Discover and read the best of Twitter Threads about #steroids

Most recents (24)

@ESICM #LIVES2022 #ventilation
#ARDS #Steroids. This morning I covered "4 key questions on NIV" and "steroids". Here is a collection of those threads.
@DrLeoHeunks 2. Claude Guerin on COVID vs. Non-covid NIV.…
Read 10 tweets
Next: Derek Angus : motivation to "TEST" steroids in COVID-19 ARDS.
Doctors "love" giving steroids. How about we "test" it?
#ards #steroids @ESICM
@ESICM steroids : long list of side effects ( 2' bac infection, impair host response, impair viral clearance).
- which steroid, when, what dose, how long
- unclear if all COVID patients in hospital should receive Steroids.
#steroids #ards
@ESICM large RCTs 1. RECOVERY(UK) - not 20mg in DEXA-ARDS but 6mg. in the O2 receiving group, Dexa seems to be better. Ventilated patient - very strong signal too of dexamethasone being better.
#COVID19 #steroids #LIVES2022 @ESICM
Read 13 tweets
NEXT: Clinical question : ARDS and steroids-sensitive patterns by President-Elect @ElieAzoulay5
lots of questions: why? how ? phenotypes? timing? dose? are we missing "systemic vasculitis,etc" behind defn ARDS?
#steroids #ARDS @ESICM
@ElieAzoulay5 @ESICM Refreshing ARDS definition. Berlin definition needs further updates (more on this later). 🤓
Pathological : DAD : Diffuse Alveolar Damage" has many causes - most of them we wont discuss steroid use at all.
@ElieAzoulay5 @ESICM thus DAD pathological diagnosis is not helpful to ask clinical question of steroids.
Interesting finding in autopsy data in ARDS. #LIVES2022
Read 10 tweets
NEXT: Corticosteroids in Bacterial pneumonia? By @antoniotorres Barcelona Spain.
Starting with 30-day mortality of severe CAP is very high. Microbial etiology is Strep pneumoniae, Legionella, Staph aureus, Pseudomonas and Polymicrobial #LIVES2022
@AntonioTorres @ESICM anti-inflamm Rx :steroids / macrolides may reduce mortality. Rationale : local and systemic inflammatory responses are increased in CAP, thus "down-regularte" them. Delfi consensus : no recommendation for any CAP but for in icu CAP patients, recommended. #steroids #ards @ESICM
@AntonioTorres @ESICM Rx steroids 0.5mg/kg/12 hr methylpred for 5 days for CAP. However influenza patient -- steroids may increase mortality. What happen also with Macrolides and Steroids combination ? In study : no synergistic effect and no additional improvement. #steroids #cap #ventilation @ESICM
Read 9 tweets
Earlier we learnt the *nuances* of NIV. Next session: Steroids in ARDS. chaired by Annane Djillali and Chiche Jean-Daniel #LIVES2022
@ESICM 1. @njuffermans on immune cell interactions in viral pneumonia. Reminder : Innate and Adaptive immunity. big topic so will be a brief overview. Innate Im : goal to illicit cytokine response Granulocytes, macrophages, dendritic cells. Adaptive: T cells CD4 and CD8. #LIVES2022
@ESICM @njuffermans What happens during viral pneumonia ?
- virus causes destruction of natural barriers
- Virus then meets innate immunity "cytokine storm". made popular durn COVID19 but This term is 1st coined in 2005 with H1N1 infection.
Read 9 tweets
@rebelliousgut @MondayNightIBD @southasianIBD @ibdesis @Empoweringpts9 @DCharabaty @ownyourcrohns @LivingWithUmeed @vkckiranpullela @TheMaveilousGut @dunung_ruchita 1/ I'm Sharan from 🇬🇧, co-founder Team @ibdesis. We are proud to lead #PatientExperience on @mondaynightibd to discuss specific aspects of #SouthAsianIBD experience. We hope to improve care for our community around the 🌍. #MondayNightIBD
@rebelliousgut @MondayNightIBD @southasianIBD @ibdesis @Empoweringpts9 @DCharabaty @ownyourcrohns @LivingWithUmeed @vkckiranpullela @TheMaveilousGut @dunung_ruchita 2/ My initial diagnosis came after months of going back & forth w my GP who was reluctant to refer to a specialist because they were certain that my symptoms couldn't be due to #IBD. In their own words, "#SouthAsians don't get IBD" #MondayNightIBD #SouthAsianIBD
@rebelliousgut @MondayNightIBD @southasianIBD @ibdesis @Empoweringpts9 @DCharabaty @ownyourcrohns @LivingWithUmeed @vkckiranpullela @TheMaveilousGut @dunung_ruchita 3/ This delay led to extreme weight loss and worsening of symptoms to the point where I was unable to get myself out of bed. I was admitted into hospital with my weight down to 28kgs, from 38kgs just months before.
#MondayNightIBD #SouthAsianIBD
Read 13 tweets
Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_ce. #Emergencymedicine researcher and devotee of deep understanding of drug mechanism of action @md_pollack will be considering why being #nonsteroidal means better #MRA. Don't miss it! @GoggleDocs
1) Welcome to a #tweetorial where we’ll explore the mechanism of action of mineralocorticoid receptor antagonists (#MRA) & consider why it's so #vogue to be #nonsteroidal. This program is accredited for 0.50 credits for #physicians #nurses #pharmacists. I am @md_pollack. #FOAMed
Read 51 tweets
Comprehensive Guidelines for Management of #COVID19 patients has been released by Director-General for Health Services (#DGHS), @MoHFW_INDIA.

