paulo wolf

[Abdulhamid @abdulhamid_199]

سوال
اللي يعرفه ارفع له القبعة 🎓

ايش اسم الحالة هذه ؟

[Dr. FEVI🫀🩺 @javier20ch]

Disincronía mecánica ventricular por ecocardiografía. 🫀💥⚡️
🟥La disincronía mecánica representa la pérdida de coordinación temporal de la contracción ventricular secundaria a un retraso en la conducción eléctrica. Puede evaluarse en tres niveles: auriculoventricular, interventricular e intraventricular.
🔺️ Disincronía AV: el retraso de conducción AV compromete el llenado del VI, reduciendo precarga y volumen sistólico. En Doppler mitral puede observarse fusión de las ondas E y A y acortamiento del tiempo de llenado. Un tiempo de llenado del VI <40% del ciclo cardíaco indica disincronía AV significativa.
🔺️ Disincronía interventricular: corresponde al retraso entre la eyección del VD y VI. Se mide con Doppler pulsado calculando la diferencia entre el inicio del flujo en TSVD y TSVI. Un retraso >40 ms se considera significativo (por sí solo no predice adecuadamente la respuesta a TRC).
🔺️ Disincronía intraventricular: describe la contracción/deformación descoordinada entre diferentes regiones del VI. En el BRIHH, el septo se activa precozmente mientras la pared lateral lo hace tardíamente; posteriormente, la contracción lateral estira al septo, generando una distribución anormal del trabajo miocárdico y deteriorando la eficiencia ventricular (septal flash y apical rocking).

📝🆓️⤵️ @ESC_Journals 🔥💯
https://t.co/g9epHJDjFB
https://t.co/xvbw4nxC8H

[MEDCRUX @medcrux]

Identify the radiological finding shown in the image.

[Kevin Quintero. @VargasKevi23363]

🧵 3 EJERCICIOS QUE TODO HOMBRE DEBERÍA DOMINAR SI QUIERE UN RENDIMIENTO MÁS FUERTE

No necesitas pasar 2 horas en el gimnasio.

Pero sí necesitas aprender a controlar tu propio cuerpo.

Estos ejercicios parecen simples...

Hasta que intentas hacerlos correctamente. 👇

[Dr Abdul Hameed 🩺 @drabdulhameed07]

What is your differential diagnosis for this giant abdominal mass? 🤔

[Dr Ihab Suliman @IhabFathiSulima]

What is the Endemic Diagnosis?

[Dr.Marlon Villanueva™ 🩺 𝕏 @MarlonVFZR]

🧠⚡𝗦𝗧𝗥𝗢𝗞𝗘: 𝗹𝗮 𝗿𝗲𝗽𝗲𝗿𝗳𝘂𝘀𝗶𝗼́𝗻 𝘆𝗮 𝗻𝗼 𝗱𝗲𝗽𝗲𝗻𝗱𝗲 𝘀𝗼𝗹𝗼 𝗱𝗲𝗹 𝗿𝗲𝗹𝗼𝗷‼️
👇🏼👇🏼👇🏼👇🏼
📑🔗🔑🔓
https://t.co/89ht2mBRSA
⬇️⬇️⬇️⬇️
🧵👇

Dentro de 𝟰,𝟱 𝙝:

💉 𝘼𝙡𝙩𝙚𝙥𝙡𝙖𝙨𝙖: 0,9 mg/kg, máx. 90 mg
⚡ 𝙏𝙚𝙣𝙚𝙘𝙩𝙚𝙥𝙡𝙖𝙨𝙖: 0,25 mg/kg en bolo, máx. 25 mg

Tenecteplasa ofrece administración más simple y, según metaanálisis, mayor probabilidad de excelente resultado funcional frente a alteplasa.

🔥 𝘾𝙪𝙖𝙣𝙩𝙤 𝙖𝙣𝙩𝙚𝙨 𝙨𝙚 𝙧𝙚𝙥𝙚𝙧𝙛𝙪𝙣𝙙𝙖, 𝙢𝙚𝙟𝙤𝙧.

