Discover and read the best of Twitter Threads about #PEARLS
Most recents (10)
Management of pregnant women with #SCD in high income countries with Dr. Eugene Oteng-Ntim (with the cutest intro from Dr. Eugenia Asare). Writing down the #pearls here so I can share with my patients for their future and so I can advocate for them. #ASH22 1/n
As we know, more low/not detectable AMH levels in women with #SCD. Know that preimplantation diagnosis and successful transfer is possible with data to support that. And many want #NIPT secondary to fear of amnio or CVS, which can be done. (w/ @Nonacus) #ASH22 2/n
What risks are we talking about in sickle cell disease and pregnancy? 1/4 of the patients in their cohort required transfusion during pregnancy and RR of preeclampsia is 2.43 and 3x risk of SGA, 4x risk of stillbirth. #ASH22 3/n 
International Affairs /1-1
#Myanmar #Burma 🇲🇲
Myanmar's Generals
Run A Nearly Sanction-Proof
BUSINESS EMPIRE
Long Before Seizing Control
Of The Streets
by @oanhha @jwf825
& Khine Lin Kyaw
MAY 11, 2021
["bloomberg.com/graphics/2021-…"]
en.m.wikipedia.org/wiki/Myanmar
#Myanmar #Burma 🇲🇲
Myanmar's Generals
Run A Nearly Sanction-Proof
BUSINESS EMPIRE
Long Before Seizing Control
Of The Streets
by @oanhha @jwf825
& Khine Lin Kyaw
MAY 11, 2021
["bloomberg.com/graphics/2021-…"]
en.m.wikipedia.org/wiki/Myanmar
International Affairs /1-2
#Myanmar #Burma 🇲🇲
- Area : 676.5K km²
- Population : 53.6 M
- Capital : #Naypyidaw
largest city : #Yangon
ETHNICS
- #Bamar 68%
- #Shan 9%
RELIGIONS
- #Buddhism 88%
- #Christianity 6.2%
- #Islam 4.3%
OFFICIAL LANGUAGE
#Burmese
en.wikipedia.org/wiki/Myanmar
#Myanmar #Burma 🇲🇲
- Area : 676.5K km²
- Population : 53.6 M
- Capital : #Naypyidaw
largest city : #Yangon
ETHNICS
- #Bamar 68%
- #Shan 9%
RELIGIONS
- #Buddhism 88%
- #Christianity 6.2%
- #Islam 4.3%
OFFICIAL LANGUAGE
#Burmese
en.wikipedia.org/wiki/Myanmar
International Affairs /1-3
#Myanmar #Burma 🇲🇲
ECONOMY
- GDP (PPP) : US$355 B
Per capita : US$6.7 K
- #InformalEconomy :
one of the biggest in the world
- Rich in precious stones :
#Rubies 90% of world's
#Sapphires #Pearls #Jade
- #Tourism
- #Agriculture
en.wikipedia.org/wiki/Myanmar
#Myanmar #Burma 🇲🇲
ECONOMY
- GDP (PPP) : US$355 B
Per capita : US$6.7 K
- #InformalEconomy :
one of the biggest in the world
- Rich in precious stones :
#Rubies 90% of world's
#Sapphires #Pearls #Jade
- #Tourism
- #Agriculture
en.wikipedia.org/wiki/Myanmar
Images of Infectious Diseases
GMS of sinus tissue of 20F with no PMH. She presented with fever and sinus pain. CT pansinusitis. Labs: WBC 1.7 ANC 0. Serum BDG and GM negative.
What is your differential diagnosis and empiric therapy? #MayoIDQ to follow...
GMS of sinus tissue of 20F with no PMH. She presented with fever and sinus pain. CT pansinusitis. Labs: WBC 1.7 ANC 0. Serum BDG and GM negative.
What is your differential diagnosis and empiric therapy? #MayoIDQ to follow...
2/
Histopath of surgically resected tissue shows fungal elements. You suggested Mucor/Rhizopus, Fusarium, Trichosporon.
Lack of serum BDG suggests Mucor/Rhizopus
The patient was started on AmBisome.
Few days later, the fungal culture of the same sinus sample shows (photo)
Histopath of surgically resected tissue shows fungal elements. You suggested Mucor/Rhizopus, Fusarium, Trichosporon.
Lack of serum BDG suggests Mucor/Rhizopus
The patient was started on AmBisome.
Few days later, the fungal culture of the same sinus sample shows (photo)
3/
#MayoIDQ Surgical debridement of the sinuses was performed plus liposomal Amphotericin B was initiated. Patient lives in rural MN and asks you if an oral option is available as step down Rx.
#MayoIDQ Surgical debridement of the sinuses was performed plus liposomal Amphotericin B was initiated. Patient lives in rural MN and asks you if an oral option is available as step down Rx.
