Discover and read the best of Twitter Threads about #clinical

Most recents (24)

🔥Highlight from @BavenoVII #cirrhosis session

CSPH Cut-off:
✅Rule in: LSM>25kPa
✅Rule out: LSM<12kPa, Plt>150

👀co-factors:
⛔️Obesity
⛔️Diabetes
⛔️Alcohol

#ILC2022 #Livertwitter @ReibergerThomas @RodriguesSu24 @crisripol @jaumebosch9 @EASLnews Image
Defining Recompensation @BavenoVII

✅Regression (struc/func)
⛔️Primary etiology
⛔️Decompensation (<12m)
✅Stable Liver func

#ILC2022 #LiverTwitter @ReibergerThomas @RodriguesSu24 @crisripol @MattiasMandorf1 @jaumebosch9 @ggarciatsao Image
🔥PSVD by Dr Aurelie Plessier @ValdigGroup

Based on #clinical/#histo
✅Specific signs
✅Non-specific signs
🗝️Histology essential for diagnosis (nor now)
👉emerging role: NOT in PSVD

#ILC2022 #LiverTwitter @BavenoVII @ggarciatsao @ReibergerThomas @VirginiaHdezGea @jaumebosch9 ImageImageImage
Read 3 tweets
Pre-dawn, MP is working remotely from the roof-top pool at the hotel, preparing for the session @IUPESMWC2022. He gets text on ‘WhatsApp’ from IM
IM: Hey doc, I see that you are checking the slides one final time. BTW, we all are looking forward to your session this morning

1/
MP: Really, how come?
IM: Since #WC2022 is hybrid, even though it is late in some parts, we are looking forward
MP: Thanks–Yes, lot of efforts went in pulling this session. Thanks to Dr Borras (@IOMP & @aapmHQ ) & Dr Tom Judd (@IFBME & @WHO ), even I am looking forward to

2/
IM: BTW doc, my cousin said, she liked your title, “Symbiotic relationship between #MedicalPhysicists and #Clinical Engineers” & so do I.
MP: Glad you liked, hopefully y’all will like what I present

@WelcomeSG
3/
Read 9 tweets
#Thread #Health #Elders #SeniorCitizens

By Arnaldo Liechtenstein, physician: "Whenever, I teach #clinical #Medicine to students in the fourth year of medicine, I ask the following question:

"What are the causes of mental confusion in the elderly?"

1
Some answer: "Tumors in the head".

I answer: No!

Others suggest: "Early symptoms of Alzheimer's".

I answer again: No!

With each rejection of their answers, their responses dry up.

And they are even more open-mouthed, when I list the three most common causes:

2
- uncontrolled diabetes
- urinary infection
- dehydration

It may sound like a joke; but it isn't.

People over 60 generally stop feeling thirsty and consequently, stop drinking fluids.
When no one is around to remind them to drink fluids, they quickly dehydrate.

3
Read 9 tweets
Victorian biomedical science and innovation come of age. #mRNA #Protein #Vaccine

A somewhat long thread:

Our #mRNA vaccine was conceptualised, invented, developed and manufactured (mostly) right here in #Australia. And has now reached #clinical trials.
heraldsun.com.au/news/victoria/…
2/ To say the least: It has been a thrilling journey.

All I want is to say a few words about innovating a new class of medicine and mention some of the important people and events related to the #mRNA vaccine.

This is my short and personal tribute to them and the events
To translate a product from bench to clinic in two years is not easy- but to do that with a completely new entity that has never been manufactured or developed in the history of Australia - mRNA vaccines- is even more challenging. But our team was up to the challenge.
Read 19 tweets
1/16 So, a long weekend to reflect on @DHRewired last week. After a couple of dog-walks and marathon poo-picking sessions, plenty of time to think. I keep coming back to the #frontline #digitisation programme. I offer this constructively. If you want to discuss, contact me ImageImage
2/16 The session with the biggest impact was #Tim #Ferris. He talked about his experience in Boston at Mass Gen and he stressed that once they’d put a single system in across 8 hospitals, all staff were part of one team and they were all on the same page for every patient
3/16 What greatly troubled me is that there was no acknowledgement in the world of ICS where we are driving vertical integration, we cannot be working on a single system
Read 16 tweets
Just a friendly reminder @moderna_tx told the @SECGov that the @US_FDA defines #mRNA as gene therapy. And called it an unprecedented new category of #medicines tho they really want that #vaccine classification anyways for liability protections & fear the public wouldn’t take it.
They know the #COVID19 #vaccine isn’t a vaccine but human #gene #therapy.
The @US_FDA #fda reaffirmed their definition of modified viral #nucleic acid that alters #CELL Jan 30th 2020 #COVID ImageImageImageImage
Read 16 tweets
1/14 🆕 🚨Accelerated article on #breastcancer just out in @nature! #bcsm

