Discover and read the best of Twitter Threads about #Meded

Most recents (24)

Thanks to all for the encouragement after my first #tweetorial on SJS/TEN! I thought I'd keep the momentum going with #dermatology emergencies with a new #twearl aka #MedThread on #DRESS Syndrome, Drug Rash with Eosinophilia and Systemic Symptoms! Thanks to @dermnetnz!
1/
DRESS is a life-threatening drug reaction that, as the name implies, can cause systemic/end-organ damage. Although less flashy than SJS/TEN, it's much more common, occurring 10x more frequently! With a mortality estimated to be up to 10%, admission is usually recommended.
2/
Clinically, the name DRESS can be misleading. Let's try a quick poll:

Which of the following features is REQUIRED for the diagnosis to be made?

3/
Read 14 tweets
In preparation of my upcoming talk on #dermatology emergencies for the @SHMlive conference, I thought I'd put together my first #tweetorial on Stevens Johnson Syndrome (SJS). Having never done this, apologies in advance for subpar tweeting! Here we go!
1/
#medtwitter #dermtwitter
SJS and its more severe cousin, Toxic Epidermal Necrolysis (TEN), are life-threatening dermatologic toxicities, usually caused by a drug trigger. In rare cases, they can be triggered by infection (more commonly seen in the #pediatric population).

2/
#SJS usually presents with an atypical targetoid macular (flat) eruption with +nikolsky. This is in contrast to another entity on the ddx, erythema multiforme, which has classic target papular (raised) lesions. See the difference? (hands are EM, back is SJS). CC @dermnetnz!

3/
Read 11 tweets
18 myths & misconceptions of Post-Exertional Malaise #PEM in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome #MECFS

#PEM (aka PENE, "flare" or “crash”) is seriously debilitating symptom caused by exercise

#SickNotWeak #SickNotTired #pwME #chronicillness #medtwitter #MedEd
1. #PEM is just tiredness

No

#pwME experience <pathological> fatigue after #exercise which can be long-lasting and includes debilitating fatigue, flu-like symptoms, cognitive impairment, #sleep disturbance

@PNASNews #MECFS #MyalgicE #MedEd #medtwitter
pnas.org/content/114/6/…
2. #PEM is not a real

No

“there exists no medical condition.. where exertion.. causes #immune/ inflammatory-related symptoms like sore throat, tender lymph nodes, or flu-like feelings, yet 60%.. of.. [#pwME].. reported these symptoms”

@PLOSONE #MECFS
dx.plos.org/10.1371/journa…
Read 20 tweets
thread

Remarkable @bmj_latest @BMJCaseReports report documenting the extreme lengths a bedbound patient went through to get a diagnosis of #POTS, #MCAS, #SIBO and #tachycardia

read her story here

#MedEd #MedTwitter @MayoClinic
casereports.bmj.com/content/2018/b…
2. After suffering for 16 years, seeing 19 docs with repeated misdiagnosis:

Her cardiologist couldnt diagnose #POTS

Her gastroenterologist couldnt diagnose #SIBO

Her immunologist couldnt diagnose #MCAS

Her neurologist referred her to a #psychiatrist!

casereports.bmj.com/content/2018/b…
3. Patient: the "neurologist was out of ideas and suggested I get a psych evaluation, which I declined"

