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@maureviv

May 12

@BhupeshPrusty

Since yesterday I've been gathering my thoughts on the excellent @BhupeshPrusty talk at the #MECFSconference 🧵

The main topics were:
- Mitochondrial dysfunction
- Herpesviridae
- Autoimmunity

#MEAwarenessDay2023 #MEAwarenessMonth

The oral presentation itself was concise (this is usual in medical conferences) & has possibly saved significant novel findigs until their upcoming article is published.

This may explain why the breakdown on possible biomarkers and treatment options has been so succinct
(...)

However, this won't be an impediment to try to expand (and speculate a bit) on potential biomarker avenues exposed in Bhupesh's talk.

✅First of all, (I know this is an accepted hypothesis but bear with me) their results show strong evidence that #MECFS has an autoimmune basis:

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@maureviv

May 12

An useful biomarker should have at least:

- A very good sensitivity, and a reasonable specificity,
- A very good specificity, and a reasonable sensitivity,

Or both.

But what are sensitivity and specificity?

Sensitivity: the ability of a test to correctly identify sick patients with a known disease.

Specificity: The ability of a test to correctly classify an individual as disease-free.

ncbi.nlm.nih.gov/pmc/articles/P…

A sensitive test aims for "positive classification": to identify all patients who are sick.

However, a biomarker that is sensitive but non-specific carries the cost of incorrectly classifying healthy patients as also sick.
(...)

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@maureviv

May 2

Basic thread about fingertip blood sampling for lactate levels 🧵#TheAcidTest

Lactic acid is a key molecule, part of our anaerobic fermentation, which is one way for cells to obtain energy (=ATP⚡).

Advantages:

1. Anaerobic metabolism means it doesn't need oxygen to work.
...

2. Lactate can go back to pyruvate->glucose (Cori cycle) to be included in the mitochondrial respiratory chain (using oxygen)

Disadvantage: anaerobic is much less efficient than the aerobic respiratory chain

➡️When we measure lactate we're usually interested in two things:

1- Lactate elevation due to tissue hypoperfusion:

It can be caused by complete occlusion of a large vessel followed by reperfusion, which releases lactate back into circulation.

Small vessel occlusions or capillary dysfunction may also lead to high lactate released in venules.

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@maureviv

Dec 10, 2020

https://twitter.com/jenbrea/status/1336732558453719043

I have read the whole thread, which describes a horrible situation, overlooking a vital problem with a patient, plus misdiagnosing her

That will likely repeat in other patients if nobody takes it as what it really is: a dire threat

(Read the quoted thread first)🙏#FOAMed
(1/n)

https://twitter.com/jenbrea/status/1336732558453719043

Central apnea occurs in many situations, and cranio-cervical instability is definitely the most common
Why does apnea happen?

Because the diaphragm (an essential muscle for breathing) doesn't activate

The breathing impulse gets carried from the brainstem respiratory centers, via brainstem and spine, until it reaches about the 4th cervical/neck vertebra (C4)

Then it exits the spine down to the diaphragm
Anything that compresses the medulla at C4 or above, affects its function

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