Discover and read the best of Twitter Threads about #Tweetorial

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You're on call and open a chest CT for a patient with suspected #COVID19.

How do you interpret and report the imaging findings?

A #TWEETORIAL of the @radiology_rsna Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19… Image

This consensus statement has been endorsed by @thoracicrad and @RadiologyACR.

Important work by our faculty @PennRadiology Drs. Scott Simpson & Harold Litt.

*Figures/tables in this #tweetorial from orig. manuscript, unless otherwise stated.


☝️First, it’s important to note that routine screening chest CT for identification of #COVID19 is NOT currently recommended by most professional organizations.

@CDCgov Guidance:…

@RadiologyACR Recommendations:…
Read 27 tweets
Uno de los casos más fascinantes de la historia de la música y la medicina, es el de la sordera de Beethoven

Acompáñanos para conocer más acerca de este artista, la presentación de su caso clínico, y los posibles diagnósticos diferenciales

Inicia Hilo
#Tweetorial #MedEd #ENARM Image
1/ Hay pocos casos tan impactantes en la historia de la música como el de Ludwig van Beethoven (1770-1827), compositor alemán que s
.2erá recordado por siempre.

Es bien sabido que en algún punto de su carrera, Beethoven perdió su capacidad de audición, una verdadera tragedia Image
2/ Esta condición no le detuvo, algunas de sus obras más famosas, fueron compuestas mientras estaba sordo
¡Una verdadera proeza!

A lo largo de los siglos se ha querido identificar la causa de esto
Veamos lo que se ha descubierto y las teorías 👀 Image
Read 30 tweets
This is my first attempt at a #tweetorial, so taking up something relatively simple for it… Case-Control Studies. Let me begin with a reminder of one of the most classic #CCStudies of all times, where study 7 patients led to a conclusive finding! 1/14 Image
Case-Control Studies investigate the relationship between a health/disease outcome and one or more putative factors (risk/protective) associated with the disease. They start from the point where the outcome of interest has already happened, and look back in time. 2/14 Image
This is different from cohort or clinical trials, where the exposure (risk/protective/interventions) factors are known, and then the individuals are followed up over time to see if the outcome of interest (health/disease condition) take place. 3/14 Image
Read 15 tweets
Adrenal Adenomas versus Metastases: Diagnostic Performance of Dual-Energy CT Virtual Noncontrast Imaging and Iodine Maps

A #TWEETORIAL for #radres

Inspired by the recent article in… Image

First, let’s discuss some background:

POLL: Approximately what percentage of CT scans have incidental adrenal lesions?

Incidental adrenal lesions are detected in approximately 5%-8% of patients undergoing CT examinations. When found, the most common clinical dilemma is to differentiate between benign adenomas and metastases, especially if there is history of malignancy.
Read 24 tweets
⚡ Protocol Biopsies in Lupus Nephritis (LN)⚡
1/ Let's take another stab at (pun intended?) protocol biopsies in LN!

💡 The idea is certainly not new - it has been successfully implemented in kidney transplant recipients #NephTwitter #Tweetorial #FOAMed @NSMCInternship
2/ Out of curiosity - have you asked for repeat biopsies in these patients? When & why? Does your hospital have a protocol for it? Share your experience in the comments too! 👇
3/ I mean, you nailed the diagnosis the first time around, right? So why would you ask for a repeat kidney biopsy in a patient with LN? 🤔 Image
Read 18 tweets

“Building Your Digital Brand” 👩🏻‍💻📱

How YOU can leverage the use of SoMe as a platform for professional development! 🚀

Key 🔑 pearls from Brooke’s Grand Rounds Presentation 🙌🏼 @UK_HealthCare
#1️⃣ What is a digital brand? & why is it important for you?

Your brand is a synonymous term for your reputation! This resembles the intersection of how you see yourself & how others see you 👩🏻‍⚕️👨‍⚕️
2️⃣ Brings us to the question what is YOUR brand⁉️ How would you define it?

