Keith Pereira MD, #VIrad Profile picture
May 11, 2020 11 tweets 8 min read Read on X
“What the eye doesn't see and the mind doesn’t accept, DOES EXIST!”

👇 picture of the hands of Thomas Edison’s assistant. Later died from Cancer due exposure to the same ‘invisible’ X-Ray radiation

Why are we discussing this in 2020, during #Covid_19 ?

1/ Image
Radiation is not visible to the human eye and neither is Coronavirus.

The size of the virus is about 0.1 um, smaller than a red blood cell and even some bacteria

Both can have devastating effects , if we do not protect ourselves

2/ Image
#Covid_19 can be transmitted by droplets >5 µm which can quickly form aerosols ≤5 µm.

Besides the well-known transmission by coughing and sneezing, the virus can be transmitted even during SPEECH….in fact the louder you speak, more are chances of transmission..

3/
Why is this virus much worse than previous respiratory infections like SARS-1?

The virus resides in your throat (not lungs): easily coughed out

Asymptomatic carriage is strong and consistent: You can get the virus even when the other person has NO SYMPTOMS! 😱

4/ ImageImageImageImage
Enter 😷- Home-made-masks

Medical masks (protect yourself) are different from Home made masks (protect others)

Home-made-masks are great for 'source control' by blocking large droplets as they are emitted in coughing and talking before they are aerosolised

5/ Image
Wearing masks doesn't protect me, but others around me- So ⁉️

An infection has R0-transmission rate
R0=1 one person infects one other person
R0<1 infection dies out

Modelling suggests: A mask 60% effective and worn by 60% people will reduce R0 to <1.0

#AllInThisTogether

6/ Image
What is the scientific evidence that Universal masking works?- Unfortunately no RCT's- impractical

SEIR and Agent Based Models showing value of Universal masking

Link: arxiv.org/pdf/2004.13553…

7/ Image
Real life experiences shows value of universal masking

Every country where mask-wearing introduced as national policy (+other measures), rates of transmission fell in the subsequent days @nytimes

Story of two European neighbors Austria and Czechia @trishgreenhalgh

8/ ImageImage
Economic value of universal masking:

"The benefits of each additional cloth mask worn by the public are conservatively in the $3,000-$6,000 range due to their impact in slowing the spread of the virus"

@Jabaluck

papers.ssrn.com/sol3/papers.cf…

9/ Image
As a physicians and Interventional specialist, we deal with radiation everyday and now #COVID_19. WE all wear lead shields to protect ourselves and #N95 while saving YOUR lives

Please 🙏 do us a favor:

Wear your masks!-Protect yourselves and Your #HealthcareHeroes

10/ Image
References:

@nature
@NEJM
@Masks4AllProj

11/ End Image

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More from @keithppereira

Nov 20, 2020
Today's 8 am #UFE begging to leave hospital at 10.30 am....we found a middle ground 11 am

The secret 🤫: #RadialFirst and #SHNB

#Tweetorial on technique and troubleshooting....

🧵1/
Relevant anatomy:
Sup hypogastric nerve plexus- sympathetic nerve plexus anterior to L5 body
Aortic bifurcation-L4
Venous confluence- L5, L5-S1 disc (*overlies the plexus 😱)

2/
Although arterial opacification can be avoided with an angiogram, venous opacification is sometimes inadvertent and maybe seen in nearly 1 in 5 cases.

We still go ahead with #SHNB:
➡️ Adjust needle position
➡️ Multiple aspirations
➡️ Test dose

3/
Read 7 tweets
Jun 14, 2020
Highlights Day 1 of #SIR20VIR, #Irad Interventional virtual meeting!

#MedTweetorial

⚫️ 1.Scientific Session
a. 🟡 Dialysis Related
b. 🟢 Others
🔴 #PAD-CLI Bootcamp
🔵 Practical Controversies in #PAE

(Long thread, use color code to jump to relevant sections)

1/
🟡 1a Dialysis related

Abstract of the year:

Are PTFE covered stents going to be standard of care to address the venous outflow stenosis in AV fistulae (AVeNEW) and AV grafts (AVeVA)?

Results from Dr Bart Dolmatch

2/
🟡 1a Dialysis related

CONCERTO (COmbiNing Cutting and drug-Eluting balloon for Resistant arteriovenous fistula sTenOsis) Pilot Study showed great promise for use of the combination therapy for AVF

First Author:
Mark Wang, Singapore General Hospital

3/
Read 16 tweets
Jun 1, 2020
#LiverTwittIR #MedEd #Tweetorial

Management of post‐TIPS refractory Hepatic Encephalopathy (HE)

🟢 Definition
🟡 Prevention
🔵 Medical Rx
🔴 Endovascular approach

1/
🟢 HE maybe:
Covert: Minimal or West haven Gr 1
Overt: West Haven Gr 2-4 which maybe episodic, recurrent (bouts within 6 mo) or persistent ( behavioral changes present with intermittent overt HE)

2/
Why does post-TIPS HE occur?

1.Shunting of blood away from liver- decreases 1st pass clearance of intestinal toxins (ammonia)
2. Upregulation of intestinal glutaminase activity- Increase ammonia production

1yr incidence 10-50%
New/ worsening 13-36%
Severe 1-3%

3/
Read 11 tweets
May 15, 2020
Vectors or Vulnerable?

#Covid_19…the more you know…🤦‍♀️🤷‍♂️

What we know about MIS-C in children so far : Evidence, CDC alert and more…

🧵 1/
Minimal medical burden

Low incidence: 1.7-2%

Asymptomatic or mild symptoms, however can pass this virus onto high risk population (vectors)

Severe illness: rare, can occur with pre-existing medical conditions, but have better outcomes (compared to adults)

2/
Late April

UK reports 8 children “Hyperinflammatory syndrome, multiorgan involvement-Kawasaki-like disease(KLD) and Shock”

Previously asymptomatic,healthy
Older ~ 7.5 yr
All Shock, 1 coronary art aneurysm,1 dies of cerebral infarct
NO cough/significant respiratory issue

3/
Read 11 tweets
Apr 13, 2020
Great #DistanceMedEd about Mx of Variceal bleeding from @TedWJamesMD and thanks for this invite!

TIPS, BRTO and BATO - 🤦‍♀️Too many puzzling acronyms?

Lets break this down for you from #Irad perspective with a #Tweetorial

1/
2/

TIPS: basic overview of variceal anatomy and flow dynamics ( will help understanding BATO and BRTO later)

Normal Liver: hepatopedal flow
Cirrhotic Liver: hepatofugal flow
TIPS: Restored hepatopedal flow
3/
TIPS performed since 1982, but whats 🔥 ?

Contraindications ⬇️ with time. Why? Newer #Irad techniques

TIPS now possible in chronic Portal vein thrombosis, specially relevant as these patients not transplant eligible

High technical success, 39% underwent transplantation
Read 10 tweets
Jan 27, 2020
⚡️ Published @JVIRmedia ⚡️, will hopefully help #Irad #InterventionalSpecialists with patient care after #UFE

"Intraprocedural Superior Hypogastric Nerve Block (#SNHB) is safe, effective, significantly reduces pain, need for opioids and allows same-day discharge #UFE"

Thread 👇
1/ YOU CAN DO IT! 🤜 🤛

#SNHB technique: Technical success 87% , which included operators who were not initially experienced with this procedure.
2/ #SNHB HELPS WITH PAIN CONTROL 💊

97.1% of patient with #SNHB DID NOT NEED PCA pump

Of patients that needed opioids, average dose was ONLY 7.5 MME
Read 7 tweets

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