Dr Moh

#FOAMed #MedTwitter #TwitteRx #IDTwitter #MedEd #POCUS #PrimaryCare #Neuroscience #Medicine #SoMe #MentalHealth

[Elon Musk @elonmusk]

With @Grok, we keep the honest versions and kill the bad transformers (I believe they are called “Decepticons”)

[Dr sthanu subramanian @drsthanus]

What does and doesn’t the INR tell us?

*Patients with cirrhosis have a complicated re-balancing of pro and anti clotting factors

*INR does not fully capture this

*Patients with cirrhosis have:

Hyperfibrinolysis
Hypofibrinogenemia
Platelet dysfunction
Thrombocytopenia
Low levels of clotting factor
Anti-clotting factor

*Giving FFP is a blunt tool that will not address all the coagulation abnormalities for a patient with cirrhosis and therefore will not appreciably affect their procedural bleeding risk.

https://t.co/BgpIYE0Rvx

[William Aird @WilliamAird4]

One 325-mg ferrous sulfate tablet ≈ 13 mg absorbed iron.

To match that with diet alone, you’d need:

🥩 3.3 lb steak
🥬 18 lb spinach

(Steak assumes ~25% heme absorption; spinach ~5% non-heme)

Food is important, but for iron deficiency, tablets are doing a very different job

[Arshiet Dhamnaskar @arshiet]

@aditya_gan3500 An example one of my consultants gave is that if you are relaxing in a jungle, and suddenly a tiger comes, you look at it = saccade

then you follow its movements as it goes across the jungle = pursuit

[The Wolf of College Street @aditya_gan3500]

Neuro-ophthalmology has two divisions

Afferent - vision
Efferent - eye movements

Efferent neuro-ophthalmology has 6 supranuclear control systems

There are 6 systems of supranuclear control

1. Saccade
2. Pursuit
3. Vergence
4. Fixation - microsaccade, microtremor and microdrifts
5. Vestibulo-ocular reflex (talking only about angular VOR here)
6. Optokinetic nystagmus (OKN)

[slow OKN = slow phase and fast OKN = fast phase]

Why do we need 6?

For that we have to go back to evolution.

The earliest animals had only vision WITHOUT a fovea which is the point with the highest visual acuity in the retina --> this was around 520-500 million years ago

So they needed to keep only the visual field in line with the head since there was no fovea!

So they developed the angular VOR and the OKN which had two different functions

VOR --> head movement WITHOUT movement of visual field

OKN --> only visual field moves WITHOUT head movement

But these usually operated together since most situations had simultaneous movement of the head and visual field

Around 450-400 millions ago, the fovea began to emerge --> this allowed fixation and much better visual acuity

Fixation --> keeping the object of interest on the fovea for maximum vision

Fixation involves miniscule movements called micro saccades, microtremors and microdrifts which help keep the object on the fovea --> these miniscule movements allow phototransduction rather than maintain fixation (that is a different issue altogether)

But how to maintain fixation on an object when the head of the animal is constantly moving?

Pursuit --> this moves the eye along an x and y axis

Vergence --> this maintains fixation along a z axis

Now what to do if we want to break fixation and focus on a new target?

We have saccades!

Now what about the older supranuclear systems of VOR and OKN?

They do well with fixation but they have evolved for at least 100 million years where they did not have fixation!

So they can do WITH and WITHOUT fixation.

In conclusion

VOR and OKN --> maintains visual field with and without fixation

Pursuit and vergence --> essential to maintain fixation

Saccades --> essential to break up fixation and acquire new fixation

This is a heavily simplified account of the evolutionary basis of eye movements!

#MedTwitter
#NeuroTwitter
#Neuroophthalmology
#EyeMovements

[sikandar adwani @SikandarAdwani]

Do you see patients with Parkinson’s disease?

Many of them have urinary symptoms we need to manage.

Storage symptoms → urgency, frequency, nocturia, urge incontinence.

Voiding symptoms → hesitancy, weak stream, incomplete emptying, retention.

Here is a simple guideline to keep handy

#PD #Neurotwitter #Medtwitter

[BensenHsu @BensenHsu]

Breakdown of the paper:

The study found that a person's life satisfaction is very, very strongly connected to their personality traits. When they removed all the usual problems from how things were measured, they could predict how happy someone was with their life almost perfectly (like 80% to 90% accurate) just by knowing their personality traits. Even with just a few personality questions, they could predict life satisfaction very well.

