What a year 2024 in hematology!

Here's a thread on selected clinical studies we've seen this year🧵🩸 Asciminib in Newly Diagnosed Chronic Myeloid Leukemia @NEJM

- asciminib showed superior efficacy and a favorable safety profile in patients with newly diagnosed chronic-phase CML
- BUT comparison with second-generation TKIs was not a primary objective!

Chimeric antigen receptor T cell therapy might revolutionize the management and our understanding of autoimmune diseases

An short educational thread🧵on current status and future directions Intro:
- CAR T therapy was originally designed to fight cancer
- now showed transformative potential in treating autoimmune diseases by targeting B cells
👉key role in disease (progression)
- safety remains focus, with a milder toxicity profile emerging in autoimmune disease

The h-index is one of the most impactful and widely used metrics to assess a researcher’s productivity and citation impact.

How it started & how it's going

A thread🧵 History:
- 2005 by physicist Jorge E. Hirsch
- assess researcher’s productivity and citation impact
- argued that total citations are skewed by few highly cited papers
👉publication counts don’t account for influence of research

We will discuss later the "dilemma of quality"...

Elsevier is one of the largest, most hated and most influential academic publishing companies in the world.

How it started & how it's going

A thread🧵 Founding:
- 1580, family named Elzevir, led by Lodewijk Elzevir, founded original publishing house in Leiden🇳🇱
- family's printer's mark
👉tree entwined with a vine & the words Non Solus
👉Latin for "not alone"
👉symbiosis between publisher & scholar

We will see the irony later!

Today is World Chronic Myeloid Leukemia Day #WCMLD24

Time to educate, reflect and celebrate what has been achieved

A short educational thread on CML Intro to CML:
-BCR-ABL1-positive
-classified as a myeloproliferative neoplasm
-predominantly composed of proliferating granulocytes and determined to have the Philadelphia chromosome/translocation t(9;22)(q34;q11.2)
-affects peripheral blood + bone marrow

The stethoscope is the image of medicine, a commonly used tool, and its importance in the field is immeasurable.

But what is its past, present, and future?

A short thread Can you imagine how anything got done without a stethoscope? In order to earn its place slung around the neck of a physician, it has undergone many changes and evolved with the times. Like all aspects of medicine, it has a long history and background.

So let's dive right in.

Pathophysiology is awesome but maybe the most hated course in med school.

A short thread of simple pathways in medicine Cell cycle & proliferation

Harrison is one of the most amazing teaching books ever produced

A short thread on brilliant educational algorithms in internal medicine Thrombocytopenia

The morbidly beautiful images of the genius Dr Frank Netter🎨

A visual thread🧵 Rabies

😱Challenges in medicine😱

Malaria🪰🩸

A short 🧵 Intro:
- caused by protozoa parasites of genus Plasmodium
- transmitted throughout most of the tropics
- in 84 countries and territories
- in 2023, WHO reported 247 million cases (up from 245 million in 2020)
- 619 thousand deaths (down from 625,000 in 2020)
1/

10 rules for life of a good mentor

A 🧵 Rule 1: Lead by example
As a mentor, your actions speak louder than words. Demonstrate the ethics, dedication, and passion you wish to instill in your mentees.

Practice what you preach🙏

😱Challenges in hematology😱

Crisis in sickle cell disease (SCD)

A short 🧵

1/15 Short intro to sickle cell disease (SCD):
-group of inherited red blood cell disorders
-affects ~ 1 in 500 African American and 1 in 36,000 Hispanic American children
-results in anemia
-main clinical feature is acute painful crisis
👉 often requires hospitalization
2/15

😱Challenges in hematology😱

acquired von Willebrand Syndrome (aVWS)🩸

A short 🧵

1/14 Intro:
-rare but underestimated bleeding disorder
-lab and clinic similar to inherited form
-usually occurs more frequently in adults with no history of bleeding
-renewed interest
👉association with 🫀disorders (eg aortic stenosis), cancer, autoimmune disease...
2/14

😱Gastrointestinal (GI) manifestations in hematology😱

A short visual 🧵with diagnosis

1/19 Intro:
-lympho-/myeloproliferative disorders
-nodal and/or extranodal
-GI tract one of the most common extranodal sites
-diagnosis of GI hematologic malignancy challenging
👉esp in absence of documented nodal/extranodal disease
👉due to higher incidence of other pathologies
2/19

😱Challenges in hematology😱

Richter transformation (RT)

A short 🧵#MedTwitter #MedX

1/20 History part I:
-1928, Maurice Richter reported generalized swelling of lymph nodes, liver + spleen in a patient with chronic lymphocytic leukemia (CLL)
-due to infiltration by rapidly growing cells
👉termed it generalized reticular cell sarcoma
-patient died after 22 days
2/20

When I started med school, I subscribed to the New England Journal of Medicine. Apart from published trials, case records are the world's treasure for education & help navigate clinical courses & differentials better than any class.

A visual 🧵of selected cases #MedTwitter #MedX 50-year-old man with back pain, fatigue, weight loss, and knee swelling

Final diagnosis: Ankylosing spondylitis
-affects 0.5% of population
-strongly associated with HLA-B27 allele
-90% of patients with ankylosing spondylitis are positive for HLA-B27
nejm.org/doi/full/10.10…

😱Complications in hematology😱

Hemorrhagic cystitis (HC)

A short 🧵 #MedTwitter #MedX

1/18 Short intro:
-sterile cystitis characterized by relevant hematuria
-most common after ifosfamide and high-dose cyclophosphamide in bone and soft tissue sarcoma and BMT
-viral
-or as a late toxicity of pelvic radiation therapy
2/18

Eye manifestations in hematology

A visual 🧵with diagnosis #MedTwitter #MedX

1/23 Short eye anatomy

2/23

Skin manifestations in hematology

A visual 🧵 with diagnosis
#MedTwitter #MedX

1/24 Koilonychia

Anemia due to nutrient deficiency
-eg iron, folate, vitamin B12
-other signs:
--pallor of the conjunctiva and palmar creases
--glossitis
--pruritus
--poikilodermatous hypopigmentation
--hyperpigmentation may be a sign of B12 and folate deficiencies
2/24

😱Challenges in hematology😱

Invasive aspergillosis

A short 🧵 #MedTwitter
1/18 Aspergillosis:
-refers to illness due to allergy, airway or lung invasion, cutaneous infection, or extrapulmonary dissemination caused by
--Aspergillus fumigatus (most commonly, ~2/3 of infections)
--A. flavus (~15%), A. niger (~10%), and A. terreus (~7%)
2/18

🧐Spotter in hematology🧐

A short 🧵 with some snapshots and diagnosis

#MedTwitter

1/13 Osteolysis in multiple myeloma

-myeloma activity sometimes appears as "lytic lesions" (with local disappearance of normal bone due to resorption) or as "punched-out lesions" on the skull X-ray ("raindrop skull")
-lesions may also be sclerotic, which is seen as radiodense
2/13