Depending upon the severity of symptoms, it guides how to treat, investigate & monitor patients.

The guideline categorises the possible symptoms of #COVID19 for patients with Asymptomatic, Mild, Moderate or Severe symptoms.

For Asymptomatic & Mildly ill- Home isolation for care recommended.

For Home Care Tips to manage COVID19 by @PrinSciAdvOff:
For patients with Mild Symptoms, the guideline details a #selfcare performa for Self-monitoring for fever, breathlessness, SpO2, BP or worsening of any symptoms.

If symptoms persist or worsen, further medical investigations may be required.

#COVID19 #IndiaFightsCorona
Read 9 tweets
In the sea of tweets about high glucose levels, let’s not forget something which can be equally important and more dangerous. Hypoglycaemia (low glucose levels). Below are some of the symptoms which can be due to low glucose levels #Diabetes #COVID19 #Steroids (1/n)
Many patients who are on steroids may be on medications for hyperglycemia(tablets as well as Insulin). Once steroid dose is gradually reduced, the glucose levels will tend to improve. Some may have low glucose levels in morning too #Diabetes #Hypoglycemia #COVID19 (2/n)
As steroids r reduced & stopped, its important to continue monitor glucose levels & consult ur Dr so the diabetes medicines can be adjustd accordingly. I have seen few cases who continued diabetes medicines & had weakness but didn’t check glucose levels regularly #diabetes (3/n)
Read 5 tweets
#Covid19 is probably the greatest debunker in #medicine we have seen...

Read this ... 👇🏾
🧵 *** The researchers found no evidence of a difference in response in biochemical markers of #inflammation between patients with #MIS-C/PIMS-TS who were treated with #IVIG, #steroids, or #biologics, compared with those who were not.
*** Despite a lack of evidence, 🇬🇧 and 🇺🇸 treatment guidelines for MIS-C/PIMS-TS have become very similar.

*** By the end of the study period, most patients had received immunomodulation.
#AcademicChatter #AcademicTwitter #MedTwitter #foamed #MedStudentTwitter #LongCovidKids
Read 5 tweets
Want to know why #Mucormycosis is more common post #COVID19 and not so common after leukemia's or other illnesses treated with steroids ?

Read on !!
These are the major reasons in my opinion:

1. The NUMBER of #COVID19 pts is far GREATER than the number of leukemia pts we treat in a year. Thus a lot more people are getting steroids at this point in time and thus a lot more are at risk of steroid related complications.
Let's say 1/5k steroid treated pts get mucor, now if we treat 500k pts with steroids we will definitely have 100 mucor cases. SIMPLE MATH !!

