Majdoline Jayoushe, MD Profile picture
Jun 29, 2019 3 tweets 2 min read Read on X
Everyone’s awed how Kamala Harris berated Biden saying that she looked “presidential” there is nothing presidential about being ruthless and aggressive in your opposition. So unfortunate to see women in leadership over-assert their strength as a means to dominate #DemDebates2020
Meanwhile male counterparts remained tactful and composed in their opposition. Harris’s ruthless prosecutor record is a testament to the kind of commander in Chief she will be and certainly not the kind we need after a Trump presidency #demdebates2020
Harris’s years as attorney general from 04-11 were spent appealing federal court laws to abolish death penalty, convicting defendants on crimes of rape w/ minimal evidence (sometimes intentionally suppressed) and opposing bills to lower sentence for misdemeanors #demdebates2020

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More from @mjayoushe

Mar 6, 2021
@MondayNightIBD @DCharabaty 1/ Thiopurines are associated with an increased risk of NMSC (non-melanoma skin cancer)

Which of the following is true about this risk relative to non-exposed IBD pts, duration of thiopurine use , and after thiopurine cessation 🛑#Back2Basics #MondayNightIBD
@MondayNightIBD @DCharabaty 32 y/o M with UC here for f/u. In remission x7 yrs on AZA 75mg/d. He is here to discuss his concerns about his risk of lymphoma associated w/ AZA. (HSTCL= hepatosplenic T cell; EBV-L= EBV assoc lymphoma) Which statement is true?
#Back2Basics #MondayNightIBD
@MondayNightIBD @DCharabaty 2/ ‼️Cancer risk in IBD‼️can be→

🔺Disease related (eg CRC, anal CA)

🔺Therapy related ( Skin, Lymphoma, Cervical, Anal)
Read 14 tweets
Oct 31, 2020
@MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 1/ 65 y/o M new dx #Crohns ileitis after he presented w abdo pain,diarrhea, wt loss, anemia. CLN: deep linear ulcers in TI. He has an active lifestyle,stable CAD. Symptoms recur when prednisone<15 mg. What is the LEAST effective strategy to keep this pt in remission? #Back2Basics
@MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 2/ #IBD is not only a disease of the young !

♦️ Typical dx age 20-39, w a second smaller peak >50

♦️ Recently ⬆️ prevalence in elderly> age 60, due to:

🔺Aging of adults w #IBD

🔺⬆️elderly onset IBD > age 60 #EOIBD:
🔹⬆️awareness & dx
🔹Environment/ microbiome changes
@MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 3/ Clinical Features of #IBD in #elderly 🔎?

📌Milder disease course, Fewer #Crohns complications, but

⬆️rates of hospitalizations
⬆️rates of colectomy in EO UC

📌❓Due to disease severity vs poor #IBD control d/t underuse of effective Rx
Read 14 tweets
Oct 10, 2020
@MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 1/29 yo M, smoker, presents with RLQ abscess w fistula to the TI; he undergoes abscess drainage & then ileocecal✂️w primary ileocolonic anastomosis. Path c/w #Crohns, margins free of disease. You see him for f/up 2 weeks post-op, What's the next ? #MondayNightIBD #Back2Basics
@MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 2/ Let’s talk #Crohn’s intestinal complications
CD can present w stricturing/perforating complications
50-60% CD will develop strictures, fistulas or abscesses over time
70% require surgical✂️by 15yrs of dx
Surgery not curative, most pts will have endo recurrence 1 yr post-IC✂️
@MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 3/ Natural course of CD recurrence post- IC ✂️

📌Histologic e/o CD within 3 wks post-op !!

📌70-90% pts w endo recurrence at 1 year

📌30-60% pts w clinical recurrence by 3 & 5 yrs

📌50% will need ✂️by 5 yrs

@MRegueiroMD
Read 12 tweets
Oct 3, 2020
@MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 1/ 35 y/o M presents with fatigue & generalized pruritus x 6weeks. No skin rash, No abdo pain, diarrhea or 🩸 in stool. AST 62 ALT 64 ALP 435 Tbili 1.3. MRI/MRCP: multifocal strictures & areas of dilatation of intra +extra hepatic ducts. What’s the next step?💡 #Back2Basics #B2B
@MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 2/ What’s #PSC & phenotypes?

🧩Idiopathic chronic inflam dis. of the biliary tree

🧩90%: Large ducts (LD): "Beads on string appearance” on ERCP/MRCP (pt👆)

🧩5% Small IHD only: nml MRCP, dx by liver bx, slide👇

🧩5% PSC w AIH overlap: abnl MRCP+liver bx w⬆️AST/ALT or IgG ImageImage
@MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 3/ 💎#B2BPearl #PSC w ⬆️IgG4

📌15% of LD-PSC

📌⬆️IgG4 serum>140mg/dL +/- tissue
💎✅IgG4 at least once w PSC dx

📌Assoc. w AI pancreatitis; other Ig4 dis.

💎⬆️severity of UC, colectomy
📌More rapid progression to cirhhosis

💎Steroid responsive: ️ ⬇️AlPhos, TBili, IgG4
Read 15 tweets
Sep 19, 2020
@MondayNightIBD @SobiaMujtabaMD @FezaRemziMD @DCharabaty 1/ 35 yo F panUC on IFX 10mg q4wk, admitted with abdo pain, hematochezia, malaise. T 39 BP 95/63 HR 110 FCP 900 mcg/g. Abdo distended, TTP; CT: colonic wall thickening+edematous mucosa. Cdiff neg; WBC 15, Hb 6. No improvement despite IVCS+Abx. Which surgery is indicated #B2BPoll
@MondayNightIBD @SobiaMujtabaMD @FezaRemziMD @DCharabaty 2/ Indications for colectomy in UC:

📌Elective:

📍UC refractory to medical Rx

📍Steroid-dependant UC

📍Unresectable dysplasia, CA

📍Complications from medical Rx

📌Emergency:

📍Toxic megacolon

📍Fulminant colitis

📍Perforation

📍Severe Bleeding
@MondayNightIBD @SobiaMujtabaMD @FezaRemziMD @DCharabaty 3/ What is a toxic megacolon?

🔺Transverse colon > 6cm

🔺AND one:
T>101.5° F
HR> 120
WBC>10.5
anemia

🔺AND one:
Dehydration
altered mental status
electrolyte abnormality
hypotension

💡Recall our #B2B tweetorial on ASUC👇🏽👇🏽👇🏽
Read 14 tweets
Aug 22, 2020
@MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 1/ 27 yo F, crohns colitis on AZA, presents w 2wk perianal pain. One week ago a “boil” developed adjacent to the anus, painful to touch and draining cloudy fluid. PE: Perianal fistulous opening tender & draining pus on palpation. What is the next best step ? #B2B
@MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 2/Recap #Crohns:
📌Transmural inflammation involving any part of GIT
📌B for Phenotypes: inflammatory/stricturing/penetrating
📌L for location: UGI,SB,Colon
📌Penetrating Behaviors:
Fistulae
Perforations
Intra-abdominal abscesses(IAA)

recall this #B2B MTL classification table👇🏼 Image
@MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 3/♦️p->Perianal ds in CD
♦️Can occur w any B&L
♦️May be initial manif in ~10%
♦️Can be isolated(no luminal dis)
♦️Affect up to 1/3 of CD pts
♦️Incidence cld be ⬇️w⬆️use of biologics @sang_hyoung @EdwardLoftus2 pubmed.ncbi.nlm.nih.gov/30346531/

♦️One of most challenging manif for pts+MDs
Read 8 tweets

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