile…9stz</span>)</a></span> and more 🏃🏻‍♂️🎽⚡<br/><br/>The project started with little and ended with the best of its fruits, the development of a native #Nostr client to run ➡️ <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsxzyppa24zdyn5rvfrdw7w54xx420jpw3set8rzmp6j029pzd86rcppamhxue69uhkummnw3ezumt0d5q3yamnwvaz7tm0venxx6rpd9hzuur4vgcka42n" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>RUNSTR</span> (<span class="italic">nprofile…a42n</span>)</a></span><br/><br/>It&#39;s important that we all support this incredible health project 🫂⚡<br/><br/>That&#39;s why today I&#39;m throwing away my old running shoes and permanently deleting Runkeeper from my phone. <br/><br/>We&#39;ll see each other running, but this time under #Nostr only 🏃🏻‍♂️🌅🧡<br/><br/>We are winning 🏆<br/>#Run #Running #Runstr<br/><br/> <img src="https://m.primal.net/QPiV.jpg"> <br/> <img src="https://m.primal.net/QPiW.jpg"> <br/> <img src="https://m.primal.net/QPig.jpg"> 2025-04-14T23:33:36Z https://nostr.now/nevent1qqsq5xajmmup0gwk5zds8fdru5kln7nmdwc72k3wywarf7suj0ynscszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c0699rh In reply to <a href='/nevent1qqswgvdtlth4syv382d3tj56f68ewcpmx846ll3yh0xy9u0d4mj0pgcpz3mhxue69uhhyetvv9ujuerpd46hxtnfdu7kr4mh'>nevent1q…r4mh</a><br/>_________________________<br/><br/>Jaajjaaja lpm 😅 2025-04-12T15:37:55Z https://nostr.now/nevent1qqst3k9y7zeuuxmejeecpsye7e3mmxfefkd22u6q43fyw20sqsxfengzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0czsalfq In reply to <a href='/nevent1qqswe2d0n7hu3u7tjjv7kk46wggwc873282sp84325wlaw68gv637wqpzemhxw309ucnjv3wxymrst338qhrww3hxumnw6akge5'>nevent1q…kge5</a><br/>_________________________<br/><br/>Bajate <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqs83nn04fezvsu89p8xg7axjwye2u67errat3dx2um725fs7qnrqlgzqtdq0" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Zapstore</span> (<span class="italic">nprofile…tdq0</span>)</a></span> y ya podés instalar las aplicaciones desde tu cuenta ahí en #Nostr<br/><br/>Para usar esa aplicación también vas a tener que usar un firmador de tu clave en Android, el mejor es Amber que también lo podés usar ahí. Cualquier cosa avísanos que te ayudamos. 2025-04-12T13:18:47Z https://nostr.now/nevent1qqsgvl6dyt25nj20y5ye6s2803eyq9re2jn22rj53w9xxt62h83e7mgzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cva0cpf I hope you join the first running group in #Runstr<br/><br/>If you&#39;re Argentinian and you love running, registration is now open for the group to see who runs the most kilometers in April.<br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqszp55czrt2t7ftq3dduqhthtwfqdkhg8xxs6cqg9wy9dprdlj26tcpzemhxue69uhkummnw3ex2mrfw3jhxtn0wfnj7qgnwaehxw309ac82unsd3jhqct89ejhxtc72cgtr" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>negr0</span> (<span class="italic">nprofile…cgtr</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqs9ql7zpg9fcmrxrd9n5cqw7ne9g56elgzz26yej8uwm6awwnqd6qspp4mhxue69uhkummn9ekx7mqpzpmhxue69uhkummnw3ezumrpdejqwa5qkk" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>Anix</span> (<span class="italic">nprofile…5qkk</span>)</a></span> <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqsp7fxsmxnahv3pkqsx4pn9pqm5739sp4cy5d8gkxelex5tc9qrspsppemhxue69uhksmmydshxzu30qy88wumn8ghj7mn0wvhxcmmv9u3nuj37" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>LaCryptaOk</span> (<span class="italic">nprofile…uj37</span>)</a></span> 🏃🏻‍♂️🇦🇷🧉<br/><br/> <img src="https://m.primal.net/QMbR.jpg"> 2025-04-12T03:18:55Z https://nostr.now/nevent1qqsfmh5ljdnkpkqy5dtjktacrfgza5fq83ftxl3l2jf5fnhg3lfk3aszyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0c6uzg4m In reply to <a href='/nevent1qqsqgc0u7wcp00w4t4mwh6u96q87k3lzgleqzzmy8jwm2tpetfwcfmqnfm8j8'>nevent1q…m8j8</a><br/>_________________________<br/><br/>Sell