Cellulitis reflects the notion of complexity in simplicity 💕

It's more than what meets the eye ✨

Let's unravel it's layers and intricacies 🧵

@CPSolvers @rabihmgeha @DxRxEdu @Sharminzi @sargsyanz @ASanchez_PS @DrStevenTChen @JasBajwa18 @seymss15 @nihardesai7 @SatyaPatelMD ➡️Basic Principles of Cellulitis

- Non necrotizing
- extremities
- Involves deeper dermis and subcutaneous tissue
- Majority cases attributable to classic infections
- Localized but fuzzy margins
- PMNs
- Good response to standard abx
- Low rates of recurrence
- Benign

💕❄️💕

💞The spectrum of Thrombotic Microangiopathies is a testament to the elegance of pathophysiology 💞

✨Let's explore the approach and management🧵✨

@rabihmgeha @DxRxEdu @sargsyanz @AnnKumfer @AaronGoodman33 @nihardesai7 @CPSolvers @ASanchez_PS @SatyaPatelMD #MedTwitter 🌟Pathophysiology

Endothelial injury➡️tissue factor and vWF➡️coagulation cascade➡️platelet activation➡️complement activation➡️microvascular thrombi➡️shear stress and MAHA➡️platelet consumption

Above steps are interdependent and amplify the loop of TMA-MAHA-Ischemia

#nephrology

Differential diagnosis of skin sclerosis reflects the complexity and elegance of medicine💫💞

Here is a short 🧵

@rabihmgeha @DxRxEdu @sargsyanz @DrStevenTChen @CPSolvers @nihardesai7 @AaronGoodman33 @ASanchez_PS @AnnKumfer @SatyaPatelMD #MedTwitter #dermatology #pathology 💝General approach

/ Distribution: hands, feet, face, trunk, back
/ Raynaud's +/-
/ ANA +/-
/ Systemic features +/-
/ Fibroblasts vs Fibrosis vs Mucin vs Eosinophils
/ Genetic vs Toxic vs Autoimmune vs Infections
/ Infiltrative disorders & Paraprotein

#MedTwitter #pathology

Acute liver failure is a true medical emergency & quick identification is crucial to avoid the death

A short & sweet💞🧵

@rabihmgeha @DxRxEdu @ebtapper @rav7ks @ASanchez_PS @SatyaPatelMD @Sharminzi @sargsyanz @nihardesai7 @AnnKumfer @CPSolvers #MedTwitter #GITwitter ⭐️Definition

➡️Severe liver injury
➡️Encephalopathy
➡️INR>1.5
➡️Absence of cirrhosis or pre-existing liver disease
➡️Developing under < 26 weeks

#MedTwitter #GITwitter #Gastroenterology

Hyponatremia in neurologic disorders is a phenomenon to behold! 💫⭐️💫

Follow this 🧵

@CPSolvers @rabihmgeha @DxRxEdu @AaronLBerkowitz @caseyalbin @LyellJ @nihardesai7 @DrCindyCooper @ASanchez_PS @rav7ks @Sharminzi @MariaMjaleman @gabifpucci

#MedTwitter #Neurology Pathophysiology and brain centers

/ Anteromedial hypothalamus: Paraventricular and Supraoptic nuclei ➡️ADH release

/ Circumventricular organs: TRPV4-AQP4 complex, ion channels & osmoregulation

/ Spinal cord autonomic innervation of vessels and kidneys

#MedTwitter #Neurology

Hyponatremia in pregnancy has unique multifaceted pathogenesis ⭐✨ ✨⚡

Here is a short 🧵 exploring this intriguing concept

@rabihmgeha @DxRxEdu @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @Sharminzi @rav7ks @RosenelliEM @SatyaPatelMD #MedTwitter #Nephpearls 1.) Reset Osmostat

- Common in first 2 months of pregnancy

- Due to altered osmolality set point at which ADH is released

- Usually asymptomatic with 4-5 mEQ drop in Na levels.

- If you see hyponatremia beyond first 3 months of pregnancy, look for other causes.

#MedTwitter

Differential dx of deranged PT/INR/aPTT: More than what meets the eye✨

Based on what I have learned from my colleagues

Follow this 🧵

@rabihmgeha @DxRxEdu @DrCindyCooper @AaronGoodman33 @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @MatthewHoMD @nihardesai7 #hematology 1.) Isolated Elevation of PT/INR

- Deficiency of or inhibitors against Factors lII, VII
- Early Vitamin K deficiency
- Warfarin (PT/INR>aPTT)

#hematology

A cryptic and intriguing connection exists between Methotrexate and Ticagrelor. It's sparkling ✨✨

Here is a short and sweet 🧵

@rabihmgeha @DxRxEdu @rav7ks @tony_breu @Sharminzi @jackpenner @DrCindyCooper @sargsyanz @SatyaPatelMD @ASanchez_PS @AaronGoodman33 #MedTwitter Methorxate's and Ticagrelor's paths cross each other at the intersection named ADENOSINE

Let's dissect Adenosine receptors

> A1R and A3R (Gi->⬇️cAMP): ⬇️AV node conduction, Bronchoconstricition, ⬆️proinflammatory cytokines from leukocytes

#MedTwitter

The spectrum of Marfan syndrome and related connective tissue disorders is intriguing and mind-bending 💫✨

Here is a🧵exploring it

@CPSolvers @rabihmgeha @DxRxEdu @Sharminzi @AnnKumfer @rav7ks @sargsyanz @DrCindyCooper @jackpenner @MatthewHoMD @ASanchez_PS

#MedTwitter #2 Skeletal manifestations

-Tall stature
-Long slender arms & legs
-Arachnodactyly
-Pectus excavatum
- Pectus carinatum
-Joint hypermobility
-Pes planus
-Camptodactyly (bent fingers)
-Kyphoscoliosis
-Micrognathia & Retrognathia
-Dolichocephaly
-Malar hypoplasia

#MedTwitter

The journey to the diagnosis of Sweet syndrome and its differentials is too sweet 🍬🍩🍫

Let's explore the sweetness.