the patient <referred herself> to @MayoClinic

#SickNotWeak #chronicillness #chronicpain #MedEd #medtwitter

casereports.bmj.com/content/2018/b…
Read 10 tweets
@McLNeuro @DrAilshire @JMGrohNeuro @sbarolo @hormiga @risss_evans @KKTreseder @SarahEMyhre @batssiki @sbrietz Set up ways to continue dialogue with @NIHDirector & committee–ongoing conversation & input. Action plan before you leave. Also make clear any further delays are unacceptable. Action plans, strong regulations/policies must be instituted immediately. Petition is excellent example.
@McLNeuro @DrAilshire @JMGrohNeuro @sbarolo @hormiga @risss_evans @KKTreseder @SarahEMyhre @batssiki @sbrietz @NIHDirector 1- Many excellent thoughts/suggestions in thread. We thought a list of comments/support/urgency from many sectors may be useful. Concerning that @NIHDirector has not made clear, active efforts to stop #SexualHarassment by @NIH grant holders while @NSF & other orgs have.
@McLNeuro @DrAilshire @JMGrohNeuro @sbarolo @hormiga @risss_evans @KKTreseder @SarahEMyhre @batssiki @sbrietz @NIHDirector @NIH @NSF 2- Why isn’t #SexualHarassment a top #NIH priority. Why the resistance to actively creating strong policies against #SexualHarassment to protect #WomenInMedicine #WomenInScience #WomenInSTEM #WomeninEngineering, even when called out repeatedly by many. What’s the real issue here?
Read 16 tweets
1/ #medtwitter if you care about #metoostem #meded #equity #burnout please follow along. Gender violence is pervasive in medical training.

bit.ly/2FBkNGG

#sciencetoo #meded #medtwitter #medtoo #timesup #beethical #heforshe #timesup
2/ “…we may hear and intimately know the experiences of gender violence, but we are unable to share. Our voices are trapped and silenced, exacerbated by the hierarchical and apprentice-based training environment.." bit.ly/2FBkNGG
3/ Over 50% of medical students experience sexual harassment from faculty and staff. The people who are entrusted to teach us how to be physicians.
Read 11 tweets
Hepatopulmonary Syndrome - or is Portopulmonary hypertension? What’s the diff (brief #tweetorial)
Pulm complications of #cirrhosis can be devastating. This month on rounds, I was reminded that these conditions are confusing.
#meded
Step 1:
Recognize when a pulmonary complication could be present or clinically important (4 transplant)
This is how they looked when first described:
1. Portopulmonary: Dyspnea without hypoxia (Fig 1)
2. HPS: Hypoxia (Fig 2)

Step 2:
TTE (Fig 3)
Ordering "agitated saline" echocardiography will always be funny

TTE▶️most sensitive way 2 dx HPS(Fig1)
The bubbles dont go right▶️left immediately (like with septal defects) but do after a few heart beats
Bonus: do not rely on pulse ox!(Fig2)
Screen or go 2 TTE on by symptoms
Read 8 tweets
@RichDuszak 1- MT @Aiims1742 “This @katekelly article reads like a paid infomercial for EPIC (in fact, I actually looked for the “This is an advertisement” disclaimer). Would have been nice to have interviewed one or two end users of the chocolate factory product.”
nytimes.com/2018/12/20/bus…
@RichDuszak @Aiims1742 @katekelly 2- Nice digs, clever marketing spin, BUT Epic highly disliked by users. #EHR has significantly disrupted relationships w #patients, #ptexp, led to clinician & pt dissatisfaction, & is seen as one cause of #burnout. @JackMurtha hcanews.com/news/ehrs-are-… @BarbaraMcAneny @meggerber
Read 22 tweets
Are you still shaking off the holiday? I know I am!

How about a #cartooncausalinference #tweetorial about casual graphs to ease us into the new year?

#epitwitter #DAGsfordocs #FOAMed #MedEd #statstwitter #econtwitter
The most common type of causal graph (at least on #epitwitter) is the directed acyclic graph, or #DAG.

DAGs have two main components: variables (also called nodes), and arrows (also called edges).

In the DAG below, there are 3 variables: sleeping, Santa, and presents.
The variables are ordered based on time — you have to go to sleep before Santa can come to your house & then he’ll leave presents!

Causation and time both flow in the direction of the arrows.
Read 24 tweets
I’d like to talk about the finances - and potential financial conflict of interest - at the National Board of Medical Examiners.

This is gonna be a long one - but thanks for hearing me out.

(Thread)
Yesterday, I started a discussion about how our focus on #USMLE Step 1 was hurting both undergraduate and graduate medical education.

It’s gotten a lot of attention, probably because I highlighted a comment from the CEO of the NBME that touched a nerve for a lot of you.
Beyond that quote, when I read the article, what struck me was this:

The CEOs of the NBME and FSMB expressed numerous concerns about adverse effects of making USMLE Step 1 pass/fail...