molars Buy #bitcoin 2025-02-27T12:11:21Z https://nostr.now/nevent1qqsv2jp2qvzrwdf3h4x2kdthkv59q4ryhwy4fva8cf3el343q0y343czyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cvvs8ja In reply to <a href='/nevent1qqstfekz5nrugyydvenypurl4p69j2pc4z9y4hqwzgntgnw82ua9eesjz2vrp'>nevent1q…2vrp</a><br/>_________________________<br/><br/>Tooth fairy must be in ecstasy 😅🦷 2025-02-27T11:46:33Z https://nostr.now/nevent1qqstwldcrxrssl0z8q2fpmj6p5h62lt7hs9fl8v4lkl34getu58gwrgzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cp2lp2h In reply to <a href='/nevent1qqspgglk2q3lp6j2yjcq7hd4q623nq8kw9n6rt0dlgzh9psd3keh0tgwu94la'>nevent1q…94la</a><br/>_________________________<br/><br/>We should ask the only professional trader i know of #Nostr his opinion 😅 <span itemprop="mentions" itemscope itemtype="https://schema.org/Person"><a itemprop="url" href="/nprofile1qqs9h7ece0fm8hly7v0pj3qanj5ddxmgwv926fgd6nz9d02h9wve4fcpz9mhxue69uhkummnw3ezuamfdejj7qgcwaehxw309anxjmr5v4ezumn0wd68ytnhd9hx2tcpzamhxue69uhhyetvv9ujuurjd9kkzmpwdejhgtcy6z4xf" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1"><span>im_icn</span> (<span class="italic">nprofile…z4xf</span>)</a></span> 2024-11-22T00:08:08Z https://nostr.now/nevent1qqst0fct0c4pvse44p8v4gcrft9cq9eeu23sdn0qkrfxh0yy32uqv5czyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cc8yja4 In reply to <a href='/nevent1qqsdzw798r662xm9ryqu6hgq6za2qvtnf0f9fzxym4zfxjtvdg8glrgcvtanv'>nevent1q…tanv</a><br/>_________________________<br/><br/>GM Fren! ☕ 2024-11-21T13:29:28Z https://nostr.now/nevent1qqst70s6zru5aef0cgdut7qn928s75ez0r93dtap0uvwzk7cs4hpz2szyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cxx086n In reply to <a href='/nevent1qqswvs8ex4qmpsmt3h9cvkxynqcthygyndzntlgey7snvtjp0ax4vygrztqha'>nevent1q…tqha</a><br/>_________________________<br/><br/>But how come Milei isn&#39;t aware? 🤣🧉 2024-11-13T13:53:44Z https://nostr.now/nevent1qqsfygmvqq4hrrv879nct98926rjv3zxqcx20dlfwdedpealk487v9qzyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cqveex9 In reply to <a href='/nevent1qqsf2tek3uy3wklfzv8n50ujty3zzjuczct0lnd9r8338sg83cc520s66sp2l'>nevent1q…sp2l</a><br/>_________________________<br/><br/>Here&#39;s a start 😅👍🏻<br/><blockquote class="border-l-05rem border-l-strongpink border-solid"><div class="-ml-4 bg-gradient-to-r from-gray-100 dark:from-zinc-800 to-transparent mr-0 mt-0 mb-4 pl-4 pr-2 py-2">quoting <br/><span itemprop="mentions" itemscope itemtype="https://schema.org/Article"><a itemprop="url" href="/naddr1qqxnzdejxucnxvfhxcerwv35qgsfxkxxw62aneutmc4l8ns7kzjst92ndpmr9gthulf9mmhlnu539lqrqsqqqa282qnfu9" class="bg-lavender dark:prose:text-neutral-50 dark:text-neutral-50 dark:bg-garnet px-1">naddr1qq…nfu9</a></span> </div> <h3 id="objectives-3"><strong>OBJECTIVES</strong></h3> <p>To establish a guideline for the management of Acute Community-Acquired Pneumonia (CAP) in our center, for both outpatient and hospitalized patients, with the aim of:</p> <ul> <li>Reducing morbidity and mortality associated with the condition.</li> <li>Improving the quality of medical care and optimizing hospital resources.</li> <li>Delaying the progression of antimicrobial resistance.</li> </ul> <h3 id="scope-3"><strong>SCOPE</strong></h3> <p>All patients over 16 years of age diagnosed with Acute Community-Acquired Pneumonia who are being followed by our institution in an outpatient or inpatient setting.</p> <h3 id="responsibilities-3"><strong>RESPONSIBILITIES</strong></h3> <p>Physicians from the Medical Clinic, Medical Emergency, Coronary Unit, and Intensive Care Service. Nursing Coordination. Pharmacy Service. Infection Control Committee.