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Nick Mark MD

@nickmmark

Jun 8

@TheLancet

The long awaited #COVIDOUT RCT is now in @TheLancet:
- high risk adults randomized to either metformin (MET), ivermectin (IVM), fluvoxamine (FLV) or placebo.
- MET reduced the risk of long COVID (6.3% vs 10.4%; NNT = 24)
- no benefit with IVM or FLV

thelancet.com/journals/lanin…
1/

https://twitter.com/nickmmark/status/1560272414323249152

COVID-OUT was a large blinded multicenter RCT looking at repurposed oral meds.

The primary outcome was severe COVID; this was one of the *MANY* negative RCTs of ivermectin. (See 🧵👇)

The current study is a planned secondary analysis, looking at the incidence of long COVID.
2/

https://twitter.com/nickmmark/status/1560272414323249152

COVID-OUT was a factorial design enabling efficient evaluation of multiple oral medications in various combinations.

After diagnosis, subjects received meds by next day mail. They were followed up to 300 days (10 months).

Diagnosis of long COVID was made by a synonym survey
3/

Read 9 tweets

Nick Mark MD

@nickmmark

May 28

twitter.com/i/web/status/1…

Pulmonary teaching case: you are called to the bedside of a 60yo man who was admitted for pneumonia a week ago. You were called because “he coughed and now his chest is PULSATING!”

This is what you see at the site of a previously removed chest drain:

What’s the diagnosis?
1/ twitter.com/i/web/status/1…

@Radiopaedia

This is Empyema necessitans (EN):

EN is a rare complication of an infected pleural effusion where purulent fluid “escapes” the pleura and erodes into the chest wall, causing an extrapleural fluid collection that communicates with the pleural space.

From @Radiopaedia:
2/ twitter.com/i/web/status/1…

twitter.com/i/web/status/1…

Because Empyema necessitans communicates with the pleural space, fluid can move back & forth with respiration, as seen here:

With inspiration, negative intra-thoracic pressure pulls the fluid into the chest. With expiration, positive intra-thoracic pressure pushes fluid out.
3/ twitter.com/i/web/status/1…

Read 7 tweets

Nick Mark MD

@nickmmark

May 25

@NEJM

Interesting RCT in @NEJM about platelet transfusions prior to CVC placement in people w/ thrombocytopenia (Plt 10-50k):
- higher rate of grade 2-4 bleeding w/o Plt transfusion: 11.9% vs 4.9%
- difference driven by much more bleeding w/ subclavian lines
nejm.org/doi/full/10.10…
1/

This trial enrolled n=338 hospitalized people in 🇳🇱 with platelets between 10-50k, INR <1.5 (changed to 3.0). 57% were heme/onc patients & 43% were ICU patients.

Median Plt count was 30k

Most were getting a CVC for chemoTx. (Most weren’t exactly your “typical” ICU patient.)
2/

Importantly they placed the CVC within 1 hour or randomization. This means they probably didn’t transfuse then place a line, more like placed a line while transfusing.

(IMO this difference matters in situations where platelets are dysfunctional, like uremia)
3/

Read 7 tweets

Nick Mark MD

@nickmmark

May 24

ATS’ Leadership are in a Kobiyashi Maru situation with #ConferenceGate
- one one hand, they signed a terrible contract and stand to lose a ton of money if they pull out of Orlando
- the other hand, they risk having no one show up & alienating most of their members
#ATSSafe4All
1/

https://twitter.com/khibbert_md/status/1661365076178206720

People are angry. Seeing how many green ribbons there are at ATS, it’s dawning on ATS’ leadership that they screwed up big time.

They wonder: Will these people boycott Orlando 3 times in the next decade? Will they keep paying dues? Is this an existential threat to the org?
2/

https://twitter.com/khibbert_md/status/1661365076178206720

The easiest move for the EC is to do nothing and (try to) pass the buck: If ATS implodes in 10 years after three disastrously unattended Orlando conferences will anyone remember whose fault it was?

By then EC members will have moved on to other things. Will we remember them?
3/

Read 6 tweets

Nick Mark MD

@nickmmark

May 14

You've probably heard that Bicarbonate has to turn into CO2 to raise the pH. “Don’t give bicarb if you can’t increase ventilation.”

But how much CO2 is there in an amp of sodium bicarbonate?

A bicarb 🧵
1/

Sodium bicarbonate raises the pH by binding H+ ions and turning into CO2 and water.

For my fellow 🧪 nerds, I’ll write:

HCO3 (aq) + H+ (aq) --> CO2 (g) + H2O (l)

2/

This means that - just like adding alka-seltzer to water - when we give sodium bicarbonate we liberate CO2 & raise the pH!

In fact the major ingredient in Alka-Selzer is sodium bicarb!

(Also can we agree that this is the creepiest mascot ever?)

3/

Read 10 tweets

Nick Mark MD

@nickmmark

May 13

@atscommunity

Real shitty explanation by @atscommunity about where they plan to hold future conferences.

TL/DR: On one hand they had to consider safety & inclusion, on the other hand ATS’ sterling “reputation in the meetings industry.” They prioritized the latter.

news.thoracic.org/community/pres…

I’m disappointed that they have prioritized profit over the concerns of members.

Frankly, I would have been willing to pay higher dues, higher conference fees, legal fees, etc if the financial concerns had been raised transparently.

Instead they decided unilaterally.
2/

A few more points to respond to:

“Who knows what the policy will be in 10 years?”

This is textbook passing the buck, a major problem in organizations with annual rotating leadership.

We ought to elect leaders who are willing to make hard decisive choices.
3/

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