Manoj Wickramasinghe
@manoj-w.bsky.social
Anaesthetic trainee. Wannabe Intensivist. #POCUS. #FUSIC #FAMUS
Reposted by Manoj Wickramasinghe
Tickets for #lactic25 are selling fast! Check out the programme below. Including the legendary
@dogicuma.bsky.social
Register here👉 clockworkmedical.com/meeting/lact...
#ICU #critcare #AIM #EM #emergencymedicine #CPD #FOAMed #medicalconference #leeds #LTHT #leedshospitals #yorkshire
@dogicuma.bsky.social
Register here👉 clockworkmedical.com/meeting/lact...
#ICU #critcare #AIM #EM #emergencymedicine #CPD #FOAMed #medicalconference #leeds #LTHT #leedshospitals #yorkshire
June 26, 2025 at 4:06 PM
Tickets for #lactic25 are selling fast! Check out the programme below. Including the legendary
@dogicuma.bsky.social
Register here👉 clockworkmedical.com/meeting/lact...
#ICU #critcare #AIM #EM #emergencymedicine #CPD #FOAMed #medicalconference #leeds #LTHT #leedshospitals #yorkshire
@dogicuma.bsky.social
Register here👉 clockworkmedical.com/meeting/lact...
#ICU #critcare #AIM #EM #emergencymedicine #CPD #FOAMed #medicalconference #leeds #LTHT #leedshospitals #yorkshire
Reposted by Manoj Wickramasinghe
What do people think about some sort of "POCUS on call" service? I'm thinking a practitioner with advanced multimodality skills who could respond to requests for POCUS from multiple hospital departments. Anyone know of anything like this that exists?
February 27, 2025 at 2:13 PM
What do people think about some sort of "POCUS on call" service? I'm thinking a practitioner with advanced multimodality skills who could respond to requests for POCUS from multiple hospital departments. Anyone know of anything like this that exists?
Reposted by Manoj Wickramasinghe
Here’s one for #Scanuary: wondered how beekeeping and #POCUS relate? Chap11 in #Scars&Stains explores pearls and pitfalls of POCUS in a seemingly dissimilar parallel.
amzn.eu/d/aVEQTTW
@manoj-w.bsky.social @casualtysrus.bsky.social
amzn.eu/d/aVEQTTW
@manoj-w.bsky.social @casualtysrus.bsky.social
January 24, 2025 at 9:17 PM
Here’s one for #Scanuary: wondered how beekeeping and #POCUS relate? Chap11 in #Scars&Stains explores pearls and pitfalls of POCUS in a seemingly dissimilar parallel.
amzn.eu/d/aVEQTTW
@manoj-w.bsky.social @casualtysrus.bsky.social
amzn.eu/d/aVEQTTW
@manoj-w.bsky.social @casualtysrus.bsky.social
Reposted by Manoj Wickramasinghe
Today's Paper of the Day is organ crosstalk and dysfunction in sepsis
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
January 20, 2025 at 7:50 AM
Today's Paper of the Day is organ crosstalk and dysfunction in sepsis
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
Reposted by Manoj Wickramasinghe
It’s a pleasure to be part of the upcoming Critical Care Symposium in Manchester on the 24-25 April
Featuring an absolute smorgasbord of excellent critical care content
I’ll be co-chairing the ECMO session and teaching POCUS
Would love to see some of you there!
www.critcaresymposium.co.uk
Featuring an absolute smorgasbord of excellent critical care content
I’ll be co-chairing the ECMO session and teaching POCUS
Would love to see some of you there!
www.critcaresymposium.co.uk
January 15, 2025 at 2:06 PM
It’s a pleasure to be part of the upcoming Critical Care Symposium in Manchester on the 24-25 April
Featuring an absolute smorgasbord of excellent critical care content
I’ll be co-chairing the ECMO session and teaching POCUS
Would love to see some of you there!
www.critcaresymposium.co.uk
Featuring an absolute smorgasbord of excellent critical care content
I’ll be co-chairing the ECMO session and teaching POCUS
Would love to see some of you there!
www.critcaresymposium.co.uk
Reposted by Manoj Wickramasinghe
As Promised
Season 3 - Episode 1 of #BILIH #BlockItLikeItsHot @bilih.bsky.social is out now!
Featuring one of our favourite blocks, the #Paravertebral!
