Discover and read the best of Twitter Threads about #Medtwitter

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"I love you."

I used to be very careful of my social interactions w my colleagues and juniors. Trying to stay conventional and safely within the limits of social propriety. Sure, we had fun together and rounds were always a jolly (albeit safe) riot.

That was pre-pandemic.
NOW I work with this amazing team of brilliant, hard-working and enthusiastic people.

NOW I end ALL my conversations with my fellow NICU colleagues( residents, nurses and NNPs) reminding them how much I love them.
Be it curbsides, middle of night consults or just plain everyday rounds.

And when I say I love you, I mean it from the bottom of my heart. And they respond in kind.

My revelation came when I was on vacation, and I missed- genuinely MISSED- every single member of my team.
Read 5 tweets
1/ #HerotoZero Health and care staff, demand FFP3 or down tools.

Do not risk your life or health. Employers have a legal duty under the Health & Safety at Work Act to provide safe working environments.

Protect yourself. No one will protect you if you fall. 👇🏼🧵
2/ You will not be protected if you fall unwell. Long COVID is growing in prevalence and is currently absent of treatment or cure. NHS workers who develop Long COVID will NOT be financially supported.…
3/ Failures in PPE policy and provision have, throughout this pandemic, placed the lives of health and care workers at risk.
Read 7 tweets
Ever wonder why tick bites can lead to a red meat allergy, including even anaphylaxis?

The answer requires us to examine sugars, tick saliva, and an anti-cancer drug.

#medtwitter #tweetorial
The first inclination that a link b/w tick bites and meat allergy might exist occurred in Georgia in 1991.

10 cases were reported (but not published) of people developing hives or anaphylaxis w/ red meat ingestion, weeks to months after tick bites.
A 2009 case series described 25 patients who developed red meat allergies 1-6 months after tick bites. Reactions to meat again ranged from urticaria to full anaphylaxis.

🔑There seemed to be a clear association b/w tick bites and meat allergy onset.
Read 19 tweets
My 6yr old had open heart surgery last year. As a paediatrician myself, stepping over onto the other side was hard.

5 things I learnt from being a parent on a paediatric ward.
A 🧵 /1
1. I have a name.
Being referred to as "mum" is fine, I get it and did it a million times, but there was one nurse who used my first name and it meant the world to me at a time when I felt really vulnerable.

I felt seen.

Learn parents' names and use them /2
2. Always acknowledge the patient & their family.
Whilst on ICU a group of 10 healthcare professionals did the ward round. They stood muttering at the end of the bed then walked off without explaining or acknowledging me. I left the unit & cried.

Families must come first. /3
Read 8 tweets
#Medtwitter friends: I've been having a blast on the BMT service with @c_j_gibson and planning next week's #bmtsm #leusm teaching theme:

📰 Why we do what we do in allogeneic transplantation for myeloid malignancies: Classic/Pivotal trials/papers.

Any you'd add/swap out?
1⃣ Chemo vs. Auto vs. Allo in AML

Cassileth PA et al. Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission. NEJM 1998…
2⃣ Donors - Related vs. Unrelated

Gupta V et al. Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis. Blood. 2010…
Read 10 tweets
10 years ago, Drs San Miguel, Merlini & I wrote that defining myeloma as myeloma only after end organ damage happened was like defining breast cancer as breast cancer only after metastatic disease occurred @NatRevClinOncol @mvmateos #MedTwitter…

2/ We proposed redefining myeloma. The International Myeloma Working Group agreed after studies to validate proposed biomarkers was completed. The new diagnostic criteria was published in 2014 in @TheLancetOncol

It now the 2nd most cited paper in myeloma…
3/ The updated criteria represent more that just the definitions outlined: it was a paradigm change that we can identify and treat myeloma before clinical end organ damage had occurred.

But the updated criteria applied only to 10-15% of patients who had smoldering myeloma.
Read 8 tweets
Help - wo kriege ich akut in Berlin (Süden) samstags Paxlovid her?

Symptomatische Covid Infektion und Risikopatientin.

1. Praxis kennt Paxlovid nicht und ich darf nicht kommen
2. Notaufnahme zwingt mich zu kommen aber stellt keine Rezepte aus.

#Berlin #medbubble #MedTwitter
Danke für die vielen Antworten!!!

Ich komm gar nicht hinterher - danke für die Sammlung, hoffe es hilft auch anderen.
Read 7 tweets
Thyronorm tablets, widely used brand of medicine for hypothyroidism, made into the list of "Not of Standard Quality" by Telangana Drug Control Authority, twice recently.

