Discover and read the best of Twitter Threads about #Rheumtwitter
Most recents (24)
🫁How to interpret pulmonary function tests ??🫁
I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists
(1/7)
#MedTwitter #RheumTwitter #MedEd
I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists
(1/7)
#MedTwitter #RheumTwitter #MedEd
1️⃣Is the test valid?
You need to check for three things
🌬️ Effort
✅The time volume curve forms a plateau in 1-2 seconds
✅ sustained expiration for 6 seconds!
(2/7)
You need to check for three things
🌬️ Effort
✅The time volume curve forms a plateau in 1-2 seconds
✅ sustained expiration for 6 seconds!
(2/7)
➰Flow loops
✅ for artefacts/abnormalities 📷⤵️
(3/7)
✅ for artefacts/abnormalities 📷⤵️
(3/7)
🔹Relapsing Polychondritis🔹
Important takeaways from an excellent presentation by @Lupusreference @eular_org #EULAR2023
#MedTwitter #RheumTwitter
Important takeaways from an excellent presentation by @Lupusreference @eular_org #EULAR2023
#MedTwitter #RheumTwitter
🔹Rare disease
🔹Middle aged adults
🔹No♀️ predominance
👂👂👂👂
It's typically characterized by:
🥵Red/swollen
👂Spares the lobule
🤕Painful
⏳lasts >48 hrs
❌ ear discharge (infection)
❌ necrosis/purpura (CAPS)
📷⤵️Prone to erroneous diagnosis!!
🔹Middle aged adults
🔹No♀️ predominance
👂👂👂👂
It's typically characterized by:
🥵Red/swollen
👂Spares the lobule
🤕Painful
⏳lasts >48 hrs
❌ ear discharge (infection)
❌ necrosis/purpura (CAPS)
📷⤵️Prone to erroneous diagnosis!!
Once 👂chondritis is confirmed, rule out mimics!
Back to basics‼️
A tweetorial on a clinical approach to #joint #pain 🪡
1/n
The 🔠ABCDE approach
🅰️ Articular (or not!) 🦴
🅱️ Background (& burden) 🎒
C Chronology 🕰️
D Distribution 📍
E Extra-articular 🍂
Let’s dive deeper
#MedTwitter
#RheumTwitter
A tweetorial on a clinical approach to #joint #pain 🪡
1/n
The 🔠ABCDE approach
🅰️ Articular (or not!) 🦴
🅱️ Background (& burden) 🎒
C Chronology 🕰️
D Distribution 📍
E Extra-articular 🍂
Let’s dive deeper
#MedTwitter
#RheumTwitter
2/n
#Pain is #inflammatory if worst in the AM/ after rest
#Swelling which is not bony #Synovitis the sine qua non of #inflammatory #arthrits
#Stiffness esp in AM & > 1 hour
“How do you feel when you wake in the morning?”
is a great question to ask
#MedTwitter
#RheumTwitter
#Pain is #inflammatory if worst in the AM/ after rest
#Swelling which is not bony #Synovitis the sine qua non of #inflammatory #arthrits
#Stiffness esp in AM & > 1 hour
“How do you feel when you wake in the morning?”
is a great question to ask
#MedTwitter
#RheumTwitter
3/n
🅱️ = BACKGROUND
Age 🕰️
Gender ♈️♎️
Race 🧕🏻
#Comorbidities
Pregnancy🤱🏻
And 🅱️ = Burden👩🏻🦼
#impact of disease
#MedTwitter
#RheumTwitter
🅱️ = BACKGROUND
Age 🕰️
Gender ♈️♎️
Race 🧕🏻
#Comorbidities
Pregnancy🤱🏻
And 🅱️ = Burden👩🏻🦼
#impact of disease
#MedTwitter
#RheumTwitter
Doctor: Where is the pain?
Patient: Pain pain everywhere!
❔How do we approach a patient with multiple joint pains❔
(1/12)
#polyarthritis #MedTwitter #MedEd #RheumTwitter
Patient: Pain pain everywhere!
❔How do we approach a patient with multiple joint pains❔
(1/12)
#polyarthritis #MedTwitter #MedEd #RheumTwitter
1️⃣ Is it polyarthritis?