Not convinced, read on.

2. A great number of #COVID19 pts have underlying CO-MORBIDITIES like diabetes which are WORSENED by steroids
Read 10 tweets
Steroids in #COVID19 (thread)
Steroid therapy is one of the cheapest and most effective therapy for COVID pneumonia. But, confusions abound. Stay with me. It's a little complicated.
RECOVERY trial looked at short course steroid use for hospitalized patients with COVID. Patients lived longer when steroids were given for patients who needed supplemental oxygen or resp device support.
Read 19 tweets
Q. What are steroids ?

Steroids are organic compounds with four rings in a very specific molecular configuration.

They are extensively found in plants and animals
Steroids have two main functions in a living thing:

a) They are part of the cell membrane
b) they act as hormones or signaling molecules in living things
Read 25 tweets
11 common ways men damage their #sperm without knowing

1. Tight underwears
2. Hot baths
3. Infections
4. Varicoceles
5. Laptops
6. Drugs
7. Mobile phones
8. Smoking
9. Marijuana
10. Heavy drinking
11. Steroids

A thread 🧵

{Share to who needs this!}
Wear boxers instead of tight pants, & go to bed naked if you want to become a father!

Wearing tight #underwears like pants or shorts keep your testicles closer to the body, leading to warmer temperatures that may kill sperm & lower your sperm count.
Bathing with #hotwater frequently exposes your testicles to heat, which can reduce your sperm count.

Same thing happens to men who use saunas often.

In fact, if you're worried about infertility, it's best to bath with normal or lukewarm water.

Avoid hot water baths!
Read 15 tweets
Hey #MedTwitter!!
This morning at our VA we had Chief @photon_ick give us a case of #ChronicSOB, where it turned out that the patient had #ABPA (#allergic bronchopulmonary #aspergillosis). It's a diagnosis we don't see too often, but one you'll definitely encounter here!! 🗝️👇
This is an #allergic condition, with 2 main predisposing conditions: #asthma & #cysticfibrosis
It can be more rarely seen in other lung disease/immunodeficiencies, but without the right lung environment like this, it is almost NEVER seen!!
There is no universally accepted criteria, but the #ISHAM criteria is often used. Let's check it out!

Traditional obligatory criteria:
- Serum #IgE RAST >0.35 OR Allergic Skin Testing (+) to A. fumigatus
- Total Serum IgE >1000 Image
Read 6 tweets
European Standard Battery numbers 27 and 28 as well as the steroid battery.

#dermtwitter #medtwitter #MedEd #contactdermatitis @ACDS_Dermatitis #RockyIV #steroids

This one will be about steroid allergy. Hold on to your hats, you will be entering the geek zone
I said GEEK not NERD. Amateurs.
Let's start with a question. A patient tests positive to Tixocortol-21-pivalate on patch testing. Which of the following steroids is most likely to cause an allergy also?
Read 23 tweets
Stop abusing steroids to build muscles.
Stop abusing steroids to enhance performance.

When your body is exposed to excess #steroids for a long time it can lead to Cushing's syndrome, a horrible condition.

A thread 🧵

RT for awareness Image
Normally, Cushing's syndrome occurs when your body is exposed to high levels of the hormone #cortisol for a long time.

But most steroid medications have the same effect on your body as cortisol.

So, when you take excess steroids over time, it can lead to Cushing's syndrome.
Cushing's syndrome can also occur when your body makes too much cortisol on its own (like in certain tumors of your pituitary gland or adrenal problems).

