Discover and read the best of Twitter Threads about #medtwitter

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Compartilhei esta imagem com a intenção de repercutir principalmente com o #MedTwitter e outros colegas da área da saúde.
Me esqueço que aqui não é uma bolha; E tenho a impressão que posso ter feito algo que critico: a demonização desnecessária do DIU.
Me permitam esclarecer:
Esta complicação pós inserção do DIU é absurdamente rara. Tão rara que é interessante compartilhar com os colegas.
Por favor, mulheres que me seguem ou q viram o tweet inicial: o DIU não sai de dentro do útero à toa,...
.. muito menos migra a troco de nada para a cavidade abdominal.

A inserção do DIU é quase sempre um procedimento ambulatorial sem maiores intercorrências e uma simples ultrassonografia transvaginal de controle após a inserção permite avaliar a localização do DIU.
Read 4 tweets
Here are 4 threads on randomized controlled trials (RCT) that may be useful for those interested in doing one, or learning about the process and what it takes. #MedTwitter #MedStudentTwitter

1. The process is not easy. Certainly not for investigator initiated RCTs in the US.
2. Here is an example of the process from start to finish of an RCT we did in @eaonc @SagarLonialMD

It gives you an idea of the process for investigator initiated NIH cancer trials— which is totally different from a Pharma company sponsored Pharma company run trial.
3. RCTs can be done for various reasons including incremental advances and drug approvals. Many of these are well done by Pharma. And Pharma has the resources to pull it off. But we also need strategic investigator initiated trials to answer important clinical questions.
Read 5 tweets
I know a LOT of MS4s out there need honest match advice, especially in this era. So time for some of the MOST honest advice I can give for General Surgery Applicants. (Full disclosure, I'm a proud @BCM_Surgery resident, and will shamelessly plug my program.) #MedTwitter
Many programs have dramatically different call burdens, operating volumes, mentorship levels, autonomy and clinical exposure- little of which is disclosed publicly. Different programs thus may honestly mean the difference between a successful career and leaving surgery altogether
Read 36 tweets
A lot can be misinterpreted on twitter in nuance, in punctuation, in tone, short tweets 🆚 deep conversations or long 🧵It’s why I use gifs a lot, in place of nonverbal communication like tone, facial expression, body language, look in the eye, eyebrow rise. 1/
I’d personally take a ‘..... ‘ as vague and be inquisitive about what the writer means 🤷🏻‍♀️2/
Then I’d maintain curiosity and ask a question to clarify the meaning. 3/
Read 10 tweets
🟠17 de septiembre es el día internacional de la #SeguridadDelPaciente. La seguridad de pacientes y #PersonalSanitario están íntimamente relacionadas y hay innumerables ejemplos históricos que lo ilustran. Las infecciones quirúrgicas es uno de ellos: 🧶 1/13
🟠 Alrededor de 1846, en Londres, Joseph Lister era apenas un estudiante de cirugía. La cirugía era una disciplina aún con más potencial que logros -aunque ya los había. El último recurso. Las infecciones = causa de que hubiera una tasa de mortalidad de cerca del 70%... 2/13 Joseph Lister. Wikipedia
🟠Gangrena, Pyemia, Erisipela, Septicemia. Mataban a pacientes y cirujanos por igual. Los cirujanos operaban sin guantes y un rasguño del cuchillo de amputación equivalía a una sentencia de muerte. En una década habrían de morir más de 45 cirujanos tan solo en el RU. 3/13
Read 14 tweets
1) Migraine Premonitory(Prodromal) Phase::
Presences of non-painful Symptoms, which can start hours to days before the onset of migraine pain and can be predictive of an impending headache.
2) Three Separate Groups of Symptoms::
1::Fatigue & Cognitive changes...
Concentration difficulty, Irritability, depression, fatigue, memory impairment.
2::Homeostatic Changes...
Food craving, Thirst, Yawning, Increased Urination, Sleep disturbance.
3) 3::Sensory Changes...
Photo, phono, osmo, Phobia, nause, neckstiffness.
Read 7 tweets
1) Migraine with AURA::
Recurrent attacks of unilateral fully reversible visual, sensory, or other CNS symptoms that develops gradually over minutes and usually followed by Headache and associated Migraine Symptoms.
2) Total 20-40% prevalent,Increased risk in 1st degree Relative + twins + Heritibility. Onset::
Gradual and progressive, unlike abrupt in Stroke.
AURA consists of Positive symptoms like flashing lights, and paresthesia while stroke dominates Negative symptoms like weakness.
3) Duration::
Typically 30 minutes but may be Prolong upto 4 hours. Symptoms::
Visual(90%,most common) > Sensory, language, motor.
Scintillating scotoma, Flashing lights, Blurry Visions.
Read 12 tweets
A #stroke #tweetorial. Inferior division MCA infarct often gets mistaken for PCA territory. Sometimes it can be quite difficult to distinguish MCA vs PCA territory infarcts (especially near the borderzone). #neurotwitter #medtwitter #medstudenttwitter
1/ Reminder of topography: MCA (yellow) and PCA (green) territory. Inferior division MCA (near the borderzone of PCA) involves the occipital lobe
3/ This is an example of a patchy MCA territory infarct. Note that the inferior division MCA affects the partieto-occipital lobe (except for the very medial portion of the occipital lobe, which we already stated is PCA). Red line indicates the borderzone between MCA/PCA
Read 7 tweets
A few months into my Neurology residency program, I found myself,unexpectedly, pregnant! With my husband pursuing his Neurosurgery residency simultaneously, the situation was not ideal. A few personal thoughts .. 1/n #MedTwitter
No amount of medical knowledge or previous imagination can prepare you for the reality of impending motherhood. Your reaction may surprise you. The only thing I was certain about was wanting to continue the pregnancy, so that made things easier for me2/n
Even if you aren't immediately sure what to do, it's alright. It's a big decision, and you have to be sure first, before you look for certainty in your spouse/family members. Don't base your decision on other people's desires. 3/n
Read 12 tweets
🚨Oregon Habeas Press Task Force Conference Happening Right Now 🚨 Families of folks who are incarcerated sharing their loved one's stories. The conditions in Oregon's prisons are horrific and inhumane.
Folks don't have access to their meds. Someone had a seizure yesterday. People are sleeping on the floor. Being advised to vomit in their socks. Women don't have access to feminine products and bleeding through their clothes. These are just a few horrible examples.
Read 7 tweets
1/ #medtwitter #tweetorial Raise your hand if you have ever inappropriately checked an ammonia level.🙋
1. Why is ammonia ⬆️ in liver failure and how is this connected w/ encephalopathy?
2. When should levels be checked?
3. Aside from cirrhosis, what other conditions ⬆️ammonia?
2/ Ammonia is primarily produced by bacteria w/ urease enz in intestines but is also produced in muscle and the kidneys.

