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I’m starting a thread on #COVID19 just to keep everything I learn about it in one place.
🌹 New information
🌹 well summarized information
🌹 Things that changed my mind
🌹 Things that I did not expect

##pathology #pulmpath #CoronavirusOutbreak #SARSCoV2

1. Thread 👇🏾👇🏾
2. Great update with Dr. Fauci
Most interesting tidbit: why is well controlled hypertension a risk factor? Could ACE inhibitors be predisposing to coronavirus infection by increasing ACE receptors?

Link to video 👇🏾

3. Podcast episode 3/17 by @nytimes . Very moving interview with a pulmonologist who has treated dozens of patients in Bergamo, Italy. Warning: it will make you cry.

“Nothing is as before”

They see 50-70 patients with severe pneumonia every single day

https://t.co/rmmAPpUlZq
4. “My colleagues, nurses and physisicians, we cry everyday”

460 nurses are home sick or burned out or quarantined

Personal protective equipment “impossible to find”

Patients “die alone”

https://t.co/rmmAPpUlZq
5. Here is a #COVID19 thread by @AnneMillsMD that residents will find helpful. She’s putting various resources in there 👇🏾👇🏾

https://t.co/GVxa7RJYXz
6. Two excellent free youtube videos by my guru @JMGardnerMD who is trying his best to get the word out. The first video was watched by 125,000 people in 5 days. He covers a LOT of ground in a way that only he can:



https://t.co/KqoyPuVkr2 Image
7. Incredible, scary, moving and educational interview by the @JAMA_current editor in chief Dr. Bauchner with another doctor on the frontlines in Italy. If this doesn’t make you take #COVID19 seriously, nothing will

Image
8. Great site by Johns Hopkins with updated numbers. The screen capture refers to the numbers as of today, March 18, 2020. Thank you for the link @damilnermd 🙏🏾

worldometers.info/coronavirus/ Image
9. Sorry, just realized I forgot to link to the first #COVID19 video by @JMGardnerMD

Very timely and well argued. A must-watch.

Image
10. Incredibly well-made animated simulations on social distancing by the
@washingtonpost

It makes intuitive sense that you should stay away from contagious people but seeing it at this scale is a game changer 👇🏾👇🏾

PS: there’s no paywall

washingtonpost.com/graphics/2020/…
11. I’m adding my video on #ARDS to this thread. It’s heavy on pathology, but is useful if you want to understand what happens is likely happening inside the lungs of the unlucky few who get very sick or die of #COVID19

https://t.co/byRI1nqlhs
12. Here’s the situation in Spain on March 19, 2020, described by our good friend and Tweeple, #pathologist @lara_pijuan

Stay safe, my friend! #COVID19

https://t.co/t4Ddvh2421
13. One of the first studies of #COVID19 from the United States. This is from Seattle, WA. Sounds pretty bad.

Important: these are ONLY numbers for people admitted to ICU.

100% ARDS
67% mortality
9.5% discharged from ICU

jamanetwork.com/journals/jama/…

Thoughts @BDSouthern ? ImageImage
14. Terrifying numbers from the Imperial College report with a great explanation by @jeremycyoung . Consequences of doing nothing (massive death) vs. “mitigation” (very bad) vs. “suppression” (possibly the best option but there’s a catch)

https://t.co/PB8vQhYhYW
15. Here are some figures and passages from the actual Imperial College report.

There are LOTS of assumptions here but If they are right it’s pretty grim.

The graph is particularly worth looking at carefully @JMGardnerMD @Aiims1742 ImageImageImageImage
16. Sorry the graph didn’t quite make it into the previous tweet! Here we go again @JMGardnerMD @Aiims1742

The red line (close to bottom) is the estimated ICU bed surge capacity in the US

Y axis is critical care beds occupied per 100,000 population

X axis is time (months) Image
17. A new article in @AJCPjournal on handling #Covid_19 specimens in the laboratory

Bottom line: formalin fixation inactivates the virus, so routine processing should not be a problem

Frozens: different story

https://t.co/d6178ms8VU
18. Full report from the Imperial College

imperial.ac.uk/media/imperial…
19. A wonderful infographic/explanation of the test for #COVID19

https://t.co/SCogi1tQKy
20. An interview on #COVID19 I did with @NakedScientists (very accessible and easy to understand)

thenakedscientists.com/podcasts/naked…
21. Really striking running tally of #COVID19 cases. The United States went from 0 to the most in the world. This at least partially depends on who is testing the most. If you have thousands of cases but can’t test any you would show up as zero.

https://t.co/oOACw5gAfn
22. Great educational thread in language we can all understand about lab testing (old vs. fast and new) by @jenheemstra 👇🏾👇🏾

https://t.co/gFNAfE260E
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More from @smlungpathguy see all

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Sanjay Mukhopadhyay
@smlungpathguy
1/
 How about a #Tweetorial on immunotherapy in quiz and answer form? Let’s try it! I’ll post a quiz in one tweet and then the answer in the next, and so on. Scroll down to follow the thread!

