Discover and read the best of Twitter Threads about #tweetorial

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T-5 days until rheum boards! 🙃 Today, let’s review MSK manifestations of endocrine disease. We’ve got it all: diabetes, hypothyroid, hyperthyroid, parathyroid...ready?
Let’s start with diabetes. People with diabetes tend to produce more “advanced glycation end products,” which are metabolic byproducts that get deposited into tissues and make tissues thicker, stiffer, and weaker.
The worse the glycemic control, the more AGEs get deposited, and the worse the stiffness gets. This phenom is at the root of a LOT of diabetes MSK issues.
Read 18 tweets
#Tweetorial on #ASNC2020 session

⚡Selecting Between Different Functional Tests⚡

☢ vs 🧲 vs ⏺ ❓

🔘 Strengths/Limits of Lesion Specific vs Myocardial Ischemia
🔘 Comparing Dx Accuracy of Tests
🔘 Ischemia Testing in #INOCA
🔘 How to Select Best Noninvasive Test

#ASNC2020 #cvNuc
Dr Di Carli

☢ Issues with proposed #FFR threshold 0.8
☢ Exercise MPI correlates well with FFR but not at 0.8
☢ Benefit of FFR-guided revasc dominantly occurs w/ thresholds <0.8
☢ Quantification of lesion-specific #ischemia insufficient for patient mgmt
#ASNC2020 #cvNuc
Dr Di Carli

Lesion-specific #ischemia measurements (FFR/#FFRCT)

☢ Strength
Validated against ETT/MPI
Strong outcome data
Guidelines supported

☢ Limit
Controversial threshold (0.80 vs MPI-validated 0.66)
⬆ microvasc resist causes FFR pseudonormalization
Read 11 tweets
Okay, I said I'd try my hand at a #tweetorial for #meded so, here goes:

Let's talk about Lewy Body Dementia (LBD) diagnosis. Management would be another thread. I'll provide refs as we go and link to some really great tools, and try to tag relevant folks for their work. 1/21
First, please read Susan Schneider Williams editorial in Neurology about Robin Williams, and strongly encourage you to watch Robin's Wish on @netflix… 2/21
Terminology is confusing: Lewy Body Dementia is best thought of as the supraordinate category made up of PDD and DLB.

If movement problems develop concurrently with dementia or after the dementia (and fits otherwise) then = DLB. In 'well-established PD' = PDD. 3/21
Read 23 tweets
1/Pulmonary embolism is a commonly encountered condition; however, how comfortable are you with the acute diagnosis and treatment of the disease? Let's take a walk through the guidelines. #tweetorial #MedEd @VCU_PCCM @crit_caring_MD @lkbrath @PSinkam @AvrahamCooperMD @VCU_IMRes Image
2/ Venous thromboembolism is currently the 3rd most frequent acute cardiovascular syndrome encountered globally with an annual incidence rate ranging from 39-155 per 100,0000 population. @michellebr00ks @cjchiu @mdlizs @mkashiouris @B_M_Wiese @ptfaddenMD
3/This chart by Rogers, Anderson, and Spencer found in the @EuroRespSoc guidelines displays predisposing risk factors for VTE based on odds ratios. Check out all the risk factors with an odds ratio >10! @DxRxEdu @rabihmgeha @CPSolvers @AdamRodmanMD @tony_breu @KevinSwiatek Image
Read 18 tweets
Short #tweetorial on issues related to toxicity in oncology trials. How do we conclude Tx A is more/less toxic than Tx B? Room for improvement when you look at how we collect and report toxicity. Vital for both therapy escalation and de-escalation trials [Thread]
Do we consistently grade events? Answer is no for retrospective and even prospectively this is a challenge with CTCAE. High grade events also require adjudication and attribution which is inherently a challenge. Nice study here @julian_hong @mpalta1098
We don't do well with chronicity of AE (CTCAE or PRO). Daily pads due to fecal incontinence for life (CTCAE grade 2) better or worse than grade 3 admit? One pt with a grade 3 for 2 weeks may be counted the same as another with the same AE for 6 months. "AUC" models needed
Read 10 tweets
Time for another #morphology #Derm101 series #tweetorial on the skin exam. Today, we'll cover:


How the location a rash occupies on the body might help us with the differential diagnosis!

