Meena Bewtra Profile picture
Jan 18 19 tweets 40 min read
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 2/ 📸 Faculty disclosures & CME certification ℹ
Want a #CME certificate? → ℹ️ bit.ly/3IbTRdB
#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 3/ 😭 most pts are NOT getting safe 💉 like flu, pneumonia & HepB.
🤷‍♀️ Why?
🚫Many GIs won't/can't give 💉
❓Many PCPs don't know what to give
📞 Better communication is needed
#MondayNightIBD

Who do you think should make vaccine recs & where should pts w/ #IBD get 💉?
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 4/ pts w #IBD , esp if on ⚠️immunosuppressants (IS), at ⬆risk of (preventable) infections, so #vaccination is 🗝️
Infection in IBD = ⬆hospitalization ⬆ 🏥 stays ⬆costs & ⬆mortality.

Despite their benefits, vaccination rates remain LOW.

#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 5/ ☢️ Corticosteroids, immunomodulators, biologics & small molecules therapies significantly ⬆ the risk of infection in pts with #IBD.

#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 6/ 🚨#GITwitter #MondayNightIBD

47y/oM w #UlcerativeColitis about to start Tofacitinib.
Which of the following vaccines is recommended & should be given before/soon after he begins treatment with TOFA ?
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 7/ If you picked the recombinant zoster 💉, you are correct! 👏🥳
🚫 Varicella Zoster, or MMR = live vax

🧩Who should get 💉?
✅ All #IBD pts 👉 standard + IBD-specific 💉 recs ➕ 🏡 household members

🛑 No live 💉 if IS
#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 8/ 🚨 #GITwitter #MondayNightIBD

If taken within the last 2-3 months, which of the following therapies does 🚫NOT constitute #systemic #immunosuppression in a patient with #IBD?
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 9/ 🧩Who is IS? #IBD pts on or had within last 3 months:
🚩 Prednisone > 20mg/day >2wks
🚩 AZA >2.5 mg/kg/day
🚩 6MP >1.5 mg/kg/day
🚩 MTX >0.4 mg/kg/week
🚩 Cyclosporine
🚩 Tacrolimus
🚩 Tofacitinib, ozanimod
🚩 TNFi, UST

Also:
🚩 Significant protein-calorie malnutrition
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 10/ 🚸Pediatric pts w #IBD & IS should be 💉 for pneumococcal disease + all routine scheduled 💉

📌If age >6yrs give PCV13 first 👉 wait 8wks before PPSV23
📌If age >2yrs, give 1st dose PPSV23 👉 2nd dose 5yrs later

@CrohnsColitisFn HCM in #IBD ✅🗒️ bit.ly/3GIMZUD
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 11/ 🙋‍♀️19y/oF w #Crohns in clinical remission on IFX q8wk presenting today for #COVIDvax.

Pt asks about:
#COVID-19 risks
❓💉👉 #IBD flare
❓🔢💉doses
❓mRNA vs Janssen

🧩What do you tell them?

#MondayNightIBD
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 12/ All #IBD pts ≥5yrs 👉primary 💉 COVID-19 (mRNA Pfizer/Moderna pref over Janssen)

🚩 Mod-severe IS pts ≥5 yrs who complete 2-dose mRNA 👉💉 extra primary mRNA dose

✨BOOSTER DOSE: All pts ≥16yrs 👉💉 ≥5mos after mRNA series or ≥2mos after Janssen dose

#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 13/ IBD pts are NOT at ⬆ risk of #COVID-19 & do NOT need to stop meds to 👉#COVIDvax

✅Therapy important to keep #IBD in remission/prevent flares

#MondayNightIBD
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 14/ Nov 2021 📶👉 COVID-19 💉EFFECTIVE✅ for #IBD pts 👏:

📌602 IBD pts vs 168 non-IS controls given mRNA or AstraZeneca 💉
📌82.2% of IBD pts on biologic tx, 48.5% on TNFi
📌Post💉 seropositivity 👉97.8% IBD pts vs 100% controls
📌ALL IBD pts w no seropositivity received AZ 💉 Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 15/
March 2021📶👉 #COVIDvax SAFE✅ for #IBD pts 👏:

📌80% of study pts on IS therapy
📌AE freq similar to clinical trials: 39% after Dose 1, 62% after Dose 2
📌Biologic therapy 👉 fewer AEs after Dose 2 (p=0.013)

#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 16/
Pregnant #IBD pts and infants at 🚨HIGH RISK of SEVERE #COVID-19🚨

💉EARLY in 🤰pregnancy to ensure antibodies 👉👶
👉Pregnant minorities at increased risks COVID-19

#MondayNightIBD Image
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 17/ SUMMARY:
📌#IBD pts @⬆risk of infection & neg outcomes
📌 All providers 👉evaluate💉status 👉all pts w IBD regardless of IS
📌#COVIDvax SAFE & recommended 👉all pts w IBD>5yrs
📌Special populations & racial/ethnic disparities 💥 considerations 👉💉& outcomes
#MondayNightIBD
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 18/ 🙌🙌🙌
Thanks from @MondayNightIBD @DCharabaty & @BonumCe 4 participating in this Tweetorial!