First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING
& NOT 🚫
🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Myalgia
🔹Bone pain
🔹Neuropathic pain
Let's deal with polyarthritis ⏬
(2/12)
First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING
& NOT 🚫
🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Myalgia
🔹Bone pain
🔹Neuropathic pain
Let's deal with polyarthritis ⏬
(2/12)
2️⃣ Is it acute or chronic??
Acute<6 weeks
🔹 Infections- gonococcal, infective endocarditis, rheumatic fever, lyme disease, viral
🔹Elderly RA, ANCA vasculitis, paraneoplastic
(3/12)
#MedTwitter
Acute<6 weeks
🔹 Infections- gonococcal, infective endocarditis, rheumatic fever, lyme disease, viral
🔹Elderly RA, ANCA vasculitis, paraneoplastic
(3/12)
#MedTwitter
It's a purpuric rash. The two most important DDs are:
🔹Small vessel vasculitis (lupus, ANCA, cryoglobulinemia etc) ♨️
🔹Infective endocarditis (janeway lesions) ❣️
Bleeding disorders often affect areas where the skin is soft and loose rather than the soles
🔹Small vessel vasculitis (lupus, ANCA, cryoglobulinemia etc) ♨️
🔹Infective endocarditis (janeway lesions) ❣️
Bleeding disorders often affect areas where the skin is soft and loose rather than the soles
Other causes of palmoplantar rash
1️⃣Infections- maculopapular, blanching
🔹Viral eg parvovirus, coxsackie, measles
🔹Bacterial- menigococcimia (purpuric, non blanching), syphilis (2°)
🔹Rickettsia- RMSF
#MedTwitter #MedEd
1️⃣Infections- maculopapular, blanching
🔹Viral eg parvovirus, coxsackie, measles
🔹Bacterial- menigococcimia (purpuric, non blanching), syphilis (2°)
🔹Rickettsia- RMSF
#MedTwitter #MedEd
#Neuro manifestations in #Sjögren’s are common, present in nearly 20% (❗️), and 4M are estimated to have Sjögren’s in the US.
Neuro-Sjögren’s is poorly understood and underrecognized, and you’ll miss it if you aren’t looking for it. 🫣
But how do you find it❓
Neuro-Sjögren’s is poorly understood and underrecognized, and you’ll miss it if you aren’t looking for it. 🫣
But how do you find it❓
You’ve got to know the neurologic phenotypes.
What are they? Let’s see how well you know them ⬇️
What are they? Let’s see how well you know them ⬇️
What’s the most common neurologic manifestation?
😣Patient: "All my joints are painful & swollen!"😣
👩⚕️But when you examine the patient, you don't find any joint swelling
How to approach this scenario? 🤷
#MedTwitter #RheumTwitter #MedEd 🧵🧵🧵
(1/10)
👩⚕️But when you examine the patient, you don't find any joint swelling
How to approach this scenario? 🤷
#MedTwitter #RheumTwitter #MedEd 🧵🧵🧵
(1/10)
Now there are two possibilities
1️⃣ There was a joint swelling which is no longer there
OR
2️⃣ There was no joint swelling to begin with
(2/10)
1️⃣ There was a joint swelling which is no longer there
OR
2️⃣ There was no joint swelling to begin with
(2/10)
Let's start with the first one– there was indeed joint swelling which is no longer there
That means we are dealing with
☝️ An episodic inflammatory disease
✌️ Drug modified disease
(3/10)
That means we are dealing with
☝️ An episodic inflammatory disease
✌️ Drug modified disease
(3/10)
Rheumatoid factor
One of the most used & abused tests in #rheumatology
Let's learn a bit about its origin & utility!
#MedEd #MedTwitter #RheumTwitter
(1/15)
One of the most used & abused tests in #rheumatology
Let's learn a bit about its origin & utility!
