@valcohranmd

@valcohranmd

@valcohranmd

@Subramanian1MD

Valeria Cohran, MD, MS

@valcohranmd

@MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 2/ #MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds @BonumCe

🟠Earn #CME 🏆on Twitter!
🟠Full CME ℹ️ 🔗bit.ly/3Hgnpcf

📸 Faculty disclosures & important CME info 👇

@MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 3/#MondayNightIBD

💊💉Meds = important 🛠 in mgmt of #ShortBowelSyndrome

💎Antimotility & antisecretory agents frequently used to control stool loss
💎Incl loperamide, diphenoxylate w atropine, codeine, & tincture of opium
💎Most effective ~30 min B4 meals & @ bedtime 🛏

@MondayNightIBD

@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 4/Growth factors also available for #ShortBowelSyndrome
🚦Somatropin (rhGH) approved in SBS
🛑Use largely discontinued due to unacceptable toxicity & modest long-term efficacy

#MondayNightIBD

Read 23 tweets

Valeria Cohran, MD, MS

@valcohranmd

@MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma 2/ #MedTwitter #GITwitter #MedPeds @BonumCE

🟠Earn #CME 🏆on Twitter!
🟠Full CME ℹ️ 🔗bit.ly/3SZrpB4

📸 Faculty disclosures & important CME info 👇

@MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut 3/ #Parenteralnutrition is used in cases w GI dysfunction
➡️replace nutrients ➡️essential components pt would otherwise be unable to absorb from their 🥪🍜🍱

In pts w #ShortBowelSyndrome, PN is given @ home🏠 usually @ nt🌛
#MondayNightIBD

@MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut 4/@AmerGastroAssn Clin Practice Update on #ShortBowelSyndrome #ParenteralNutrition

🌟Best practices
💎 Pref of tunneled CVCs
💎Micronutrient deficiencies monitoring
💎PN volume/contents based on pt weight, labs, stool/ostomy & urine output, signs of dehydration
#MondayNightIBD

Read 21 tweets

#MondayNightIBD

@MondayNightIBD

@valcohranmd

⌛️#GITwitter #PedsGI - the wait is over!
🎆 Join @valcohranmd & @DCharabaty
📽️#MNIBDWebinar🎞#ShortBowelSyndrome Consult w the Expert

#CME👉 🔗bit.ly/sbs-consult-1-…
👇#PostConvo #IBDPolls

Supported by an educational grant from @TakedaPharma twitter.com/i/broadcasts/1…

2/#PedsGI #GITwitter #GIFellow #IBDTwitter #MedEd #MedTwitter

🟠Earn #CME 🏆
🟠Full CME ℹ️ 🔗bit.ly/sbs-consult-1-…

#MNIBDWebinar #BonumCE
📸 Faculty disclosures & important CME info 👇

3/#MNIBDWebinar #MedTwitter #GITwitter #GIFellow
🟠Full CME ℹ️ 🔗bit.ly/sbs-consult-1-…

🔴 Where are you in your career?

Read 7 tweets

Nigel Curtis

@nigeltwitt

Should #children be vaccinated against #COVID19?

Our review outlines the points to consider in weighing up whether all healthy children under 12y should be vaccinated against COVID-19.

bit.ly/2ZYyPi0

#medpeds #IDTwitter #PaedsID #tweetiatrician #paediatrics

🧵1/n

@Dr_Petzi

As specialists in paediatric #InfectiousDiseases and #Vaccinology, we recognise enormous benefits of and strongly support child vaccination programmes

@Dr_Petzi @PittetLaure @adamhfinn @ajpollard1 @nigeltwitt

@unifr @unige_en @BristolUni @OxfordVacGroup @MCRI_for_kids @UniMelb

@ASIDANZ

Our review highlights that the balance of risks and benefits of COVID-19 vaccination in children is more complex than in adults as the relative harms from vaccination and disease are less well established in this age group.

@ASIDANZ @ESPIDsociety @WSPID @PIDSociety @DFTBubbles

Read 10 tweets

Nigel Curtis

@nigeltwitt

#LongCOVID

We reviewed 14 studies of persisting symptoms following #COVID19 in #children & #adolescents

Most had major limitations and should be interpreted with caution.

True risk is likely to be nearer 1 in 100 than often quoted 1 in 7.

#medpeds #IDTwitter

(Long) 🧵1/n

@Dr_Petzi

@Dr_Petzi @PittetLaure @MCRI_for_kids @RCHMelbourne @UniMelbMDHS @ASIDANZ @ESPIDsociety @ESPR_EBN @WSPID @PIDSociety @DFTBubbles @PIDJournal

#medpeds #IDTwitter #tweetiatrician #paediatrics #pediatrics #PaedsID #PedsID #PedID #PID

The 14 studies involved 19,426 children & adolescents.

