Want to know why #Mucormycosis is more common post #COVID19 and not so common after leukemia's or other illnesses treated with steroids ?

Read on !!
These are the major reasons in my opinion:

1. The NUMBER of #COVID19 pts is far GREATER than the number of leukemia pts we treat in a year. Thus a lot more people are getting steroids at this point in time and thus a lot more are at risk of steroid related complications.
Let's say 1/5k steroid treated pts get mucor, now if we treat 500k pts with steroids we will definitely have 100 mucor cases. SIMPLE MATH !!

Not convinced, read on.

2. A great number of #COVID19 pts have underlying CO-MORBIDITIES like diabetes which are WORSENED by steroids
3. A greater number of #COVID19 pts are being treated by physicians not so familiar with using steroids. It's an art to use these magic pills as @SChellapuram rightly said a few days back. If used WRONG there is potential for HARM as proven even in the RECOVERY trial.
4. The paranoia/ fear created by #COVID19 and the lack of established guidelines makes for PROLONGED STEROID COURSES in covid. I have personally seen pts treated with MPS for as long as 28days 🤷‍♂️ that's like a leukemia induction therapy.
This makes pts prone to all sorts of secondary infections, eg mucor !!

5. It's not just the duration, the DOSE is also a big problem. There is absolutely NO JUSTIFICATION for giving 250mg MPS (6mg dexa = 30mg MPS)
One can understand a 125 mg "pulse" but NOT a 1gm MPS pulse !
6. If doctors err so do the patients. OVER THE COUNTER use of steroids must be STRICTLY PROHIBITED. Please trust your treating doctor, if they are NOT prescribing you steroids it's because you DON'T NEED THEM !!
Reading about #Mucormycosis on SM and worrying won't help. We must nip the problem in the bud, stop using unnecessary meds, not just steroids. All meds have side effects. It's all about RISK vs BENEFIT in medicine.
The COMPLICATIONS are often more DIFFICULT to treat than the primary disease. #COVID19 is mild/ asymptomatic in >70% pts and your body is adept at controlling it. Trust your body. It doesn't need immunity boosters. It knows what to do. Please don't disturb the HOMEOSTASIS 🙏🏻

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More from @nihardesai7

15 May
So there are a lot of people asking about the risk factors for #mucor post #covid.

The biggest risk factor isn't the steroid itself, it's the hyperglycemia that it causes. If the sugars are well controlled using insulin the risk is almost negligible. So STOP freaking out !!
The 2nd major risk factor is prolonged NEUTROPENIA but that's a problem in our #Hematology patient population and not in #covid patients, so we can safely ignore that for now.
Bring us back to hyperglycemia due to steroids. The sure shot way to prevent it is frequent monitoring of sugar levels and NOT self medicating with steroids. Steroids anyway don't have any benefit if one isn't hypoxic so don't use it because ur aunt/uncle/friend used it.
Read 6 tweets
11 May
#MedStudentTwitter might find it useful. Some common case scenarios !!

Case 1

72, male, on routine CBC is found to have ⬆️ WBC count. Asymptomatic.
CBC: 12.2 / 77k / 215k
Lympho: 88%
No HSmegaly

This is most likely CLL.
Q now is, does he need rx?
The answer in this case would be NO.

Always think about benefit vs risk when u want to start Rx. CLL many a times may not need rx at all.

Important learning point➡️DON'T get ALARMED by a ⬆️TLC.
Case 2

42, male, p/w fatigue and dragging abdominal pain, ⬇️appetite x 2months

CBC: 12.6/356k/405k
Baso: 4%
Spleen 4cm BCM

This is most likely CML.

DX is confirmed by FISH for 9;22 or BCR-ABL PCR
MC transcript type: p210
Read 7 tweets
8 May
CELLS in Hemat 💪🏻

Sickle cell=Drepanocyte➡️SCD
Tear drop=Dacrocyte➡️MF
Spur cell=Acanthocyte➡️Liver ds
Burr cell=Echinocyte➡️Uremia/PK def
Target cell=Codocyte➡️Hb'pathies
Bite cell=eccentrocyte➡️G6PD def
Pencil cell=ovalocyte➡️IDA
Pincered cell➡️Band 3 def
Prickle cell➡️PK def
Sickle cells, not hard to identify.
Can't miss these isn't it ?
Read 9 tweets
7 May
#FERRITIN is being widely ordered these days. Let's dive into the details and learn more about this protein. A short thread for those interested. Covers some history, biology and practical aspects about FERRITIN.

1/n
It was discovered in 1937 by Laufbérger but it wasn't until 1972 that an assay was devised to measure serum ferritin.

Ferritin is present in 2 forms
👉 Intra-cellular (in the cytosol)
👉 Extra-cellular

2/n
It is a ~450kDa protein.
Has 24 subunits of 2 major types
👉 H : gene on chr 11q
👉 L : gene on chr 19q

Serum ferritin has ⬆️ L: H ratio.

3/n Image
Read 7 tweets
4 May
So mucor is on the rise, time for a quick revision. A short thread for those interested.

It's a bad infection with an unreasonably high mortality(40-80%) which depends on the organ involved.

Risk factors: DM/ neutropenia/ HSCT

DM=rhino-orbital mucor
Neutropenia=pulmonary mucor
Mucormycosis is caused by fungi of order "MUCORALES" which includes rhizopus/mucor/licthemia/cunninghemela species. But DON'T WORRY species identification doesn't change treatment so we don't need to get to that.
Coming to the PRACTICAL POINTS that need to be remembered.

➡️IMAGING even at the slightest suspicion of mucor coz it's RAPIDLY PROGRESSIVE and kills quick.

➡️CT PNS/Orbits/ MRI Brain
➡️HRCT chest as per presentation
Read 8 tweets
1 May
Got #covid ? Don't worry it's not a death sentence.

Step 1: Isolate and monitor

I assume u must have started isolating even before you tested + , if not, do so immediately. Get the others at home tested ASAP. Monitor your temperature and oxygen saturation.

1/n
Step 2: Managing Co-morbidities

If u have any co-morbidity continue to take the meds you were already on. Don't STOP meds for ur diabetes or hypertension or thyroid d/o.

2/n
Step 3: Managing fever

Fever is a very common symptom. Please dont panic. Take a paracetamol. An adult may take upto 3gm/day i.e ~650mg 6 hourly. Continue to monitor your oxygen sats every 4-6 hrs.

3/n
Read 9 tweets

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