You did the 💪 work, now get🏅 🆓 #CME bit.ly/3I8mdp0

Before you 🏃🏽‍♀️, answer the post-test ❓s 👇
or in the 👆 CME🔗 if you want to claim credit
#MondayNightIBD
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn @BonumCe 19/ 🚨#PostConvo #IBDPoll 1⃣
#MondayNightIBD
🏆🆓 #CME 👉 bit.ly/3I8mdp0

47y/oM w #UlcerativeColitis about to start Tofacitinib. Which of the following vaccines is recommended & should be given before/🔜 after he begins treatment with TOFA?
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn @BonumCe 20/ 🚨#PostConvo #IBDPoll 2⃣
#MondayNightIBD
​​🏆🆓 #CME 👉 bit.ly/3I8mdp0

If taken within the last 2⃣-3⃣ months, which of the following therapies does 🚫NOT constitute #systemic #immunosuppression in a patient with #IBD?

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More from @DrsMeena

Jan 26
1/ I have thoughts; I have a lot of thoughts.
"In a study of > 1.3MIL patients getting surgery, female patients treated by male surgeons had worse postoperative outcomes...."
Let's talk about this (thread 👇🏽)
#ILookLikeASurgeon
ja.ma/3rQMPV7 @JAMASurgery @JAMANetwork
2/Great article👇🏽
"female pts also had a 16% ⬆️risk of complications; an 11% ⬆️ risk of readmission; & were 20% more likely to have to stay in hospital longer."
Women had a ⬆️risk of death, readmission or complications when a man performed the operation."
theguardian.com/society/2022/j…
3/ Looking at the study itself, it's a retrospective cohort study that attempted to correct for many factors (confounders) incl: age, sex, geographic location, socioeconomic status, rurality, general comorbidity, surgeon sex, years in practice, specialty, and surgical volume.
Read 6 tweets
Jul 2, 2021
1/ Every year, I give a talk that wipes me out-emotionally & mentally.
But it’s an impt talk to give: about the experience of women in medicine, academics, STEM.
It’s hard because it hits home; & because I answer any question & tell the truth.
Here are some facts; more in thread
2/ In medicine alone, there is high drop out of women as you go up the ranks.
And while marginally better over a 10 year period, it’s not even close to ACTUALLY better.
Why do so few women move up ranks?
Some of it should be apparent 👇.
For the rest--read on…
3/ This was an interesting study from HBR of 81K performance evaluations of men & women.
Look at the frequency of positive vs. negative reviews.
Now-look at how they were described.
(One word missing from here: bitch. Every woman has been called that. All of us.)
Read 10 tweets
Nov 15, 2020
1/ With an ⬆️in anti-maskers (incl some elected to Congress), questions keep coming up: how do you know a mask works?
Here’s ANOTHER piece of evidence: a mask protects those around you AND it also protects YOU.
Read article; read thread
vox.com/science-and-he… via @voxdotcom
2/ New unpublished research from Kansas & Tenn suggests masks:
-prevent #COVID19
-blunt severity of #COVID19
-⬇️the number of serious cases that require hospitalization
“masks remain among our cheapest most effective tools to control the pandemic — if worn consistently.”
3/ Some evidence emerging from this cluster that is the disjointed States of America:
Eight of the top 10 states that saw the highest new cases per capita in October did not have a widespread mask mandate.
Read 9 tweets
Oct 28, 2018
1/ I refrained from responding with the level of vitriol I felt last night because I was at a lovely same-sex marriage and wanted to celebrate the beautiful day/night with the wonderful people there.
But not tonight...
Follow the thread for some FACTS....
2/ Let's start with this excellent article summarizing some FACTS we know.
And as a reminder: FACTS don't give a DAMN if you believe them or not.
And the FACTS tell us that more guns = higher rates of murder and suicide...
scientificamerican.com/article/more-g…
3/ In fact, as the article above discusses, people w/guns at home for self-defense had a 40-70% INCREASED CHANCE of being murdered at home. This went up to 270% INCREASED chance of being murdered if the gun was loaded.
Guns at home also = a 3-6-times increased risk of suicide
Read 9 tweets
Oct 25, 2018
1/ LOVE the guys .@tntradioempire: they make poop in a box as funny as dick in a box. Listen live, online, or via your favorite podcast.
Covered a few things, but NE!!! Please take note of thread for info on Medicaid-SPREAD FACTS.
Then: get out & vote FOR 427 Medicaid Expansion
2/ No, no, NO—Milk’s NOT racist! You know what’s racist? NAZIS.
Up to 75% of the world’s population has lactose intolerance-but most can tolerate limited amounts of dairy; & dairy is GOOD for you! And it does NOT cause cancer!
ncbi.nlm.nih.gov/pubmed/22081693:
academic.oup.com/ajcn/article/1…
3/ Scientists did find (in a MOUSE model) that THC fits in receptors in the olfactory bulb, causing increased smell & increased food intake. The same group also found that regular chronic marijuana use affected short-term memory. So…eat up—again.
nature.com/articles/nn.36…
Read 12 tweets
Oct 17, 2017
1/ Folks-I brought this up on @tntradioempire this am, so a little explanation of Trump's sabotage; read thread if interested
2/ First, Trumps exec order (EO) allows small employers to get health plans that don't meet ACA’s essential health benefits requirement.
3/ As a reminder, Essential Health Benefits are the following--and they're called essential for a reason!
Read 10 tweets

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