But taking or injecting steroid medications (exogenous steroids) is the single most common cause of this horrible condition. Image
Read 6 tweets
Just published in @bmj_latest, an update to our @WHO living guideline on drugs for #COVID19 – this update focuses on #remdesivir & was informed by the results of 4 trials w/7,333 participants – ACTT-1, SOLIDARITY, Spinner (JAMA), & Wang (Lancet). Image
Summary: based on currently available data, there is insufficient evidence that #remdesivir improves patient-important outcomes ➡️ thus, a conditional (weak) recommendation against the use of remdesivir in hospitalized patients with #COVID19.
A conditional, or weak, recommendation against #remdesivir means that, based on current data, the undesirable effects probably outweigh the desirable effects, but substantial uncertainty exists. With this in mind, we very much felt that trials of remdesivir should continue.
Read 8 tweets
#CCCF2020 Brian Kavanaugh Controversies - #COVID19: #ARDS or not? What we really addressed - not so much "is it ARDS?" but rather, "does it matter?" So happy to have been a part of this, but man, I still have so much to say! My take on the ? – yes, it matters - to an extent 🧵 1/ Image
Pre-intubation management: YES, but not because it substantially changes methods of support, or the criteria used for #intubation. It matters because categorizing patients as having #ARDS has value. 2/
If we use the Berlin definition, patients on Venturi masks or arguably #HFNC don’t actually meet criteria for #ARDS because they’re not on PEEP >/= 5. The natural history of ARDS though almost certainly begins prior to the use of mechanical ventilation (invasive or not). 3/
Read 13 tweets
It’s been a busy couple of nights in the ICU. Normally I’d be asleep right now, but I’m pumped to talk about #steroids in #COVID19.

A Brief Thread on #steroids in #COVID19.

(Spoiler alert: more compelling RCTs show that steroids work!)
Early in the pandemic it was unclear if steroids would be beneficial or harmful.

There were studies that steroids could reduce mortality in ARDS (DEXA-ARDS), but also studies showing that they could prolong viral shedding in related viruses (MERS).

Clear equipoise for RCTs.
This changed in June, when the #RECOVERY trial ( found an impressive mortality decrease in patients treated with #dexamethasone.

This large, well designed study almost immediately changed practice. But a few questions lingered..

Read 12 tweets
Some fcukin bastards do not deserve ANY mercy. They take our money, our taxes and build bungalows for themselves, YES I am looking at your #Matoshri. They travel in range rovers (hi AU) while ppl in #Mumbai get crushed in trains. They drink in 5 star bars while bridges ..
fall on their damn heads. They pollute #Mumbai with hard drugs (not talking about weed) but #meth, #cocaine, #LSD, #MDMA and ruin our youth through it. They can bring in ‘maal’ from #Malaysia, #Nepal, #Afghanistan but cannot feed the poor on the streets in the city. They run..
over homeless ppl sleeping on streets and then make bakchod movies & shows like #Tubelight & #BiggBoss14 and we are expected to pay to watch that shit. They pay #ViralBhayani & #ManavManglani etc to take photos of #Diwali parties with their wives but don’t tell you about how ..
Read 12 tweets
10 common ways men damage their sperm without knowing

1. Tight underwears
2. Hot baths
3. Infections
4. Varicoceles
5. Laptops
6. Drugs
7. Mobile phones
8. Smoking
9. Marijuana
10. Steroids

A thread 🧵

{Share to who needs this!}
Wear boxers instead of tight pants, & go to bed naked if you want to become a father.

Wearing tight #underwears like pants or shorts keep your testicles closer to the body, leading to warmer temperatures that may kill sperm & lower sperm count.
Bathing with #hotwater frequently exposes your testicles to heat, which reduces your sperm count.

Same thing happens to men who use saunas often.

In fact, if you're worried about infertility, it's best to bath with cold water.

Avoid hot water baths!
Read 15 tweets
Posting some reflections on the #ACTT & #RECOVERY trials related to #remdesivir & #dexamethasone for the treatment of #COVID19

Those results feel like definitive advances, but we need to realize their limitations and need for confirmation despite everyone's #pandemic fatigue

1/ Image
There are lot of skeptics in and outside of #Twitter on the results of both trials, strong emotions regarding big-pharma made medications, the way the #EUA was made, also about use of #steroids in the #ICU that has a quite rocky history among those who run those units.
And we need to acknowledge from the outset all sorts of basic, and not so basic, emotions that come in the doing clinical trials, exacerbated by academic cliques, national defense issues (and nationalisms) that can get exacerbated with the strains in health systems. Image
Read 21 tweets
Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol ( to better digest them.

Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol

- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
Read 11 tweets

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