We asked:
1️⃣ What drives response to #chemotherapy in #breast #cancer
2️⃣ Can we use #machinelearning to predict response to chemotherapy❓

Link: nature.com/articles/s4158…

A 🧵👇👇👇 @OncoAlert
2/14 We are unable to #predict #response to treatment in clinic…

✅Good response ➡️treatment very effective ➡️better survival
❌Poorer response ➡️treatment less effective ➡️worse survival

Being able to forecast response would be a landmark advance!
3/14 We ran a study in women with #breastcancer @CUH_NHS+@CRUK_CI:
1️⃣who had a #cancer biopsy (which we analysed)
2️⃣received 18 weeks of chemo+/-targeted therapy
3️⃣had surgery (and we measured how much cancer remained)

We associated PRE-therapy profiles↔️POST-therapy response👇
Read 14 tweets
1/ Excited to share how T cell therapies kill #leukemia!! multi-omics + new #computational #singlecell tools for longitudinal analysis 👉unexpected answer! cell.com/cell-reports/f…

*👏* @elhamazizi! 🙏 @dpeer Cathy Wu @MDAndersonNews @CPRITTexas @ColumbiaBME @sloan_kettering
2/ We studied donor lymphocyte infusion (DLI) - an #Immunotherapy for relapsed #leukemia after #BMT & the #og of #celltherapy. Previously, we showed DLI reversed T cell exhaustion - but didn't know why/how/which T cells were responsible...
ashpublications.org/blood/article/…
3/ To address these ?'s, we modeled intraleukemic T cell dynamics by integrating longitudinal, multimodal data from ~100K T cells (!) during response (R) or resistance (NR: nonresponder) to DLI.
Read 18 tweets
This month marks a decade since I completed medical #internship. I thought then that I had achieved my goal, that I would find joy in my work. Little did I know where life would lead me. My #reminisces & #reflections - too long for a tweet & too short for a blog - hence, a 🧵
As the first & only #medical student in the extended family, I was in #unfamiliar waters. Moving to uncle's house in another city was a not-too-comfortable but not-wholly-unpleasant change. I'm privileged to be part of a family who did all they could to keep me happy
The pedagogy was #authoritative & #oppressive; seemed to be designed to #humiliate, not teach. I couldn't learn by rote, didn't know of any better ways (pre- ubiquitous smartphone era) Expected to address #seniors using honorifics, I felt they were as unapproachable as teachers
Read 10 tweets
The Webinar on "Monoclonal gammopathy and its significance for kidneys" is about to begin!
There is still time to test your knowledge by solving the @ISNeducation quiz ➡️ bit.ly/3j7U5cn
Starting now!
Webinar: "Monoclonal Gammopathy of Renal Significance - Clinical Perspective" with
@arzuvelix and Serhan Tuglular
#ISNwebinar
Welcome Dr @arzuvelix and Dr Serhan Tuglular
Webinar: "Monoclonal Gammopathy of Renal Significance -Clinical Perspective" with

#ISNwebinar
Read 44 tweets
Here's a fun #NINO - the UK's National Insurance Number - [Thread] to start the weekend 👇

Maybe I should do an #NHSnumber one sometime? It's a fascinating story, which (ironically) starts with these...
[With thanks to @guy_herbert, @TomSamaki, @PrivacyMatters & others for encouragement!]

Before I start a geeky 'deep dive' on the #NHSnumber, to provide some (personal/professional) context that will hopefully become apparent, I'll just drop these two images here:
So, to begin.

After the Second World War, in a time when we started to think (again) what a #civilised society would be, and when our leaders tried to agree #principles like #UDHR that might prevent the recurrence of genocide, and support #dignity and #HumanRights for all...
Read 32 tweets
Further, suboxone has required special training and certification, adding an administrative barrier and creating an added fear barrier among risk-averse clinicians whereas oxycodone can be prescribed easily with the DEA certificate we all have.
Because doctors/prescribers are definitely lacking in administrative burden and CME obligations, we're just twiddling our thumbs eager for someone to ask us to get MORE educated, taking time off from patient care to get this:

medpagetoday.com/psychiatry/add…
The law enforcement side sees doctors through this lens. So doctors seek to limit their risk and liability. I'm all for taking down those who harm patients. I've testified in cases like the ones below for the AG's office as a medical expert.

medscape.com/viewarticle/91…
Read 7 tweets
1
Listen to this story of #tuberculosis
Real, not fiction. Even though may sound like super fiction. Of a patient now admitted under me.