#MedEd #MedTwitter #RheumTwitter
(1/15)
1️⃣ what is RF actually?🤷♀️
They are antibodies directed against the Fc fragment of IgG antibody
(2/15)
They are antibodies directed against the Fc fragment of IgG antibody
(2/15)
2️⃣ How & when was it first discovered?📆
1st described by Waaler in 1940, a factor present in 🚶♂️serum (in patients with RA & other diseases) that agglutinates 🐑 RBCs when sensitised with sub agglutinating doses of anti-🐑-RBC 🐰 immunoglobulin
onlinelibrary.wiley.com/doi/10.1111/j.…
(3/15)
1st described by Waaler in 1940, a factor present in 🚶♂️serum (in patients with RA & other diseases) that agglutinates 🐑 RBCs when sensitised with sub agglutinating doses of anti-🐑-RBC 🐰 immunoglobulin
onlinelibrary.wiley.com/doi/10.1111/j.…
(3/15)
Juxta-articular (near joint articulations) punched out erosions on the metatarsals is indicative of GOUT | (Gout = mostly toes)
1/6
#MedTwitter #RheumTwitter #neurotwitter #usmle
1/6
#MedTwitter #RheumTwitter #neurotwitter #usmle
Psuedogout presents with chondrocalcinosis (calcification of cartilages) | (psuedogout = mostly knees)
2/6
2/6
Chronic neuropathic (charcot) arthropathy presents in those with chronic diabetes and peripheral neuropathy.
Common signs on xray are :
1. Hour glass phalanges
2. Sucked candy apperance
3. Subluxation of several foot joints.
3/6
Common signs on xray are :
1. Hour glass phalanges
2. Sucked candy apperance
3. Subluxation of several foot joints.
3/6
DERMATOMYOSITIS (DM)
Let’s spend some time in this #tweetorial on the dermatologic manifestations of this potentially paraneoplastic disease!
First, a question: What is necessary to make a diagnosis of DM?
1/
Let’s spend some time in this #tweetorial on the dermatologic manifestations of this potentially paraneoplastic disease!
First, a question: What is necessary to make a diagnosis of DM?
1/
None of the above! DM is a clinical diagnosis, which is why getting the exam right is super important! That said a biopsy CAN help with getting to a diagnosis, but it’s not necessary.
So let’s start! Heliotrope rash! This poikilodermatous erythema occurs around the eyes.
2/
So let’s start! Heliotrope rash! This poikilodermatous erythema occurs around the eyes.
2/
Remember though that exams are different across skin tone. Heliotrope can look a lot more subtle in someone with more melanated skin. That rash can also include the rest of the face!
3/
3/
It's 🥶 & we're coming across many cases of peripheral ischemia/gangrene
🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑
🔁It's essentially a demand≠supply mismatch
#MedEd #MedTwitter #RheumTwitter
🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑
🔁It's essentially a demand≠supply mismatch
#MedEd #MedTwitter #RheumTwitter
The 📝 goes on & so that we can save ⏳ & 💰 on the tests, I like to broadly divide the pathology into:
1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia
2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)
3️⃣External compression
1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia
2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)
3️⃣External compression
Q1️⃣: How was the onset?
🐌Insidious onset, gradual progression is the most common
➡️peripheral vascular disease
➡️most vasculitides
➡️vasculopathy
#MedEd #MedTwitter
🐌Insidious onset, gradual progression is the most common
➡️peripheral vascular disease
➡️most vasculitides
➡️vasculopathy
#MedEd #MedTwitter
Lot of queries related to the classification criteria(CC) for #Sjogrens syndrome. Hence, this 🧵
The criteria are the result of a collaborative effort by researchers in the US & Europe.
PS:CC are for use in trials and not for clinical Dx
#MedTwitter #rheumtwitter
The criteria are the result of a collaborative effort by researchers in the US & Europe.
PS:CC are for use in trials and not for clinical Dx
#MedTwitter #rheumtwitter
While looking through case reports of #Sjogrens and renal tubular acidosis, came across a peculiar neurological demyelinating disorder...
A long 🧵
#rheumtwitter #neurotwitter #MedTwitter
A long 🧵
#rheumtwitter #neurotwitter #MedTwitter
Intriguingly, there were multiple reports of osmotic demyelination syndrome (ODS), aka central pontine/extrapontine myelinolysis.