They found that being emotionally stable (not getting upset easily), being extraverted (outgoing), and being conscientious (organized and hardworking) were the most connected to life satisfaction. Being open to new things or agreeable (kind) had a smaller connection.

These strong connections were found in all three groups of people, even though they spoke different languages. They also found that life satisfaction stayed pretty much the same over 10 years, and its connection to personality traits also stayed strong over that time.

......

[MEDICINE MADNESS @Doctors_GUILD]

Liver enzymes diagnostic cheat sheet

[Adam Schwarz @AdamJSchwarz]

1 in 3 doctors were born overseas.

1 in 2 builders were born overseas.

1 in 6 nurses were born overseas.

1 in 4 transport workers were born overseas.

1 in 7 UK business founders were born overseas.

1 in 5 university academics were born overseas.

[TraineENT @traineENT]

🚨 Resident doctors earn ~£26/hr in 2025.

🔧 Plumber: £45/hr
⚡ Electrician: £50/hr
🏋️ PT: £35–£50/hr
🔑 Locksmith: £90/hr
💻 Freelance dev: £65/hr
📸 Photographer: £36/hr

The system’s broken when saving lives pays less than unblocking pipes.
#DoctorsStrike #NHS #PayRestoration

[Aravind Palraj @Rheumat_Aravind]

🧵 ANA and the Birth of Autoimmunity: A Discovery That Changed Everything

1️⃣
Before the 1950s, autoimmune diseases were mysterious and misunderstood.

Then came the discovery of antinuclear antibodies (ANA) — the test that gave lupus a face and autoimmunity a name.

#RheumTwitter #Autoimmunity #MedicalHistory #MedTwitter @IhabFathiSulima

[Dr.AY @Ayomik2025]

The chart below is the singular chart you will need if you are curious about best places of residency training in the UK.
All the questions about regions with good training, rota etc answered in one single post.

Culled from GMC national training survey.

You may want to save this post for future reference

[Nicholas Fabiano, MD @NTFabiano]

There is no expiry date on neuroplasticity.

Go learn that new thing.

Change your brain for the better.

[Turning the Tide @Turningthe_Tide]

🧵 Lymphangions: The Hidden Pump Protecting You From Oedema
1️⃣ What if I told you that you have hundreds of tiny hearts quietly pumping litres of fluid every day?
They’re called lymphangions—segments of your lymphatic system that actively contract to return interstitial fluid to the blood.
Let’s dive in. 💧🫀

[Psychiatry Excellence @psycheureka]

Over 46% of the population carries the DRD2 A1 allele, which is linked to lower dopamine receptor density and increased risk of impulsive and compulsive behaviours (Blum et al., 2022).

Blum et al. (1995) found it could predict Reward Deficiency Syndrome behaviours, such as substance use and overeating, with up to 74.4% accuracy.

How does this genetic profile shape behaviour?

[Aravind Palraj @Rheumat_Aravind]

3/
📉 Risk of TB reactivation by biologic class:
Agent TB Reactivation Risk
Infliximab Very High
Adalimumab High
Etanercept. Moderate
Abatacept Low
Tocilizumab Low
Rituximab Very Low

📚 Ref: ACR 2021 / EULAR 2019

[Pablo Corral MD @drpablocorral]

☝️Atherosclerosis IS NOT an inflammatory disease

👉Tuberculosis is not an inflammatory disease. It’s an infectious disease
👉HIV is not an inflammatory disease. It’s an infectious disease
👉Rheumatoid arthritis is an inflammatory disease.
👉Systemic lupus erythematosus is an inflammatory disease.

Atherosclerosis?
It has a strong inflammatory component — no doubt.
But fundamentally, it is a disease of retention and deposition.

☝️Let’s stop confusing the mechanisms involved with the disease itself.

[David Puder M.D. @DavidPuder]

🧵 Different personality styles struggle under different triggers:

Borderline: attachment loss

Narcissistic: image loss

Depressive: loss of love or moral/meaning failure

Obsessive: collapse of inner rules or chaos

Schizoid: invasion or engulfment

[Turning the Tide @Turningthe_Tide]

Why do we need a charity to promote good fluid management? Prescriptions like this are unfortunately commonplace. 102g of salt in 5 days = nearly 300 bags of crisps. Multiple organ failure due to iatrogenic fluid overload🌊

[Turning the Tide @Turningthe_Tide]

1/
You might think:
"Why give NaCl to someone overloaded with salt and water? Shouldn’t we be pulling sodium out, not putting it in?"
🧂💧
It feels wrong — but correcting chloride can unlock natriuresis.
Let’s break the paradox. 🧵