</p> <h3 id="references-and-bibliography-3"><strong>REFERENCES AND BIBLIOGRAPHY</strong></h3> <ol> <li>Community-Acquired Pneumonia in Adults. Recommendations for its management. Lopardo et al. MEDICINA (Buenos Aires) 2015; 75: 245-257. Argentine Society of Infectiology. ISSN 0025-7680</li> <li>Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. 2019. American Journal of Respiratory and Critical Care Medicine Volume 200 Number 7 | October 1, 2019. DOI: 10.1164 rccm.201908-1581ST</li> <li>ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med (2023) 49:615–632 <a href="https://doi.org/10.1007/s00134-023-07033-8">https://doi.org/10.1007/s00134-023-07033-8</a></li> <li>Antimicrobial resistance. WHO. <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial">https://www.who.int/news-room/fact-sheets/detail/antimicrobial</a> resistance</li> <li>Internal Medicine. Farreras-Rosman. Volume I. Elsevier. 2008 Edition.</li> <li>Considerations for the Responsible Use of Antibiotics in COVID-19. Argentine Society of Infectiology. 2020. <a href="https://drive.google.com/file/d/1BmXD5x6rEpSqDIc8urccdqLcZKkP3U7X/view">https://drive.google.com/file/d/1BmXD5x6rEpSqDIc8urccdqLcZKkP3U7X/view</a></li> <li>Penicillin Allergy. Castells M. New England Journal of Medicine, 381(24), 2338–2351. doi:10.1056 nejmra1807761</li> </ol> <h3 id="introduction-11"><strong>INTRODUCTION</strong></h3> <p>Pneumonia is one of the leading causes of morbidity and mortality worldwide, affecting patients of all ages and with various risk factors. Proper management in both outpatient and hospital settings is crucial for improving clinical outcomes and reducing associated complications.</p> <p>This document aims to standardize and optimize the treatment of pneumonia based on the most current evidence and recommendations from leading scientific organizations. It seeks to be a practical tool for healthcare professionals, providing a clear and concise approach to the diagnosis, treatment, and follow-up of patients with pneumonia.</p> <h3 id="foundations-hospital-situation-analysis-3"><strong>FOUNDATIONS. HOSPITAL SITUATION ANALYSIS:</strong></h3> <ul> <li>Pneumonias represent a significant burden on the healthcare system due to their high prevalence and potential severity, underscoring the need for a standardized approach.</li> <li>A clinical guideline facilitates decision-making, ensuring that all healthcare professionals follow a uniform protocol that integrates best practices, thereby reducing variability in treatments. This allows for better resource utilization, optimizing antibiotic use and reducing the emergence of antimicrobial resistance.</li> <li>Antimicrobial resistance has been proposed by the World Health Organization (WHO) and related organizations as the leading cause of death and hospital expenditure by the year 2050.</li> <li>Pneumonias in our center, in their various presentations, have shown significant prevalence in hospitalizations according to measurements taken in 2024.</li> <li>In our center, antibiotics, as a whole, have been the main source of financial losses related to drugs during the billing cycle from June 2023 to July 2024.</li> </ul> <h3 id="epidemiological-situation-3"><strong>EPIDEMIOLOGICAL SITUATION:</strong></h3> <p>Pneumonias represent a global incidence of 1.26 cases per 1000 inhabitants. It has been documented in some centers that this incidence can increase in patients over 65 years of age, representing 34 cases per 1000 inhabitants. Outpatient mortality varies between 0.1% and 5%, but can reach up to 50% in hospitalized patients, especially those requiring Intensive Care Unit stay.</p> <p>The main risk factors for developing pneumonia are:</p> <ul> <li>Chronic Heart Disease.</li> <li>Chronic Respiratory Disease.