Discover and read the best of Twitter Threads about #Immunosuppression

Most recents (13)

Human #intestinal #spirochetosis:
✔️#sexual #transmitted infections
✔️of the large intestine by anaerobic spirochetes of the genus Brachyspira spp.
1/10

🖊️A De Gea, @alfredomaldo ,@clarapath, @MarianaDazAlmi1, @alirri, Raquel Escudero, et al.
👇
sciencedirect.com/science/articl… Colonoscopic biopsy. In rou...
@alfredomaldo @clarapath @MarianaDazAlmi1 @alirri Gastrointestinal symptoms such as abdominal pain, proctitis, or chronic diarrhea are the most common manifestations.

Most cases with accompanying symptoms show improvement with metronidazole antibiotic therapy.
2/10

#IntestinalSpirochetosis
Routine staining methods (haematoxylin & eosin & Warthin-Starry) can identify spirochetes on the surface of enterocytes.
Histologically, characteristic findings include a decrease in microvilli &a predominantly eosinophilic inflammatory infiltrate.
3/10

#Pathologists #pathology Colonoscopic biopsy compare...
Read 12 tweets
*FDA did not find #LYMErix increased arthritis.

They only reviewed arthritis complaints b/c the crooks running the trials had redefined #LymeDisease & rigged testing to only DX arthritis-susceptible cases.

Not gonna find dangerous AEs only looking for swollen knees.
Oct 2021 I told FDA investigators, in person, that current #LymeDisease #vaccine trials must be halted.

There is no valid diagnostic so there is no way to determine efficacy.

Plus, it’s not a vaccine.
Read 5 tweets
#Immunosuppressive therapy in virus-negative inflammatory CMP : 20-year follow-up of the #TIMIC trial

Immunosuppressive Tx of virus-negative inflammatory #CMP is associated to a persistent improvement of LV
function and better outcomes during long-term follow-up

#HeartFailure
#Immunosuppressive Tx promoted an improvement in cardiac function in 88% of the cases compared the placebo group

A persistent ⤴️ in the #LVEF is seen in long -term (up to 20 years) clinical outcomes of the whole cohort of 85 patients originally enrolled in the #TIMIC trial
Recurring virus-negative myocarditis responding to #immunosuppressive therapy

EKG showing LBBB (A) resolving after therapy (B)

(C and D) Echo apical view showing recovery of LV dysfunction from EF -28% ➡️ up to 51%

#HeartFailure #EchoFirst @ESC_Journals academic.oup.com/eurheartj/adva…
Read 6 tweets
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 2/ 📸 Faculty disclosures & CME certification ℹ
Want a #CME certificate? → ℹ️ bit.ly/3IbTRdB
#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 3/ 😭 most pts are NOT getting safe 💉 like flu, pneumonia & HepB.
🤷‍♀️ Why?
🚫Many GIs won't/can't give 💉
❓Many PCPs don't know what to give
📞 Better communication is needed
#MondayNightIBD

Who do you think should make vaccine recs & where should pts w/ #IBD get 💉?
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 4/ pts w #IBD , esp if on ⚠️immunosuppressants (IS), at ⬆risk of (preventable) infections, so #vaccination is 🗝️
Infection in IBD = ⬆hospitalization ⬆ 🏥 stays ⬆costs & ⬆mortality.

Despite their benefits, vaccination rates remain LOW.

#MondayNightIBD Image
Read 19 tweets
1) Welcome to a new #accredited #tweetorial on the #goKDIGO guidance regarding evaluation and management of focal segmental glomerulosclerosis (#FSGS)--one of the most common causes of primary glomerular disease in adults. Leading us through this material is @edgarvlermamd.
2) Dr. Lerma is core faculty at both @ckd_ce & @cardiomet_CE and is an expert #nephrologist and #educator. This tweetorial is accredited for 0.5h CE/#CME for #physicians #nurses #NPs #PAs #pharmacists. Please follow along!
3) This educational program is supported by grants from Travere, Bayer, & Otsuka, and is intended for healthcare providers. Faculty disclosures can be found at ckd-ce.com/disclosures/. Past programs, still available for CE/#CME credit, are at ckd-ce.com.
Read 34 tweets
#immunosuppression

IMMUNE CONTROL POINTS AND COVID-19

✅IMMUNOLOGIC CONTROL POINT MOLECULES ARE #INHIBITOR RECEPTORS EXPRESSED IN IMMUNE CELLS THAT TRIGGER IMMUNOSUPPRESSOR SIGNALING PATHWAYS.
These molecules are crucial to maintaining self-tolerance. 👉SIGNALING THROUGH THESE MOLECULES MAY TAKE IMMUNE EFFECT CELLS (ESPECIALLY T CELLS) TO A STATE KNOWN AS "DEPLETION". T cell depletion is defined by reduced effector function, poor memory responses
👉 due to sustained expression of immune checkpoint molecules (such as PD1, # CTLA4, # LAG3 ...). There are numerous types of activating and inhibitory interactions that occur between antigen presenting cells (APC) and T cells and thus regulate the nature of immunity.
Read 28 tweets
1/

Another #immunosuppression #tweetorial...spotlight today on #belatacept today

How do you say it? @Babybel @MedTweetorials
2/

Belatacept is the FUSION protein that has been the @NKOTB in #kidneytransplant - having been approved for use in 2011.

