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Toxicologists are often consulted about 🍄foraging misadventures (wild mushroom ingestion).

Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.

So what to do?

A 🍄🧵
#FOAMed #FoamCC #MedEd
If you do have a good sample or photo you can work with a mycologist (your posion center knows one) to identify the shroom. But this is not frequent.
Since we almost never have that we usually rely on history and symptoms
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.
Read 15 tweets
Parlons un peu de la #contention #physique #passive chez les personnes âgées

- Le sujet est délicat
- Est-ce intéressant ?
- Comment trouver des alternatives ?

Un thread
#MedTwitter #gériatrie #psychogériatrie
La #contention physique passive

Moyens, méthodes, matériels ou vêtements
Qui limitent les capacités de mouvements volontaires
De tout ou partie du corps
Censés garantir la sécurité
En réponse à 1 comportement dangereux/inadapté


Moyens utilisés

Parmi les dispositifs se trouvent
- les barrières de lit,
- les ceintures de maintien,
- les gants de contention,
- ou encore les fauteuils inclinables avec harnais.

Read 36 tweets
Refresher on Hemodynamics:

From: Cardiovascular Hemodynamics. An Introductory Guide. Arman T. Askari, Adrian W. Messerli. Springer International Publishing; 2019 Image
CVP waveform (note: there is generally an electromechanical delay of ~ 80 msec between the atrial depolarization of the P wave & the pressure deflection of atrial systole represented by the "a" wave) Image
Intracardiac pressure waveforms derived from the pulmonary artery catheter Image
Read 28 tweets
10 rules for life of a young doctor.

How to deal with death and suffering.

A short 🧵

#MedTwitter Image
#1 Embrace empathy.

Understand that every patient is unique and has a story worth hearing.


Connect with your patient on a deeper level than just a "health provider".

Provide comfort and support.

It's necessary to reflect upon their pain.
#2 Caring for others requires caring for yourself.

Take time for activities that replenish your energy and help you decompress. You don't help anyone with your insecurity and own problems you have with this world. Your well-being and confidence is crucial for quality care.
Read 12 tweets
The moment you start withholding information from the public during a pandemic — such as deliberately suppressing the reality & risk of #LongCovid — Is the moment you open the floodgates for bad actors to spread dangerous misinformation.

At that point — you’ve lost all trust.
So when people are confronted with reality of #LongCovid but realize they are not hearing this information from the public health authorities who swore to inform them —

It creates an incident of exposure, & folks become susceptible to conspiracy narratives about other topics.
If they were lying to us about risk of infection how do we know they are not lying to us about XYZ?

How do I know whether scientific community can be trusted or Joe Rogan off his rocker?

At that point you cannot corroborate “following the science” & current public health policy
Read 6 tweets
Randomised clinical trials in cardiogenic shock in the PCI era Image
Treatment considerations for patients with AMI-cardiogenic shock Image
Enrolment data for major randomised cardiogenic shock trials (EuroIntervention 2021; 17: 451-65) ImageImage
Read 14 tweets
Less common symptoms of stroke

1. Weakness of one side of face, arm or leg; and speech impairment are the commonest symptoms of stroke.
However, it is important to be aware of lesser known symptoms of stroke, so that an early diagnosis can be made.
#MedTwitter #stroke…
2. Sudden onset Confusion- due to involvement of speech area (located in left side of brain) concerned with comprehension of spoken words. Patients are unable to appropriately respond to queries and keep talking something that doesn't make sense. (Sensory or Wernicke's aphasia).
3. Drooping of one eyelid and weakness of opposite side of body- occurs due to involvement of midbrain.
4. Dizziness, slurred speech, imbalance while walking- occurs due to involvement of brainstem+/- cerebellum (posterior circulation stroke)
Read 8 tweets
Today, I finished my last inpatient shift of internal medicine residency.

Here is a short thread of some of the most important lessons I have learned over the last few years:

#MedTwitter Image
Be kind to others and to yourself. Kindness is a choice and a conscious effort. At the end of a long day, in the midst of high acuity, or when we are overwhelmed, it is EASY to be mean or dismissive (and to beat ourselves up too).

Instead, take a breath and demonstrate grace.
Be humble and remain curious.