</li> <li>Chronic Kidney Disease.</li> <li>Advanced-stage HIV infection.</li> <li>Immunosuppressed. Solid Organ Transplant. Hematopoietic Stem Cell Transplantation.</li> <li>Diabetes mellitus.</li> <li>Neoplasms.</li> <li>Smoking.</li> <li>Chronic use of Corticosteroids or Proton Pump Inhibitors.</li> <li>Multiple Myeloma and Hypogammaglobulinemia.</li> <li>Anatomical or Functional Asplenia.</li> </ul> <p>The main causative agents of acute community-acquired pneumonia in our setting are:</p> <ul> <li>Respiratory Viruses (Influenza, SARS-CoV2, RSV).</li> <li>Streptococcus pneumoniae.</li> <li>Haemophilus influenzae.</li> <li>Staphylococcus aureus.</li> <li>Mycoplasma pneumoniae and Chlamydophila pneumoniae.</li> </ul> <p>It should be noted that Streptococcus pneumoniae shows a good sensitivity pattern to penicillin and continues to be the most frequent causative microorganism. Haemophilus influenzae only shows beta-lactamase production in 10% to 23% of cases. Staphylococcus aureus in our setting has a low incidence of methicillin resistance, although this possibility should be considered in certain situations and severe clinical presentations. Given these considerations, beta-lactams remain the first-line treatment.</p> <p>Regarding Pseudomonas aeruginosa isolates, they will only be relevant in patients with risk factors such as bronchiectasis, cystic fibrosis, prior treatment with corticosteroids, or broad-spectrum antibiotics.</p> <p>Emerging pathogens of some relevance include the eventual emergence of cases caused by Leptospira interrogans, Legionella pneumophila, and Hantavirus. These cases should always be associated with a specific epidemiological link.</p> <h3 id="diagnosis-3"><strong>DIAGNOSIS</strong></h3> <p>The diagnosis of pneumonia is based on clinical and imaging criteria. For the diagnosis of Acute Community-Acquired Pneumonia, we will consider:</p> <p>Symptoms and Clinical Signs (at least 1 of the following): * Fever. * Altered general condition. * Cough. * Sputum production. * Chest pain. * Dyspnea. * Hemoptysis.</p> <p>plus</p> <p>Radiopacity on Chest X-ray (Alveolar consolidation with or without air bronchogram, interstitial pattern, bronchiectasis, cavitation, pleural effusion, new radiopacity, etc.). It is always recommended to request both frontal and lateral views.</p> <p>Chest CT remains a method with greater sensitivity and specificity for evaluating lung parenchyma compared to conventional X-ray in infectious pathology. However, a simple chest X-ray is an adequate method for the initial evaluation of the condition and its complications, which is why a CT scan is not recommended as an initial method for evaluating pneumonia and should always be preceded by a conventional chest X-ray.</p> <p>CT studies should be considered in the following situations:</p> <ul> <li>Respiratory failure.</li> <li>Evaluation or suspicion of differential diagnoses to Acute Community-Acquired Pneumonia.</li> <li>Evaluation or suspicion of complications of Acute Community-Acquired Pneumonia.</li> <li>Evaluation of radiological patterns that are not entirely clear on the chest X-ray.</li> </ul> <h3 id="choice-of-care-site-and-treatment-3"><strong>CHOICE OF CARE SITE AND TREATMENT</strong></h3> <p>For the choice of care site and treatment of pneumonia, it is recommended to complement clinical criteria with validated mortality scores associated with risk factors and clinical status.</p> <p>CURB-65 (1 point for each item): * Confusion * Elevated urea greater than 90 mg/dl * Respiratory rate greater than 30/minute * Systolic blood pressure &lt; 90 mmHg or diastolic blood pressure &lt; 60 mmHg * Age equal to or greater than 65 years</p> <p>Results:</p> <ul> <li>Groups 0 to 1: Outpatient management.