Take a moment to find out and search your name on google....What do you find?
Read 13 tweets
Hasta el momento, ¿qué fármaco ha demostrado beneficio en el tratamiento de COVID-19? Hidroxicloroquina/Remdesivir/Lopinavir+Ritonavir
En este #Tweetorial te explicaremos los hallazgos básicos de los resultados preliminares sobre #Remdesivir y #COVID19 publicado en @NEJM:…
El #Remdesivir es un inhibidor nucleósido de la ARN-polimerasa dependiente de ARN. Fue estudiado en el tratamiento de la epidemia de Ebola y actualmente está siendo estudiado para tratamiento del COVID-19.
Read 18 tweets
Since selection/collider bias is currently a hot topic, it seems like a good time for a #tweetorial!

Gather round #EpiTwitter (but not too close!) for a tour of my paper investigating the when's and why's of selection bias in birth defect epi. 👇🏻

One of the reasons reproductive epidemiology is trick is that you are *always* dealing with selection.

Who becomes pregnant? Who stays pregnant? Who delivers too soon? Who has an induction?

Is the population in your study a biased sample?

Let's add in a rare outcome with a strong effect on survival: birth defects.

Because specific birth defects are rare, we need huge samples to do meaningful studies. But many times data sources with these properties only have live births.

Can we still do valid studies?

Read 29 tweets
NEW: “When does postural instability appear in monogenic parkinsonisms? An individual-patient meta-analysis” in The Journal of Neurology.
A 2-year effort with @LucaMarsili1 @andrea_sturchio @Dr_Murli_Mishra @DrAlfonsoFasano @nachogenePD @Marcelokauffman @AlbertoEspay

Monogenic parkinsonisms are very different from one another. Not only on the severity of parkinsonism, but also on cognition, behavioral, and autonomic function.
(See a nice review ⬇️…)
A critical marker of disability is postural instability🚶➡️🧑‍🦯➡️🧑‍🦽, which leads to falls, and increased morbidity and mortality. The frequency and time-to postural instability in different monogenic parkinsonisms remained unknown.
Read 16 tweets
My very first #ExerciseIsMedicine #Tweetorial is here: Breaking “it makes me feel good” into pieces🧠😀🏃‍♀️🏊‍♂️🚴#Thread ⬇️⬇️
#TwitterPoll at the END
1/ Are you exercising🏃‍♀️to boost your mental well-being during the pandemic🦠? People exercise because it makes them feel good🙃, but what exactly happens in our body? Keep reading to satisfy your curiosity & learn about the #mechanisms behind aerobic exercise & #mentalhealth
2/ Anxiety and depression are common mental health conditions. The prevalence in cardiac patients is ~20-30% & 2x higher in ♀️ vs ♂️. Social roles (e.g. caregiver role), cultural norms (e.g. societal sexism) and more pronounced hormonal shifts in ♀️ influence this sex-difference
Read 28 tweets
Good morning! Based on my latest poll, I’m going to start off this (short!) week with a non COVID heme #tweetorial.

It turns out there are other conditions still affecting patients!

4yo previously healthy 👦 presents with dark urine and fever.
Initial labs remarkable for hemoglobin of 6.6, LDH 2260, and bilirubin of 6.8 (largely indirect).

DAT is negative for IgG and 1+ for C3.

DAT (direct antiglobulin test or direct Coombs) detects in vivo sensitization of RBCs.
RBCs are washed to remove unbound antibodies. Anti-IgG (or complement) reagent is added. If antibody is present on RBCs—> agglutination!

Antibodies are then eluted off to determine specificity.
Read 14 tweets

UK PM Boris Johnson has declared a “war on fat” after confronting the role his #obesity played in his harrowing encounter with #COVID.

In this #tweetorial, we’ll take a closer look at the studies sounding the alarm in the UK.

#medthread #MedTwitter…

Ho et al. (pre-print) studied 428,225 subjects in the @UK_Biobank of which 340 had confirmed #COVID.

BMI had a risk ratio (RR) of 1.24 (per 1SD). Obesity itself had a RR of 2.29.…

To put this in context: for every 4.5 point increase in BMI, the risk of hospitalization from #COVID increases by almost 25%!
Read 15 tweets
My team recently asked WHY we give Fe to pts with HFrEF+anemia.

First answer: b/c someone told me so
Better answer: let me get back to you on that

Let’s explore and try to understand, #medtwitter #medstudenttwitter 0/14
1/First off, it helps to review a general schema for anemia.