Join @jeffgadsden.bsky.social and I on this fun episode
#RAsky #AnSky #PainSky
Spotify link: open.spotify.com/episode/0aUX...
Season 3 - Episode 1 of #BILIH #BlockItLikeItsHot @bilih.bsky.social is out now!
Featuring one of our favourite blocks, the #Paravertebral!
Join @jeffgadsden.bsky.social and I on this fun episode
#RAsky #AnSky #PainSky
Spotify link: open.spotify.com/episode/0aUX...
January 15, 2025 at 10:08 AM
As Promised
Season 3 - Episode 1 of #BILIH #BlockItLikeItsHot @bilih.bsky.social is out now!
Featuring one of our favourite blocks, the #Paravertebral!
Join @jeffgadsden.bsky.social and I on this fun episode
#RAsky #AnSky #PainSky
Spotify link: open.spotify.com/episode/0aUX...
Season 3 - Episode 1 of #BILIH #BlockItLikeItsHot @bilih.bsky.social is out now!
Featuring one of our favourite blocks, the #Paravertebral!
Join @jeffgadsden.bsky.social and I on this fun episode
#RAsky #AnSky #PainSky
Spotify link: open.spotify.com/episode/0aUX...
Reposted by Manoj Wickramasinghe
The Association of Anaesthetists have published new guidelines on blood components & their alternatives!
Tranexamic acid has been proven to ⬇️ bleeding in most surgical settings.
But what dose of TXA should you use in different clinical contexts?
#AnSky #MedSky #HaemSky
https://buff.ly/4hbI4O6
Tranexamic acid has been proven to ⬇️ bleeding in most surgical settings.
But what dose of TXA should you use in different clinical contexts?
#AnSky #MedSky #HaemSky
https://buff.ly/4hbI4O6
January 13, 2025 at 7:03 AM
The Association of Anaesthetists have published new guidelines on blood components & their alternatives!
Tranexamic acid has been proven to ⬇️ bleeding in most surgical settings.
But what dose of TXA should you use in different clinical contexts?
#AnSky #MedSky #HaemSky
https://buff.ly/4hbI4O6
Tranexamic acid has been proven to ⬇️ bleeding in most surgical settings.
But what dose of TXA should you use in different clinical contexts?
#AnSky #MedSky #HaemSky
https://buff.ly/4hbI4O6
Reposted by Manoj Wickramasinghe
And - if you get bored on your next commute, do check out our @bilih.bsky.social @jeffgadsden.bsky.social on Knee blocks here #WSM2025 @assocanaes.bsky.social
open.spotify.com/episode/6LKW...
open.spotify.com/episode/6LKW...
I ”Kneed” To Know More
Block It Like It’s Hot · Episode
open.spotify.com
January 10, 2025 at 10:14 PM
And - if you get bored on your next commute, do check out our @bilih.bsky.social @jeffgadsden.bsky.social on Knee blocks here #WSM2025 @assocanaes.bsky.social
open.spotify.com/episode/6LKW...
open.spotify.com/episode/6LKW...
Reposted by Manoj Wickramasinghe
Was great to see and catch up with you at #WSM2025 too @sthjournalclub.bsky.social !
That video is fantastic from @jeffgadsden.bsky.social !
I also have one here
youtu.be/bAxMvcTf0kU?...
That video is fantastic from @jeffgadsden.bsky.social !
I also have one here
youtu.be/bAxMvcTf0kU?...
Anterior Femoral Cutaneous Nerve Block
YouTube video by Dr Amit Pawa
youtu.be
January 10, 2025 at 10:11 PM
Was great to see and catch up with you at #WSM2025 too @sthjournalclub.bsky.social !
That video is fantastic from @jeffgadsden.bsky.social !
I also have one here
youtu.be/bAxMvcTf0kU?...
That video is fantastic from @jeffgadsden.bsky.social !
I also have one here
youtu.be/bAxMvcTf0kU?...