#Sjogrens Syndrome - Year-end thoughts.
Ever since I have been a rheumatologist, I have always found diagnostic delay distressing, and perhaps nowhere is it as prevalent as in Sjogren's.
I am summarising some of my thoughts in a short-long🧵
Ever since I have been a rheumatologist, I have always found diagnostic delay distressing, and perhaps nowhere is it as prevalent as in Sjogren's.
I am summarising some of my thoughts in a short-long🧵
⭕️The experiences of the very brave and inspiring patients have brought the focus back on the diagnosis of #Sjogrens
⭕️Even in a tertiary care centre where there is so much focus on identifying #Sjogrens -the success of rheumatologist in making a provisional diagnosis of Sjogrens was only ~64.84%.
#MedTwitter #RheumTwitter
pubmed.ncbi.nlm.nih.gov/31328441/
#MedTwitter #RheumTwitter
pubmed.ncbi.nlm.nih.gov/31328441/
#Methotrexate is the nr1⃣drug of choice for Rheumatoid #Arthritis.
MTX's history is eventful, and deserves a 🧵
🔹It started with childhood leukeamia
🔹Sleeping Beauty in the 1960-70's
🔹Awakened by Hoffmeister
🔹FDA👍1988 and 🔝 in the 1990's
1/🧵 #RheumTwitter #MedTwitter
MTX's history is eventful, and deserves a 🧵
🔹It started with childhood leukeamia
🔹Sleeping Beauty in the 1960-70's
🔹Awakened by Hoffmeister
🔹FDA👍1988 and 🔝 in the 1990's
1/🧵 #RheumTwitter #MedTwitter
The start:
🔹1948, Dr Farber treated 5 children with #leukemia with Aminopterin, an anti-folate & precursor of #MTX, with outstanding results
🔹1951, first positive results of Aminopterin in #RA & #Psoriasis pts
Despite this, Aminopterin was aborted in RA
2/🧵 #RheumTwitter
🔹1948, Dr Farber treated 5 children with #leukemia with Aminopterin, an anti-folate & precursor of #MTX, with outstanding results
🔹1951, first positive results of Aminopterin in #RA & #Psoriasis pts
Despite this, Aminopterin was aborted in RA
2/🧵 #RheumTwitter
MTX enters:
Due to difficulties in manufacturing, Aminopterin was modified and MTX was created.
🔹1962, positive results with MTX in both RA and #PSA
🔹Next 10 years: MTX was extensively studied in #psoriasis but halted in #RA
🔹In RA, MTX becomes the Sleeping Beauty👸💤
3/🧵
Due to difficulties in manufacturing, Aminopterin was modified and MTX was created.
🔹1962, positive results with MTX in both RA and #PSA
🔹Next 10 years: MTX was extensively studied in #psoriasis but halted in #RA
🔹In RA, MTX becomes the Sleeping Beauty👸💤
3/🧵
Discussing problems unique to our region 🌍
🔘Kick-starting the South Asian Rheumatology Symposium with Prof. Syed Atiqul Haq joining us in spirit !
Vaccination in ##Rheumatology
#IRACON22 #vaccine
#RheumTwitter
@IndianRheum
🔘Kick-starting the South Asian Rheumatology Symposium with Prof. Syed Atiqul Haq joining us in spirit !
Vaccination in ##Rheumatology
#IRACON22 #vaccine
#RheumTwitter
@IndianRheum
Pneumococcal 'prime and boost'
🕜PCV13⏩ 8 ⏩ weeks PSV23
🕜PSV23⏩1 year ⏩PCV13
🔁Repeat PSV23 at 5 years and once after 65 years!
🕜PCV13⏩ 8 ⏩ weeks PSV23
🕜PSV23⏩1 year ⏩PCV13
🔁Repeat PSV23 at 5 years and once after 65 years!