Blood loss, decreased production, increased destruction

So, why are patients with HFrEF anemic?
2/Controlling for other co-morbids or meds that can lead to blood loss and destruction, it turns out that ↓RBC production drives anemia in HFrEF.

Read 17 tweets
#MTPathUnknown #56
For anyone: Where are we? What process is occurring?
#MTPathUnknown #56 Answer
Explanatory slides attached (1/3)
Great discussion! #tweetorial
@giulicattivelli @KBaranoma @drabhayprakash2 I admire your persistence
Numerous other great comments: @codarra @ConnorZuraski @prableenMD @Stanowszczanka
Slide 2/3
@Stanowszczanka : here is a higher power magnification; postmortem autolysis always makes autopsy slides more difficult to interpret

I just wanted to show the utility and occasional interesting sides that SA and AV node examination can yield
Read 4 tweets
Dual-Energy CT to Differentiate Small Foci of Hemorrhage From Calcium

A #TWEETORIAL for #RadRes and #MedStudentTwitter

Inspired by the recent @radiology_rsna article:…

Important work from our very own @BWHRadEdu @walterfwiggins @AaronSodickson
First some background:

Non-contrast Head CT is the first-line imaging study in trauma.

While most acute hemorrhage can be diagnosed confidently on a CT, small foci of hemorrhage and calcification can be hard to differentiate. This is where dual-energy CT (DECT) can help!
To understand DECT, we have to understand some basic CT physics concepts.

POLL: In diagnostic imaging, photon absorption for high atomic number elements is dominated by what process?
A) Photoelectric effect
B) Compton scattering
C) Rayleigh scattering
D) Pair production
Read 22 tweets
Back with another #neurology #neuroanatomy #tweetorial.
This one goes out to all the #MedStudentTwitter studying
for the steps:


#MedEd #NoMoreNeurophobia cc: @MadSattinJ @Tracey1milligan @StaceyLClardy @DxRxEdu @CPSolvers
This is often considered one of the most complex parts of neuroanatomy.

Let’s break it down:

First, the brainstem is divided into 3 levels, from superior to inferior:


These are MRI view so anterior on top, posterior on the bottom
Midbrain= looks like Mickey Mouse

Pons=two huge cables connecting it to the cerebellum (middle cerebellar peduncles)

Medulla=looks almost like the spinal cord
Read 26 tweets
After a very successful experience with #virtualinterviews, I thought I would create a little #tweetorial for my #MedEd colleagues looking for some tips and tricks on how to convey your program’s best assets virtually. From your friendly #urogyn team @OHSUSOM 1/
My biggest piece of advice is to make all of your interactions intentional. Come up with a game plan for how and what you want to showcase. For us, it was important to convey a spirit of collegiality that (I think) is our program’s greatest strength. 2/
We started our mission by sending individualized emails to each interviewee from one faculty member and one fellow four weeks prior to the scheduled interview. This served to 1️⃣ open lines of communication 2️⃣ begin to introduce our program and #PDX. 3/
Read 14 tweets
Residency Interview, Circa 1995

Him: “You say here in your #PERSONALSTATEMENT ‘Research is the linchpin of a thriving academic medical center.’”
Me: *smug smile*
Him: “Tell me what you meant by that.”
Me: 😳

Rut roh.

Real talk? I just wanted to use the word “linchpin.”
Also? I thought it would sound smart. (Spoiler alert: I didn't match there.)😂

Hand over heart—that EXACT sentence was in my PS for residency. That moment (which DID happen) was mortifying. But I LOVE that it did. Why? Because it serves as a #PSfail cautionary tale.

Mmm hmm
I know a LOT of folks on #medtwitter are thinking about writing a #personalstatement right now. After the great #linchpin debacle of '95, I've learned to LOVE the PS process.