Reposted by Manoj Wickramasinghe
The second trial result for #CCR25 in Titanic Belfast
in June is GASTROSAM
Gastroenteritis Rehydration of African Children with Severe Acute Malnutrition
Join us in June for the best critical care trials in the world
Register at criticalcarereviews.com/meetings/ccr25
in June is GASTROSAM
Gastroenteritis Rehydration of African Children with Severe Acute Malnutrition
Join us in June for the best critical care trials in the world
Register at criticalcarereviews.com/meetings/ccr25
January 9, 2025 at 9:50 PM
The second trial result for #CCR25 in Titanic Belfast
in June is GASTROSAM
Gastroenteritis Rehydration of African Children with Severe Acute Malnutrition
Join us in June for the best critical care trials in the world
Register at criticalcarereviews.com/meetings/ccr25
in June is GASTROSAM
Gastroenteritis Rehydration of African Children with Severe Acute Malnutrition
Join us in June for the best critical care trials in the world
Register at criticalcarereviews.com/meetings/ccr25
Reposted by Manoj Wickramasinghe
#hr2025 will be an absolutely excellent event.
I’m looking forward to joining in and talking about ventilation, ECMO, and POCUS.
It would be great to see as many of you there as possible.
Register here: ccusinstitute.wixsite.com/ccus/events/hr…
@katiewiskar.bsky.social @thinkingcc.bsky.social
I’m looking forward to joining in and talking about ventilation, ECMO, and POCUS.
It would be great to see as many of you there as possible.
Register here: ccusinstitute.wixsite.com/ccus/events/hr…
@katiewiskar.bsky.social @thinkingcc.bsky.social
HR2025 - Fluid Tolerance, all Things VExUS & Shock Hemodynamics | CCUS.meducate
<p>HR2025 is about putting it all together. We’ve been talking about the venous side for a long time and it has been fantastic seeing how much it has taken off. There’s enough data out there to show a...
https://ccusinstitute.wixsite.com/ccus/events/hr…
January 8, 2025 at 8:13 PM
#hr2025 will be an absolutely excellent event.
I’m looking forward to joining in and talking about ventilation, ECMO, and POCUS.
It would be great to see as many of you there as possible.
Register here: ccusinstitute.wixsite.com/ccus/events/hr…
@katiewiskar.bsky.social @thinkingcc.bsky.social
I’m looking forward to joining in and talking about ventilation, ECMO, and POCUS.
It would be great to see as many of you there as possible.
Register here: ccusinstitute.wixsite.com/ccus/events/hr…
@katiewiskar.bsky.social @thinkingcc.bsky.social
Reposted by Manoj Wickramasinghe
I mean, I'm pleased that clinicians "beat" #AI - but this kind of study totally misses the point of medical exams.
We examine doctors by written exam as only one of many assessment types, on the (usually valid) assumption that it predicts real-world performance.
1/
bmjopen.bmj.com/content/14/1...
We examine doctors by written exam as only one of many assessment types, on the (usually valid) assumption that it predicts real-world performance.
1/
bmjopen.bmj.com/content/14/1...
ChatGPT (GPT-4) versus doctors on complex cases of the Swedish family medicine specialist examination: an observational comparative study
Background Recent breakthroughs in artificial intelligence research include the development of generative pretrained transformers (GPT). ChatGPT has been shown to perform well when answering several s...
bmjopen.bmj.com
December 31, 2024 at 11:14 AM
I mean, I'm pleased that clinicians "beat" #AI - but this kind of study totally misses the point of medical exams.
We examine doctors by written exam as only one of many assessment types, on the (usually valid) assumption that it predicts real-world performance.
1/
bmjopen.bmj.com/content/14/1...
We examine doctors by written exam as only one of many assessment types, on the (usually valid) assumption that it predicts real-world performance.
1/
bmjopen.bmj.com/content/14/1...
Reposted by Manoj Wickramasinghe
Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management
CCR Journal Watch
criticalcarereviews.com/latest-evide...
CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
CCR Journal Watch
criticalcarereviews.com/latest-evide...
CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
January 4, 2025 at 12:52 PM
Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management
CCR Journal Watch
criticalcarereviews.com/latest-evide...
CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
CCR Journal Watch
criticalcarereviews.com/latest-evide...
CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
Reposted by Manoj Wickramasinghe
It's Jan 1st, so we reset the Paper of the Day record
Every day we'll review one topic & cover the entire spectrum of critical care across 2025
The papers are open access & available on the website or via email
Interested? Join in!
criticalcarereviews.com/latest-evide...
Every day we'll review one topic & cover the entire spectrum of critical care across 2025
The papers are open access & available on the website or via email
Interested? Join in!
criticalcarereviews.com/latest-evide...
January 1, 2025 at 11:05 AM
It's Jan 1st, so we reset the Paper of the Day record
Every day we'll review one topic & cover the entire spectrum of critical care across 2025
The papers are open access & available on the website or via email
Interested? Join in!
criticalcarereviews.com/latest-evide...