Weekend Digest
Giemsa stain of blood smear of a 50M who returned to the US after a 10-year missionary work in Mali and Senegal. He presented with episodic angioedema and eosinophilia.
Name the pathogen, its treatment and complication of Rx.
Giemsa stain of blood smear of a 50M who returned to the US after a 10-year missionary work in Mali and Senegal. He presented with episodic angioedema and eosinophilia.
Name the pathogen, its treatment and complication of Rx.
2/
#Loa loa
Bite of chrysops deer fly
Larva migrates in tissues; matures into adult worm in 5 months, and live for 20 years.
Adults produce microfilaria that gets into lymphatics / blood —> tissues. Microfilaria does not mature into adult but lives for a year.
#Loa loa
Bite of chrysops deer fly
Larva migrates in tissues; matures into adult worm in 5 months, and live for 20 years.
Adults produce microfilaria that gets into lymphatics / blood —> tissues. Microfilaria does not mature into adult but lives for a year.
3/
#Loa loa migrates in tissues
Most infected people ASYMPTOMATIC
1. Calabar swelling - transient localized, non-tender swellings usually on arms and legs and near joints
2. Eye worm - visible movement of adult worm across the surface of eye
3. Eosinophilia and pruritus
#Loa loa migrates in tissues
Most infected people ASYMPTOMATIC
1. Calabar swelling - transient localized, non-tender swellings usually on arms and legs and near joints
2. Eye worm - visible movement of adult worm across the surface of eye
3. Eosinophilia and pruritus
Images of Infectious Diseases
This is GMS stain and culture of a skin biopsy from a patient’s leg.
Who is the host? What is the syndrome? Name the pathogen. How to treat?
#MayoIDQ and case details to follow...
This is GMS stain and culture of a skin biopsy from a patient’s leg.
Who is the host? What is the syndrome? Name the pathogen. How to treat?
#MayoIDQ and case details to follow...
2/
66M. 4 mo after heart Tx: painless leg nodules that spread distally x 5 weeks. No pain. No fever.
PE unremarkable except lesions in left leg / foot + tinea pedis
Biopsy: GMS fungal elements in dermis. Culture: Trichophyton rubrum
What is true of this condition?
66M. 4 mo after heart Tx: painless leg nodules that spread distally x 5 weeks. No pain. No fever.
PE unremarkable except lesions in left leg / foot + tinea pedis
Biopsy: GMS fungal elements in dermis. Culture: Trichophyton rubrum
What is true of this condition?
3/
Case diagnosis:
#Majocchi’s Granuloma due to #Trichophyton rubrum
Histopath shows fungal elements (GMS) - not sufficient for identification.
Important: Send specimen for culture identification!!!
Treatment: Itraconazole Rx
Case diagnosis:
#Majocchi’s Granuloma due to #Trichophyton rubrum
Histopath shows fungal elements (GMS) - not sufficient for identification.
Important: Send specimen for culture identification!!!
Treatment: Itraconazole Rx
Images of Infectious Diseases
56M Mexico. Chronic abdominal pain, weight loss, anorexia.
Work up: elevated markers (CA19-9, CA-125, AFP). CXR normal. CT peritoneal carcinomatosis.
Laparoscopy (photo). Biopsy showed granuloma. What is your DDx? #MayoIDQ MCQ next...
56M Mexico. Chronic abdominal pain, weight loss, anorexia.
Work up: elevated markers (CA19-9, CA-125, AFP). CXR normal. CT peritoneal carcinomatosis.
Laparoscopy (photo). Biopsy showed granuloma. What is your DDx? #MayoIDQ MCQ next...
#MayoIDQ
Thank you for your responses.
Culture of tissue (peritoneal nodules) of this 56M (see prior tweet) with granuloma on biopsy: Mycobacterium tuberculosis complex. Resistant to pyrazinamide.
Which of these choices is the most likely mechanism of transmission?
Thank you for your responses.
Culture of tissue (peritoneal nodules) of this 56M (see prior tweet) with granuloma on biopsy: Mycobacterium tuberculosis complex. Resistant to pyrazinamide.
Which of these choices is the most likely mechanism of transmission?