56 yr man. Prior #smoker No #alcohol use, no #DRUGS. Family guy. Starts havin cough. Nagging no sputum
Keeps him awake at night
#MedTwitter
2
He goes 2 a GP. Clinical examination and blood tests done. Says some chest infection. Puts him on antibiotics for a week. Asks for review. 1wk later some change in symptoms, but not fully ok. GP extends antibiotic course 7 more days. C, no fever and no signs of infection yet.
3
After 14d course, no change. Patient chucks the GP. Goes for a senior GP. Senior GP does clinical exam,blood tests AND chest X ray. X ray comes back as "not looking normal" 🙄 But no diagnosis. So he says. Let's try a short course of #antibiotics AND antifungal. Again 14 days
Read 18 tweets
My highlights of the @10xGenomics #Xperience2021 event. The list of products keeps growing, I would highlight Chromium Connect as an underappreciated tool to bring the products up another level of throughput. Important as with #NGS, it won't take long to go from n=1 to n=96+. Image
#CellPlex species-agnostic multiplexing up to 12 samples: not dissimilar to products such as TotalSeq, but baked-in so that it's been tested to work with the rest of the workflow. Image
Going close to 1M cells, the #ChromiumX brings about 100x fold throughput increase, all marked with 'HT' in the Kits. I'd be interesting to know how the different #BodyAtlas projects embrace this and for what. ImageImage
Read 31 tweets
@FBI - I have been marked as a target by alt right already - my #GOTV work is what #MarjorieTaylorGreene spreads hate on - citizen rights of minorities. The violence that smashed the skull of #OfficerSicknick on Jan 6 was about effective #votingrights work of @staceyabrams
(Deleted tweets cuz the posted link was wrong - gah. I hate deleting tweets but the meaning totally changed.)
What I threaten is the power differential in #healthcare -by my identity & work - all bullying is about power first & foremost. Yes, I threaten bullies & their sidekicks. I open, expand, include vs paranoia to exclude, block.

Other Muslims like me, shot: dailytarheel.com/article/2020/0…
Read 12 tweets
A Thread (🧵)

Let's discuss long-read #sequencing, optical mapping, and the implications of a recent study (linked below).

Please view my disclosures at the end. I've intentionally made this thread more technical as I think it's necessary.

biorxiv.org/content/10.110…
First, let's deconstruct the paper's title: "De Novo Assembly of 64 Haplotype-Resolved Human Genomes of Diverse Ancestry and Integrated Analysis of Structural Variation".

De novo (Latin: "Of New") assembly involves sequencing a genome without the help of a reference.
Assembling a #genome de novo is like solving a jigsaw puzzle without using the picture on the front of the box. You could start with the corners, assemble the edges, and try to fill in the rest using color- or shape-matching methods.

Let me use an analogy.
Read 31 tweets
@jenbrea Hey! So I'm getting to the point where I could write a long paper about potential overlapping connections b/t #Alzheimer's and #MECFS, but I'll summarize a few top trends in this thread! First, I brainstormed often on topic with the late Rob Moir
@jenbrea 2/ Rob’s research (done w/ Rudy Tanzi + Will Eimer at Harvard) forms the core of a potential ongoing paradigm shift in Alzheimer’s - namely that #amyloid beta may be an antimicrobial peptide that forms in response to pathogens in #brain tissue: pubmed.ncbi.nlm.nih.gov/30001512/
@jenbrea 3/ To better understand that research, read this #interview I did with Rob before he passed away last year from glioblastoma. Key to ME/CFS is his work indicates that amyloid may form in response to herpesviruses like HSV1 in the Alzheimer’s brain: microbeminded.com/2017/12/18/int…
Read 14 tweets
🎉CELEBRATION ALERT!! We reached 10K followers @NatureCancer - massive thank you to our wonderful community for the warm welcome! Given it is also 10 months of our online life, here are some of our best articles (although all are *fantastic*) #thread 1/n