👉 Recombinant zoster vaccine (shingrix)
👌immunity
🚫need for past h/o of VZV
2 doses:
first dose 2 weeks prior to immunosuppressant initiation
2nd dose 3 months after end of intensive immunosuppression/ drug holiday
👉Zostavax- more than 50 years if previous VZV exposure
👌immunity
🚫need for past h/o of VZV
2 doses:
first dose 2 weeks prior to immunosuppressant initiation
2nd dose 3 months after end of intensive immunosuppression/ drug holiday
👉Zostavax- more than 50 years if previous VZV exposure
Do you look at your rheumatic patients' tongues as part of your physical examination?
let's review the the tongue 👅 findings in rheumatic diseases in this thread 🧵
#RheumTwitter #MedTwitter
let's review the the tongue 👅 findings in rheumatic diseases in this thread 🧵
#RheumTwitter #MedTwitter
The prevalence of #rheumatoidarthritis 🌍 ~1%
🙀 So ~14 million suffer from RA!
So we 👩⚕️ have to deal with special situations while managing this fairly common disease!
#MedTwitter #MedEd #rheumatology #RheumTwitter
@MedTweetorials @nihardesai7
(1/9)
🙀 So ~14 million suffer from RA!
So we 👩⚕️ have to deal with special situations while managing this fairly common disease!
#MedTwitter #MedEd #rheumatology #RheumTwitter
@MedTweetorials @nihardesai7
(1/9)
Let's begin with one of the most beautiful miracles of life ☺️
#pregnancy in #rheumatoidarthritis
(2/9)
#pregnancy in #rheumatoidarthritis
(2/9)
🤔Is it safe to conceive for a patient with RA? 🤰
👉Overall it is safe ☑️☑️☑️
👉But a mild risk of hypertensive disorders, IUGR and need for caesarian section +!
(3/9)
👉Overall it is safe ☑️☑️☑️
👉But a mild risk of hypertensive disorders, IUGR and need for caesarian section +!
(3/9)
💭When we think of #Rheumatoid #Arthritis , a mental image of this comes up 👇
But does it have to get to this🤔???
🙅NO! Definitely, NO! 🙅
#MedTwitter #MedEd #RheumTwitter #Rheumatology
@MedTweetorials
(1/8)
But does it have to get to this🤔???
🙅NO! Definitely, NO! 🙅
#MedTwitter #MedEd #RheumTwitter #Rheumatology
@MedTweetorials
(1/8)
🪜The first step is early diagnosis, do not wait until the deformities to form!
💬Think of RA when a patient presents with
🔸Peripheral
🔸Symmetric
🔸Arthritis
🔸Morning stiffness>30 minutes
#MedTwitter
(2/8)
💬Think of RA when a patient presents with
🔸Peripheral
🔸Symmetric
🔸Arthritis
🔸Morning stiffness>30 minutes
#MedTwitter
(2/8)
🧪👨🔬A positive Rheumatoid factor is seen in ~70% of cases and anti-CCP in ~75% cases, so about 1/5th of the cases may be seronegative!!
So a good history and clinical examination is the king 👑
(3/8)
So a good history and clinical examination is the king 👑
(3/8)
INFLAMMATORY ARTHRITIS
it's a word we throw around a lot
What does it mean? How can you tell the different causes from one another?
a🧵
#meded #rheumatology #rheumtwitter #arthritis @VuMedi
it's a word we throw around a lot
What does it mean? How can you tell the different causes from one another?
a🧵
#meded #rheumatology #rheumtwitter #arthritis @VuMedi
Inflammatory arthritis just refers to:
🌟immune cell (typically innate) invading the joint space
🌟 typically neutrophils are the 1st to the scene of the crime
🌟immune cell (typically innate) invading the joint space
🌟 typically neutrophils are the 1st to the scene of the crime
Normal synovium has very few cells
if you tap a joint, and there is greater than 2,000 WBC, this is considered "inflammatory"
lots of things can do this:
🌟trauma-foreign body into a joint
🌟infection-septic joint
🌟crystals-gout or pseudogout
🌟autoimmune!
if you tap a joint, and there is greater than 2,000 WBC, this is considered "inflammatory"
lots of things can do this:
🌟trauma-foreign body into a joint
🌟infection-septic joint
🌟crystals-gout or pseudogout
🌟autoimmune!