1/
Case diagnosis: Peritoneal #tuberculosis due to #Mycobacterium #bovis
Path: granuloma and positive #AFB stain
Culture: M tuberculosis complex
Clue: #PZA resistance —> THINK M. bovis
Reported by @GaboMotoa during his rotation in Mayo Clinic
doi.org/10.1002/ccr3.3…
Case diagnosis: Peritoneal #tuberculosis due to #Mycobacterium #bovis
Path: granuloma and positive #AFB stain
Culture: M tuberculosis complex
Clue: #PZA resistance —> THINK M. bovis
Reported by @GaboMotoa during his rotation in Mayo Clinic
doi.org/10.1002/ccr3.3…
A #practical topic for today. #Pregnancy changes things - but more so for our #neurology patients - or not? #pearls from the #EAN2020 #MedEd #MedTwitter #MedStudentTwitter #neurologyresident @EANeurology @WNGtweets
Let’s first address #multiplesclerosis. Patients get better in third trimester and 30% relapse #postpartum. Immune responses shifts to anti-inflammatory in 3rd trimester to accommodate fetus - #etcomehome - but rebounds after birth. #MedEd #doubledoc #AcademicTwitter
Continue #firstlineinjectables #glatiramer and #interferon - these don’t cause #teratogenicity. In flares, consider IVIG and PLEX. How about #steroids? Usually fine except in 1st trimester when they can cause birth defects #MedEd #MedStudentTwitter #MedTwitter
1/ Clinical #Pearls and summary of @NEJM #CPS:
"A Chilly Fever"
For full case: bit.ly/37Co43k
A young man presents in March w/ 1 week of fevers, shaking chills & severe headaches which peaked at night & defervescence by morning.
"A Chilly Fever"
For full case: bit.ly/37Co43k
A young man presents in March w/ 1 week of fevers, shaking chills & severe headaches which peaked at night & defervescence by morning.
2/ My initial approach to fever is as follows, and is adapted from Penn frameworks: med.upenn.edu/frameworks/fev…
#PEARL1: I always try to remember the importance of assessing:
1. Host: immunosuppressed?
2. Exposures: work, sexual, travel, animals, IVDU, food/water
#PEARL1: I always try to remember the importance of assessing:
1. Host: immunosuppressed?
2. Exposures: work, sexual, travel, animals, IVDU, food/water
3/ He recently traveled to Cape Cod + trip to Uganda 2 years earlier w/ appropriate vaccinations and adherence to malaria ppx. This impacts the DDx:
⬆️ Tickborne infection:
- Lyme disease
- Anaplasmosis
- Babesiosis
#Medtwitter, which infections do you a/w travel to Uganda?
⬆️ Tickborne infection:
- Lyme disease
- Anaplasmosis
- Babesiosis
#Medtwitter, which infections do you a/w travel to Uganda?
1/x Summarized #pearls from @NEJM CPS from 3/5/15. Diagnosis will be spoiled at the end! For full case: nejm.org/doi/full/10.10…
Patient presented with pruritus. An initial approach involves asking:
1. Is the process dermatologic?
2. Is the process due to a systemic illness?
Patient presented with pruritus. An initial approach involves asking:
1. Is the process dermatologic?
2. Is the process due to a systemic illness?
2/x Patient was found to have acute kidney injury, making uremia a likely cause of the pruritus.
Initial approach to AKI involves:
1. Pre-renal
2. Intra-renal
3. Post-renal
Framework from @runthelistpod, also from Penn Frameworks: med.upenn.edu/frameworks/acu…
Initial approach to AKI involves:
1. Pre-renal
2. Intra-renal
3. Post-renal
Framework from @runthelistpod, also from Penn Frameworks: med.upenn.edu/frameworks/acu…
3/x
Patient had a FENa > 12%, fatty casts, no dysmorphic cells and 24h protein of 22g. This + hypoalbuminemia + edema → nephrotic syndrome.
Imagine of fatty casts: images.app.goo.gl/VjQZBhTSBjfb5z…
@CPSolvers schema for intrarenal AKI: clinicalproblemsolving.com/dx-schema-intr…
Patient had a FENa > 12%, fatty casts, no dysmorphic cells and 24h protein of 22g. This + hypoalbuminemia + edema → nephrotic syndrome.
Imagine of fatty casts: images.app.goo.gl/VjQZBhTSBjfb5z…
@CPSolvers schema for intrarenal AKI: clinicalproblemsolving.com/dx-schema-intr…
1/15 As promised, here is a summary of my presentation from today about “Using Your Phone for Lifelong Learning”
As a note, these slides are all hyperlinked instead of referenced and can be seen in full in the previous tweet.
As a note, these slides are all hyperlinked instead of referenced and can be seen in full in the previous tweet.
2/15 We started with our objectives for today. While the topic is huge, we focused on three things that have been instrumental in my education. Twitter, podcasts, and the Human Diagnosis Project.
3/15 I argued that these tools are not only useful, but also necessary! Medical knowledge is increasing too quickly for us to keep up, and using all our technology gives us an advantage at staying up to date.
Source: ncbi.nlm.nih.gov/pmc/articles/P…
Source: ncbi.nlm.nih.gov/pmc/articles/P…
