Discover and read the best of Twitter Threads about #IDTwitter

Most recents (15)

1/15 #Fever #tweetorial

Parents and paediatricians alike are obsessed with fever

We've all got fever fever 🔥 But it is SO misunderstood

Let's take a look at what fever actually is, and finish off with some myth busting!

#FOAMPed #FOAMed #IDTwitter #PedsICU #PedsID
2/15
Fever (pyrexia) is an elevated core body temperature as part of a physiological response to infection controlled by the hypothalamus

This is opposed to hyperthermia, a pathological elevated temperature

This is important, as your body is IN CONTROL. Fever happens on purpose
3/15
What temperature counts as a fever?

There's no strict definition (there's no really good data on what a "normal" temperature is...), but an arbitrary cut of off 38C is often used.

Its better taken in context; 37.8C following temps >38.5C is probably still a fever.
Read 15 tweets
Join the webinar NOW🔥🔥
Seeing Red: Managing Multidrug
Resistant Gram-Negative Infections
@SIDPharm @ProCEhealth @OncIDPharmd @ErinMcCreary
#IDTwitter #medtwitter #ASHP19
Mechanisms behind antibiotic resistance. #IDTwitter #ASHP19
Surprisingly! #IDTwitter #ASHP19
Read 4 tweets
NEW 🔥in @CMIJournal
Vancomycin AUC/MIC area ratio predicting clinical outcome: a systematic review and meta-analysis with pooled sensitivity and specificity. #IDTwitter #medtwitter @IDpharmresearch sciencedirect.com/science/articl…
Vancomycin AUC:MIC performance was modest and inconsistent. Analysis was limited by studies without sufficient data, therefore meta-analytic results may overestimate TPC values.#IDTwitter
Given this, as well as the lack of standardization of methods, widespread adoption of AUC:MIC as the preferred vancomycin monitoring parameter may be premature. #IDTwitter
Read 3 tweets
1/
Hi hi hi. We see lots of red flags on a daily basis when we review labs.

One thing we see commonly is #lymphopenia. Should we care? When can we dismiss it and when should we work it up?

Let’s find out.

#MedEd #MedTwitter #IDTwitter #Tweetorial #oncology
2/
- Lymphopenia assc w/ ⬆️risk of sepsis
- More common in elderly and w/ co-morbidities
- lymphs account for 20-40% of WBC, may go unnoticed when WBC checked w/o diff
- Primary- recurrent infxns in kids, CVID in adults
- Secondary-⬇️production; ⬆️destruction; hiding in tissue
3/
What is the most common cause of lymphopenia in hospitalized patients?
Read 14 tweets
BEFORE READING THIS THREAD, do you think this statement is TRUE or FALSE?

Despite being a documented #epidemic for decades, @HHSGov's #CenterForDiseaseControl(@CDCgov) intentionally obstructs its collecting #statistics on what causes at least 10% of deaths NEEDLESSLY every year.
2

HINT: You already know of these systemic #DataScams due to #PublicCorruption & #RegulatoryCapture:

🤥#HackedVoting/#illegitimateResults
🤥#UScensus is maliciously biased
🤥#Gerrymandering

Thread coming soon about #CauseOfDeath #DataFraud

#AmericanSwamp #MedicalControlFraud
3

ANOTHER HINT: My inability to escape intrahospital, interhospital & health/disability insurers’ #ConspiracyAgainstRights using #MedicalControlFrauds exposes motive of the right answer.

Watch this video later to understand #PublicCorruption by example📽️
Read 43 tweets
starting #ACCPAM19 with the amazing @emilylheil presenting an update on the recently-published community-acquired pneumonia #CAP guidelines ncbi.nlm.nih.gov/pubmed/31573350
@emilylheil So what actually causes CAP? @emilylheil states "the pathogenesis and etiology of CAP has changed over time with increased rates of vaccination and better diagnostics." Jain et al 2015 unable to identify a pathogen in > 60% of patients, viruses most common
ncbi.nlm.nih.gov/pubmed/26172429
@emilylheil Since etiology a great unknown, do we need to cover atypicals? Garin et al found BL monotherapy NOT non-inferior to combo, but on flip CAP-START suggested atypical coverage perhaps unneeded...
ncbi.nlm.nih.gov/pubmed/25286173
ncbi.nlm.nih.gov/pubmed/25830421
Read 19 tweets
1/9

@rabihmgeha shared a fantastic approach to positive BCx! I use a similar schema, but add ‘Questions to ask the lab/what to do next?’ since #ID usually doesn’t get the ‘critical result’ call from micro, and I want to empower those who do with actionable knowledge.
2/

I arrange the potential Gram stain results that one can be called w/ as follows: Gram(+) cocci, Gram(+) rods, Gram(–) rods, Gram(–) cocci, yeast. Gram(+) cocci are grouped by ‘morphology’ since the lab usually tells you this: clusters, pairs, chains, etc. Fill in with orgs.
3/

Like @rabihmgeha's schema, the orgs are deliberately ordered this way: Gram(+) orgs are often [skin] contaminants, Gram(–) orgs & yeast are not. Remember that clinician adjudication is the ‘gold standard’ for deciding what is a contaminant!
Read 10 tweets
1/

Hello everyone! I’ve been inspired by #MedEd colleague @JenniferSpicer4 to make my foray into #IDTwitter. I’m jumping right in with a #Tweetorial that combines my curiosity for the language of medicine and passion for powerful visuals and teaching about antibiotics!
2/

I’ve always been intrigued by how we describe abx decisions – ‘narrow’, ‘broaden’, ‘expand’, ‘[de]escalate’, etc. For my UME micro course, I made a figure that captures this terminology and lets learners compare/contrast spectra of activity visually.

