Discover and read the best of Twitter Threads about #medTwitter

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It's time for a new and updated #orthotwitter thread on ANKLE ARTHRITIS!

A 🧵*....

*This will be as inclusive but brief. This may not include everything but will provide an overview of this topic. These slides are mine.

@AOFAS @AAOS1 #MedTwitter @MedTweetorials

The Ankle Joint is composed of three bones:

There is cartilage between each articulation.

2/? Image
When the diagnosis of ankle arthritis is brought up, it is referencing the CARTILAGE LOSS between the TALUS and the TIBIA.

Here are some basic science facts surrounding this phenomena:

3/? Image
Read 16 tweets
NEW: In New Orleans, a group of Black doctors risked their careers to accuse their medical school of institutional racism. The year was 2020. What would it take to prove that there was a problem — and fix it?

This is an anatomy of a racial reckoning.…
Princess Dennar was the first Black woman to run a medical residency program at Tulane. She alleged that her white bosses undermined her authority for a decade-plus, trying to drive her out, and her Black trainees suffered the consequences. Her claims set off a chain of events:
Lawsuits from 3 Black women (one resolved, one lost, one pending). A survey showing that many fear that Tulane ignores racism. A boycott (#DNRTulane). Dr. Dennar's demotion—then resignation.

And now, Tulane's accreditation is at risk if it doesn’t improve its diversity climate.
Read 8 tweets
📢 Tips for Responding to Peer Reviewer Recommendations (or, join me on my🧼box), a🧵 by the Editor-in-Chief @JHospMedicine

#SagewisdomSecretsbySamirShah (this one's for you @DoctorVig) Image
1⃣ Do you have to address every comment?
💛 Yes, absolutely
💛 No need for excessive praise. No need to thank the reviewer for each comment. However, no snark either. Respond in a neutral tone. Convey how thoughtful you are in your response to each comment.
2⃣ Can you disagree w/ a reviewer or say no to a suggestion?
💛 Yes. There is no need to blindly incorporate every comment. However, provide a rationale for why not.
💛 Help the editor understand your thought process.
Read 10 tweets
Rapid Response Series, #2: Hypotension

So in medical school we were all shown a table like this to learn shock, which made my eyes roll back. 🙄 When I’m called about hypotension, I don’t have time to recall a table.⏱️ #MedTwitter #TipsForNewDocs Image
But I do like math formulas 🤓, and using this familiar formula ensures I never miss a potential cause of shock.

Which of these formulas best estimates blood pressure (BP)?
The correct answer is BP = CO (cardiac output) x SVR (systemic vascular resistance). ✅

To take it one step further, what is the formula for CO?
Read 11 tweets

#FOAM #EKG #MedTwitter

bei der interpretation eines EKG gibt es wahrscheinlich soviele meinungen wie kardiologen oder wege zum ziel wie nach rom|merskirchen.

daher empfehle ich meinen SuS immer, sich an der anatomie/physiologie zu orientieren und…

1️⃣ frequenz: sie ist ausdruck der durch elektrische aktivität zustande gekommenen anzahl an herzschlägen pro zeiteinheit (beats per minute). wenn aus jeder elektrischen aktivität eine „mechanische antwort“ erfolgt, sprechen wir von pulsschlag.
2️⃣ rhythmus: von einem sinusrhythmus (eigentlich besser sinusknotenrhythmus) sprechen wir, wenn der sinusknoten (SN) als autonomer taktgeber der alleinige „erregungsproduzent“ ist. um dies nachweisen zu können, bedarf es eigentlich drei kriterien:
Read 10 tweets
📢Tips to Make Your Manuscript Easier to Read

Apropos of nothing, a brief🧵from the Editor-in-Chief @JHospMedicine #MedTwitter
(or, join me on my 🧼box)

1⃣ Use a readable font size (eg 11 arial, 12 times new roman)
-Though I can enlarge a pdf, my computer screen is only so big
1⃣ (cont.)
Fonts are serious business: SNL papyrus skit ➡️
2⃣ Double space unless specifically instructed otherwise
- I'm getting old. Single spaced work is difficult to read if the font is also small.
Read 9 tweets
1/14 I hesitated at voicing my opinion on this rather contentious issue…

But I feel that without individual testimonies, we will fail to understand why some GPs (myself included) feel mainstream primary care is no longer for them.

