2/ The hypothesis that ancient Romans may have been chronically lead poisoned was first explored in @NEJM in 1983 due to the observation that Roman aristocrats and rulers had notably high rates of gout.
3/
Chronic lead exposure predisposes to gout by poisoning the proximal renal tubule's ability to excrete uric acid, ? via interference with the function of the URAT1 transporter, raising serum uric acid levels.
4/ The resultant gout has been called "Saturnine" gout, in reference to Saturn, the alchemical name for lead, as well as the Roman festival of Saturnalia, where much wine was drunk (which, we will see, is relevant to our initial question)
7/ Romans sweetened their wine with a syrup called sapa, which was produced by boiling grapes in leaden pots. The heat leached the lead from the pots into the sapa, which was then consumed. This is thought to be the main source of Roman lead exposure.
9/ Other potential sources of Roman lead exposure were lead-infused make up products and lead pipes of aqueducts, leading to elevated lead levels in the general water supply. Roman tap water had about 100X more lead than the surrounding natural springs.
10/ So, were ancient Romans, especially the aristocratic and leadership class (who drank a lot of wine), chronically lead poisoned? The evidence suggests yes.
Did this contribute to high gout rates? Possibly.
11/ Chronic lead poisoning is also associated with infertility and after the reign of Augustus the Roman birth rate and population began to decline steeply, especially after 150 AD.
🧐 This was particularly pronounced amongst the aristocracy.
12/ Can we draw a connection between a chronically lead-poisoned populace, low birth rates, population decline, and the decline and fall of the Roman Empire? What do you think?
13/ To sum up what we've learned:
▶️ Ancient Romans had high blood lead levels
▶️ This may have been due to significant sapa (syrup) consumption and leaden aqueduct pipes
▶️ It also may have contributed to high gout rates amongst the Roman aristocracy
14/ And a lingering question:
▶️ Did lead poisoning contribute to infertility and Roman population/social decline?
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1/ Why can multiple sclerosis symptoms worsen with heat exposure, something known as the Uhthoff phenomenon?
This question is especially relevant in the era of record-breaking heat waves and climate change.
#tweetorial #medtwitter
2/ In 1890, Wilhelm Uhthoff noted multiple sclerosis (MS) patients having a “marked deterioration of visual acuity during exercise" or after a hot bath, which ⬆️ body temperature.
1 patient lost vision just by walking vigorously in Uhthoff's clinic.
3/ The Uhthoff phenomenon is now recognized as exceedingly common in MS.
Up to 80% of patients experience ⬆️ neurological symptoms w/ even small body temp increases. These can include diminished physical (eg gait) and cognitive (eg mental fog) function.
1/THREAD
Has it ever occurred to you that Graves' disease presents a conundrum?
Graves' involves an autoimmune antibody that ACTIVATES a receptor, which is relatively unique in the landscape of human disease.
Let's unpack this fascinating mechanism.
#medtwitter #tweetorial
2/ Graves’ disease was first described by English physician Caleb Parry in 1786, when he noted an association between thyroid enlargement, tachyarrythmias, and exopthalmos in 8 patients.
Parry’s son posthumously published his description in 1825.
I ask teams to focus on efficiency, ⬆️ time for teaching/ discussion
⏳⬇️ transitions b/w patients by alerting next RN
⏳Enter orders on rounds, w/ clearly defined roles as to who will do that
⏳Present from memory (if possible), focusing on critical issues
2️⃣ Education
🧠I ❤️ to teach but avoid overwhelming residents by teaching high yield points on 2-3 patients max. I supplement w/ PM chalk talks after lunch and notes are done
🧠 I also ask each learner to share one learning point from rounds, and do so myself as well