🧲⏱️ 𝙒𝙖𝙠𝙚-𝙪𝙥 𝙨𝙩𝙧𝙤𝙠𝙚: 𝙡𝙖 𝙞𝙢𝙖𝙜𝙚𝙣 𝙥𝙪𝙚𝙙𝙚 “𝙧𝙚𝙘𝙤𝙣𝙨𝙩𝙧𝙪𝙞𝙧 𝙚𝙡 𝙩𝙞𝙚𝙢𝙥𝙤”

Patrón:

✅ 𝘿𝙒𝙄 𝙥𝙤𝙨𝙞𝙩𝙞𝙫𝙖
✅ 𝙁𝙇𝘼𝙄𝙍 𝙣𝙚𝙜𝙖𝙩𝙞𝙫𝙖

Este 𝘿𝙒𝙄–𝙁𝙇𝘼𝙄𝙍 𝙢𝙞𝙨𝙢𝙖𝙩𝙘𝙝 identifica pacientes probablemente dentro de una ventana biológica temprana y puede apoyar trombólisis en tiempo de inicio desconocido.

También puede utilizarse perfusión favorable en ventanas extendidas.

🩸🧠 𝙏𝙧𝙤𝙢𝙗𝙚𝙘𝙩𝙤𝙢𝙞́𝙖: 𝙚𝙡 “𝙡𝙖𝙧𝙜𝙚 𝙘𝙤𝙧𝙚” 𝙙𝙚𝙟𝙤́ 𝙙𝙚 𝙨𝙚𝙧 𝙪𝙣𝙖 𝙚𝙭𝙘𝙡𝙪𝙨𝙞𝙤́𝙣 𝙖𝙪𝙩𝙤𝙢𝙖́𝙩𝙞𝙘𝙖

La evidencia reciente apoya trombectomía en:

✅ oclusión ICA/M1 proximal
✅ hasta 𝟮𝟰 𝙝 en pacientes seleccionados
✅ incluso con 𝘼𝙎𝙋𝙀𝘾𝙏𝙎 𝟯–𝟱

Y en casos muy seleccionados:

⚠️ 𝘼𝙎𝙋𝙀𝘾𝙏𝙎 𝟬–𝟮
⏱️ <6 h
👤 <80 años
📊 NIHSS ≥6
✅ buena función previa

🫀🧠 𝘾𝙞𝙧𝙘𝙪𝙡𝙖𝙘𝙞𝙤́𝙣 𝙥𝙤𝙨𝙩𝙚𝙧𝙞𝙤𝙧 𝙨𝙞́; 𝙫𝙖𝙨𝙤𝙨 𝙙𝙞𝙨𝙩𝙖𝙡𝙚𝙨, 𝙩𝙤𝙙𝙖𝙫𝙞́𝙖 𝙘𝙤𝙣 𝙘𝙖𝙪𝙩𝙚𝙡𝙖

Para 𝙤𝙘𝙡𝙪𝙨𝙞𝙤́𝙣 𝙗𝙖𝙨𝙞𝙡𝙖𝙧:

✅ trombectomía puede considerarse hasta 𝟮𝟰 𝙝
✅ especialmente con 𝙉𝙄𝙃𝙎𝙎 ≥𝟭𝟬

En cambio, para oclusiones medianas/distales:

🚫 ESCAPE-MeVO, DISTAL y DISCOUNT no demostraron beneficio global claro.

Aunque estudios recientes muestran señales prometedoras, la selección sigue siendo individualizada.