...but loss of revenue to the @NBMEnow was not mentioned.
Read 37 tweets
A thread.
So the @US_FDA @SGottliebFDA issued a warning re: Fluoroquinolones (FLQ) and aortic dissection (AD) or aneurysm (AA). Do FLQs cause AD/AA? Not really. Is there an association? Maybe. Let’s go throw the evidence and you can decide for yourself.
#CardioTwitter #MedEd
1/ Why was this association even studied? FLQ are known to be associated with Achilles tendon rupture, tendinopathy, retinal detachment. How? 1)decrease collagen synthesis and increase MMP (especially 2, 9) activity (among others). Aorta is affected by these processes
2/First study was published in 2015 using a national database in Taiwan. 1477 cases (662 AD, 850 AA) matched to 147 700 controls. There was signal of the association of FLQ and AD; rate ratio ranging 1.37 - 2.11 with any FLQ use (tinyurl.com/ybhcpexz)
Read 13 tweets
THREAD: Differential diagnosis of tachycardias can be tricky business! Here are some strategies to help keep you between the ditches. Hope you will like and share. #FOAMed #FOAMems #MedEd #CardioTwitter
1/ First let's look at the 2015 AHA ECC Guidelines tachycardia algorithm. It's fairly straight forward but there are some important concepts here that deserve some elaboration.
2/ In the first place we're asked to consider appropriateness of tachycardia for the clinical condition. This is really important! We don't want to attack the heart rhythm if it's a compensatory tachycardia! The second part causes a lot of confusion. What is significance of 150?
Read 29 tweets
@schnitzr This is absolutely appalling. Research shows responsible transparent non-stigmatized conversations around sexual health information and behaviors are essential to sexual public health. Joe Gow should be being heralded as a hero for breaking the barrier to discussion. #healthysex
@schnitzr The Need to Promote Sexual Health in America: A New Vision for Public Health Action ncbi.nlm.nih.gov/pubmed/28876308 #healthysex
@schnitzr Sexual Health in America: Improving Patient Care and Public Health jamanetwork.com/journals/jama/… "3rd, cuz STIs...R highly stigmatized conditions, use of a broader, sex-positive, health-focused framework...2 reduce stigma, fear, & discrimination assoc w/ these conditions." #healthysex
Read 12 tweets
A great case of bicuspid-associated aortopathy.
How common is aortic dissection in BAV? To date, many surgeons operate on patients with dilated aortas in the 4.5-5.0 cm range without concomitant severe valve disease. But, how about the evidence so far?
#cardiotwitter #MedEd
1) IRAD had 1.9% BAV patients in a 2006 report (out of 303 type A dissections)
ncbi.nlm.nih.gov/pubmed/16820599
2) GenTAC registry had 2 dissections / 772 BAV (follow-up 3.6 years, outcome ascertained in 88%)
ncbi.nlm.nih.gov/pubmed/27282895
Read 8 tweets
1/
Necrosis = cell death (unlike apoptosis, it does not occur naturally and is not programmed)

This short #Tweetorial shows you some of the histologic flavors of necrosis. The stain in each of these pics is hematoxylin-eosin (H&E)

#pathology #pulmpath #pathtweetorial
2/
First a question to test your knowledge. Necrosis with large numbers of neutrophils is called:
3/
And now a few examples. Necrosis in colorectal carcinoma is often described as “dirty” because it contains nuclear debris. This makes it look purplish instead of pink.