Let’s build it together.
3/

Let’s start with a horizontal bar that represents the spectrum of clinically important bacteria. We will represent antibiotics above that spectrum with another horizontal bar.
Read 13 tweets
Today I'm going to do a #Tweetorial on non-resolving pneumonia (NRP)! These are a series of pearls on a prior #MorningReport case that I gave earlier this year. We are going to cover definitions, differential diagnosis/schema & workup of NRP #IDTwitter #PulmTwitter
So first off, what is non-resolving pneumonia (NRP)?

It is a bit vague, but it's a lack of resolution of symptoms or radiographic findings over an expected time period despite appropriate antibiotic treatment.
Let's separate this term from "recurrent PNA", which consists of multiple episodes with symptom free intervals & radiologic clearance (e.g. aspiration PNA).

We will avoid the topic of "what is a pneumonia anyway?"
Read 14 tweets
Colistin, a drug made available prior to the 1962 US FDA Kefauver-Harris Drug Amendments requiring proof of safety & efficacy for FDA marketing approval, would be unlikely to receive regulatory approval today. #IDTwitter #IDhistory
CMS/colistin was never subjected to drug development procedures that are now mandated by international drug regulatory agencies such as the Food and Drug Administration. #IDTwitter #IDHistory
The bactericidal effect of colistin is extremely rapid but there is limited knowledge of the mechanism of antibacterial activity.Since there is only one amino acid difference between colistin and polymyxin B,it is believed that they have the same mechanism of action. #IDTwitter
Read 10 tweets
1/ Yday on micro rounds we discussed Group A streptococcus (GAS). We briefly touched on the rationale behind using adjunctive clindamycin for severe forms of invasive GAS. So here is a short tweetorial on the topic. @CarlosdelRio7 @Dr_AmyKacin @colleenkraftmd
2/ GAS is an aerobic GPC. GAS invasive disease (iGAS) is defined by isolation of GAS from a normally sterile body site. The most severe of these invasive disease entities are generally thought to be necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS).
3/ Currently, the addition of clindamycin therapy to B-lactams and surgical debridement is recommended by the IDSA for Necrotizing fasciitis and used routinely in management of STSS, despite low rates of PCN resistance . What is the rationale?

doi.org/10.1093/cid/ci…
Read 11 tweets
Two oral💊 antibiotics can be used for Pseudomonas aeruginosa👾: Ciprofloxacin (usually preferred) & levofloxacin. Typically, go with the high dose (750mg/dose).
#TipsForNewDocs
Beta-lactamase inhibitors (clavulanate,sulbactam,tazobactam) broaden activity spectrum of penicillins for MSSA, anaerobes, & more Gram-negatives (not pseudomonas). Sulbactam can be used for its activity against Acinetobacter baumannii. Clav cause > GI side effects
#TipsForNewDocs
Aminoglycosides active against several MDR Gram -ve but prefer combination (one exception: UTI). Used as adjunctive agent for Gram +ve as it does not penetrate cell wall to act on protein synthesis except when cell wall is opened by cell wall inhibitors (BL/vanco)
#TipsForNewDocs
Read 13 tweets
50yo F p/w acute onset fever, diarrhea. On exam is hypotensive and mildly confused. Sx started 2 days after return from Zambia. No malaria ppx. Smear w/ 30% P falciparum parasitemia. MICU concerned for cerebral malaria (CM). How can we confirm on #PhysicalExam ?#IDConsults
Cerebral malaria is defined by WHO as coma with peripheral parasitemia after other causes ruled out. In endemic regions this predominantly affects young kids due to immunologic naivety. Unfortunately, this defn is nonspecific as 40-70% of asymptomatic ppl may be parasitemic 2/
Pathophys of cerebral malaria is related to sequestration of parasitized RBCs in the CNS blood vessels...thanks to Hermann von Helmholtz’s invention of the ophthalmoscope in 1851 (with just a few updates from the original), we have a window to the vasculature of the CNS! 3/
Read 11 tweets
1/ Why tuberculosis has a preferential apical localization?
Is it the host? Is it the pathogen?
To answer this question, let’s review some cool stuff
#MedTwitter #IDTwitter #IDMedEd #IDDailyPearl

Follow the thread
2/ Arnold Rich stated: “There is no more puzzling circumstance in the pathogenesis of pulmonary tuberculosis […] than the peculiar fact that in the adult the disease begins almost invariably in the upper portion of the upper lobe“
ncbi.nlm.nih.gov/pubmed/6839825
3/ M. tuberculosis is an obligate aerobe (they have an absolute requirement of O2 to grow).
*Tubercle bacilli respire maximally in vitro at O2 concentrations of 20-40%
*Experimental infections in animals are inhibited by very low O2 concentrations
Am Rev Tuberc 1939; 40:157-68
Read 9 tweets
Today I gave divisional rounds @UofA_ID on the power of #SoMe and #IDTwitter for ID physicians and microbiologists.

I have gained loads in this space, and here I compile some of the takeaways 🥡 for those who remain unconvinced of the benefits of #MedTwitter

A thread 1/
Whether we like it or not, #SoMe has changed our world. It has changed the way leaders are chosen, the way we communicate & interact with one another, the empowerment & mobilization of societies, & giving us unprecedented access to people and spaces otherwise unimaginable. 2/
#SoMe has also changed the way academic physicians and scientists practice and how we conduct and communicate science. 3/
Read 35 tweets

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