@HelenRSalisbury @MartinRCGP @rcgp
2/ Obvs the relentless vilification from the MSM hasn’t helped, esp the claim by some that the number of ‘part-time’ GPs is the problem.

Those on the inside know that a typical day is 11-12hrs long & a ‘half-day’ is regularly 7-8, but hey, let’s not let facts get in the way.
3/ & I don’t suppose those of us who volunteered to work f2f in acute #COVID services within the community in spring 2020 will forget that our pleas for effective #PPE were repeatedly ignored & dismissed by govt, PHE, NHSE, HSE & senior advisors.

@CMO_England @MattHancock @UKHSA
Read 15 tweets
🧵 on repeat infections, negative lateral flow & #PCR tests, and the use of #COVID19 antibody tests. An n=1 experience #OmicronVariant #LongCovid #MedTwitter #TeamGP #psychtwitter #LongCovidKids #COVIDisAirborne #CovidIsNotOver 1/n
I had acute #COViD19 in Nov 2020, PCR +ve. Developed #LongCovid a month after. Had one dose #Pfizer Feb ‘21 which gave me new symptoms. Out of interest I had my anti-spike antibodies done May ‘21- they were above the upper limit the assay could measure 2/n
With the passage of time my antibodies dwindled. I had them rechecked in Dec 2021- both nucleocapsid & spike antibodies were below the protective limit. Therefore I had no protective antibodies. 3/n
Read 18 tweets
Die Bundesregierung hat auf die kleine Anfrage der @cducsubt-Fraktion zu #MECFS geantwortet.


Inhaltlich ist die Antwort mMn eine herbe Enttäuschung - obwohl meine Erwartungen ohnehin niedrig waren. Alte Textbausteine & Desinformation wie gehabt.
Einige der kritikwürdigen Punkte der Antwort habe ich auf Facebook kommentiert:

Da es sich in weiten Teilen um eine Wiederholung alter Positionen handelt, sei auch auf unsere Stellungnahme zur #SIGNforMECFS-Anhörung verwiesen:
Bemerkenswert ist der Verweis auf den med. Lernzielkatalog NKLM 2.0 (

Dort heißt es zu #MECFS u.a.:
"Problempatienten", Therapie: GET und CBT, #MECFS sei "umstritten".

#MedTwitter, wie soll es jemals besser werden, wenn DAS die "Lernziele" sind? 😵‍💫🤪
Read 4 tweets
ESR-CRP discordance,a #MedTwitter #tweetorial

First off, let’s talk about ESR physiology.
ESR is the rate at which RBCs settle in plasma of an anti coagulated blood sample.
(-) charged RBCs repel each other thus ⬇️ ESR.

