Internist, hematologist-oncologist, transplant physician. Interest in clinical reasoning, risk, pragmatism.
1 added to My Authors
Sep 18, 2020 • 25 tweets • 13 min read
How did hematopoietic stem cell transplantation (BMT) develop? A procedure that is so widely used now and have led to the cure of many hematologic disorders has evolved over the last 70 years. This 🧵 is a short historical overview of #BMT
After Word War II, and specifically after the atomic bomb was dropped on Hiroshima and Nagasaki in 1945, there was an interest in funding treatments for radiation sickness that caused bone marrow failure and led to the death of many.
May 28, 2020 • 21 tweets • 9 min read
In 1956, Benjamin Castleman et al described 13 cases of mediastinal lymph node hyperplasia that resembled thymomas grossly and microscopically
Castleman argued against their thymic or neoplastic origin.
The nodes were highly vascular with marked capillary proliferation with hyaline thickening of the vessel walls penetrating the follicles (left), resembling Hassall corpuscles (right).
Feb 19, 2020 • 5 tweets • 1 min read
Recently read @Bourdain’s Kitchen Confidential. The suggestions he gives future chefs can be applied to future (and current) physicians (with very little editing)
1. Be fully committed. Be sure about what you want. Don’t be a waffler. Be ready to take and give orders.
2. Learn Spanish! Ok this doesn’t apply to everybody. But if you live in Miami, it’s a plus.
3. Don’t steal. Don’t do anything you couldn’t take a polygraph test over. Don’t take free stuff unless you know where it’s from; often free goodies are in exchange for something
Jan 16, 2020 • 26 tweets • 12 min read
First described by Dr. Burkitt as a sarcoma, this lymphoma is notorious for being rapidly fatal without treatment. Here is the remarkable history of the discovery of Burkitt’s lymphoma and the men and women behind it. #lymsm
Denis Burkitt was born on February 28th, 1911 in Enniskillen (Northern Ireland). He grew up in a Presbyterian family, and his faith influenced him greatly. He went to Trinity College in Dublin, with a goal to follow in father’s footsteps as an engineer.
Dec 17, 2019 • 25 tweets • 9 min read
“Hodgkin’s disease” led to the earliest classification of lymphomas, which still stands today! If a lymphoma is not a Hodgkin’s then it’s a non-Hodgkin’s. Much has been written about the history of Hodgkin’s lymphoma. Here is a short visual walkthrough. #lymsm
Thomas Hodgkin, born on August 17 1798, was raised in a devout Quaker family. Because of his religion, he was unable to study medicine in England, which required people to be part of the Church of England.
Jun 3, 2019 • 15 tweets • 5 min read
My only #ASCO19 Tweets will be in this thread. I will post a few abstracts of negative trials with and without positive spin. Things not to do as of June 2019.
This is somewhat obvious, but in case you didn't know, do not give rituximab maintenance for DLBCL. meetinglibrary.asco.org/record/174772/…
How often are cancer drugs approved based on trials that compared them to suboptimal controls?
Quick thread jamanetwork.com/journals/jamao…
First, this is a tricky question to answer. The choice of what is considered “standard” therapy is somewhat subjective. Here is what it’s NOT:
-> It is not a drug that was proven to be superior to placebo based on a phase 3 RCT (in fact, many are not)
Apr 27, 2019 • 19 tweets • 3 min read
Let's talk broad concepts - Causality. #thread
Suppose Jack took LSD and then got into a car accident. Did the LSD cause the car accident?
Apr 27, 2019 • 17 tweets • 4 min read
Why the confidence interval (CI) is very useful. #thread#epistats
Hypothesis testing involves estimating the probability that an observed result would have occurred by chance if the null hypothesis were true.
Apr 20, 2019 • 16 tweets • 3 min read
The odds ratio (OR). Is it important?
- Odds: probability of an event occurring divided by probability of event not occurring.
- OR: odds of an event in one group over the odds of an event in another (i.e. the ratio of 2 odds of the same event)
If you gamble, the concept of "odds" is probably easy for you to understand. If you don't gamble, it can be confusing
Have you ever seen a single-arm, non-randomized study with survival curves showing one subgroup of patients doing better the other and thought "wow, that drug must improve survival in that responding subgroup"?
Learned from @VinayPrasadMD about this type of analysis, called "survival by tumor response". Paper published in JCO in 1983 by Anderson et al. describes this in detail.
Jun 17, 2018 • 11 tweets • 3 min read
In 2005, Gregory Berns, a neuroscientist at Emory University, decided to conduct an experiment to demonstrate the power of conformity (this has relevance in oncology and medicine in general, so bear with me)
Berns and his team recruited volunteers and asked them to participitae in a game in which each group member was shown 2 different 3D objects on a computer screen and asked if the first object can be rotated to match the second