Every day we'll review one topic & cover the entire spectrum of critical care across 2025
The papers are open access & available on the website or via email
Interested? Join in!
criticalcarereviews.com/latest-evide...
Reposted by Manoj Wickramasinghe
Echocardiography in the Ventilated Patient: What the Clinician Has to Know
CCR Journal Watch
criticalcarereviews.com/latest-evide...
Get the latest critical care literature every weekend via CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
CCR Journal Watch
criticalcarereviews.com/latest-evide...
Get the latest critical care literature every weekend via CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
December 29, 2024 at 4:58 PM
Echocardiography in the Ventilated Patient: What the Clinician Has to Know
CCR Journal Watch
criticalcarereviews.com/latest-evide...
Get the latest critical care literature every weekend via CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
CCR Journal Watch
criticalcarereviews.com/latest-evide...
Get the latest critical care literature every weekend via CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
Reposted by Manoj Wickramasinghe
🔥 FDA just *rejected* full approval for Adnexxa 🔥
likely due to increased thrombosis risk in ANEXA-I trial
IMHO the best strategy is to keep this off your hospital's formulary (thereby avoiding endless circular debates about Adnexxa vs PCC)
firstwordpharma.com/story/5921956 #EMIMCC
likely due to increased thrombosis risk in ANEXA-I trial
IMHO the best strategy is to keep this off your hospital's formulary (thereby avoiding endless circular debates about Adnexxa vs PCC)
firstwordpharma.com/story/5921956 #EMIMCC
FirstWord
firstwordpharma.com
December 20, 2024 at 4:46 PM
🔥 FDA just *rejected* full approval for Adnexxa 🔥
likely due to increased thrombosis risk in ANEXA-I trial
IMHO the best strategy is to keep this off your hospital's formulary (thereby avoiding endless circular debates about Adnexxa vs PCC)
firstwordpharma.com/story/5921956 #EMIMCC
likely due to increased thrombosis risk in ANEXA-I trial
IMHO the best strategy is to keep this off your hospital's formulary (thereby avoiding endless circular debates about Adnexxa vs PCC)
firstwordpharma.com/story/5921956 #EMIMCC
Reposted by Manoj Wickramasinghe
It’s becoming an increasingly relevant topic that were debating regularly in the CICU. Should we stop SGLT2i in critically ill decompensated heart failure? When should we start? #cccsky #emimcc #cardiosky
#SGLT2i use in critical care, icu-- interesting read
#SGLT2 inhibitors
#cardiosky #pharmsky #chf
link.springer.com/article/10.1...
#SGLT2 inhibitors
#cardiosky #pharmsky #chf
link.springer.com/article/10.1...
How to manage sodium-glucose cotransporter-2 inhibitors in the critically ill patient? - Intensive Care Medicine
Intensive Care Medicine -
link.springer.com
December 19, 2024 at 8:05 PM
It’s becoming an increasingly relevant topic that were debating regularly in the CICU. Should we stop SGLT2i in critically ill decompensated heart failure? When should we start? #cccsky #emimcc #cardiosky
Reposted by Manoj Wickramasinghe
🦠We call a lot of things “sepsis”
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
December 17, 2024 at 4:08 PM
🦠We call a lot of things “sepsis”
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
Reposted by Manoj Wickramasinghe
🔥🔥 Join us on @criticalcaretime.bsky.social to hear Drs. Paul Wischmeyer and Alin Gragossian share their experiences #BeneathTheDrape on this week’s episode. Links 👇
🌎 tinyurl.com/3d7p4e9f
🍎 tinyurl.com/3737eusu
🟢 tinyurl.com/mry33267
🎥 tinyurl.com/2nchzw5c
🌎 tinyurl.com/3d7p4e9f
🍎 tinyurl.com/3737eusu
🟢 tinyurl.com/mry33267
🎥 tinyurl.com/2nchzw5c
Episodes — Critical Care Time
tinyurl.com
December 16, 2024 at 7:26 PM
🔥🔥 Join us on @criticalcaretime.bsky.social to hear Drs. Paul Wischmeyer and Alin Gragossian share their experiences #BeneathTheDrape on this week’s episode. Links 👇
🌎 tinyurl.com/3d7p4e9f
🍎 tinyurl.com/3737eusu
🟢 tinyurl.com/mry33267
🎥 tinyurl.com/2nchzw5c
🌎 tinyurl.com/3d7p4e9f
🍎 tinyurl.com/3737eusu
🟢 tinyurl.com/mry33267
🎥 tinyurl.com/2nchzw5c
Reposted by Manoj Wickramasinghe
Management of pain and sedation in the intensive care unit
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://criticalcarereviews.com/newsletters/subscribe
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://criticalcarereviews.com/newsletters/subscribe
December 16, 2024 at 7:40 PM
Management of pain and sedation in the intensive care unit
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://criticalcarereviews.com/newsletters/subscribe
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://criticalcarereviews.com/newsletters/subscribe
Reposted by Manoj Wickramasinghe
We present another publication-quality chapter from ShockWaves, the 1st chapter in the RHC section.
