Discover and read the best of Twitter Threads about #tweetorial

Most recents (24)

1/ ❤️🤓 Time to reacquant yourselves for ARDS management!

Here is a @cardionerds #tweetorial review of this phenomenal lecture:

🔥On ARDS in #COVID19 🔥

By @AnnGageMD, @RanLeeMD & @AndrewHigginsMD

Video:

Article: casereports.onlinejacc.org/content/early/…
2/ I need a PA Catheter to diagnose ARDS to rule out cardiogenic pulmonary edema:
3/ 🤔Why pay attention?

We can't afford not to! 👩‍⚕️👨‍⚕️

🤒ARDS is a MAJOR part of COVID19 illness:

⛔️Wuhan: 6% needed vents, 3.4% get ARDS
⛔️Italy: 10% got ARDS

💥US: plan to manage ARDS regardless of specialty 😥

But Don't worry: we got you #InThisTogether
Read 29 tweets
1/10 More research is showing that those recovered from COVID-19 might be able help those currently suffering...

Time for a #convalescentplasma for #COVID19 intro #Tweetorial :
2/10 What is #convalescentplasma therapy?
-An individual recovered from COVID-19 (convalescent)has blood drawn/screened for virus-neutralizing antibodies
-If high levels of novel coronavirus antibodies are present, plasma can be given to individuals suffering severe COVID-19
3/10 Does #convalescentplasma work?
-History dating back to the 1890s; use for measles, mumps, H1N1, ebola, SARS, MERS
-Systematic review of use demonstrates reduced mortality and safety with use of convalescent plasma for SARS
Read 10 tweets
1/21 After caring for patients in the ICU with #COVID for the last week, the time seems right for a #pulmonology #tweetorial on #Proning or #PronePositioning

@sanjayvdesai @OslerResidency @JHUPCCMFellows @CPSolvers @thecurbsiders @cardionerds @tony_breu @david_furfaro @chadhoc
2/ Let’s begin with a question: how does prone positioning improve oxygenation in patients with severe Acute Respiratory Distress Syndrome (ARDS)?
3/ First, some history. Prone positioning was first proposed in the 1970’s as a method to improve gas exchange in resp. failure and has long been shown to improve Pa/FiO2 in mechanically ventilated patients with severe ARDS.

ncbi.nlm.nih.gov/pubmed/?term=1…
ncbi.nlm.nih.gov/pubmed/3383620
Read 21 tweets
1/ Have you ever wondered how a vaccine💉 is made and how long it takes before it reaches your arm 💪? #medtwitter #tweetorial #NKFClinicals #COVID19
2/ How long does it take for a #vaccine to reach the general public from the initial development phase?#medtwitter
3/ Making a vaccine is not an easy task, it is a tedious process from its initial planning phase. Let’s go over what a general process looks like for vaccine development.
Read 21 tweets
1/
Do you want to learn the mechanisms of the drugs being tested for #COVID-19 (aka SARS-CoV-2)?

The WHO has launched the SOLIDARITY trial, rapidly testing 4 treatment regimens.

This is a quick primer.

sciencemag.org/news/2020/03/w…

#medtwitter #tweetorial
2/
First, Remdesivir

🔹Adenosine nucleotide analogue that competes w/ ATP incorporation into viral RNA

🔹This inhibits viral RNA-dependent RNA polymerase and blocks replication (in vitro, at least)

See step 4 in the viral life cycle diagram below

ncbi.nlm.nih.gov/pubmed/32020029
3/
Next, hydroxychloroquine (HCQ)

🔹SARS-CoV-2 infects airway by endocytosis (tweet #2, step 1 in fig.)
🔹HCQ = weak base
🔹It accumulates in and inhibits lysosomes by ⬆️ pH, which blocks endocytosis
🔹HCQ also ⬇️ inflammatory cytokines (? significance)

ncbi.nlm.nih.gov/pubmed/32034323
Read 6 tweets
A quick #tweetorial for @BMCimRES (a first for me!)

