Discover and read the best of Twitter Threads about #Pulmonary

Most recents (16)

Do you have an undiagnosed patient despite exome sequencing? 🤔

It could be a repeat expansion disorder.

Here are 5 scenarios that should make you think of a repeat expansion disorder in adults. 🧵

#GeneChat #MedTwitter
A 21 y man with slurred speech who is experiencing difficulty with coordination and balance over the last several years. He fatigues easily.

Diagnosis: Friedreich's ataxia
Genetics: GAA repeat expansion in the 1st intron of FXN
Inheritance: Autosomal recessive

A 25 y woman with hot flashes and irregular menses over the last several months (early menopause).

Diagnosis: Fragile X-associated primary ovarian insufficiency (FXPOI)
Genetics: CGG repeat expansion in the 5' UTR of FMR1
Inheritance: X-linked

Read 7 tweets
1/4 "In this cohort study, more #severe acute illness, a higher #Charlson #Comorbidity #Index score, and being #unvaccinated were associated with a higher risk of reporting #COVID19 symptoms lasting 28 days or more."

#Unvaccinated and #immune naive or #convalescent?
2/4 "Participants with #COVID19 were more likely to seek medical care for #diabetes, #pulmonary, #neurological, and #mental health–related #illness for at least 6 months after onset compared with their pre-#COVID #baseline health care use patterns."
3/4 "These findings may inform the risk-benefit ratio of COVID-19 #vaccination #policy."

#SARSCoV2 #CovidIsNotOver #PASC #LongCovid

All were not checked for viral reservoirs and/or persistence, not tested in upper and lower respiratory tract and in the gastrointestinal tract.
Read 4 tweets
Sehr aktueller Preprint zu #longcovid und #Genalayse und #GProteinGekoppelteRezeptoren

Kurze Zusammenfassung / Short summary of this data analysis

Long COVID: G Protein-Coupled Receptors (GPCRs) responsible for persistent post-COVID symptoms…
Durch computergestützte Methoden wurden 255 #LongCOVID-#Symptome analysiert und die dazu relevanten Gene identifiziert.

This work utilised computational methods to analyse the persistence of COVID symptoms after recovery and to identify the relevant genes.
Protein-protein interaction network overview. Nodes = proteins, edges represent the interaction between two nodes (proteins). The top 10 key hub #genes of 255 symptoms of #longcovid are related to G-protein coupled receptors shown in circular nodes in pink.
Read 11 tweets
This important study found a significantly elevated frequency of #SARS-CoV-2-specific TNF-α-producing CD8+ T cells in patients with pulmonary #LongCovid (PASC). PASC subjects experienced an average symptom duration of over 6 months:…
2/ This is how the authors interpret the finding: "This increased frequency could be detected in response to peptide pools of all the #viral structural proteins in comparison to the resolved #COVID-19 (RC) cohort.
3/ Interestingly, these T cells were also significantly higher in female PASC participants compared to males, which may contribute to the higher prevalence of PASC in #women
Read 10 tweets
Do you know all of these nuances of #pleuraldisease? Why is an #empyema distinct from a complicated #parapneumoniceffusion? What is #contarinisyndrome #explosivepleuritis #chyliform #pseudochylous? Are all #chylothorax milky? #pccm #pulmcrit #pulmonary
#pleuraldisease is fascinating and nuanced. First step is #lightscriteria which give favor to finding #exudates which tend to be more urgent. You only need one criterion, which maximizes #sensitivity. Meaningless statement: "It's an exudate only by protein." One criterion=exudate
(Like on Tinder, the more criteria you require, the more you narrow your pool, compromising sensitivity for specificity.) Transudates I will skip over. Most common #exudate is #parapneumoniceffusion #PPE. If there is or is likely to be #pneumonia, it's PPE. Next task is to...
Read 26 tweets
Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_CE. #Emergencymedicine #thrombosis researcher @md_pollack will be discussing safe, effective management of selected patients with venous thromboembolism (#VTE) from the #emergencydepartment.
It used to be SOOO much more complicated, but since we entered the era of the #DOACs, #lifeisgood! #Physicians #nurses #pharamcists all work together to make it happen, and all can earn CE/#CME here! @AlexSpyropoul @ScottKaatz @RenatoDLopes1 @GenoMerli @aakonc @vic_tapson
1) Welcome to a #tweetorial on the safe and effective management of acute venous #thromboembolism (#VTE) directly from the #emergencydepartment. This program is accredited for 0.50 credits for #physicians #nurses #pharmacists by @academiccme! I am @md_pollack. Image
Read 23 tweets
H pylori #tweetorial for resistant H pylori
#AGA released CPU in 4/21 revisiting topic of resistance/treatment failures, not a guideline, but the expert opinion @BradSpellberg loves! (1/x)…
@ABsteward @RushCCH_ID #MedEd #medtwitter #idtwitter
As GN bacteria go, it's an interesting bug:
Highly motile, curved, GNR, #Urease-positive, catalase-positive, oxidase-positive
Related to Campylobacter, for family fun
Nice crossover with our #Gastroenterology colleagues, eh #IDtwitter and @IDSAInfo
GN, and as such should be sensitive to most #antibiotics that target GN with pretty good susceptibilities over time for:
#amoxicillin #tetracycline #aminoglycoside #nitroimidazole #macrolide
Read 25 tweets
1/ After having so much fun during my #Pulmonary consults block, I decided to put together some of my favorite reads during this rotation. No specific order, a mix of guidelines, reviews, and trials that I found helpful. #Sharingiscaring
2/ Cavitary Lung Diseases: A Clinical-Radiologic Algorithmic Approach - @journal_CHEST -