#FOAMEd #MedEd #medtwitter #dermtwitter #medstudenttwitter #dermatology
An important point to start:
Distribution is LEAST important in the skin exam. Primary & secondary lesions, configuration & scale are all better in informing our DDx.

I tell my learners that if confused about a rash, pretend it's elsewhere on the body & see if that helps.
Also - throughout this #tweetorial, I will try to display skin disease in lighter & darker skinned patients side by side. Remember in darker skin, erythema is harder to see, so I hope this highlights the point!

A question: In tweet 1, what distribution is shown in the photo:
Read 18 tweets
Meniscus injury: a complete review.

@MedTweetorials @RosenelliEM
#MedEd #OrthoTwitter #Tweetorials
The meniscus function is two-fold. It increases stability by deepening the tibial surface and it aids in force transmission by increasing the contact area to spread force over a larger surface area. The meniscus is responsible for 50% of load transmission across the knee. (1)

The lateral meniscus has a more circular shape than the C-shaped medial meniscus. The lateral meniscus covers a larger portion of the articular surface and is also more mobile than the medial meniscus. The medial meniscus is relatively immobile and is attached to the MCL.

Read 16 tweets
Just like you evaluate an Angiogram you can evaluate a Neurogram! Here’s a quick guide for the Brachial Plexus🤗
Orient nerves within an Oblique Sagittal plane so you can evaluate for symmetry. Remember symmetry is the radiologist’s friend😊
Read 14 tweets
1/ Here is the #Tweetorial presenting the story behind our paper on the structure and function of #StatorUnits of the bacterial #FlagellarMotor published in @CellCellPress!…
2/ Many bacteria swim by rotating their flagella, a motion crucial for survival and pathogenicity. Flagellar rotation is bidirectional: in Salmonella and E. coli, counterclockwise (CCW) rotation causes the cell to swim forward, while clockwise (CW) rotation causes it to tumble.
3/ The flagellum is made of an external filament, a flexible hook and a motor. This motor consists of a rotor surrounded by a ring of stator units (MotAB). #MotAB is an ion channel that powers the rotation of the motor using energy from the transmembrane ion gradient (H+ or Na+).
Read 17 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
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
#ASEchoJC #Tweetorial on #WASE
Societies of Echocardiography
Normal Values Study

#Echofirst most widely used imaging modality BUT

WHAT IS NORMAL for ❤️ size & function? @JournalASEcho
2/ Prior ❤️measurement studies:
❤️used VARIOUS methods- M mode, M mode & simpsons, 2D
❤️No standard analysis or core lab
❤️Only single race or country/region
❤️?? State of the art machines or techniques

❤️Need for a prospective international observational study #WASE was born
@ASE360 @escardio #EACVI recommended normal values used all over the 🌎 but only represent normal Caucasian people from USA & Europe #ASEchoJC
Read 10 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
2/ The first question in hyponatremia is...


If you have a patient with cerebral edema from acute hyponatremia you need to 3% Saline first and ask questions later.
3/ If patients have hyponatremia and have severe symptoms it is 150 ml of 3% then recheck the sodium and give another 150 ml of 3% (I'm using the European guidelines)…
Read 20 tweets
(1/11) #AFibAwareness #Tweetorial: Today is #AFibAwarenessDay and we’re sharing facts about atrial fibrillation! Follow this thread to learn more & answer Qs about #AFib symptoms, treatments & more in “Treatment of Atrial Fibrillation: Is Timing Everything?”

(2/11) #AFibAwareness #Tweetorial: AFib is the most common sustained heart rhythm problem & affects 43.6 million patients across the 🌎.

