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Joseph Sleiman, MD Profile picture
@JosephHabibi_MD
May 16, 2022 • 8 tweets • 43 min read • Read on X
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@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma #PreConvo #IBDPoll1⃣

🆓#CME bit.ly/3wdwE7J

25y/oM w refractory #UlcerativeColitis undergo colectomy w IPAA. Takes acetaminophen PRN headaches & drinks a🍷glass w dinner. Presents for a routine f/up visit. labs: Alk Phos 250. What is the most likely cause of this AP?
@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma #PreConvo #IBDPoll2⃣

🆓#CME bit.ly/3wdwE7J

What is the most common extra-intestinal manifestation #EIM in patients living with #IBD?
@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma 1/⬆️ EIMs in #IBD
⭐️ CD > UC.
⭐️ Colon involvement

💣 Pathol:
⭐️ Direct result of bowel disease (e.g kidney stone from oxalate malabsorption )
⭐️ Influx of mononuclear cells activated in the intestine➡️another organ
⭐️ Systemic Immune activation independent of gut🔥 Image
@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye 2/ EIM come in different shapes & forms

🔺Can precede GI symptoms
🔺Can manifest with gut 🔥 and resolve with gut 🔥 control
🔺Can be independent of gut 🔥 , or occur after colectomy in UC Image
@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD 3/ #Joint: Most common EIM

🦴25% have peripheral arthralgias

🦴Knee, ankle affected first ▶️ to upper joints.

🦴Fewer arthritic complications in pts w ileocecal resection.

🦴Axial arthritis:
10% have Sacroiliitis (often asymptomatic)
3% have ankylosing spondylitis Image
@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD @ZarrarKhanMD @Timothy_A_Zaki @mahirxqureshi @JassimranSingh9 @NickLe64 @TrieuMD @MahamHayatMD @ASyedMD @SheharyarW @DrFiyin 4/ #Skin EIMs

🔸5-15% of pts
🔸Most common:
🔺Erythema nodosum: often on shin, resolve w Rx of gut 🔥
🔺Pyoderma gangrenosum: on LE, trauma/Sx area, avoid Bx, respond to TNFi
🔸Hidradenitis suppurativa: 🚫confuse w perianal dis
🔸Rare: Sweet Syndrome, Metastatic Crohn's dis ImageImage
@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD @ZarrarKhanMD @Timothy_A_Zaki @mahirxqureshi @JassimranSingh9 @NickLe64 @TrieuMD @MahamHayatMD @ASyedMD @SheharyarW @DrFiyin @aileenbui @Wissam_Ghusn @AdvaniRashmiMD @DVinsard @WilechanskyMD @NSeth2021 @nelson1987 @ReezwanaCMD @AimenKhanMD @DrewfordMD 5/ #PSC

🎯80% of PSC have IBD
🎯5% of UC

⬆️ALP/GGT should trigger eval w MRCP
‼️Can be dx before or after dx of IBD, or even after colectomy in UC
‼️ Assoc. w ⬆️ risk of colon CA, GB CA, cirrhosis, cholangioCA

🎯Median survival time w/o liver transplantation is 10 years.
@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD @ZarrarKhanMD @Timothy_A_Zaki @mahirxqureshi @JassimranSingh9 @NickLe64 @TrieuMD @MahamHayatMD @ASyedMD @SheharyarW @DrFiyin @aileenbui @Wissam_Ghusn @AdvaniRashmiMD @DVinsard @WilechanskyMD @NSeth2021 @nelson1987 @ReezwanaCMD @AimenKhanMD @DrewfordMD 6/ 👀EIMs

🔸3rd most common EIM (2-7%), 🧒>👨, CD>UC
🔸Most common: Episcleritis•scleritis•anterior uveitis (medical emergency!)•
🔸Rare: retinal vasculitis•papillitis•corneal infiltrates•myositis•scleromalacia perforans•optic neuritis
🔸co-occur w/ Skin & Joint EIMs Image

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More from @JosephHabibi_MD

Joseph Sleiman, MD Profile picture
Feb 27, 2023
@MondayNightIBD 2/📣#IBD & meds carry an⬆️risk of #Malignancies, including lymphomas

🔺Who is at risk?
🔺Is it IBD-mediated or drug-related?
🔺What is our prevention & screening🔎strategy?