Table source:…
3/ 85% of ammonia is cleared by the liver through the urea cycle. 15% is cleared by muscle/kidneys. If the ammonia (/other nitrogenous waste) not metabolized it passes through the blood brain barrier glutamate>glutamine> astrocyte swelling and free radicals>encephalopathy.
Read 19 tweets
I would like to lay out why this work is scientifically unsound and problematic. Note that my PhD was in a genetics/informatics lab, and I spent time working with population geneticists. This is a thread. #MedTwitter
One of the mistakes of my early training was conflating race and genetics. This is still done at every level of medicine and science. Race is a SOCIAL construct. It is not based on biology. Race is not a risk factor; racism is.
When you take a group of people of the same "race" and look at their genetics, it's incredibly diverse because again, race as a social construct is not capturing underlying biology, genetic ancestry. Race isn't biological.
Read 13 tweets
Yikes: lots of #MedEd teaching but no time to tweet to #MedTwitter! Here's a thread of #postitpearls with @dukeemergency !
Read 23 tweets
If you follow #medtwitter, #epitwitter or #covid twitter even cursorily, you've probably noticed a serious freakout over political interference in an obscure journal you've likely never heard of before: MMWR - Morbidity and Mortality Weekly Report. Who cares? Why so much? 1/
MMWR is...not the world's most exciting journal. Imagine if your mom produced a medical journal. It would be a lot like MMWR. Reports about consumption rates of sugary drinks in high schoolers, etc. But it has a very special role in the medical ecosystem. 2/
For instance, on June 4, 1981, MMWR published the report, Pneumocystis Pneumonia -- Los Angeles. Yes, that's really its title. About as exciting as pencil shavings, right? 3/…
Read 6 tweets
Ever wonder why eosinophils vanish from the blood after exposure to steroids?

I assumed that steroids somehow destroy them and that is why they disappear.

But there's a lot more going on.

#tweetorial #medtwitter
First let's review eosinophil biology.

Eosinophils are granulocytic white blood cells that develop in the bone marrow and reside primarily in tissues.

They have a multitude of physiologic functions, from parasite defense to immuno-regulation.
In the 1970s the effects of steroids on blood eosinophil levels were first studied.

🔑 Prednisone led to marked declines in peripheral eosinophil counts within 4 hours.

(bonus: the senior author on this paper was Dr. Anthony Fauci!)
Read 14 tweets
Apparently, posting a picture of a grill with a large fire leads people to have a lot of questions.

Pull up a chair and let’s talk about the joys and deliciousness of wood fired grilling (1/6)
Some basics.

This is a parilla — it’s a staple of Argentinian cooking.

You’re not cooking over flames — you are burning wood to make a bed of embers to cook over. Goal is to not let flames touch meat.

The area on right lets you continually burn wood to replenish embers (2/6)
Use a chapa on grill to make appetizers to start.

We did blistered shishitos and a provoleta (not pictured).

Provoleta is basically a block of provolone melted on chapa till crusty.

Sprinkle cooking cheese with oregano, red pepper flakes and vinegar. Serve with bread (3/6)
Read 16 tweets
1/ Paraproteinemic kidney disease: Cast nephropathy, myeloma kidney, MGUS, MGRS, LCCN, AL, AH, MIDD, LCPT…)

Lost in the alphabet soup!!!