#AFib can be associated with significant symptoms & an ⬆ risk of #stroke, #heartfailure, dementia & mortality.
Questions: Given high prevalence of #AFib, what is the optimal screening strategy for AF? When and how? What is the role for wearable technology?
Read 17 tweets
1/ A 68 yr old lady with h/o HTN, HLD, DM for left TKR. Pre-op celebrex, meloxicam and an adductor canal block with iPACK block. Spinal anesthesia for intra-op. How much intravenous dexamethasone would you administer? @KalagaraHari @EMARIANOMD @SreeHPraveenKO1 @dr_rajgupta
2/ In our practice, most patients receive 4mg or 8mg of intravenous dexamethasone. Is one dose better than the other - more effective or lesser side-effects?
We did a retrospective study find an answer:…
3/ Dexamethasone is a potent long acting, synthetic corticosteroid. Concerns with intra-op dexamethasone include hyperglycemia, altered immune response & delayed wound healing.…
Is there an optimal dose to harness benefits without undesirable side-effects?
Read 13 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
1/ We are going to start a series of threads, starting with this #tweetorial, to share more info about our program & curriculum. We will collate in a Twitter moment!

First topic—our Social Medicine Curriculum & Block:… Image
2/ Why is this such a valued part of our residency program curriculum for > a decade?

Healthcare & health outcomes are about far more than just access to medical care and treatments. Social determinants of health (SDoH) are crucial to these outcomes…
3/ Our Social Medicine curriculum includes an ambulatory block rotation & longitudinal learning across 3 years

We aim to:
⬆️resident knowledge of health disparities & system gaps
⬆️sociocultural awareness of SDoH
✅provide culturally responsive care for stigmatized patients
Read 9 tweets
What is "auto-hypophysectomy' ? A #Tweetorial
This is an interesting phenomenon seen in endocrinology. I will illustrate the same with a case
An elderly gentleman (non-diabetic) presented to the ER with recurrent hypoglycemia and hyponatremia
Read 14 tweets
Counterfactual Values and Exchangeability #tweetorial
Now with typos fixed, and a bonus slide on pedagogy. #thread #epitwitter
Say you are an investigator in a world with people who are either stressed or unstressed, and either smokers or non-smokers.
You have access to a great dataset that represents this population. You are interested in the causal effect of stress on smoking.
Read 23 tweets
Hip dysplasia measurements 101!

A #gif #tweetorial below.
Hips are very important for stability and handle a lot of tensile force
Unfortunately dysplastic hips don’t have complete coverage of the joint which can lead to extra stress, labrum tears as well as cartilage loss.
Read 14 tweets
Optimizando mi sistema inmune. Un #tweetorial
Todos queremos tener un sistema inmune de acero. Una vida saludable nos puede ayudar. Estrategias sólidas para un sistema inmune saludable: Hacer ejercicio, dieta rica en frutas/verduras, dormir 7-8 horas, no fumar, beber en moderación, lavarse las manos y minimizar el estrés.
El sobrepeso y la obesidad pueden ser factores que alteren el funcionamiento del sistema inmune a largo plazo. Perder 5-10% del peso en exceso, es una meta real que puede traer beneficios. Pero, esto debe ser una empresa a largo plazo y por amor a tu salud. No por miedo.
Read 8 tweets
1/Welcome to this week’s #IDBoardReview #Tweetorial presented by @bacteri_al

75 YOM w/ DM, CHF, NAFLD p/w fever, swelling & pain of left leg x48h. Gram stain from BCx pictured below 👇

#IDTwitter #IDMedEd @ID_Fellows @IDSAMedEdCOP
2/What epidemiological exposure do you suspect?
3/Gram stain shows a curved GNR (oxidase +)

Diagnosis: Vibrio vulnificus necrotizing skin/soft tissue infection (SSTI)

Pt reports recent fishing 🎣 in "brackish water"
Read 18 tweets
HOW does gabapentin work?
DOES gabapentin work?
WHY is gabapentin so shady?

Join me for a #tweetorial?

Keywords: Glutatmate, Asterixis, Alcohol-use disorder
#livertwitter #MedTwitter #meded

Admitting a non-#cirrhosis patient with gabapentin overdose as an intern, I saw asterixis

This 🤯

If it caused asterixis (throwback: ), did that mean it causes HE?

Gabapentin has confused me ever since
Everything about gabapentin is🍌
What follows is no different

There once was a💡dream💡 of using GABA signaling 2 prevent seizures. Yada yada yada, we made GABApentin. It approved in 1993!

Just one prob:
GABApentin doesnt bind GABA-receptors!

Like I said…🍌
Read 13 tweets

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