A woman in her 40s presented with a new rash, abdominal pain, knee pain & swelling. She reported having an upper respiratory infection few weeks ago. She also noticed some blood in her urine. Vitals w/⬆️BP. What is the likely diagnosis? #Medtwitter #MedEd tinyurl.com/5cjju3ww
INTRAVENOUS IMMUNOGLOBULIN
Or IVIG as the 😎 cool kids call it
⭐️ What is it?
⭐️How did we first start using it?
⭐️How was it accidentally found to treat autoimmune conditions?
A thread 🧵
#meded #rheumtwitter @HRheuminations #immunodeficiency
Or IVIG as the 😎 cool kids call it
⭐️ What is it?
⭐️How did we first start using it?
⭐️How was it accidentally found to treat autoimmune conditions?
A thread 🧵
#meded #rheumtwitter @HRheuminations #immunodeficiency
Immunoglobulin is another way of saying antibodies (Abs)
Abs are what your immune system produces after being exposed to an infection or what you produce in response to a vaccine to protect you long term
Abs are what your immune system produces after being exposed to an infection or what you produce in response to a vaccine to protect you long term
IVIG is “pooled” antibodies (Ab)
Originally made to treat people who can’t make Ab
(More on this soon)
⭐️ Why pooled?
If you took Ab from just me, then you would be immune to just what I’m immune to
If you take antibodies from 1000s of people, you’re immune to much more
Originally made to treat people who can’t make Ab
⭐️ Why pooled?
If you took Ab from just me, then you would be immune to just what I’m immune to
If you take antibodies from 1000s of people, you’re immune to much more
METHOTREXATE
Considered a cornerstone of Rheumatoid Arthritis treatment among other autoimmune conditions
FDA approved in 1988 for the treatment of #rheumatoidarthritis but DISCOVERED in the 1940s
⁉️ why the delay ⁉️
here is the (short)story 🧵
#meded #rheumtwitter
Considered a cornerstone of Rheumatoid Arthritis treatment among other autoimmune conditions
FDA approved in 1988 for the treatment of #rheumatoidarthritis but DISCOVERED in the 1940s
⁉️ why the delay ⁉️
here is the (short)story 🧵
#meded #rheumtwitter
Dr Sidney Farber, pediatric pathologist, considered a founder of chemotherapy
recognized folic acid is important for DNA synthesis
🌟cancer needs more DNA synthesis
🌟Aminopterin developed to BLOCK folic acid and decrease cancer cell growth
🌟Used to treat childhood Leukemia
recognized folic acid is important for DNA synthesis
🌟cancer needs more DNA synthesis
🌟Aminopterin developed to BLOCK folic acid and decrease cancer cell growth
🌟Used to treat childhood Leukemia
Methotrexate, a similar molecule was found to be better tolerated and easier to administer
Un hilo 🧵 sobre podcasts de Reumatologia.
Una forma muy agradable de mantenerse al día desde cualquier lugar. A mi especialmente me gusta escucharlos temprano en la mañana tomando un café ☕️ #RotReuma
Una forma muy agradable de mantenerse al día desde cualquier lugar. A mi especialmente me gusta escucharlos temprano en la mañana tomando un café ☕️ #RotReuma
Comenzamos por Un Café por la Reumatologia , de los primeros en la especialidad y en español . Se encuentra en @GlobalRheum globalrheumpanlar.org/secciones/28/p…
Spotify open.spotify.com/episode/0FEbMW…
Apple podcasts.apple.com/co/podcast/glo…
El piloto se lanzó en junio 2019 globalrheumpanlar.org/podcast/un-caf… #podcast
Spotify open.spotify.com/episode/0FEbMW…
Apple podcasts.apple.com/co/podcast/glo…
El piloto se lanzó en junio 2019 globalrheumpanlar.org/podcast/un-caf… #podcast
ACR on Air , podcast del @ACRheum conducido por @hausmannMD con episodios desde agosto del 2019 rheumatology.org/Learning-Cente…
Spotify open.spotify.com/show/5GU5M5Wmb…
Apple podcasts.apple.com/co/podcast/acr…
Spotify open.spotify.com/show/5GU5M5Wmb…
Apple podcasts.apple.com/co/podcast/acr…