Clinical Question: Hydroxychloroquine (HCQ) is used against malaria and autoimmune diseases, and new data suggest it may be effective against CoVID-19. What exactly is HCQ, how does it work against so many different diseases?
1/ HCQ belongs to the quinoline family of antimalarials (quinine, chloroquine, and mefloquine). Quinine (the original) has been extracted from the bark of cinchona trees for centuries, and is also found in tonic water. HCQ was developed to be a less toxic version of chloroquine.
2/ So how does it work? HCQ has many mechanisms, but one of the main mechanisms involves increasing the pH of intracellular vacuoles. These are the little compartments in your cells that can do specialized things! Remember lysosomes from cell bio?
Read 12 tweets
1/17
SARS-CoV-2 and the RAAS System

Curious about the role of ACE2 in the pathophysiology of #COVID19? Read on!

#medtwitter #cardiotwitter #tweetorial @MedTweetorials @boback @gcfmd @kewatson @datsunian @AliNsairMD @tony_breu @JeffHsuMD @uclaimchiefs @drtishawang
2/
What is the role of angiotensin converting enzyme 2 (ACE2)?
3/
What do ACEi/ARBs do to ACE2 levels?
Read 17 tweets
Ever wondered what causes edema in nephrotic syndrome (NS)? #nephtwitter #medtwitter #nsmc #Tweetorial #NephroticSyndrome #edema #albumin😃
Edema in NS is secondary to?
2 major factors thought to contribute to edema in NS. 1. Underfill hypothesis: low s. albumin➡️low plasma oncotic pressure➡️imbalanced starling forces➡️fluid leak into interstitium➡️reduced effective circulating blood volume➡️activation of RAAS, SNS, AVP
researchgate.net/figure/The-Und…
Read 16 tweets
1/
As the #COVID19 pandemic progresses, exactly why men get infected more frequently, and with greater severity, than women is unknown.

This #tweetorial examines a theory (emphasis on theory) that might explain some of this difference.

#medthread #medtwitter
2/
First, let's look at the gender distribution data for covid19.

It was noted early in the outbreak in China that more men than women were getting infected.

In this sample 58% of infections occurred in men (and they died at a slightly higher rate).

ncbi.nlm.nih.gov/pubmed/32109013
3/
A similar gender difference has emerged in Italy.

So far 59% of Italian cases have been in men.

statista.com/statistics/110…
Read 14 tweets
We all learn in medical school to give calcium in hyperkalemia for ‘membrane stabilization’. But what does ‘membrane stabilization’ actually mean? 🤷‍♀️ #iforgot #medschool #nephtwitter #tweetorial #physiology #pleasecareeventhoughstep1ispassfail
2/
Trick question - because there are 2 answers! But before we tackle hyperkalemia, check out this brief but brilliant refresher on action potentials in the heart.
3/
Now, hyperkalemia raises the resting membrane potential of cardiac myocytes, shifting them closer to the threshold for activation.

This should make the myocytes more irritable and easily activated - which it does... at first!
Read 17 tweets
#COVID19 #tweetorial lung ultrasound for covid or other respiratory inflammatory conditions.
According to several small studies covid-19 lesions include subpleural effsuisons, b lines, air bronchograms, thick irregular pleural lines. These findings are non specific and can be seen with various lung conditions.
Normal lungs show a lines (horizontal reverb lines equidistant from the pleural) thin regular pleural line and lung sliding with respiration
Read 10 tweets
О, я знаю, що ми зробимо. Ми замутимо тред про штучну вентиляцію легень. Для немедиків чи медиків-неспеціалістів. Тобто я замучу, а ви лайкайте і ретвітьте, бо хочется слави. Від кількості лайків тред залежати не буде.
Спеціалісти - вибачайте за неточності, буду спрощувати.
Основи основ: дихальні шляхи (ДШ) поділяються на верхні та нижні і складаються з порожнин носа, рота, глотки, гортані, трахеї та бронхів, що розгалуджуться 23-ма порядками у легенях. Через ДШ повітря потрапляє до цих самих легень, де відбувається наступний етап - газообмін.
Ось цей обмін повітрям з навколишнім середовищем і називається вентиляцією. Природня вентиляція (спонтанне дихання) - це те, що робимо ми з вами прямо зараз (ну, більшість із нас, я сподіваюсь). Коли воно з якихось причин неможливе, в гру вступає ВОНА - штучна вентиляція легень.
Read 53 tweets
1/
La pandemia por #COVID19 está en boca de todos en estos días y todos deberíamos estar familiarizados con las medidas que se deben tomar
Cambiaré el enfoque de la cuenta por esta ocasión para desmenuzar una de las medidas más importantes

El lavado de manos 🧼🤲

Abro hilo:
2/
Se tocarán los siguientes puntos básicos que nos ayudarán a entender el tema:
- Virus vs bacterias
- Bases del coronavirus
- Jabón vs Gel "Antibacterial"
- El lavado de manos en si mismo

¿Cuál de los dos piensas que es mejor?
3/
Usualmente los hilos de esta cuenta están orientados para estudiantes/profesionales de la medicina, pero en esta ocasión, dada la situación actual, pretendo que la información sea accesible para la población general.