Time for an #MGRS #tweetorial
#NephTwitter #Hemetwitter #MedTwitter #Onconephrology #NSMC
2/ Let’s start with a poll: which of the following disease states can cause MGRS (monoclonal gammopathy of renal significance):
3/ Before we get to the answer, let’s dissect the term MGRS:

Monoclonal Gammopathy:
⚡️Signifies the presence of a "monoclonal" immunoglobulin or its components
⚡️Seen as a spike in the "gamma" region on protein electrophoresis…
Read 21 tweets
Wow, many @StanfordMed faculty took a stand for science and truth in the battle against #COVID19 misinformation being pushed by Dr. Atlas. These faculty are respected infectious disease doctors, microbiologists, epidemiologists, and more. #MedTwitter
The number of signatories goes on and on:
And more:
Read 5 tweets

Sexually transmitted infections/diseases are more common than you think.

1. There are many sexually transmitted diseases
2. Condoms do not protect against all types of STIS/STDS
3. Some may not show obvious symptoms 

4. Some cause irreversible damage within a very short time.

5. Some can lead to complications that may manifest 15 to 30 years later 

6. Some have uncommon symptoms like behavioural changes, headache, fleshy growths abnormal bleeding between period etc.
7. When infected, you must do contact tracing of recent sexual partners, so they can be treated

8. New sexual partners should screen/test before engaging in sexual activities 

9. You can’t treat all STIs with same medications

10. If in pregnancy, it can lead to miscarriage
Read 5 tweets
Diagnóstico diferencial do olho vermelho pro clínico geral a thread #MedTwitter
Existe dois tipos de hipermia e é importante saber a diferença...
Foto 1- injeção ciliar, fica uma coroa de hiperemia ao redor do limbo: INDICA ACOMETIMENTO INTRAOCULAR!!!!
Foto 2- hiperemia conjuntival difusa: maior probabilidade de doença na parte externa (conjuntiva e tals).
Agora que vc sabe a diferença, passos a seguir pro diagnóstico:
1- anamnese bem caprichada
2- ver se é injeção ciliar ou hiperemia conjuntival
3- confira se tem secreção e o aspecto (hialona? Mucoide? Purulenta?
4- teste reflexo pupilar (no escuro sempre, né)
Read 17 tweets
Show me a doctor-only staffing model that allows us to care for all Americans, including rural and inner city, those on Medicaid, uninsured, undocumented. The system is broken. We need a range of clinicians.
I am fine being unpopular with doctors. I don’t give any clinician a pass, tho. I don’t give any faculty a pass either.

What I ❤️❤️❤️ @MIT @MITSloan @MITSloanFellows is get to be honest, creative, expressive, fail, try again.

Pushing past boundaries is the goal. Have an impact.
We need fewer silos and turf wars. We need to break down walls and boundaries.

Fail often but fail smartly. Expect to fail. Have a disciplined process by which to learn from failure.

Every time you learn you have pushed a boundary of your mind or skills or effectiveness.
Read 21 tweets
A 🧵 ~
As #nursePractitioners we must take a stand and say enough is enough. #FPA will continue to ruin our profession in many ways. Here is one way: forcing unprepared NPs into FPA to be marketable in today’s job market. /1
Over the last 10-15 years Nurse Practitioner educational standards have become less rigorous. Online schools rely heavily on paper writing versus hands on clinical learning, yet the drive for FPA has continued at full speed. /2
Some will state that “their school was just fine, very rigorous, with high quality education that taught them to practice at the top of their education. What is the “top of our education” and why do we equate it with FPA? /3
Read 11 tweets
Trials claiming benefits of weight loss *actually* measure many effects of pleiotropic interventions (incl. weight loss). But we don't manipulate weight. No manipulation, no causality.

It's scientifically irresponsible to confuse a DEPENDENT VARIABLE W/ THE INDEPENDENT VARIABLE
I am a fierce advocate for exercise and healthy foods. I reject the idea that they matter only insofar as they decrease weight. But that's the message of these studies. Weight loss gets all the credit. It gets the title. It gets the abstract. It gets the punchy headline.
Let's have some fun today. Anyone on #medtwitter #nursetwitter or just a human interested in the *body weight independent* benefits of exercise and fitness on the following: NAFLD, asthma, diabetes, hypertension, all cause mortality?

or how about just improving quality of life?
Read 17 tweets
40 year old male - presented with chest pain and one episode of loss of consciousness at home from which he recovered in few seconds spontaneously. Came to ER with ongoing chest pain and hypotension. ECG - SR, extensive AW STEMI #MedTwitter #cardiotwitter #COVID19 #SCA
Given Heparin, loading doses of DAPT and Tirofiban started. Shifted on nor adrenaline infusion to Cath lab. Angio done from RFA. #femoral pt in pulmonary edema .. angio showed thrombus in distal left main with slow flow in LAD
Stented from LMCA to LAD. Intubated and put on ventilator as pulmonary edema worsened. Stable. Pressure 90-100 systolic on Dopa and noradrenaline. EF 35% AW Akinetic. IABP inserted.
Read 10 tweets

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