Sergio Caravita presents a masterclass on the invasive PA waveform.
Section editors: Sophia Airhart and Zach I'lGiovine
shockwaves.icu/app/page/1O3...
Sergio Caravita presents a masterclass on the invasive PA waveform.
Section editors: Sophia Airhart and Zach I'lGiovine
shockwaves.icu/app/page/1O3...
December 15, 2024 at 5:56 PM
We present another publication-quality chapter from ShockWaves, the 1st chapter in the RHC section.
Sergio Caravita presents a masterclass on the invasive PA waveform.
Section editors: Sophia Airhart and Zach I'lGiovine
shockwaves.icu/app/page/1O3...
Sergio Caravita presents a masterclass on the invasive PA waveform.
Section editors: Sophia Airhart and Zach I'lGiovine
shockwaves.icu/app/page/1O3...
Reposted by Manoj Wickramasinghe
Fresh blog: the ADAPT and SCREEN trials are full of sound & fury, signifying little
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
PulmCrit: ADAPT and SCREEN trials are full of sound and fury, signifying little
I think ICU docs may have developed a bit of an RCT problem; not an addiction, but perhaps a dependency. It all started off fine at first. RCTs are the
emcrit.org
December 13, 2024 at 6:28 PM
Fresh blog: the ADAPT and SCREEN trials are full of sound & fury, signifying little
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
Interesting. The best study I can see looking at this is www.obstetanesthesia.com/article/S095...
Increased dose dependant risk of Fetal bradycardia with intrathecal opioids. Postulates theories beyond maternal hypotension for Fetal bradycardia.
Increased dose dependant risk of Fetal bradycardia with intrathecal opioids. Postulates theories beyond maternal hypotension for Fetal bradycardia.
December 13, 2024 at 11:21 AM
Interesting. The best study I can see looking at this is www.obstetanesthesia.com/article/S095...
Increased dose dependant risk of Fetal bradycardia with intrathecal opioids. Postulates theories beyond maternal hypotension for Fetal bradycardia.
Increased dose dependant risk of Fetal bradycardia with intrathecal opioids. Postulates theories beyond maternal hypotension for Fetal bradycardia.
Reposted by Manoj Wickramasinghe
Are combined spinal-epidurals better than labour epidurals?
Are anaesthetists who do not universally adopt CSEs disadvantaging patients?
Universal use of CSE would likely:
⬆️ burden of PDPH morbidity
⬆️ risk of fetal bradycardia & maternal pruritus
#ObGynSky #AnSky
https://buff.ly/41rbYJs
Are anaesthetists who do not universally adopt CSEs disadvantaging patients?
Universal use of CSE would likely:
⬆️ burden of PDPH morbidity
⬆️ risk of fetal bradycardia & maternal pruritus
#ObGynSky #AnSky
https://buff.ly/41rbYJs
December 13, 2024 at 11:02 AM
Are combined spinal-epidurals better than labour epidurals?
Are anaesthetists who do not universally adopt CSEs disadvantaging patients?
Universal use of CSE would likely:
⬆️ burden of PDPH morbidity
⬆️ risk of fetal bradycardia & maternal pruritus
#ObGynSky #AnSky
https://buff.ly/41rbYJs
Are anaesthetists who do not universally adopt CSEs disadvantaging patients?
Universal use of CSE would likely:
⬆️ burden of PDPH morbidity
⬆️ risk of fetal bradycardia & maternal pruritus
#ObGynSky #AnSky
https://buff.ly/41rbYJs
Reposted by Manoj Wickramasinghe