#10atNatureCancer
January @NatureCancer: Nabel &co @SanofiUS develp #trispecific antibodies against CD3, CD28 and CD38, with preclinical efficacy and safety in humanized mice and NHPs 2/n

go.nature.com/30GlQyH
rdcu.be/b78Zr

#10atNatureCancer
February @NatureCancer: Golub and Co @broadinstitute develop PRISM, a tool for non-oncology drug repurposing in #cancer 3/n

go.nature.com/36zCxQh
rdcu.be/b78ZE

#10atNatureCancer
Read 12 tweets
This

@bruce_y_lee succinctly says what I lay out in multi-tweet threads

This is it in a nutshell

Divide and conquer is as old as time. Ask anyone whose history includes being colonized

#Healthcare is 1/5th of the U.S. economy. You bet non-clinicians want a piece of that
If you are someone who touches patients, has ever touched patients, provides direct care, has any clinical background, I'll be totally frank, I respect your role. If your salary adds to the 30% administrative overhead of #healthare in America, then I have questions about #value.
This is a framework my coauthors and I offered on how to assess value and cut waste. Let's start with administrative burden. What exactly do you get paid to do in #healthcare? (we should be asking) What does your job do to deliver on the quadruple aim?

journals.sagepub.com/doi/abs/10.117…
Read 18 tweets
1/3
The devil is in the 'detailed' #drug history #clinical
22 yr male, underweight
Teetotaler
Fatigue, appetite loss
Liver test AST 400 ALT 600
Viruses negative
Liver #biopsy 👇Severe #fatty #liver #disease, Mallory Denk++
#livertwitter #pathology #MedTwitter #MedStudentTwitter Image
2/3
The culprit 👇#Ayurveda #medicine
#Ayurvedic jam with butter, honey, milk as base given for premarital #weight gain! 3 months after stopping, liver tests normal
Consider #drug induced fatty liver in #patients. Not everyone is #metabolic #syndrome
#pseudoscience #Nash #nafld Image
3/3
Common drugs causing fatty liver
Steroids, Valproate
Inj Tetracycline
#HIV #AIDS meds NRTIs
Rare - methotrexate, chemodrugs irinotecan, 5FU, tamoxifen
Also important is Amiodarone
Herbals with #Margosa oil too
Remember #alternative meds rich in fats are important causes too.
Read 3 tweets
"Further validation of the affective bias test for predicting antidepressant and pro-depressant risk: effects of pharmacological and social manipulations in male and female rats" @Dr_Hinch @doctmcgee link.springer.com/article/10.100…
Summary: #pharmacology #affectivebias #depression #animalmodels #affectivestate #malesandfemales #ABT
The need for a reliable and #translational tool measuring emotional behaviours in animals that possessing robust validity is unquestionably important but 1/
but very challenging to achieve. Commonly used assays are generally lacking in at least one aspect of #validity and do not fully translate into #clinical work. In this paper, the affective bias test (ABT) has demonstrated to reliably detect both positive 2/
Read 6 tweets
1/2
2017: #young #male after a #trip to Hills with '#Naturalists'. Fever and abnormal liver tests. #jaundice in a week. Long evaluations multiple places. Following up as fever of unknown origin. Father a pastor. Son denies everything, studious. #Liver #biopsy done.
#livertwitter Image
2/2
Classical #liverpath
Top:Lobular #inflammation, #Portal triaditis; Bottom: central venulitis, perivenular #cholestasis
Asks young man alone, 1hr #interrogation
Finally, S(n)ORTED OUT THE PROBLEM.
#Cocaine induced #Hepatitis
Its pays to invest in good #clinical #history
Read 3 tweets
Strange cause for #cirrhosis
Maybe very #rare #MedEd
53yrs man, voice change, recurrent headaches, male breast enlargement. Stops socialising. Has bleed one day, #endoscopy varices, #biopsy fatty liver cirrhosis
No metabolic syndrome.
MRI Brain done. #livertwitter #radio
1/3 Image
What is the diagnosis?
In patients with cirrhosis, always try to find the cause in those who present early. There is no idiopathic, no cryptogenic. Its all 'missed' cirrhosis.
2/3 #liverpath
#MedTwitter #pathology #radiology #MRI #brain #Neurology #Endocrinology #NeuroTwitter Image
#diagnosis: #fatty liver related cirrhosis due to #pituatory macro adenoma with high prolactin, high GH, low #thyroid function. #clinical examination, acromegaly features with central obesity. #Examine 1st, then investigate. #MedicalStudent #medicine #MedStudentTwitter
3/3
Read 4 tweets

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