In the presence of (+) charged large asymmetric proteins, ⬆️ neutralization and RBC aggregation causes ⬆️ ESR. Which of the following physiological conditions would have an increased ESR ?
That’s right. Pregnancy. In the 1900s, based on differences in ESR between pregnant and non-pregnant women, it was used as a test of pregnancy. This was due to physiological increase of fibrinogen production in pregnancy.
Other proteins like Immunoglobulins also ⬆️ ESR. (3/12)
Read 17 tweets
So many professions direct their services at disabled populations. Education and healthcare are both glaring sectors where non-disabled people can receive absolutely no training from disabled voices, and interact with disabled people on a daily basis. 1/5
Why are disabled people paying for services where they'll be seen by wholly untrained "professionals?" People who do not understand or care to understand our needs/desires/goals, who put us into boxes based on capacity? 2/5
These people quite literally get to determine our access to services. Our access to medications, treatments, interventions, therapeutics. Our access to life. They determine our inclusion. And they act as barriers to save the government money. 3/5
Read 5 tweets
Why is cranial nerve 6 uniquely affected by⬆️ intracranial pressure? Why is it special? A common question after the CN6 tweetorial.
Here is a maybe #tweetorial, but maybe a🧵about why CN6 is alone affected by ⬆️ pressure. #FOAMed #medtwitter #Medstudenttwitter #neurotwitter Image
Think of the intracranial CSF space like a balloon, distended by CSF instead of air. Cranial nerves begin inside the balloon, and then they exit as they begin their extradural portion Image
Most cranial nerves move immediately away from the CSF space after they exit—usually going out through their respective foramina. However, CN6 uniquely runs along the outside of the “balloon” in Dorello canal Image
Read 7 tweets
🧵 If the use of airborne #PPE & improving air quality in healthcare settings are to be ‘optional’ & ‘a matter of personal choice’, then we should give strong consideration to applying the same rule to the following #MedTwitter #MedEd #TeamGP 1/n
1. Handwashing before, between & after patients (& audits of it)
2. Plastic gloves & aprons
3. ‘Bare below the elbows’
4. Jewellery
5. Hair above the collar
6. Mandatory training
If you are recoiling in horror because
1. ‘Airborne transmission of COVID is controversial’
2. ‘The above are established evidence-based practices’
3. ‘COVID is mild, we can’t avoid it, we have to learn to live with it, we’re all vaccinated now anyway’,
Read 7 tweets
A new week, a new thread…
Hyacinth Bucket* as the Intensive Care Consultant, a 🧵

1. She arrives for Monday morning handover and there have been multiple admissions overnight, 3 elective admissions expected, a post-op laparotomy patient in PACU and there are no beds on The Unit
2. The night registrar delivers the handover but Consultant is keen to start strategy planning with her consultant colleague as soon as possible
Read 17 tweets
Pleased to share ⁦@FarazFallahi⁩’s #MECFS video this time with English captions featuring some of my favourite German & Austrian names #LongCovid #MyalgicEncephalomyelitis #pwME #MedTwitter #MedEd #TeamGP #psychtwitter. A sobering watch.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe neuroimmunological disease that mainly occurs after infections (including COVID-19).

Please watch, like and share the video - help us to finally get attention!
Unfortunately, there are no therapies, hardly any research funds and no significant care structure. Due to COVID19 the number of sick people is increasing drastically.

Those affected demand:
Read 6 tweets
When are we going to incorporate disability studies into medical training? How much of our population (and how much of our population who needs frequent medical care) needs to become disabled before we integrate meaningful curriculum changes? 1/11
Medical professionals are not kind to disabled people. COVID policies continue to uphold eugenics-centered ideologies (like utilitarian ethics). Policies will continue to focus on treating ICU patients rather than preventing disease or providing palliative care. 2/11
Disabled people have, for the whole pandemic, put off care. Now even more people are putting off care because some medical centers have dropped mask mandates, or are requiring switches to subpar surgical masks instead of proper N95s. 3/11
Read 11 tweets
Thread for Doctors (a thread to be updated time to time)

I will write here about,
What doctors can do to protect themselves, against complaints under SC/ST Act, complaints in police for medical negligence, complaints for medical negligence in

#Doctors #MedTwitter #India
2/ police station, complaints filed in criminal courts, summons by court to private doctors to appear as a witness with medical record of a patient, cases in civil court for damages, steps a doctor can take if he perceives threats from a patient, etc.

#doctors #MedTwitter
3/ First basic principles : An error in diagnosis (or Judgement) is not by itself a negligence. If a patient dies during an operation or immediately after surgery, is by itself not a medical negligence.
Read 37 tweets
Grateful to @AASLDFoundation,@AASLDtweets for recognizing our work @DDWMeeting & choosing us as one among ten to receive the prized Foundation Fellow Award globally

AASLD's recognition has been instrumental in progression of our clinical research in our State & Nation+
Our featured works to be presented at the @DDWMeeting, San Diego May 21-24 include:

A. Use of high dose probiotics in patients with severe alcohol-liver disease where we discuss novel findings associated with intestinal microbiome and their interactions after probiotic therapy +
& B. The changes in fungal communities in intestines of patients with severe alcohol-liver disease treated with high dose probiotics (Poster of Distinction)

Were the changes beneficial?
How did bacterial communities interact with fungal communities?