Ahora si, iniciamos!
Read 30 tweets
1/ #COVID19 #Tweetorial, calling #MedStudentTwitter / #medtwitter to help search the literature as we refine treatment protocols @YaleMedicine @The_BMC @Pranay_md @KaminskiMed for the benefit of all.

Background: We need to tackle antiviral and hyperinflammation pathoimmunology
2/ Given no known efficient therapy, chloroquine was investigated given its prior described inhibition of several coronaviruses. This became a backbone of therapy (pubmed.ncbi.nlm.nih.gov/32171740/). Chloroquine is not readily available in the US at this time.
3/ Hydroxychloroquine (in vitro) was shown to reach 3x the potency of chloroquine (pubmed.ncbi.nlm.nih.gov/32150618/). More readily available in the US. Retinal toxicity of HCQ at the very short intervals we use for COVID19 is unlikely. Trials in South Korea and China are ongoing.
Read 11 tweets
1/ Hi #medtwitter! Let’s talk about the 2nd most abundant intracellular cation, magnesium (Mg), by discussing a patient with hypomagnesemia. #tweetorial #nephtwitter #FOAMED @TheSkeletonKG @NSMCinternship
Read our post @RenalFellowNtwk here: renalfellow.org/2020/03/12/ske…
2/ You are asked to see an elderly man, who was recently diagnosed with rectal adenocarcinoma, with a [Mg] of 0.6mg/dL and baseline Cr of 0.9mg/dL. He had loose bowel movements and abdominal pain 2 months ago. Here are his labs from today:
3/ Patient is receiving FOLFOX (folinic acid, fluorouracil and oxaliplatin) for metastatic rectal adenocarcinoma over the past 3 months, and cetuximab was added last month. His other medications include chlorthalidone, atenolol, nifedipine and sitagliptin.
Read 17 tweets
Today, our IBDLIVE program focused on #COVID19, with >25sites & >200 participants from across the 🇺🇸Great discussion on how it impacts our patients w/ #IBD. @MRegueiroMD @ConorDelaneyMD @IBD_FloMD @BenClickMD @tqaziMD @ScottRSteeleMD @drtracyhull @HolubarStefan @AmyLightnerMD
1/
Here is a #tweetorial with selected slides from the presentation
Although the main mode of transmission seems to be through droplets, #SARSCoV2 can be found in stool and in gastrointestinal glandular epithelial cells, raising the possibility of fecal-oral transmission 2/
Here are outcomes among inpatients with #COVID19 based on available data. Mortality rates are higher in older patients and in patients with comorbidities
3/
Read 10 tweets
Hi Twitterverse.

I get it. You're young, you're healthy, and you're not worried about #COVID19. Give me a chance to tell you why you should be in this #tweetorial. (1/10)
You've heard about this every day in the media. You think that everybody is scaremongering, and you think that those people hoarding toilet paper are crazy. via @dataisbeautiful (2/10)
The @WHO has declared #COVID19 a #pandemic today. That means that we're seeing #COVID19 spreading around the world. This is the real deal. (3/10)
Read 10 tweets
Thanks to all my colleagues for voting. This is an interesting question in breast oncology, and practice varies quite a bit (As you can see from the poll)
#medtwitter #breastcancer #OncoAlert #chemo #courtingcontroversy
#oncology
#tweetorial

Thread
1/6
There is interest in getting rid of anthracyclines from adjuvant chemotherapy of breast cancer, due to long-term concerns of heart failure and secondary leukemia. The ABC meta-analysis seemed to concur that taxane+anthracycline (TaxAC) beats 6TC by a small margin
2/6
An unplanned subgroup analysis revealed interaction with number of nodes in HR+ patients, with no benefit in HR+ N0 disease.
3/6
Read 6 tweets
#TalkingToTeens101: Let’s Talk About Gender & Sexuality, the #tweetorial

Talking abt gender starts at the beg of the visit. Introduce urself, ur pronouns, then ask patients their name & pronouns.