</li> <li>Groups 1-2: Admission to General Ward.</li> <li>Groups 3-5: Admission to Intensive Care Unit.</li> <li>Appendix: A pulse oximetry reading of less than 92% is recommended as an independent factor for inpatient management under expert recommendation to complement the score.</li> </ul> <h3 id="complementary-studies-and-culture-sampling-3"><strong>COMPLEMENTARY STUDIES AND CULTURE SAMPLING</strong></h3> <p>Once the diagnosis is completed, the patient&#39;s risk stratification and the choice of admission site are made, the following complementary studies and culture sampling are recommended to proceed with the patient&#39;s study during treatment.</p> <p>Outpatient patient: * Pulse Oximetry. * Laboratory routine (complete blood count, glucose, urea, creatinine, liver function tests).</p> <p>Inpatient patient in general ward: * Pulse Oximetry. * Laboratory routine (complete blood count, glucose, urea, creatinine, liver function tests). Acid-base status if pulse oximetry is less than 92%. * Sputum sample (Gram stain, culture, antibiogram). * Blood cultures. * In the presence of pleural effusion: Thoracentesis. Physical-chemical study for Light&#39;s Criteria. Direct and Culture of Pleural Fluid.</p> <p>Inpatient patient in intensive care unit: * Pulse Oximetry. * Laboratory routine (complete blood count, glucose, urea, creatinine, liver function tests) plus acid-base status. * Sputum sample (Gram stain, culture, antibiogram). Tracheal aspirate, Mini-BAL, or BAL sampling for patients requiring ARM upon admission. * Blood cultures. * Urinary antigen for detection of Streptococcus pneumoniae, if available in microbiology. * In the presence of pleural effusion: Thoracentesis. Physical-chemical study for Light&#39;s Criteria. Direct and Culture of Pleural Fluid.</p> <p>Special considerations for Viral Pneumonias: * We recommend performing a viral panel for Influenza A/B for any pneumonia presenting at least 1 risk factor mentioned during periods of viral circulation in the community. * We recommend performing a viral panel for SARS-CoV2 for any pneumonia presenting at least 1 risk factor mentioned during periods of viral circulation in the community or having epidemiological criteria of a suspected COVID-19 case. * The Infection Control Committee will timely inform based on the National Epidemiological Bulletin about the presence of circulating respiratory viruses in our setting.</p> <p>Special considerations for Atypical Pneumonias and HIV Testing: * We recommend serological testing for IgM/IgG for Chlamydia and Mycoplasma for any pneumonia presenting a subacute evolution at the time of clinical presentation or clinical-radiological dissociation in its presentation. * In the suspicion of pneumonia caused by emerging pathogens (Legionella pneumophila, Leptospira interrogans, Hantavirus), consider the necessary epidemiological link as a prior epidemiological background before requesting specific diagnostic tests. * HIV testing is recommended for all pneumonias, with special emphasis on those that do not present the conventional risk factors mentioned.</p> <h3 id="antimicrobial-treatment-and-duration-of-treatment-3"><strong>ANTIMICROBIAL TREATMENT AND DURATION OF TREATMENT:</strong></h3> <p>Directed antimicrobial treatment will be based on the present risk factors and the choice of care site and treatment.</p> <p><strong>Outpatient patient &lt;65 years and without risk factors:</strong></p> <p>First choice: * Amoxicillin 875mg/12h orally for 5-7 days.</p> <p>Scheme for history of allergy to Beta-Lactams: * Clarithromycin 500mg/12h orally for 5 days or * Azithromycin 500-1000mg/day for 5 days.