#medtwitter #livertwitter +
Read 4 tweets
By far, the most important events in the lifecourse of my daughter's #MECFS were two massive relapse events that severely degraded her baseline level of functioning. Hoping to crowdsource ideas from #Medtwitter and #NEISVoid on this phenomenon and how to study it effectively. 1/
A better understanding of exactly what happens during these events would help us make faster progress in understanding #MECFS and perhaps #LongCOVID. Yet this phenomenon remains dramatically understudied. We need to change this! 2/
The field lacks clear and uniform terminology for describing these events, which is one of many obstacles to studying them. For now I have settled on the term "massive relapse event" for these reasons: 3/
Read 27 tweets
🧵 ⭐️ NICE chronic pain guidance summary ⭐️ The word ‘psychological is used 27 times. ‘CBT’ 17 times. Recommends ACT- ‘acceptance and commitment therapy.’ 1/
Management = exercise. Psychology. Acupuncture. Anti-depressant. However in the ‘don’t’ list section it says don’t even offer paracetamol. 2/
However the first section of the guideline says ‘Offer a person-centred assessment to those presenting with chronic pain’ 3/
Read 10 tweets
What I have learned since being unwell myself has destroyed any faith I had in my profession’s leaders. I used to think that deep down most senior clinicians acted because they had the best interests of the patient, their colleagues & society at heart. That illusion is gone. 1/n
Be it the treatment of those with #MECFS #LongCovid #Fibromyalgia #POTS #MCAS #EDS #HSD #PansPandas #Lyme #FQtoxicity #vaccineinjuries & other so-called invisible illnesses; 2/n
the refusal of senior medics to stand up & protect colleagues, the public & schoolchildren from airborne spread of #SARSCoV2 as they are too afraid to displease those in the ivory towers of infection control, @UKHSA & @NHSE management & @UKgovcomms; 3/n
Read 7 tweets
Record Numbers of Americans Dying of Overdoses. Instead of Justice, We Get Theater👨‍⚖️

"Whole thing is kabuki theater, It ought to be about money" said Ausness. "About who pays what & instead they want to make Sacklers listen to people complain about them"…
Guggenheim joined several other museums last week w/an announcement they are removing the Sackler nameplate from their arts center,

Once again victims are being offered busy work as though it were meaningful reform.
#opioids #medtwitter #sacklers #HarmReduction @praddenkeefe
We are in the midst of the opioid crisis, an addiction & overdose crisis fed by the ubiquity of illicit & deadly fentanyl in the black market,

over 108k people died from an opioid overdose in 2021,… #opioids #addiction #news #twitter #CrimesAgainstHumanity
Read 27 tweets
Today's 🧵 is about autonomically-led post-exertional symptom exacerbation (PESE) in #LongCovid, #MECFS and other infection-associated chronic illnesses. This form of PESE is different to metabolically-led PESE, but it is also possible to have both occurring at the same time (1/)
Autonomic dysfunction happens a lot in #LongCovid and #MECFS and can be highly debilitating. The autonomic nervous system (ANS) manages a lot of intricate body physiology. For instance, every time you change position from laying down to sitting up, your ANS makes changes to (2/)
your blood pressure and heart rate to make sure that blood can travel all the places it needs to (e.g. the brain) despite the new position. The ANS does 1000 little ingenious, complex and entirely automatic functions like this on the daily. As such, when people experience (3/)
Read 18 tweets
There is a critical #FormulaShortage in the US. This post reviews why this is happening & highlights what bad things happen if infants don't get formula or breastmilk and receive something else (cow's milk, diluting formula, homemade) #FOAMed #MedTwitter…
The shortage is due to bacterial contaminants in Abbott's largest factory in Michigan that was linked to two infant deaths
At least 40% of stores are out of stock of Similac products because of this, and the plan has been closed from February though now with no open date in sight. Couple this with supply chain woes and you have the #FormulaShortage
Read 10 tweets

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