Ex: “I’m Dr. Fenton & I use she/her pronouns. What name & pronouns do you use?”
1
If a teen is w a parent, ask more privately. I keep it open-ended: “how do you describe your gender?” For teens looking at me confused, I explain like this: “people can identify as male, female, non-binary, a combination, or no gender at all. How do you identify?”
2
Asking for & using a patient’s affirmed name/pronouns is important to do at ALL visits, but asking abt gender identity is not always necessary; it depends on visit reason. For example, it is clutch for well visits, but not for many acute complaints. No need to ask just to know.
3
Read 15 tweets
I’m commonly asked “Why don’t we just test everyone for #COVID2019 ?”

I’ll explain below in this #epitwitter #medtwitter #tweetorial #thread

Please share/RT to help spread real understanding in the midst of all the panic and guesswork!

1/10
The accuracy of medical tests is typically described using two terms:

Sensitivity (what percentage of ppl WITH the disease will test POSITIVE?)

Specificity (what percentage of ppl WITHOUT the disease will test NEGATIVE?)

2/10
… but what the patient wants to know is measured by two DIFFERENT terms:

Positive Predictive Value (PPV- if you test POSITIVE, do you actually HAVE the disease?)

Negative Predictive Value (NPV- if you test NEGATIVE, do you actually NOT HAVE the disease?)

3/10
Read 10 tweets
1/
How about a #Tweetorial on immunotherapy in quiz and answer form? Let’s try it! I’ll post a quiz in one tweet and then the answer in the next, and so on. Scroll down to follow the thread!

#pathology #pulmpath #ihcpath #pdl1 #Immunotherapy #pathtweetorial
2/
First question. When PD-1 on T cells binds PD-L1 on tumor cells, what happens to the T cells?
3/
The correct answer is that the binding of PD-1 to PD-L1 INHIBITS T cell killing of tumor cells.

See nice tweet on this by @kis_lorand

Read 35 tweets
A Friday #tweetorial #medthread about patient privacy on
#medtwitter #SoMe

There are many facets of patient privacy & professionalism concerns in this communal space—I’m going to focus on this through the
lens of case-based teaching

🧵
1/N
We know that #medtwitter & #SoMe enhance learning based on tenants of adult learning theory—this includes the microsimulation, mini-challenges, & active discussion of case-based learning.

However, how can we make this effective safe for our patients AND ourselves?

2/N
I want to introduce this concept—the term came to me a couple of weeks ago:

“POST THE PEARL, NOT THE PATIENT”

3/N
Read 25 tweets
What’s a stronger regimen of furosemide, 40 daily or 20 bid?

I ask this question often on rounds. The answer: it depends.

Understanding what it depends ON is really helpful for dosing decisions.

Let’s explore. #tweetorial 1/
It’s helpful to think of therapeutic effect as “episodes of diuresis” adding up to total diuresis.

A single “good” dose of a loop will result in excretion of about 250mEq (~6g) of Na in about 2-3L of urine.

For furosemide, this occurs over ~6 hours.

tinyurl.com/uyxkl7f 2/
This is the dose-response curve for loop diuretics (roughly applies to each episode / dose).

The sigmoidal shape, similar to hgb-dissociation curve, means:
- at doses left of the steep part, nothing happens
- once you get past steep part, increasing dose more doesn’t do much

3/
Read 11 tweets
Anyone that took the #EmergencyMedicine ITE last week knows that we got approximately 220 out of 225 questions on LVADs, and I’m pretty sure I got 85% of those questions wrong. So here’s a #tweetorial on LVADs

#FOAMed #CardioTwitter

1/
LVAD Basics

🔺They dont have pulses‼️due to linear flow device
🔺How to assess perfusion? Mental status, cap refill, warm extremities
🔺Auscultate (more on that later)
🔺Pulse Ox can be unreliable due to lack of pulsatility➡️get ABG if poor waveform
🔺Do bedside echo early

2/
Blood pressure with LVADs

✅MAP goal: 65-80mmHg
🔺Measure BP using manual cuff and doppler (95% accurate) as opposed to standard automated BP cuff (~50% accurate)
🔺Put in A-line if critically ill for continuous BP monitoring

#FOAMed #FOAMcc

3/
Read 13 tweets

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