What's fused?

1. Human IgG1 Fc fragment
2. Extracellular domain of cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4)

pubmed.ncbi.nlm.nih.gov/25416857/
3/

The goal of this fusion protein? Disrupt Signal 2⃣ of the 3⃣-Signal T-cell activation pathway

Signal 2 = Binding of CD28 (on T-cell) to B7-1/B7-2 (on APC)

This important step is called co-stimulation and is necessary for T-cell activation

nejm.org/doi/full/10.10…
Read 11 tweets
Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol (recoverytrial.net/results) to better digest them.

Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol

- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
Read 11 tweets
Recent @CellCellPress #COVID19 study on #immunity helps explain why these 2pts with X-linked agammaglobulinemia (genetic immunodeficiency where pts have complete abscence of Bcells: inability to produce antibodies) developed COVID19 pneumonia—but RECOVERED
onlinelibrary.wiley.com/doi/abs/10.111…
2/In another recently published case #COVID19 study in @AnnalsAllergy—pt with another genetic immunodeficiency (common variable immunodeficiency on monthly IVIG w/stable bronchiectasis) had #COVID19 but fully recovered after ICU care despite increased risk
annallergy.org/article/S1081-…
3/ Of note, CVID pt with #COVID19 also had breast cancer in remission on tamoxifen OD, hypothyroidism & Sjögren’s on #hydroxychloroquine 200mg BID. She presented to ER on D7 of symptoms. Her home dose of hydroxychloroquine was incr to TID w/IVIG. No azithromycin d/t known allergy
Read 4 tweets
All right #dermtwitter & #medtwitter, it's time for the...

@MedDermSoc & @DermHospitalist Mini-Symposium on #COVID19 & #dermatology!!

I will be attempting to #livetweet the Zoom meeting!

Join along if you'd like. I will be using the h/t #COVIDDerm!

@RoxanaDaneshjou @dschless
Let's get started!!!!

Your cohosts are super excited to have you join. To give a little background, this meeting was planned in ~1 week, and we have over 500 RSVPs!

@MishaRosenbach now kicking us off with #COVIDDerm! Image
.@DrEstherFreeman is speaking and reminding us all to register our #COVID19 #dermatology cases in the @AADskin #COVID registry!

Reminder to do so here:
aad.org/covidregistry

#COVIDDerm
Read 39 tweets
1/ Continuing the #immunosuppression #tweetorial series...@MedTweetorials

Today's player: #mTORi, mammalian/mechanistic target of rapamcyin inhibitors

Rapamcyin was @US_FDA approved for #kidneytransplant in 2003.

It was isolated from a soil sample from which island in 1975?
2/ Meet mTOR, a phosphatidylinositol 3-kinase (PI3)-related kinase (adds a phos). mTOR adds a phosphoryl group to serine/threonine residues.

It is a key component of the complexes mTORC1 and mTORC 2 - which regulate processes including cell growth, proliferation, and survival.
3/ mTOR inhibition blocks "Signal 3" of #TCell activation - reducing cytokine dependent cell proliferation and activation.

Take a look at all 3 signals below 👇🏽

nejm.org/doi/full/10.10…
Read 11 tweets
1/

Here's another #immunosuppression #tweetorial. This time, a focus on mycophenolic acid (MPA). #MMF #Mycophenolate

The main mechanism of action of MPA is inhibition of which of the following:
2/ Let's meet the players. Mycophenolate mofetil (MMF, left) is a prodrug of MPA while mycophenolate sodium (MPS, right) is an enteric-coated salt of MPA.

MMF administration releases MPA in the stomach, while mycophenolate sodium (MPS) releases it in the small intestine.
3/ MPA is often referred to as an "anti-metabolite", which means a substance that interrupts a metabolic process within cells.

The process that MPA interrupts here: PURINE SYNTHESIS
Read 9 tweets
This! The activity of the host #immune response largely determines whether #pathobionts acquired from an #FMT donor might become capable of virulence 👉 So including immune status in the study of FMT outcomes would be extremely informative
IMO immune status should be included in the general study of #antibiotic resistant infection 👉 It’s no coincidence that most “superbug” infections occur in immunocompromised patients, often in hospitals (w/ patients on cocktails of steroids for procedures like organ transplants)
Because extrapolate that trend and consider that the immunosuppressive biologics used to palliate “#autoimmune” disease symptoms are the top selling medications in the world 👉 With top side effects of such drugs being “serious #infection by viruses, fungi or bacteria”(see below) Image
Read 6 tweets

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