Thank you for joining this special #MondayNightIBD #Back2Basics @DuekerJeffrey Image
@MondayNightIBD @DuekerJeffrey @amelia_kellar @DCharabaty @IBD_Afzali @drdani23 @ibddoctor @EdithHoMD @fgomollon @IBD_DrEMF @ibdgijami @MaiaKayalMD 3/ 🔥IBD may carry a unique risk of primary intestinal lymphoma (PILD), but NO🔼risk of extra-intestinal NHL

In CESAME population,
▪️Crude IR of PILD was 0.12/1000 patient-years (py)
▪️All B-cell NH LD
▪️79% ♂️, 11 CD, 3 UC
▪️86% arose in IBD lesions
▪️45% were EBV positive Image
@MondayNightIBD @DuekerJeffrey @amelia_kellar @DCharabaty @IBD_Afzali @drdani23 @ibddoctor @EdithHoMD @fgomollon @IBD_DrEMF @ibdgijami @MaiaKayalMD @JChristieMD @KDeFelice_IBD @dunleavy_katie @IBDMD @MN_GIMD @SaraElOualiMD @nloganmd @KrugCleveland @PDulaiMD @PriSantiagoMD 4/ Lymphoma in #IBD is mostly linked to IBD therapy, particularly #Thiopurines (6MP, AZA)

🔺⬆️Risk in CD, less evidence with UC
🔺M>F
🔺Risk increases with exposure⏲️, particularly >2 years
🔺Risk decrease after cessation of AZA Image
Read 9 tweets
Joseph Sleiman, MD Profile picture
Oct 3, 2022
@MondayNightIBD 1/ 📣 #GITwitter #IBDTwitter
It’s a new🔥#Back2Basics session with #GI #Fellow @JosephHabibi_MD

Let’s talk AZA/6-MP in IBD

✅#IBDPolls 1️⃣&2️⃣👆🏽
✅Role as Mono/combo therapy
✅Escalation consideration
✅TPMT & NUDT15 testing
✅Side effects & counseling Image
@MondayNightIBD @NavreetChowlaMD @MilestoneIBD @IBD_FloMD @tinahamd @DrCoreySiegel @HorstIBDDoc @MLongMD @LauraRaffalsMD @doc_ibd @IBDBen 2/ AZA trials in IBD:

🔹Corticosteroids needed to induce remission
🔹Takes ~12 wks for AZA/6MP to become effective, so taper steroids accordingly
🔹AZA/6-MP effective for maintenance of remission (mainly in UC); Not effective for induction ImageImage
@MondayNightIBD @NavreetChowlaMD @MilestoneIBD @IBD_FloMD @tinahamd @DrCoreySiegel @HorstIBDDoc @MLongMD @LauraRaffalsMD @doc_ibd @IBDBen @IBDHorizons @IBD_Houston @IrisWangMD @LoriPlung @vaibhav_manu @KatieFalloonMD @amneethansmd @ManuelBragaMD @Chatterjee_MD @SuhaAbushamma 3/ AZA in today’s practice

1⃣CS-sparing monotherapy for maintenance of moderate IBD
2⃣Combo w/ TNFi to
↑ TNFi levels
↓ Ab formation
2nd MOA for severe/complex IBD not responsive to mono💉
Perianal Crohn’s

...⏬
Read 18 tweets
Joseph Sleiman, MD Profile picture
Mar 31, 2020
Let’s pause for a second, and remember two major #stigma spreading around as contagiously as #COVID19. 🦠
1️⃣Ethnicity of the virus and
2️⃣wearing #PPE

I’m addressing 2️⃣ today, but for more guidance on 1️⃣, & more social Do’s and don’ts, please refer to 👉unicef.org/documents/soci…
To summarize the ongoing debate: “Absence of evidence is NOT evidence of absence”. A half full glass 😷 can be better than none at all. This 🏴&🏳️ system is leading to two issues:
1️⃣ opportunity to incentivize PPE production is lost
2️⃣ STIGMA against those who choose to don.
If you have 12 minutes to spare, enjoy this well illustrated thesis on the topic, it might change your mind. @medpedshosp
Read 9 tweets
Joseph Sleiman, MD Profile picture
Jun 12, 2019
10 things IMG (and USMG) applicants should know for the 2020 residency MATCH: I can’t help but recall how stressful the application journey was one year ago. I hope this thread helps out (instead of adding stress)! @ERAS @AAMC
Build your CV: it helps as you are requesting letters from mentors, or basically any email you're sending. Have a clear CV that speaks of your accomplishments. Do not miss a certificate or work in progress. Here is a link to how to do a cover letter.
Before programs see your application & statement letter, look at it yourself. Know your goals, or at least outlines of your goals. Know your weaknesses and SHOW that you are working on them. Practice your ONE LINER. This will improve your statement letter and application.
Read 12 tweets

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