#pathology #pulmpath #ihcpath #pdl1 #Immunotherapy #pathtweetorial
2/
 First question. When PD-1 on T cells binds PD-L1 on tumor cells, what happens to the T cells?
3/
 The correct answer is that the binding of PD-1 to PD-L1 INHIBITS T cell killing of tumor cells.

See nice tweet on this by @kis_lorand

Read 35 tweets
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Sanjay Mukhopadhyay
@smlungpathguy
1/
 #Melanoma can look like anything: a #Tweetorial

Most melanomas are fairly easy to recognize but the outliers are pretty crazy.

Like this example with signet ring cells 👇🏾👇🏾
2/
 Melanoma with clear cells

3/
 Melanoma with gland formation

Read 17 tweets
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Sanjay Mukhopadhyay
@smlungpathguy
How about a #Tweetorial with no ending? A document that can be added to at any time? Can it work? Let’s find out!

1/
This #pathtweetorial will address the entity know as “talc granulomatosis” and review the literature, including old papers!

#pathology #pulmpath #granuloma
2/
 I did a quick search to find the first time “talc granulomatosis” was used as a term for lung lesions caused by excipients in pills, and came across this 1970 paper. Were Hopkins and Taylor the first to coin the term? Correct me if I’m wrong @yro854

ncbi.nlm.nih.gov/pubmed/5410600/
3/
 But first, let me give you a taste of what talc granulomatosis looks like, courtesy of Extra Super Duper Pathologist @DrjohninNE

The main finding is foreign body granulomas surrounding birefringent particulate matter (excipients) in the interstitium

Read 14 tweets

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Dinakar Peri
@dperi84
#Thread @adgpi Chief Gen MM Naravane outlines vision as Chief. Advocates ABC: Allegiance, Belief and Consolidation. “We swear our allegiance to the constitution of India... As in the preamble Justice, equality and fraternity. That is what we are fighting for.
Gen Naravane: Belief in ourself, our organisation. Our superiors and subordinates.. We will not fall prey to vile rumors and innuendos. Belief is what will keep us strong.

Consolidation leads to continuity... Somewhere along the way there will be midcourse correction. #ArmyDay
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We should not lose sight that its one place where collusivity can happen. So we should keep control
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A.E. Turnbull, DVM, MPH, PhD
@vitaincerta
#Thread
Our new #OpenAccess work @AnnalsATS examines how ICU doctors talk to families when they don’t expect a patient to survive. Congratulations to @SVasherMD, Sandra Zaeh of the @JHUPCCMFellows, and @mneakin
#ICU #PalliativeCare @creativecommons

atsjournals.org/doi/abs/10.151…
63 intensivists in the intervention arm of the SCIP trial (NCT02721810) answered the question “Do you expect this patient to survive to hospital discharge?”

50 of the 63 in the intervention arm answered that they did NOT expect the patient to survive.
These intensivists then participated in a recorded simulated family meeting.

During the meeting, 25 intensivists told the actor playing the daughter that her dad might not live. The actor responded verbatim:

“What do you think is most likely to happen?”
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Simwal
@Simwal
#THREAD
These days when Muslims give advise or denounce an unislamic act publicly done by a fellow Muslim, some Muslims will say “ who are you to judge them? only God can judge them” the Sahabas R.A when advised to fear Allah, will thank the person with tears in their eyes.
it is every muslims duty to speak the truth and accept that truth, even if it is against themselves.
"O you who believe! Stand out firmly for justice, as witnesses to Allah, even as against yourselves, or your parents, or your kin, and whether it be (against) rich or poor”
for Allah can best protect both. Follow not the lusts (of your hearts), lest you swerve, and if you distort (justice) or decline to do justice, verily Allah is well-acquainted with all that you do." [An-Nisa 4:135]
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Wing Chun Life🧠💪🗡️
@wingchun_life
#Thread
CURSE OF KNOWLEDGE:
This is a powerful cognitive bias, and the one that's probably most responsible for you staying stuck in your dead-end way of doing things instead of breaking out.

What is it?
The mind's inability to remember what it was like to not know something.
At first glance you may think this is a relatively unimportant thing. Completely harmless.

But it's robbing you of your freedom. Here's how.

To understand, we're going to use an example from my life: Magic Tricks.

I'm a professional mentalist; I've performed in Vegas.
I know how the mind works, and I understand why the simple methods of magic are so powerful; they leverage exactly these kinds of mental hiccups. So, here's the example.

I do a trick, and you want to know how it works. You'll do ANYTHING. Pay me $100, even. Great! Pay up!
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AltFDA
@alt_fda
#DallasThread #Thread #Hurricane #HurricaneFlorence #Flood #Cleanup As the flood waters recede, I want to talk to you about cleaning up. I have received training in disaster relief and sadly have had to use this training.
While this thread is not in-depth, it will be most useful info in one place that I think you will find. It’s also a bit long. Sorry not sorry 😬
Let’s start out by stating the obvious, unless you are saving another human, nothing is worth risking personal sickness or your life for. You must protect yourself first in disaster areas. If it takes another day to get the right gear, wait that day.
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