So who's ready to cook up a yummy, winning P.S. with ingredients already found in your kitchen?
Read 24 tweets

This test has such a big footprint in the landscape of liver disease management. But it is just too complicated to deserve its spotlight

Reposting this #tweetorial

NH3 levels:
1⃣a potent biomarker of illness
3⃣only part of the HE story
Since I posted this tweetorial:

1. ISHEN released a consensus, touching on NH3.…. This features the fig below
2. A major publication on the variability and lability of Nh3 levels from @JasmohanBajaj @BloomPringle @AmCollegeGastro #amjgastro #livertwitter…
Read 4 tweets
1/ My patient has tachycardia, fevers and lactic acidosis. Does he/she have sepsis? Heffner et. al found that, up to 18% of patients with SIRS, initially diagnosed as sepsis, had a non-septic SIRS also known as "sepsis mimicker". #Tweetorial
2/ A 30-ish y.o. patient with history of type 1 diabetes mellitus, essential hypertension & asthma presented to the ED with a 2-day history of dry cough. No dyspnea, chest pain, documented fevers, sweats, rhinorrhea or sore throat. Mentions 30-lb wt loss + fatigue last 6 months.
3/ Patient stopped working due to fatigue. Diabetes is well controlled (A1c 7.5%). Patient smokes cigarettes, drinks socially and denies using drugs. No vaping.
On presentation: BP 150/110, HR 134, RR 20, SpO2 98%, Tm 99.5F.
Read 21 tweets
A #periopmedicine-meets-#COVID19 #tweetorial #Medthread

There has been a lot of overlap between the two areas in the last few months:
🦠appropriate PPE use
🦠pre-op covid19 screening of asymptomatic patients
🦠OR & postop ward management/re-designs

other topics have been explored, such as the safety of laparoscopic surgery v laparotomy given risk/benefit of
overall surgical risk, operative time, potential aerosolization of particles via gas suspension and pneumoperitoneum

one article:…

I’ve also captured my thoughts about how we resume “elective” surgical volume as states and countries start to “reopen” in this #tweetorial

I'm not going to revisit these subjects here. But...


Read 24 tweets
With so much attention on #COVID19 in children, time for an updated #tweetorial on what we do and don't know!

We'll talk impact, risk, hyperinflammation syndrome, transmission, schools and more

Lets go!

Children remain grossly underrepresented in all case numbers, hospital admissions and deaths worldwide

See latest ISARIC report of >15,000 severe cases, or @PHE_uk UK deaths……

This report from @sunilbhop and friends looks at child deaths from #COVID19 compared to other causes to put them in perspective

Of ~37,000 child deaths, 43 were from COVID19

In the words of @d_spiegel , children are "unbelievably low risk"

Read 21 tweets
@DrNeuro123 @AaronLBerkowitz In muscular dystrophies with leg involvement, the calf muscles and leg muscles are affected first. Ext dig profundus (EDB) overcompensates for the foot drop caused by atrophy of the tibialis anterior (TA) so it hypertrophies as it tries desperately to lift the toes. (1)
@DrNeuro123 @AaronLBerkowitz In generalized neuropathies like CMT, the nerve dies backwards so by the time the nerve to the TA is affected, the nerve to the EDB has already been affected, so the EDB is atrophied just like the TA. So it’s a useful way to determine whether it’s a nerve or muscle problem. (2)
@DrNeuro123 @AaronLBerkowitz Peroneal neuropathies and L5/S1 radiculopathies are common causes of foot drop. When you examine foot drop, check foot inversion because that’s done by the tibialis posterior which is innervated by the tibial nerve. If that’s involved, it can’t be just the peroneal nerve (3)
Read 8 tweets
What's the deal with ... Gilbert's syndrome?

Unconjugated bilirubin deserves its own #tweetorial

🟨Is it bad or...PLOT TWIST...good!?
🟨What to do about it?
🏆The most 🍌🍌trials ever conducted

#livertwitter #meded #MedTwitter

What is Gilbert's?

1⃣Healthy person gets labs. Bili 2.4, >80% indirect
2⃣Student studies all🌙, forgets 2 eat.
In AM,👀slightly 🟨

Turns out:
👉3% of🌎has bili>1.4mg/dL (fig1)

Many things⬆️indirect bili:
👉Only 1⃣ makes bili⬆️w/fasting (Fig2)



Who?1⃣Described c1901. Hilarious paper
(🙏google translate, my🇨🇦franglish education)
Why?2⃣Familial⬇️UDPGT protein
(the thing that 'conjugates' bili)
Why?3⃣Base pair insertion in UGT1A1 promoter
(#TATAbox, the gene that makes UDPGT)

Read 11 tweets

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