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Majdoline Jayoushe, MD Profile picture
@mjayoushe
Dec 11, 2019 • 4 tweets • 2 min read • Read on X
super proud of my mom for finally getting her screening colonoscopy today after a lot of back and forth, and came across some interesting papers that delve into cultural barriers towards #CRCscreening amongst some immigrant communities 👇🏼 [thread] Image
🔸Common cultural barriers reported that were not directly associated with healthcare access:

- mistrust in Western Medicine
- religious beliefs
- cancer fatalism
- low level of health literacy
- fear or shame of procedure itself
🔸Colonoscopy facilitators:

- Culturally targeted peer-patient navigation (CTPN) was shown to ⬆️ adherence from 66% to 74.7%

- Interpersonal communication with PCP

- Storytelling

- Assistance in scheduling + navigating healthcare system Image
For practicioners caring for multiethnic patient population- what in your experience are common barriers to screening? And what are some strategies you implement in your practice to overcome fears associated with colonoscopy?

#CRCscreening

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More from @mjayoushe

Majdoline Jayoushe, MD Profile picture
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
Majdoline Jayoushe, MD Profile picture
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
Majdoline Jayoushe, MD Profile picture
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
Majdoline Jayoushe, MD Profile picture
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
Majdoline Jayoushe, MD Profile picture
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
Majdoline Jayoushe, MD Profile picture
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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