#MedTwitter

Wanted to share something special: what brought me to twitter in the first place.

As a clerkship student, I was in awe of residents/attendings, and hoped to imitate not only their knowledge base but also their organized way of thinking.

pubmed.ncbi.nlm.nih.gov/37081721/ My co-med student & friend Dr. Jarrod Ehrie and I started working on frameworks. We had support and mentorship from @NadiaBennettMD and Dr. Kogan. We spent years making the frameworks and having fellows then faculty review.

#Medtwitter friends: I've been having a blast on the BMT service with @c_j_gibson and planning next week's #bmtsm #leusm teaching theme:

📰 Why we do what we do in allogeneic transplantation for myeloid malignancies: Classic/Pivotal trials/papers.

Any you'd add/swap out? 1⃣ Chemo vs. Auto vs. Allo in AML

Cassileth PA et al. Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission. NEJM 1998

nejm.org/doi/full/10.10…

🧵Our latest in @BloodJournal
@coleman_lindsley @c_j_gibson @DanaFarberNews

Older patients with AML undergoing HCT have high rates of relapse & non-relapse mortality

We investigated how outcomes relate to both baseline characteristics and molecular MRD

tinyurl.com/4bn76ham 2. @DrChrisHourigan and others have shown that AML pts with mutations at remission (molecular MRD) have more relapse➡️ inferior survival after HCT, especially if receiving reduced intensity conditioning.
tinyurl.com/23rrbjte

🩸Roundup of Myeloid Malignancies/BMT papers, starting w/ something I care a lot about:

1/ Poor Survival & Differential Impact of Genetic Features of Black Patients w/ #AML #leusm

Bhatnagar et al, Cancer Discovery
pubmed.ncbi.nlm.nih.gov/33277314/

We got work to do ya'll 😰 ✊🏾 2/ pubmed.ncbi.nlm.nih.gov/33664234/

Salvage use of venetoclax-based therapy for relapsed AML post allogeneic hematopoietic cell transplantation

Joshi et. al, Blood Cancer Journal

1/8 Day 1 of intern year orientation. The nerves & excitement are real

A tweetorial of tweetorials - resources that may be helpful for our first days on the job! We are all in this together 👊🏾

First up:
Calling consults like a pro: @VarunPhadke2

https://twitter.com/VarunPhadke2/status/1233841954615681025

2/ Describing a rash like a pro @UCSFIMChiefs

https://twitter.com/UCSFIMChiefs/status/1183812599617445888

1/n Inspired by RLR: @rabihmgeha & @DxRxEdu...
HLH - @haematognomist & @HannahRAbrams

Two rising interns interested in🩸Heme-Onc & 📚MedEd

Teaching pearls from @NEJM CPC published 6/6/13
Dx spoilers below! @MedTweetorials 2/n First a PR:

Middle age man w/ PMHx HBV infection p/w chronic fevers and progressive weakness, found to have painful asymmetric mixed motor & sensory distal multiple mononeuropathy and nerve biopsy showing active vasculitis diagnosed with...

@CPSolvers #VMR inspired me to fill gaps in knowledge re: sterile pyuria (adapted from @NEJM article cited in phenomenal thread 👇🏾)
@MedTweetorials

First: what is pyuria?
▪️≥ 10 WBC/mm3
▪️≥ 3 WBC/hpf
▪️pos gram's stain (unspun urine)
▪️Urinary dipstick pos for leuk esterase

https://twitter.com/RosenelliEM/status/1258720659666018304

"Sterile pyuria is the persistent finding of white cells in the urine in the absence of bacteria"

And it is super common!
"13.9% of women and 2.6% of men are affected"

🤯 The DDx is waaaaay broader than I suspected, so let's take it by category

1/ Welcome to the next installment of @NEJM #CPS summaries!

For full case: bit.ly/2SWTDiq
@MedTweetorials

40yo F w/ hx of treated immature teratoma & HBV infection p/w chronic, progressive diffuse pain and weight loss

Me when I get to share clinical pearls 👇🏾 2/ 🌟Initial DDx 🌟
#medstudenttwitter: I often find it tempting to jump straight into listing possible Dx.

Often have to remind myself to be systematic. For this patient:

Up next: how does the PMHx ("background") affect our analysis of this presentation ("foreground")

1/ Clinical #Pearls and summary of @NEJM #CPS:
"A Chilly Fever"
For full case: bit.ly/37Co43k

A young man presents in March w/ 1 week of fevers, shaking chills & severe headaches which peaked at night & defervescence by morning. 2/ My initial approach to fever is as follows, and is adapted from Penn frameworks: med.upenn.edu/frameworks/fev…

#PEARL1: I always try to remember the importance of assessing:
1. Host: immunosuppressed?
2. Exposures: work, sexual, travel, animals, IVDU, food/water

1/x Summarized #pearls from @NEJM CPS from 3/5/15. Diagnosis will be spoiled at the end! For full case: nejm.org/doi/full/10.10…

Patient presented with pruritus. An initial approach involves asking:

1. Is the process dermatologic?
2. Is the process due to a systemic illness? 2/x Patient was found to have acute kidney injury, making uremia a likely cause of the pruritus.

Initial approach to AKI involves:
1. Pre-renal
2. Intra-renal
3. Post-renal

Framework from @runthelistpod, also from Penn Frameworks: med.upenn.edu/frameworks/acu…