This is more important than having “medical knowledge.” Don’t be afraid to ask questions. Biology is complex. Patients don’t obey the textbook. The luxury of being a trainee is that under watchful eyes, we get to learn the practice of medicine.
Read 18 tweets
Professor Stephen Griffin accepts invitation to give @thackraymuseum #Insights lecture in memory of Monty Losowsky

Recorded 04.03.23

🧵 of lecture highlights

1 of 20

▪️ What is a vaccine?
▪️ How do vaccines work (1 of 2)

#SARSCoV2 #Vaccines #Children…
🧵of lecture highlights. Professor Stephen Griffin

2 of 20

▪️ What is a vaccine?
▪️ How do vaccines work? (2 of 2)

#SARSCoV2 #Vaccines #Children
🧵 of lecture highlights. Professor Stephen Griffin

3 of 20

▪️ What is a virus?
▪️ What is SARS-CoV2?
Read 21 tweets
Flame Cells: These are plasma cells with vermillion-staining glycogen-rich overstuffed fibrils. Although these cytoplasmic features are suggestive of neoplastic plasma cells, can also be found in reactive cells.… #mmsm #myeloma #MedTwitter #USMIRC #MedEd ImageImage
Mott cell is a plasma cell characterized by an accumulation of multiple Russell bodies, globular cytoplasmic inclusions composed of immunoglobulin… #mmsm #myeloma #MedTwitter #MedEd #USMIRC ImageImage
Russell bodies are cytoplasmic inclusions filled with immunoglobulins… #mmsm #myeloma #MedTwitter #MedEd #USMIRC ImageImage
Read 7 tweets
10 commonly asked questions about stroke answered

1. Stroke affects heart
#stroke affects brain and causes paralysis.
#heart attack is known by the term myocardial infarction.
#MedTwitter #NeuroTwitter…
2. Common symptoms of stroke:
*Weakness of arm, leg or face, usually on one side
*Inability to understand spoken words or to speak
*Imbalance while walking
*Reduced vision on one half or in one eye
*Sudden onset severe headache
3. Risk factors for stroke
*High blood pressure
*High total and LDL cholesterol or high triglycerides and low HDL
*High homocysteine
*Heart diseases
*Alcohol consumption
*Lack of sleep
Overweight or obesity
*Older age
*Family history of stroke
Read 10 tweets
Patients with Inflammatory bowel diseases (IBD) have a higher risk of suffering a stroke

1. Persons with Crohn's disease or ulcerative colitis have an increased risk of developing thrombo-embolic events. A recently published study looked at the association between IBD & stroke.…
2. >85,000 patients with IBD were followed up long-term (1969-2019), and the risk of stroke in them was compared to those without IBD.
Patients with IBD had 14% higher risk of suffering from ischemic stroke during follow up.
#MedTwitter #stroke #IBD
3. The elevated risk of stroke remained increased even 25 years after diagnosis, corresponding to one additional stroke case per 93 IBD patients until then.
Read 5 tweets
Let’s take a minute to recap our latest blog post on a pretty daunting hematological emergency🩸

A thread 🧵 1/7 #MedEd #MedTwitter Image
An imbalance between ADAMTS-13 and von-willebrand factor can lead to catastrophic physiological damage 💔

🧵 2/7 Image
The classic FATRN presentation actually only occurs in less than 7% of cases 😳

Instead, look for:
🧠 CNS symptoms - 60% of cases
🤮 GI symptoms - 35% of cases
🫀 Cardiac symptoms - 25% of cases

🧵 3/7 Image
Read 7 tweets
🫁How to interpret pulmonary function tests ??🫁

I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists


#MedTwitter #RheumTwitter #MedEd Image
1️⃣Is the test valid?

You need to check for three things

🌬️ Effort
✅The time volume curve forms a plateau in 1-2 seconds
✅ sustained expiration for 6 seconds!

(2/7) Image
➰Flow loops

✅ for artefacts/abnormalities 📷⤵️

(3/7) Image
Read 8 tweets
Investment tips for doctors

It is a fact that most of us lack the basics of managing our finances. It is not unusual to come across doctors who have little awareness about their income, expenses & future goals (for which money is needed). Here are some tips that could help.…
1. Life insurance: If you have dependents (children, spouse), life insurance is a must to safeguard their future in case of any unexpected incidents. Life #insurance is to protect the risk, and not an investment to get returns. Term plans are good.
2. Medical insurance: Medical care is expensive and we would have to bear the expenses if we or our family members fall sick. Family floater schemes are the best as premiums work out to be lower.
Read 15 tweets
OUR NEW STUDY @JAMANetworkOpen is a follow up on our initial work to quantify harassment of physicians and scientists on social media DURING the pandemic.

In a sample of over 350 physicians and scientists on social media...THREAD… infographic describing our ...
2 in 3 physicians and scientists reported being harassed or attacked Image
88% cited advocacy as the reason they were harassed Image
Read 10 tweets
1. Mr Hari to his wife Mrs. Rani: "Have you lost all shame? Why are you changing dress in the living room, where our driver is waiting?"

Mr Hari had noted instances of mood swings in his 55-year old wife for the past six months but today's incident was shocking.
2. Mrs Rani was otherwise a pleasant woman, however, she had become irritable for the past few months. She would get agitated over small issues and go into a shell (for several hours) on many occasions. She would refuse to talk to her husband and even refuse food.
3. Mr Hari attributed these changes in her personality to post-menopausal symptoms and tried to ignore them, and hoped she would get back to her previous self soon.
He had noted inappropriate behavior in his wife on a few occasions, when she would crack jokes with strangers.
Read 12 tweets
The #VDPS send me their decision today.

