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Nick Mark MD

@nickmmark

25 Dec

https://twitter.com/BadMedicalTakes/status/1474852953508876291

Nothing conveys so much scientific ignorance so concisely as “Dandelion 22.7pH”

https://twitter.com/BadMedicalTakes/status/1474852953508876291

It’s a common misconception that you can’t have a pH above 14.

You actually CAN have a strong base with pH >14 (or an acid with a pH <0). It’s just super duper hard to dissolve that much base in water.

🧪 Let’s look at what it would take to make a BASIC solution with pH=22!
1/

First off what do we mean when we say BASIC?

I guess it could be any of these things…
2/

Read 19 tweets

Nick Mark MD

@nickmmark

25 Dec

Doing a coding refresher while my kids were watching a movie, resulted in an epic crossover: Home Alone ICD10

First the title. 3 options:
Z62.29 Other upbringing away from parents
Z60.2 Problems related to living alone
T76.02XA Child neglect or abandonment, initial encounter
1/

The movies opens with household chaos. The protagonist (Kevin) is bullied by his older Brother “Buzz”.

Don’t worry there’s not one but two ICD10 codes for this:
1️⃣Y07.41 Sibling, perpetrator of maltreatment
2️⃣F93.9 Childhood emotional disorder, unspecified
2/

Kevin fears that Fuller (played by his real life brother Kieran) will wet the bed.

You can code this concern from Fuller’s perspective or from Kevin’s:
1️⃣N39.44 Nocturnal enuresis
2️⃣W55. contact with urine of unspecified mammal

3/

Read 32 tweets

Nick Mark MD

@nickmmark

23 Dec

More good news! FDA authorizes another oral COVID treatment today: molnupiravir

A short 🧵 about how molnupiravir (MOLN) works & how/when to use it.

1/
fda.gov/news-events/pr…

Molnupiravir is a pro-drug that is converted to the ribonucleoside analog N4-hydroxycytidine (NHC).

Phosphorylated NHC is incorporated into SARS-CoV-2 RNA by the viral RNA polymerase. This causes many mutations in the virus (“viral error catastrophe”), preventing replication.
2/

But wait aren’t mutations bad? Isn’t Omicron a bunch of mutations that make it more infectious?

The distinction is the *number* of mutations.

RNA viruses are error prone - accumulating on average 1-5 mutations with every copy.

MOLN induces many DOZENS of mutations at once.
3/

Read 18 tweets

Nick Mark MD

@nickmmark

18 Dec

@NJHealth

Yesterday I gave grand rounds lecture at @NJHealth about the Omicron Variant: molecular biology, epidemiology, and clinical pearls.

Here's the video & link to download my slides.
🎥
📂 onepagericu.com/blog/grand-rou…

Google says AH-MUH-KRAN is 🇺🇸 & OH-MU-KRON is 🇬🇧
Oversimplified..

In ancient Greek, there were 2 letters pronounced similarly:
Ω made a long Oooo - it was called big O or O Mega
Ο made a short Oo - it was called little O or O Micron

Thus, OH-MI-KRON is probably more accurate
2/

@GISAID

To understand Omicron, we need to understand pandemic surveillance:

A sick person 🤒 gets COVID tested.
The (+) results get sequenced (depending on where in the 🌎 ) & published to @GISAID (or other platform).
Sequences are used by researchers globally, such as @nextstrain.
3/

Read 9 tweets

Nick Mark MD

@nickmmark

27 Nov

There’s a new SARS-CoV-2 variant of concern: Omicron (aka B.1.1.529) #OmicronVariant

What is this Omicron COVID variant & is the panic of it justified? (spoiler alert: no)

A short #OmicronExplainer 🧵 about what we actually know, what we suspect, & what’s still unknown.
1/

4 reasons Omicron is worrisome:
1️⃣ it is spreading rapidly in South Africa (known)
2️⃣ it is highly mutated (known)
3️⃣some mutations likely increase transmissibility (suspected)
4️⃣others *may* allow it to evade existing immunity or vaccines (unknown)

We’ll talk about all 4...
2/

First some nomenclature:
B.1.1.529 (its Pango lineage) is the same as “Omicron" (WHO declared it a variant of concern & assigned a Greek letter) #OmicronVariant
It’s also known as K21 (Nextstrain clade)

It’s erroneously been called the #NuVariant ... yeah that’s not a thing
3/

Read 16 tweets

Nick Mark MD

@nickmmark

9 Nov

Medicine has thousands of eponyms. Most are named for doctors but a few eponyms honor patients.

For example, Bacitracin, named for the bacteria Bacillus subtilis var Tracy, was first identified in a little girl “Tracy I.”

New post & medical history🧵
1/
onepagericu.com/blog/magnanimo…

Hieronymus Karl Friedrich Freiherr von Münchhausen, a German Baron, was legendary for telling stories of his adventures in the Russian Cavalry during the Russo-Turkish War.
(even the dogs look entertained!)
Notably he was *NOT* regarded as a liar but as a great story-teller!
2/

A German writer & con-artist, Rudolf Erich Raspe, created a fictional character Baron Munchausen loosely based on Baron Münchhausen (note the spelling: u not ü)

Munchausen had incredible adventures such as riding a cannonball, fighting a 40 foot crocodile, & going to the Moon
3/

Read 23 tweets

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