</p> <p><strong>Outpatient patient &gt;65 years or with at least 1 risk factor:</strong></p> <p>First choice: * Amoxicillin-Clavulanate 1g/12h orally for 7 days.</p> <p>Scheme for history of allergy to Beta-Lactams: * Clarithromycin 500mg/12h orally for 5 days or * Azithromycin 500-1000mg/day orally for 5 days.</p> <p><strong>Inpatient patient in General Ward &lt;65 years and without risk factors:</strong></p> <p>First choice: * Ampicillin-Sulbactam 1.5g/6h IV +/- Clarithromycin 500mg/12h orally/IV for 5-7 days.</p> <p>Scheme for history of allergy to Beta-Lactams: * Ceftriaxone 1g/day IV for 5-7 days.</p> <p><strong>Inpatient patient in General Ward &gt;65 years or with at least 1 risk factor:</strong></p> <p>First choice: * Ampicillin-Sulbactam 1.5g/6h IV for 7 days +/- Clarithromycin 500mg/12h orally/IV for 5 days.</p> <p>Scheme for history of allergy to Beta-Lactams: * Ceftriaxone 1g/day IV for 7 days.</p> <p><strong>Inpatient patient in Intensive Care Unit:</strong></p> <p>First choice: * Ampicillin-Sulbactam 1.5g/6h IV for 7 days +/- Clarithromycin 500mg/12h orally/IV for 5 days.</p> <p>Scheme for history of allergy to Beta-Lactams: * Ceftriaxone 1-2g/day IV for 7 days.</p> <p><strong>Special Considerations for Inpatients:</strong></p> <p>Scheme for risk factors for Pseudomonas aeruginosa*: * Piperacillin/Tazobactam 4.5g/6h IV or Cefepime 2g/8h IV for 7 days +/- Clarithromycin 500mg/12h orally/IV for 5 days.</p> <p>Scheme for risk factors for Methicillin-Resistant Staphylococcus aureus**: * Add to conventional scheme: Vancomycin 15-20mg/kg/8-12h IV +/- Clindamycin 600mg/8h IV for 7-14 days.</p> <p><strong>Aspiration Pneumonia:</strong></p> <p>First choice: * Ampicillin-Sulbactam 1.5g/6h IV for 5-7 days.</p> <p>*Risk factors for Pseudomonas aeruginosa: Bronchiectasis, cystic fibrosis, prior treatment with corticosteroids or broad-spectrum antibiotics. Documented isolates in respiratory cultures of Pseudomonas aeruginosa.</p> <p>**Risk factors for Methicillin-Resistant Staphylococcus aureus: Previously healthy young patients with severe, necrotizing, and rapidly progressive pneumonia, cavitary infiltrates, hemoptysis, prior influenza, intravenous drug users, rash, leukopenia, recent or concomitant skin and soft tissue infections.</p> <p>The routine use of corticosteroids in pneumonia is not recommended.</p> <h3 id="considerations-on-antimicrobials-in-viral-and-atypical-pneumonias-3"><strong>CONSIDERATIONS ON ANTIMICROBIALS IN VIRAL AND ATYPICAL PNEUMONIAS:</strong></h3> <p>In the case of a concomitant antigen test or PCR for Influenza A/B or SARS-CoV2, the following treatment recommendations are made:</p> <p><strong>Influenza Virus A/B:</strong></p> <p>First choice: * Oseltamivir 75mg every 12 hours orally for 5 days. Other considerations: * In cases of Respiratory Failure in ARM or Obesity: Oseltamivir 150mg every 12 hours orally for 5 days. * Concomitant antimicrobial treatment is recommended as there is documented frequent association of Influenza Virus and Streptococcus pneumoniae.</p> <p><strong>COVID-19:</strong> * First choice is conventional treatment with dexamethasone 8 mg IV for 10 days in the event of respiratory failure. * Routine antimicrobial treatment is not recommended for COVID-19; therefore, upon a positive SARS-CoV2 test, it is recommended to discontinue antimicrobials.</p> <p>Consider maintaining concomitant antimicrobial treatment only in suspected bacterial infection due to severe presentation: * Focal alveolar consolidation +/- air bronchogram in imaging studies plus 1 of the following: sepsis, risk factors, and/or immunosuppression.</p> <p><strong>Atypical Pneumonias with Seroconversion for Chlamydia or Mycoplasma:</strong></p> <p>First choice: * Clarithromycin 500mg every 12 hours IV/orally for 14 days. * Azithromycin 500-1000mg/day IV/orally for 14 days. * Doxycycline 100mg every 12 hours IV/orally for 14 days.