R "M" Z

MD- Research&Music

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

A MUST-READ!

This is probably one of my most important papers where I try to teach how to fish rather than offer fish.

How I Read a Clinical Trial Report?

BG’s primer for Busy Clinicians.

Thank you @JCOOP_ASCO @EthicsdoctorP for the kind invitation. I hope the readers will find this useful.

https://t.co/HJhZlsBpU2

[R "M" Z @Ray_Zfdv]

@StreamOnMax
Ads won’t let me watch any content on Chrome, impossible to press x on GoogleTv

[R "M" Z @Ray_Zfdv]

Se vienen cosas chidas :)

[Irene Aguiar @IreneAguiarG]

Como ya llegan los de que es “una mujer con altos niveles de testosterona” o que “tener cromosomas XY no hace que no sea mujer”…

Hilo con lo que se sabe y lo que no sobre el caso de Imane Khelif.

[L'enfant sauvage @BadLuckBeto]

Les voy a contar una anécdota del R2. No más por los lols.

En una guardia turbo horrible de esas que te hacen pensar si realmente quieres ese título universitario de posgrado, llego un bato bien tumbado, gorrita mamona, un hoodie y una bolsa sospechosona. E

[R "M" Z @Ray_Zfdv]

@porktendencia Que triste… sin palabras.
Quién sabe si fallece por el trauma de cráneo o por sección medular por movilizaron de su cabeza y cuello posterior al accidente.
Hay que reforzar en la población los primeros auxilios y mostrar cómo movilizar a alguien con trauma cervical.

[R "M" Z @Ray_Zfdv]

@elonmuskADO I call it XTwitter :)

[The Figen @TheFigen_]

Master

[R "M" Z @Ray_Zfdv]

@IM_Crit_ M mode showed barcode pattern?

[Eddy J. Gutierrez, MD @eddyjoemd]

What is your go-to method for managing patients who are in cardiogenic shock? Mine is placing a PA catheter. 🎩 tip to the authors.

https://t.co/4Ise540F2X

[IMCrit @IM_Crit_]

ICU - POCUS week:

Many times in ICU patients w shock +/- respiratory failure, we try to estimate the cardiac output by using LVOT VTI. Unfortunately, when a patient is obese, on the ventilator, with hyperinflated lungs etc, it is impossible to get a decent 5-chamber or 3-ch view

[R "M" Z @Ray_Zfdv]

@pharmed0929 Propofol

[Eddy J. Gutierrez, MD @eddyjoemd]

Let’s minimize the amount of iatrogenic anemia we cause in the ICU from our obsession with labs. Also, here’s a quick diagnostic flowchart to screenshot and have on your phone. 🎩 tip to the authors.

https://t.co/4Ise540F2X

[Historic Vids @historyinmemes]

The 'moonlight swing' in Scotland drops you 132ft in total darkness

[Lea Alhilali, MD @teachplaygrub]

Tired of always speculating about MR spectroscopy?

If you've ever looked at an MR spectroscopy & thought: "I have no idea what I’m looking at!"--then this cheat sheet is for you!

Here are the 4 basic rules you need so you can understand the spectrum of basic spectroscopy!

🚨First you need to know the peaks🚨

➡️3 main peaks: Choline, Creatine, NAA
🔸Remember a spectrum looks like cold mountains
🔸CHOld CREATures NAp or hibernate in the mountains

▶️Choline
🔸Marker of membrane turnover
🔸Remember: membranes coat or “CHOat” the cell
🔸Choline = ChoLEAN, choline LEANS into creatine peak--right next to it

➡️Creatine
🔸Marker of energy, basically an internal control
🔸Remember, everyone takes Creatine powder for energy!
🔸Creatine is at ~3—creatine rhymes with 3

➡️NAA
🔸Marker of neuronal health
🔸N is for Neuron
🔸NAA has twin As so it is at ~2!

🚨Four rules🚨

▶️Hunter’s angle:
🔸Spectrum peaks should go up as you move lateral, called Hunter’s angle
🔸Most bad things reverse Hunter’s angle
🔸Ask yourself: Is my arrow pointed up to shoot into the air at the enemy (good) or to the ground where it will hit dirt (bad)

▶️TE & spectrum length are inversely related
🔸Spectroscopy follows the rule: Speak small, but carry a big stick. Small TE is a big spectrum
🔸Short TE = long spectrum, lots of extra peaks for glutamate/glycine, myoinsitol
🔸Long TE = short spectrum, mainly the basic 3 peaks

▶️Each region has its own unique signature or tattoo
🔸Brain region have unique MR spectr that might alter Hunter’s angle a bit, but not reverse it
🔸Need a spectrum in contralateral same region to control for this & compare apples to apples

▶️Lactate peak goes like a sine wave
🔸Lactate peak represents anerobic metabolism—sign of cells in trouble
🔸It’s at 1.3 ppm. Remember 13 is an unlucky number & lactate is unlucky!
🔸Like a sine wave: up at short TE (35), down at intermediate TE (144), and up again at long TE (244)
🔸Can use this flip to better visualize the lactate peak
🔸Remember it’s down in the middle TE bc when you’re caught in the middle, you’re down & out

Just remember these tricks & you will be spectacular at basic spectroscopy!

[Julio @JulioFdez79]

Hay fármacos con una historia fascinante detrás, si además forman parte de la piedra angular de algunos tratamientos para el cáncer de mama, hace que sea más relevante hablar de ellos.

TAMOXIFENO

[R "M" Z @Ray_Zfdv]

Mi vida en un Post

[piscis en crisis 🍉 @felip_ruvalcaba]

Le dije que con leche deslactosada!!

[R "M" Z @Ray_Zfdv]

@MetaleraGacha Cómo sería chido gritarle al cara de culo, que lo viole un toro, mientras le da una embolia

[Mauricio Gonzalez MD. @DrMauinforma]

Cuando te sientas solo y triste, recuerda que hay personas que piensan que el café es malo.

[R "M" Z @Ray_Zfdv]

@msnjw44669 @_still_we_rise_ @drkeithsiau Late for looking for articles I’ll send and attach my references later

[R "M" Z @Ray_Zfdv]

@msnjw44669 @_still_we_rise_ @drkeithsiau Still the guidelines in pediatric DKA and as it follows Adult DKA the main reason for using D5W in DKA manage algorithm is for preventing alongside hypoglycemia is to prevent cerebral edema