In one test it failed "identification and assay", meaning ...
Thryronorm didn't have the drug thyroxine as it is supposed to have, and in other test there were some issues with labeling of the dosage as well. 2/
Thyronorm is a brand of Abbot, a highly reputed International pharma company. But the name "abbot" doesn't appear in DCA entries, just say manufactured by "Acme Generics LLP" in Himachal Pradesh. Check your bottle of Thyronorm, "Marketed by" Abbot "Mfd by" Acme/someone else 3/
Read 7 tweets
Want to be busy early on in your surgical career?
Below is a 🧵 on how I was able to perform >1000 procedures in less than two years into being an attending.
Don't limit yourself to a single method of intervention!
I perform endoscopy, open, laparoscopic, robotic assisted surgery.
This allowed me to ramp up my practice, as I was able to offer various services to my patients and not refer them.
Try to schedule same types of cases in a day. For example multiple laparoscopic cholecystectomy.
You will get quicker as the day goes on, this builds muscle memory for you, makes your team more efficient.
Read 16 tweets
1/ I absolutely cannot convey the importance of the #LongCOVID community & the #pwME community working together to advance the science & understanding of both of these conditions. The faster that happens, the faster we can advance treatment options of both and alleviate suffering
2/ In this moment, there is tremendous power in these communities to advocate for care.

There is a hard won *decades long* wisdom from the #pwME community that #LongCOVID patients will only benefit from.

This data has been underfunded and understudied for just as long.
3/ The clinicians who research and specialize in these patients are FEW, probably less than 20 in the entire country.

#LongCOVID further compounds the problem of there simply not being enough clinicians to take care of all the people suffering.
Read 20 tweets
🧵 A simple and effective way to get COVID-19 vaccine hesitant patients immunized.

The overwhelming majority of people still not vaccinated are not staunch anti-vaxxers, they’re understandably confused given the massive ongoing disinformation campaign. 1/6
Tell your patient “Honestly, there’s a lot of anti-vaccine nonsense flying around the internet and on social media,” and ask them what they’ve heard. Chances are it will be one or more of the following. 2/6 #MedTwitter Image
Next, tell them “There’s a small group of incredibly unethical doctors spreading lies about the vaccines, and then they invite people to make telemedicine appoints and sell them bunk medications that don’t work on COVID. It’s a scam.” 3/6
Read 6 tweets
Bilateral locomotor brachialis in a middle aged patient with severe hypertension and severe dizziness under eval ? post circulation stroke --> 280/170 mmg Hg (manually measured 4 times by 4 different people)

HTN is a killer!

Patient consent taken before recording and posting video on SM!
Read 5 tweets
Please, I beg you. I am a physician. I am so breathless. I have been ever so patiently waiting outside your pharmacy for the past 3 hours, and inside for the past 2. You told me you have a spacer, could I please get it? I will pay out of pocket, any money you ask me. Please.
This is what I found myself saying, calmly, whispering as loud as I could, in between short breaths, to the pharmacist across the thick plastic shield. I know their day was tough. I had been there to witness half of it. I didn't want to be the 100th asshole to them that day.
This wasn't their fault.

But I really needed a spacer. A thin plastic tube that let's me inhale my asthma medicine when my asthma is at its worst and I can't coordinate my breaths with the actuation( pressing) of the inhaler.

"Sorry, can't give you one without ur PMD's orders"
Read 16 tweets
Just a surgical case discussion-

57/M came with C/o leaking urine from his operated site since 2 days.
Burning Micturition & a foleys in situ

History- pt was operated by an AYUSH person for laparoscopic right inguinal hernia 5 years ago, which failed
So he got operated for the same I.e open right inguinal hernioplasty 2 years later (with honestly the most horrible incision) after this surgery patient develops a swelling on the OP site after 3 years (now this is the recent history)
Now he developed a swelling at op site around 1 month from presenting complaints which was painful & was excised by the same person following which pt developed UTI & pt was catheterised & caused injury to urethra
Read 12 tweets
A patient comes in with joint pain, fever, and the skin findings below. They recently finished a course of antibiotics.

Diagnosis? Name of the skin findings?

#dermtwitter #medtwitter #meded #FOAMed
Nice work everyone!

The skin findings are keratoderma blenorhagicum (KB) and erythema nodosum, both findings that support the diagnosis of reactive arthritis.

Remember this is a seronegative spondyloarthropathy, usually after a gu or gi infection. Think hla-b27.
As @ZachHopkinsMD points out, there are more skin findings, such as mucosal findings in the oropharynx and in the genital region, & dactylitis (📸 is from psoriasis).