@rabihmgeha @DxRxEdu @Sharminzi @DrCindyCooper @jackpenner @sargsyanz @rav7ks @RebeccaEBerger @RosenelliEM @CPSolvers @MithuRheum #MedTwitter #rheumatology #1 Malignancies & Sweet syndrome

- AML (common)
- MDS (common)
- CML
- MM
- Hodgkin's lymphoma
- NHL
- Mycoses fungoides
- Cutaneous T-cell lymphoma
- Hairy cell leukemia
- Solid tumors

#oncology #hematology #MedTwitter

Differential diagnoses of ⛈️Thunderclap headache⚡ are indeed thunderous.

Here is a brief 🧵.

@AaronLBerkowitz @caseyalbin @rabihmgeha @DxRxEdu @sargsyanz @AnnKumfer @rav7ks @gabifpucci @jackpenner @RosenelliEM @Sharminzi @CPSolvers

#MedTwitter #NeuroTwitter #Neurology #1 Subarachnoid hemorrhage

Aneurysmal SAH
Cortical SAH (due to RCVS)

- Seizures
- Meningismus
- Altered mental status
- RBC & Xanthochromia in CSF

Look out for possible
sequelae: Rebleeding, vasospasm & ischemia, hydrocephalus

#MedTwitter #Neurology

nejm.org/doi/10.1056/NE…

Differential diagnosis of RA-like arthritis based on the pattern of joint involvement is fascinating

Here is a 🧵 exploring this journey

#medtwitter #RheumTwitter @CPSolvers @rabihmgeha @DrCindyCooper @DxRxEdu @Sharminzi @sargsyanz @rav7ks @RosenelliEM @AnnKumfer @jackpenner Various patterns of hand joint involvement

- PIP +DIP +1st CMC = OA
- MCP +PIP +Wrist = RA
- 2nd & 3rd MCP = Hemochromatosis
- Wrist +2nd MCP + 2nd PIP + all DIP= PsA
- Dactylitis/Sausage digits = PsA, Sickle cell anemia, Polyarticular gout, Sarcoidosis

#medtwitter @MithuRheum

Not many entities in Medicine are as intricate as Paraproteinemias

As we celebrate National Internal medicine day today, here is a 🧵exploring its various associations and complications

#MedTwitter #hematology @AnnKumfer @RebeccaEBerger @Sharminzi @rabihmgeha @DxRxEdu @rav7ks Entities that can feature a monoclonal protein/M component:

-MM
-WM
-MGUS
-MGCS
-MGRS
-Splenic Marginal Zone Lymphoma (HCV)
-CLL & MBL
-Heavy Chain disease (Gamma, Alpha & Mu)

There are various others indirectly associated with the M component. More to follow

Guillain barre / GBS has an interesting differential diagnosis that has crucial management implications

Here is a thread based on what I have learned from my dear residents, attendings & journals

#MedTwitter #NeuroTwitter @rabihmgeha @DxRxEdu @AaronLBerkowitz @rav7ks #1 GBS

- Infxs (C. jejuni, Mycoplasma, EBV, CMV, Zika,Influenza, HIV)
- Ascending weakness
- Cranial nerve involvement (CN 7)
- Usually no bowel/bladder disturbances
- Cyto-albuminologic dissociation and areflexia (may not manifest very early on)
- Rx - IVIG & Plasmapheresis

Adult-onset Still's disease/sJIA is beyond fascinating. The myriad of symptoms it can present with overlaps with many other disorders

Here is a thread exploring its spectrum

Any suggestions appreciated

#MedTwitter @CPSolvers @rabihmgeha @DxRxEdu @sargsyanz @rav7ks Still's disease/sJIA classic symptoms
- Fever (Quotidian)
- Sore throat
- Synovitis/Arthralgia
- Hepatosplenomegaly
- Rash (Evanescent Salmon colored)
- Lymphadenopathy
- Anemia + Leukocytosis + Thrombocytosis + Hyperferritenemia + elevated ESR
- Rx (IL-1 inhibition)

Inspired by recent posts from @AaronGoodman33 , here is my attempt to review briefly the interplay between Hematology and Autoimmune phenomena.

It's magic when that fusion occurs.

Any comments & suggestions appreciated.

#MedTwitter @rabihmgeha @DxRxEdu @CPSolvers CLL & Autoantibodies:

1.) WAIHA (IgG), CAD (IgM), PCH

2.) PRCA, Autoimmune Neutropenia

3.) C1-NH (acquired angioedema)

4.) GM-CSF (Pulmonary alveolar Proteinosis)

5.) Factor VIII, vWD, V (Coagulopathy)

6.) ADAMTS13 (TTP)

7.) CFH & CFI (aHUS)

contd...

#MedTwitter