</p> <h3 id="considerations-on-penicillin-and-other-beta-lactam-allergies-3"><strong>CONSIDERATIONS ON PENICILLIN AND OTHER BETA-LACTAM ALLERGIES:</strong></h3> <p>Patients who report penicillin allergy are often misclassified. It is documented that more than 95% of patients who report penicillin allergy can receive beta-lactams without any complications. Additionally, penicillin hypersensitivity diminishes over the years.</p> <p>Allergy to one beta-lactam does not imply the impossibility of using the entire spectrum of beta-lactams, as there are only a few cases of cross-hypersensitivity.</p> <p>Therefore, we recommend the safe use of beta-lactams except in cases of a reported or documented history of severe allergy to penicillin (anaphylaxis).</p> <p>In doubtful cases or confirmed allergy events during hospitalization, a consultation with an Allergy Specialist is available to evaluate the case.</p> <h3 id="follow-up-in-outpatient-treatment-modality-3"><strong>FOLLOW-UP IN OUTPATIENT TREATMENT MODALITY</strong></h3> <p>Patients undergoing pneumonia treatment in an outpatient setting can continue their treatment at home, considering advising them to seek further consultation in case of alarm signs (fever that does not subside after 48 to 72 hours, dyspnea, hemoptysis, chest pain, etc.). Nevertheless, it is good practice to consider a follow-up consultation in the emergency department or clinic after 48 to 72 hours of starting antibiotic therapy.</p> <p>It is not routinely recommended to repeat a chest X-ray or CT scan to evaluate the evolution of pneumonia under outpatient treatment. Only in the case of suspected complications or unfavorable evolution. A follow-up at the end of treatment with the primary care physician is suggested.</p> <h3 id="follow-up-in-inpatient-treatment-modality-3"><strong>FOLLOW-UP IN INPATIENT TREATMENT MODALITY</strong></h3> <p>For hospitalized patients, we should consider transitioning from parenteral medication to oral when the following conditions are met</p> <ul> <li>Completion of 48 hours of parenteral treatment.</li> <li>Presence of a 24-hour afebrile period, with hemodynamic stability and significant clinical improvement.</li> <li>Availability of the oral route.</li> </ul> <p>It is not routinely recommended to repeat a chest X-ray or CT scan to evaluate the evolution of pneumonia under outpatient or inpatient treatment. Only in the case of suspected complications or unfavorable evolution.</p> <h3 id="prevention-3"><strong>PREVENTION</strong></h3> <p>The prevention of pneumonia is based on timely immunization with pneumococcal vaccines, influenza vaccination, and COVID-19 vaccination according to the immunization recommendations and current schedule from the Ministry of Health.</p> <h3 id="icd-11-coding-3"><strong>ICD-11 CODING</strong></h3> <ul> <li>CA40 - Pneumonia.</li> <li>CA40.0 - Bacterial Pneumonia.</li> <li>CA40.1 - Viral Bronchopneumonia.</li> <li>CA40.2 - Fungal Pneumonia.</li> <li>CA40.Z - Pneumonia, organism unspecified.</li> </ul> <h3 id="autor-3">Autor</h3> <p><strong>Kamo Weasel - MD Infectious Diseases - MD Internal Medicine - #DocChain Community</strong> npub1jdvvva54m8nchh3t708pav99qk24x6rkx2sh0e7jthh0l8efzt7q9y7jlj</p> </blockquote> 2024-09-24T12:57:58Z https://nostr.now/nevent1qqs8tz8a4esqm3k2e34t55dxukptrexs45uzsjxat42ffzkwj56ft7szyzf433nkjhv70z7790euu84s55ze25mgwce2zal86fw7alul9yf0cjzqwr4 Uber Eats for #catstr 😸🛵🍗🍟🍖🌯🍔<br/><br/><video controls width="100%" class="max-h-[90vh] bg-neutral-300 dark:bg-zinc-700"><source src="https://v.nostr.build/oP0x.mp4"></video> 2024-02-08T09:35:09Z