Common persistent symptoms reported 4-12 weeks after acute #COVID19 were:

•headache
•fatigue
•sleep disturbance
•concentration difficulties
•abdominal pain.

Symptoms rarely lasted more than 12 weeks.

Read 13 tweets

Nigel Curtis

@nigeltwitt

To reassure parents, a reminder of some key facts about #COVID in #children:

#SARSCoV2 infection remains asymptomatic or mild in the vast majority of children, even with the #DeltaVariant. Hospitalisation and deaths from COVID are still rare in this age group.

1/n 🧵

However, the greater transmissibility of the Delta variant means there is more COVID in *all* age groups, including children, so we will see more paediatric cases.

As a large number of older people are now vaccinated, the increase is blunted in the elderly so, compared with earlier in the pandemic, a higher *proportion* of current cases will be in children: this can give the mistaken impression that the Delta variant is targeting children.

Read 7 tweets

Kimberly D. Manning, MD

@gradydoctor

1/
#InternReflections, Day 6

*tap, tap, tap*

Me: *startling awake* “What? Huh?” *looking all around*

Suddenly, he came into focus. It was one of our hospital security officers.

He gestured for me to roll down the window.

Me: “Huh? Oh. Uh okay.”

I tried but couldn’t move.

2/
I remembered then that I’d tucked and folded my arms beneath my scrub top just after reclining my car seat.

It was now dark outside. I was so disoriented.

And . . . cold. Like freezing cold.

*tap, tap, tap*

He gave his finger a more exaggerated roll down motion.

3/
When I lowered the window, I noticed his eyes dart to my left shoulder. I registered the fleeting look of disgust and then disbelief on his face.

Him: “Were you out here, like, taking a nap . . . on purpose?”
Me: *placing my hand over the giant slobber stain* “Uhhh. . .what?”

Read 20 tweets

Febrile

@febrilepodcast

@JillWeather

1/
In the newest episode, @JillWeather spoke about eosinophilia!

#1 step: calculate your absolute eosinophil count (AEC).

You can then grade eosinophilia based on AEC (mild/mod/severe)👉although this doesn't exactly predict organ damage

What else?

@HawraAllawati

2/
The ddx for eosinophilia is broad! It can help to think of different causes in groups.

Here is a nice mnemonic and graphic from @HawraAllawati on how she remembers: iPa3d!

I nfection
P arasite
A3 atopy, autoimmune, adrenal insufficiency
D rug rxn

3/
Another memory tool is 3 Ws:
🪱Worms: helminth infections
🫁Wheezes: allergic/atopic, adverse drug reactions
🤪Weird diseases: hypereos syndromes, rare immunodef

Here is a nice review on a practical approach to pt with hypereosinophilia: pubmed.ncbi.nlm.nih.gov/20538328/

Read 8 tweets

Rebekah Roll (she/her)

@rebekah_roll

(1/x) Last night the #MedPeds21 group chat was rocked with news of a sudden change in program leadership for the MedPeds residency at Tulane University. Dr. Dennar, the first Black female program director at Tulane, was no longer PD.

(2/x) This morning we were devastated to find that this unfair termination was a direct result of racism. I will include some screenshots of the court case for the lawsuit that Dr. Dennar filed against Tulane for reference.

(3/x) Told that Tulane did not want to change the face of medicine in fear of losing white applicants.

Read 20 tweets

Nicholas Lee, MD

@NickLeeMD

@medrxivpreprint

1/ A #MedTweetorial on #HowIReadThisPaper for #DISCOVERYtrial - dex edition on @medrxivpreprint. We’ll be exploring the pre-print, supplement, and trial document. Would love for feedback, thoughts, & comments!

Currently, what is your opinion on using dexamethasone?

2/ Trial info:

▶️RCT, open-label, adaptive
▶️6,425 pts enrolled
▶️Dex 6mg daily for 10d (PO or IV) v usual care (1:2 ratio, respectively)
▶️176 🏥in UK
▶️Prim Outcome: OS

🔑Intention-to-treat
🔑Pre-specified stats plan
🔑Not randomized by O2 status

3/ Results - Table 1
✅Well-balanced between dex & usual care
▶️Younger, less-comorbid cohort on vent
▶️Days of illness ⬆️w/ ⬆️O2

Imbalances in O2/vent cohort raises ❓s
1️⃣How to account for O2 & vent?
2️⃣Can we adjust & trust result?

Read 14 tweets

Nicholas Lee, MD

@NickLeeMD

@nmpra

#askMedPeds

Guidance regarding virtual interviews
@nmpra guidance forthcoming
Try to get rid of your picture to look at your interviewer

More tips below!