An algorithmic approach for the evaluation of cavitary lung disease; full of CT-images, definitions, and important clinical aspects.
3/ High-Resolution CT of the Lung: Patterns of Disease and Differential Diagnoses -

A Bible during my consult rotation, a comprehensive combination of HRCT with pathology of an infinite numerous of lung diseases. Great resource to build differentials.
Read 23 tweets
This is a very late #WeekendLecture
but you can review it anytime you want😉
🧠#Aneurysm & #Subarachnoid Hemorrhage
Unruptured intracranial aneurysms are pathologic dilations at major branching brain arteries
~3% of adult population…… Image
#Aneurysms & #SAH
The most common presentation of intracranial aneurysm is rupture leading to #SAH
The risk of rupture depends on patient and aneurysm related factor, ie: age/gender/location/size/growth, etc
🧠… Image
#Aneurysms & #SAH
It is well known that endovascular or neurosurgical management of #unruptured intracranial aneurysm is not free of procedural #complications
This study investigates risk factors for this complications @JAMANeuro
👇… ImageImage
Read 10 tweets
Hey #MedTwitter!!
This morning at our VA we had Chief @photon_ick give us a case of #ChronicSOB, where it turned out that the patient had #ABPA (#allergic bronchopulmonary #aspergillosis). It's a diagnosis we don't see too often, but one you'll definitely encounter here!! 🗝️👇
This is an #allergic condition, with 2 main predisposing conditions: #asthma & #cysticfibrosis
It can be more rarely seen in other lung disease/immunodeficiencies, but without the right lung environment like this, it is almost NEVER seen!!
There is no universally accepted criteria, but the #ISHAM criteria is often used. Let's check it out!

Traditional obligatory criteria:
- Serum #IgE RAST >0.35 OR Allergic Skin Testing (+) to A. fumigatus
- Total Serum IgE >1000 Image
Read 6 tweets
Learned about Paradoxical Vocal Fold Dysfunction for the first time today, figured I'd share a few pearls!

#MedTwitter #MedStudentTwitter #pulmonary
PVFM is defined by recurrent closure of the vocal folds during inspiration. Remember to accurately breath, we need to normally have abducted vocal folds, cause otherwise there is no air passing distally. Image
Its etiology is not specifically known as a functional disorder, but some triggers are:
▶️Airway Irritation via Trauma or Asthma
▶️Neurologic Disease
▶️GERD or Larygnopharyngeal Reflux
▶️Medications: EPS are associated (acute dystonia being a common link)
Read 11 tweets
#Pulmonary Hypertension (pHTN) can really take your breath away!

For today's #MTC, Chief @photon_ick, PGY3 Dr. Armando Martinez, & #CTEPH expert Dr. Demos Papamatheakis reviewed a super cool case of a legit #SPY diagnosed with pHTN & CTEPH, flown to #UCSD for management!
1. pHTN is increased pressure in the #pulmonaryarteries
2. Most common symptoms include: EXERTIONAL #dyspnea, fatigue, pleuritic chest pain, and even #hemoptysis🩸
3. It's typically diagnosed on #ECHO showing dilated arteries, right❤️strain, & elevated RV systolic pressure!
4. There are 5 #WHO Classes of pHTN, distinguished based on physiology and treatment options:
1⃣ Pulmonary Arterial Hypertension
2⃣ pHTN 2/2 LV failure
3⃣ pHTN 2/2 Respiratory/Lung disease
5⃣ Other causes Image
Read 7 tweets
Here's another #Pulmonary teaching case: #FOAMed

A middle aged woman presents with many months of pleuritic chest pain and dyspnea. PFTs and CXR are shown (current CXR on right, prior from 5 yrs ago on left). DLCO is normal. HRCT shows no parenchymal lung disease.
1/ Chest radiographs from 3 ye...Pulmonary Function Test (PF...
Which of the following co-morbid conditions might explain the abnormal CXR and PFT findings:

Shrinking Lung Syndrome (SLS) is a rare complication of SLE or occasionally other #autoimmune/#rheumatologic conditions.

SLS is characterized by a triad of dyspnea, pleuritic chest pain, & progressive decrease in lung volumes w/o interstitial disease.

Here are her serologies
3/ Results of autoimmune testi...
Read 6 tweets
Non-COVID #pulmonary teaching: a young man recently diagnosed with asthma comes to clinic with progressive dyspnea on exertion. Despite treatment with an inhaled corticosteroid (ICS) & short acting bronchodilator (SABA), he feels worse. CXR & spirometry are shown. #FOAMed
1/ Pulmonary Function Test (PF...Chest radiograph: Posterior...Chest radiograph: lateral
What would you like to do next?
The key to this case is recognizing a distinctive abnormality in the flow-volume loop, specifically the truncation of both the inspiratory & expiratory flows.

This is characteristic of a fixed obstruction, which can occur with external compression or stenosis of the trachea.
3/ Enlarged flow volume loops ...ICU OnePager describing pat...
Read 10 tweets

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