Don’t forget the board exam mnemonic:

Can’t pee (urethritis)
Can’t see (uveitis)
Can’t climb a tree (arthritis)
Read 3 tweets
1/ Time for another illustrative learning case in the form of a 🧵#tweetorial #medtwitter #neurotwitter #neurocriticalcare #neurology. Case deidentified as always
2/ Young human with no medical history but IVDA (heroin, cocaine, PCP) with multiple prior overdoses and recent discharge from drug rehab 2 days prior who presents to #ED after acting funny
3/They were noted to be lethargic, GCS 13, not able to provide history. CT demonstrates cerebellar edema with #hydrocephalus (💧) and some ⬆️ transtentorial 🧠 herniation
Read 21 tweets
It's surreal to read what has likely caused my severe, suffocating, debilitating #LongCovid breathlessness for 2 years.

"A team of researchers zeroed in on microscopic abnormality the way oxygen moves from the lungs into the blood vessels of LC patients"…
“'Those feelings of breathlessness are completely consistent with our finding that we’re not moving the oxygen as efficiently as we should'

Many #LongCovid sufferers have been stumping Docs as to what’s wrong with them.. routine clinical tests come back with normal readings."
"Using an MRI technique five times as sensitive and has five times the spatial resolution of a CT scan, the researchers were able to see how tiny branches of air tubes in the lungs were moving oxygen into the red blood cells of their patients."
Read 11 tweets
You may have heard of the recent spate of hospitalizations linked to Daily Harvest ready-to-eat lentil/leek crumbles.

The exact cause remains a mystery, but several theories are swirling around. I'd like to explore a few of them. (1/n) 🧵⬇️

#ToxTweets #FOAMed #MedTwitter
Anecdotal reports on Twitter and Reddit share common elements. People:

1) Ate the lentil crumbles;

2) Rapidly developed severe stomach pain, dark urine, itchiness;

3) Had symptoms/labs consistent with acute liver failure (ALF) on hospitalization. (2/n)
The product has since been voluntarily recalled, and the FDA is currently investigating potential causes. Most speculation currently centers around a few possibilities:

1) Lectins
2) Aflatoxins
3) Other Pathogens

I'll mainly focus on the first two for this thread. (3/n)
Read 26 tweets
12 Principles for rounding and case presentations for medical students,

residents, and attendings who are forever residents at heart

Whether you are presenting to the attending or calling in a consult,

it is your responsibility to convince
Where is this going?

Are you lost?

I am!
Read 21 tweets
1/Do radiologists sound like they are speaking a different language when they talk about MRI? T1 shortening what?T2 prolongation who?
Here’s a translation w/a #tweetorial introduction to MRI
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres @MedTweetorials #neurosurgery Image
2/When it comes to bread and butter neuroimaging—MRI is definitely the butter. Butter makes everything taste better and packs a lot of calories. MRI can add so much information to a case Image
3/In fact, if CT is a looking glass into the brain—MRI is a microscope. It can tell us so much more about the brain and pathology that affects the brain. So let’s talk about the basic sequences that make up an MRI and what they can show us. Image
Read 22 tweets
Reminder for our new resident peers:

If you find yourself in the role of a consultant, be kind. The person paging you is asking for help from you, the expert. It's an opportunity to help & educate.

Remember how nervous you might've been the 1st time you called a consult!
Yes, all those "silly consults" add up to be more work. But remember, you are the expert now, and what is "silly" to you may be truly confounding to the primary team. Something that might seem so simple to you is only that way because of your training, and that's pretty great.
I still remember the times I got annoyed or angry about a "silly consult." Without fail, I always regretted how I reacted on the phone. It's so much easier to be kind, than to apologize later. You are serving as an ambassador for your specialty to the rest of the hospital!
Read 4 tweets
What's going on with the Impella?

As a follow up to my previous #tweetorial on the IABP, this🧵 will explore the nuts and bolts of the Impella for those in the CCU

Special thanks to @AHajduczok for helping with this🧵.
#medtwitter #cardiotwitter
@AHajduczok Learning objectives:
💔 history of the Impella
💔 learn how it works
💔 how to troubleshoot when it doesn't work
@AHajduczok The Impella is based on concept from Egypt in the 3rd Century BC

The Greek mathematician Archimedes, developed a machine to raise water up while in Egypt. The machine consists of a screw within a hollow cylinder that transfers water upwards by each segment of the screw.
Read 25 tweets
(1) The Oklahoma Public Health Lab is on life support. Federal investigations with major deficiencies, last in the nation variant testing, “withdrawn”accreditation, massive false +’s on newborn testing, and the only state lab that can’t do bioterrorism and TB testing. #Oklahoma
(2) The #Oklahoma Public Health Lab is a shell of its former self, when it was located in #OKC. Below is a list of testing they now have to outsource to other labs because they don’t have enough lab workers to do them. 👇 ImageImage
(3) Moving the Oklahoma Public Health lab in the middle of a pandemic, with no input from #okleg, and with unified opposition from the entire medical community was one of the most damaging moves to the health of Oklahoma in the last decade.
Read 12 tweets

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