20/

https://twitter.com/sophiakmckinley/status/1263991017239449600

#askMedPeds Dual applying

▶️ Can likely stick to one residency - MP - if you interview enough places will be OK
▶️ If you're geographically restricted, may make sense
▶️ PDs will not view it as a negative thing if you dual apply

21/

twitter.com/i/lists/127123…

#askMedPeds Resources for applicants

1️⃣ #MedPeds residents willing to answer Q
twitter.com/i/lists/127123…

2️⃣ @nmpra compiling list of potential advisors for students

3️⃣ Brown residents have been working to ID faculty mentors at institutions where MP programs not present

22/

Read 6 tweets

Nicholas Lee, MD

@NickLeeMD

@nmpra

@nmpra, #MPPDA, #AAP webinar #3 coming online!

Personally, must admit that it warms my heart to see my current PD and med school PD (@YaleMed, Dr Doolittle) chatting before this session starts!

Let's get started, #askMedPeds!

1/

Doing some quick introductions with multiple PDs, including some that went to programs w/o #MedPeds programs!

This'll be a great discussion & will keep everyone posted throughout it.

#askMedPeds

2/

Objectives:

▶️ Doing our best to advise applicants
▶️ Represents personal opinion, so there may be some differences in advice
▶️ But we're all here to help YOU 🤜 🤛

#askMedPeds
3/

Read 21 tweets

Nicholas Lee, MD

@NickLeeMD

@nmpra

#askMedPeds w/ @nmpra, #MPPDA, & #AAP is BUMPING with over 200 people! Tune in w/ us for some wholesome #MedPeds information for upomcing applicants.

Great to see @maxabillioncruz, @MedPedsMike, Dr Doolittle, et al. all on the call!

1/

@nmpra

Intros to orgs:

@nmpra: #MedPeds residents org + med student membership. Incoming prez @maxabillioncruz

#MPPDA: Med-Peds PDs org that collaborate w/ ABIM, ABP, and other communities. Prez is @MedPedsMike (U of MN PD).

#AAPSOMP: Keeps everyone up to date on ACP, AAP, cert

2/

#MPPDA Prez Elect really emphasizing that he wants applicants to be able to come forth with questions to any of the PDs. Knows that it will be a stressful year, and wants to have everyone leaving to be less stressed.

3/

Read 26 tweets

Maximilian Cruz

@maxabillioncruz

1/ Alright guys, w/yet another new clinical year approaching, a new and updated thread on Med-Peds (MP), to help provide some clarity on what MP is/isn't, esp for rising M4s (some of whom may not have had full IM/Peds clerkship experiences), trying to determine their careers!

2/ Let's start w/what MP actually is: a 4 year integrated residency combining Internal Medicine (IM) and Pediatrics training. At the end you are board eligible for BOTH IM and Peds. You condense 6 years of training (3 for categorical IM and 3 for categorical Peds) into 4 years.

3/ You are, and I cannot stress this enough, *both* an IM AND a pediatric resident. You do not exist in a separate universe (though they may think it when you flip back and forth). The IM and peds categorical residents are your coresidents. You are fully IM and fully Peds.

Read 22 tweets

Rachel Peterson

@MPAcadHosp

1/Palliative Care Redeployment:

What I learned from 6 weeks working with our county hospital’s palliative care team during the COVID-19 initial surge in Indiana.

2/At the end of March, I stopped by our division offices to do some work. I overheard my colleagues in palliative care in the office as well.

Layered in their voices and expressed in their words was worry, stress, and concern for patients.

A call was put out for help.

@EskenaziHealth

3/I learned so much during my time with the palliative care team @EskenaziHealth. I thought I'd list some here.

1⃣A loved one who is sick is difficult. One who you can’t touch/visit/see – it is heartbreaking for families. It also makes “painting the clinical picture” difficult.

Read 13 tweets

Kimberly Manning, MD

@gradydoctor

1/
The night before this day—20 years ago—I was a senior #MedPeds resident finishing up the last days of my rotation in the cardiac ICU. I was on pre-millennium eve overnight call that night.

Yup.

I remember because that was the same night that my dad had an ST elevation MI.

2/
A page came through. A call from the operator. It was my dad. He chatted first—not unlike my dad. But then he went straight to a complaint. That isn't like my dad.

Him: “My shoulder hurts.”
Me: “Which one?”
Him: “The left. But I played 36 holes today.”
Me: “Okay.”

Um. Okay.

3/
Him: “It’s probably that.”
Me: “Maybe.”
Him: “I took some ibuprofen but that didn’t help.”
Me: “No?”
Him: “No. But it’s not really that kind of pain, so. . . .”

Um. Okay.

Read 23 tweets

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