They accept causality to the vaccine on the following grounds:
My acute flu-like side effects

Therefore they consider me 1-5 % disabled from the vaccine, and ineligible for payment

#vaccineinjuries #postvac
The document is very long and i need to re read to check ive interpreted correctly. Currently im quite in shock. The vaccine has ruined my life. Based on others, i expected rejection but how theyve determined < 5 % disabled is beyond me
Since the vaccine in March 2021, ive had about 6 months off work sick due to being near bedbound.

I was found to have multiple blood clots in my lungs, and since then, my risk of clotting is so high i am on anticoagulants indefinitely
Read 17 tweets
🔹Relapsing Polychondritis🔹

Important takeaways from an excellent presentation by @Lupusreference @eular_org #EULAR2023

#MedTwitter #RheumTwitter
🔹Rare disease
🔹Middle aged adults
🔹No♀️ predominance

It's typically characterized by:
👂Spares the lobule
⏳lasts >48 hrs
❌ ear discharge (infection)
❌ necrosis/purpura (CAPS)

📷⤵️Prone to erroneous diagnosis!! ImageImage
Once 👂chondritis is confirmed, rule out mimics! Image
Read 11 tweets
I was at the beach. It was bedtime, and I was tucking my two kids in bed.

As I read The Lion, the Witch, & the Wardrobe to them, that’s when we heard sirens go by the beach house

A few minutes later, we heard the helicopter landing in the field behind our house. Strange.

My 3 and 6 year olds were excited by helicopters. So we went to check it out.

When we went on the back porch, the helicopter was there in the field, but so was the ambulance we heard earlier

Someone was undergoing an air-evac behind our house

… but something was wrong.

The patient was taking too long to come off the truck.

So, I walked down in my Wake Forest baseball shorts and white t-shirt looking like a beach bum since we were on our annual beach vacation.

As I approached the truck, I was met by one of the EMTs, and said

Read 7 tweets
La méthode #DICE (Décrire, Investiguer, Cocréer, Évaluer)

- Une approche systématique et interdisciplinaire
- Des troubles psycho-comportementaux
- Se surajoutant à une maladie neurocognitive

Un thread
#MedTwitter #gériatrie #psychogériatrie
Sur note site internet

Retrouvez le support de notre #formation sur notre site internet
Avec toute la bibliographie indispensable

La méthode #DICE

Permet d’analyser en profondeur un trouble psycho-comportemental en équipe et de lui apporter une réponse mesurée, partagée et structurée
Elle est la base de tout travail en psychogériatrie

#gériatrie #psychogériatrie

Read 26 tweets
POTS (postural orthostatic tachycardia syndrome) in #LongCovid & #MECFS

I have many patients who have lived with undiagnosed POTS for years.
This is as disabling as heart failure.
Once diagnosed&treated I have patients whose lives have been drastically changed. #MedTwitter
The test is so simple.
The same as a lying/standing BP but for 10 minutes and not 3.
Full instructions here…
This can be done at home and best results I think are in usual environment (patients should always check this test is suitable before doing)
The treatment is with medications that have been used for years. They can make a massive difference to quality of life.
There is a knack to picking the correct medication for individual patients. But the main thing is getting the diagnosis.
Read 8 tweets
Cardiovascular Deconditioning (20 Hours Bedrest with -5° Head-Down Tilt (HDT)) in Middle-Aged Healthy Men…
authors suggest during HDT MAIN cause of deconditioning is "an altered distribution of body fluids & intravascular pressures" & shift of fluid to head
this is potentially VERY important for #POTS: it suggests that our dysregulated body water regulation can be a primary source of deconditioning-like cardiovascular issues.

this means: fix the haemostasis problems to improve cardiovascular condition

this study was in a very different context to POTS so we can't read too much into it. HDT shifts fluid to the head which is the opposite to POTS. this does trigger a reduction in blood volume, reduction in oxygen consumption, low renin, tachycardia, etc tho, all similar to POTS
Read 5 tweets
1/16 See below for this #Tweetorial on guideline and management updates for COVID-19. It is contributed by @RishiDesaiMD.
#MedTwitter #MedEd Image
2/ In all outpatient settings in which patients with COVID-19 are seen, including long-term care facilities, testing and treatment must be done in a timely manner. It is also crucial to consider patient risk factors for progression to severe disease and death. ImageImage
3/Conditions such as metabolic syndrome and obesity confer an increased risk of ICU admission, mechanical ventilation, acute respiratory distress, and death. Image
Read 16 tweets

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