#gipath #MedEd
Read 14 tweets
[THREAD] Our tips on small bore chest tube placement for pleural effusion! Performed by a resident @BostonCityEM supervised by fellows @BUPulmonary. We'd love your input! Not a comprehensive guide. Made with written patient authorization. #meded #FOAMcc #pulmcc
For new large unilateral effusions such as this, we place a chest tube if fluid pH <7.2, glucose <60. Without fluid studies, we place a tube empirically if effusion is large, loculated, infected, or likely to reaccumulate- except CHF/fluid overload.
First step: ultrasound. We position the probe with marker to the head, as lateral as possible. Intercostals tend to sag as you move towards the midline, so you could hit them when going above the rib. Lateral access is safest.
Read 24 tweets
@McLNeuro @statnews "In stark contrast, the NIH has done essentially nothing to address gender violence committed by NIH-funded scientists"–@statnews YET in 5 yrs it's paid out almost $2 million 2 settle #SexualHarassment cases brt by scientists in its own labs! buzzfeednews.com/article/petera… #TimesUpNIH
Read 19 tweets
1/ A long thread on LifeVest. I promise it will be entertaining. If you find any inaccuracies please let me know.

Paper of VEST published here - will discuss background to WCD and #VEST but not the trial itself nejm.org/doi/full/10.10…
2/ In 2001, FDA gave approval to Lifecor for the first WCD. Later Lifecor was acquired by Zoll (2004 agreement, 2006 acquisition). Zoll maintains a registry for prescribed LifeVests. But lets go back to the FDA approval process.
3/ Lifecor presented 2 separate prospective studies to the FDA; WEARIT and BIROAD. FDA asked for both to be combined into 1 study, and each study representing a subgroup. A total of 289 patients were included.
Read 18 tweets
Curious about how #POCUS is taught? This #Tweetorial is for U
#Preview for #ASEchoJC 🔜9/4 8pm EST

Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri

#POCUS not 🐇🎩, not short #TTE
2/ Current #goals #Cardiac #POCUS #MedEd

(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills

(2) develop scanning techniques➡️ basic competence

(3) recognize & differentiate b/w normal anatomy & basic pathology
3/ When Do We Start? Prerequisite knowledge for #POCUS teaching

"priming effect" of preclinical education

Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC

Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
Read 10 tweets
There are no winners in the senseless withdrawal of Saudi residents and fellows from Canadian teaching hospitals, by @picardonhealth theglobeandmail.com/opinion/articl… via @GlobeDebate
Withdrawal of Saudi trainees exposes vulnerability of Canadian health care cmaj.ca/content/early/… via @CMAJ @drstanbrook #MedEd
Saudi medical trainees' recall sparks a crisis in Canadian hospitals thelancet.com/journals/lance… via @DrIvyBourgeault @TheLancet @jocalynclark
Read 7 tweets
Why is your pt's ALT (or AST) >1000?
A #livertwitter #tweetorial

Take-homes:
1. Top 3 causes of acute liver injury
2. I always say it's ischemic hepatitis; 50% of the time, I'm right every time

Brought to u by:
@tonybreu et al. What causes severe ALI?
cghjournal.org/article/S1542-…
The liver is awesome.

Yet its vocabulary is ... limited.

We can all tell when it is upset - high ALT, AST.

But that could mean anything!

So what's your specific patient's specific reason for high ALT?
First - a poll:
What's the most common cause of severe acute liver injury
(ALT or AST > 10xULN)?
Read 11 tweets
#PregnancyCardiology Primer courtesy of a fantastic lecture by Dr. Sabrina Phillips from Mayo Clinic. Follow the thread #ACCFIT s for a good overview of considerations. #FelllowsFirst #MedEd

How does plasma volume and erythrocyte volume change during pregnancy? 1/12
#PregnancyCardiology Primer

Other important factors in the cycle of volume expansion and decreased SVR
2/12

#FellowsFirst #ACCFIT
#PregnancyCardiology

Cardiac Output changes in Pregnancy

3/12

#FellowsFirst #ACCFIT
Read 12 tweets
1/n #Tweetorial: As an Assistant PD for @OHSUIMRes focused on scholarship, #medtwitter, & #hcsm (health care social media), I’m often guide residents and colleagues on how to best use Twitter for academics, networking, learning, etc...
2/n recently, while welcoming newbies (esp students) and “onboarding” them to #medtwitter & #hcsm, I was asked to put together advice for IM applicants on how to best use social media during application/interview season. I think this advice is applicable beyond IM, too.
3/n First, tell me about yourself:
Read 28 tweets

Related hashtags

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!