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Eric Topol
@EricTopol
, 3 tweets, 4 min read Read on Twitter
The 1st drug (a monoclonal antibody) to delay onset of autoimmune #diabetes in high risk individuals (by ~ 2 years)
nejm.org/doi/full/10.10… #ADA2019 @NEJM #T1D @T1D_Trialnet
"The results of this trial are striking, with several caveats."
A long road that has taken 40 years. And still just a start to prevention.
Exciting, nonetheless.
nejm.org/doi/full/10.10… @NEJM editorial #ADA2019
by @clifford_rosen and @ingelfinger
'Herold procrastinated when it came time to analyze the data. “I kept pushing it off,” he says, because he worried about failure.'
Some interesting backstory to this major milestone trial
@sciencemagazine sciencemag.org/news/2019/06/m… by @jcouzin
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Eric Topol
@EricTopol
Today new data marks an advance towards the individualized diet
1. We knew our glucose response to food was highly variable and unique
(work form @WeizmannScience @segal_eran and colleagues, reviewed here
nytimes.com/2019/03/02/opi…
2. At #ADA2109 and #Nutrition2019, @timspector and colleagues reported the same for triglycerides and insulin levels in a large cohort of twins. The variability was also noteworthy in identical twins.
nytimes.com/2019/06/10/hea…
@NYTScience by @cagraber @nicolatwilley
3. The results summarized, emphasizing that the variability in response to food in these 3 metabolic metrics is striking, that they don't track each other, and that much of the heterogeneity is not genetically determined. The gut #microbiome is an important driver.
Read 4 tweets
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Eric Topol
@EricTopol
It's even worse than that. In the US, 3 consecutive years of declining life expectancy (unprecedented) and now ~$11,000 per person #healthcare spending economist.com/graphic-detail… @ECONdailycharts @TheEconomist
And the negative outlier US data extends to other key metrics including infant, childhood and maternal mortality
from #DeepMedicine
Why did the outcome curves for the US vs other countries start to diverge around 1980?
@afrakt explored that last year @UpshotNYT: nytimes.com/2018/05/14/ups… w/ many ideas including "administrative costs," the longevity metric, lack of price controls, prospective payments began, etc
Read 6 tweets
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Eric Topol
@EricTopol
Some features that differentiate Shallow Medicine, as currently practiced, and the potential of #DeepMedicine, powered by #AI
Scratches the surface of the book, some supportive data in this thread
There are at least 12 million diagnostic errors/ year and the leading cause is failure to consider the diagnosis (which relates to System 1 thinking)
Humans have 185 different types of biases which leads to misdiagnosis. Example: failing to diagnose heart attacks because doctors think they don't occur in people age < 40
Read 7 tweets

Related threads

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Mehboob Kalani
@MehboobKalaniMD
nejm.org/doi/full/10.10… #LastWeekOnNEJM We reviewed the ANNEXA-4 Trial @AHNtoday for #AHNIMRes This trial was conducted to show the effectiveness of Andexanet Alfa as a reversal agent for major bleeds caused by Factor Xa inhibitors @TKapetanos @NEJM @KaminskiMed @Rick_Pescatore
Andexanet alfa is a modified inactive form of human factor Xa designed to bind and sequester factor Xa inhibitor molecules, thereby rapidly reducing anti-factor Xa molecules and activity
#Limitations (#BigLoad): 1) nonrandomized to placebo or another reversal agent 2) unblinded 3) Median age of 77 4) patients variably excluded during the study, ie only ICP bleeds were accepted from July 2016 to August 2017 5) GCS <7 or recent planned surgery were excluded
Read 7 tweets
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Dr Elisabeth Poorman
@DrPoorman
Here are my #clinicalpearls from #IM2019. #meded #medtwitter #WomeninMedicine Share yours! 1/
The oral bioavailability of bumetinide and torsemide is 80-100% vs 10-100% for furosemide. If patients aren’t responding to furosemide orally, consider switching.

#IM2019 #clinicalpearls 2/
Vascular atrial fibrillation=mitral stenosis or mechanical valve. Vitamin K antagonists preferred over NOACs.

#clinicalpearls #IM2019 3/
Read 71 tweets
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David A. Cohen
@DavidACohen_MD
1/15

For my first #Tweetorial, I will start with a question:

Which of the following medications from the SGLT2 inhibitor class have been shown to decrease cardiovascular morbidity and mortality?

#Diabetes #EndoTwitter #MedEd #MedTwitter #DM2 #T2D #CardioTwitter
2/15

Sodium glucose transporters (SGLT) in proximal tubules mediate glucose reabsorption.

How?
Na/K ATPase moves Na out & K into the cell ➡️gradient for Na to flow intracellular

SGLT uses this potential to move glucose against its gradient from the tubular fluid into the cell.
3/15

SGLT2 inhibitors block glucose reabsorption
➡️renal glucose excretion
➡️glucose levels⬇️

Because this has nothing to do with insulin, they usually don’t cause hypoglycemia or weight gain.

Actually, because of the osmotic diuresis, they decrease blood pressure & weight.
Read 15 tweets
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Paul Young
@DogICUma
Results of the #TARGETtrial, the largest critical care nutrition trial ever undertaken, are now online @NEJM
nejm.org/doi/full/10.10…
What we did, what we found, and what it means follows…
Please RT to help translate this new knowledge.
Thanks to funding from @HRCNewZealand & @NHMRC we randomised 4000 participants from 46 Australian and New Zealand ICUs in less than a year and a half!
Adults mechanically ventilated & expected to require enteral nutrition in ICU beyond the calendar day after randomisation were assigned to energy dense enteral nutrition (1.5kcal/mL) or standard care enteral nutrition (1.0kcal/mL) at a dose of 1mL/kg/hr based on ideal body weight
Read 27 tweets
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Sharyl Attkisson
@SharylAttkisson
NEJM letter from Johns Hopkins neurologist/father of 1st known case of govt. admitting liability 4 autism after vaccines. (Dr. Poling sets straight false info distributed by Children's Hospital's Dr. Paul Offit.) 1/2 nejm.org/doi/full/10.10…
2/2 (PS Govt. sealed vaccine-autism case & payment so other parents wouldn't find out.) The NEJM letter from Johns Hopkins neurologist (Dr. Poling) references my reporting for CBS News on conflicts of interest of Dr. Offit and others.
(And then Children's Hospital's Dr. Offit provided false info to the Orange County Register after my report discussing his conflict of interests but they corrected him.) ocregister.com/2011/04/18/cor…
Read 3 tweets
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Sek Kathiresan MD
@skathire
Terrific week ahead:

@KeystoneSymp on atherosclerosis

Will be live-tweeting as appropriate.

#KSathero
atherosclerosis
1st keynote: Peter Libby @BrighamWomens

“Is the vulnerable plaque a valid concept in 2018?”

academic.oup.com/eurheartj/arti…
Libby: in vivo imaging, few thin-capped fibroatheromas actually rupture
Read 46 tweets

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