🎯 𝘼𝙣𝙩𝙞𝙩𝙧𝙤𝙢𝙗𝙤́𝙩𝙞𝙘𝙤𝙨 𝙩𝙚𝙢𝙥𝙧𝙖𝙣𝙤𝙨: 𝙥𝙧𝙚𝙫𝙚𝙣𝙞𝙧 𝙚𝙡 𝙨𝙞𝙜𝙪𝙞𝙚𝙣𝙩𝙚 𝙞𝙘𝙩𝙪𝙨 𝙚𝙢𝙥𝙞𝙚𝙯𝙖 𝙙𝙚𝙨𝙙𝙚 𝙡𝙖𝙨 𝙥𝙧𝙞𝙢𝙚𝙧𝙖𝙨 𝙝𝙤𝙧𝙖𝙨

📌 𝘼𝙨𝙥𝙞𝙧𝙞𝙣𝙖: iniciar dentro de 𝟰𝟴 𝙝, dosis inicial 𝟭𝟲𝟬–𝟯𝟮𝟱 𝙢𝙜

📌 𝙉𝙄𝙃𝙎𝙎 ≤𝟯 o 𝘼𝙄𝙏 𝘼𝘽𝘾𝘿² ≥𝟰:
AAS + clopidogrel por 𝟮𝟭 𝙙𝙞́𝙖𝙨

📌 Alternativa en NIHSS ≤5 o ABCD² ≥6:
AAS + ticagrelor por 𝟯𝟬 𝙙𝙞́𝙖𝙨

📌 Estenosis intracraneal sintomática grave:
DAPT hasta 𝟵𝟬 𝙙𝙞́𝙖𝙨 + control intensivo de factores de riesgo.

📌𝙂𝙪𝙖𝙧𝙙𝙖 𝙥𝙖𝙧𝙖 𝙩𝙪 𝙥𝙧𝙤́𝙭𝙞𝙢𝙖 𝙜𝙪𝙖𝙧𝙙𝙞𝙖❤️

📚📖 Más en 𝕏 @MarlonVFZR y en el blog 👉 [https://t.co/i9GkW3SQFI]

‼️Si te sirve: ❤️ Me gusta | 🔁 Repost | ➕ Follow para más👇🏼👇🏼👇🏼👇🏼
📚📖#ClubCrit👨🏻‍⚕️👨🏻‍🏫🧠🫶

#Stroke #NeurocriticalCare

#FOAMed #FOAMcc #CriticalCare #CriticalCare #CuidadoCritico #MedTwitter #MedX #IntensiveCare #MedXCommunity #MedED

[CardiovascularCorner @TrackYourHeart]

Patient with suspected pulmonary embolism undergoes a chest X-ray

What is this sign called?

[Dr sthanu subramanian @drsthanus]

This man in his 20s presented with a 10-year history of rash predominantly affecting his face and trunk, accompanied by mild muscle weakness.

His HRCT revealed no abnormalities.

What is the most likely diagnosis?

[C.Alberto Ortega @albertoortegana]

🩺 Clinical Image Challenge

A patient presents with a painful vesicular eruption involving the ophthalmic division of the trigeminal nerve, with periocular involvement.

Can you guess the diagnosis?

[CardiovascularCorner @TrackYourHeart]

Echo From Scratch | Post #7

2D Echocardiography: How is the image created?

When you look at a 2D echo, you're seeing thousands of ultrasound measurements assembled into a moving image.

The transducer electronically sweeps the ultrasound beam across a plane.

For each scan line:

Transmit
⬇️
Receive echoes
⬇️
Calculate depth
⬇️
Create a line of the image

The deeper the imaging field, the more time each ultrasound pulse needs to travel out and return.

Therefore:

Greater depth
⬇️
Lower PRF
⬇️
Lower frame rate

For cardiac imaging, a frame rate of ≥30 frames/s is desirable to accurately display cardiac motion.

The returning echoes contain two important pieces of information:
1️⃣ Amplitude tells the system how strong the echo is.
2️⃣ Timing tells the system how far the reflecting structure is from the transducer.

The machine then processes these signals using amplification, filtering, TGC, compression and other steps before converting them into the familiar grayscale image.

Tissue harmonic imaging

Modern echocardiography can also use tissue harmonic imaging.

Instead of relying only on the original transmitted frequency, the system detects harmonic frequencies generated as ultrasound travels through tissue.

Why is this useful?

It can:
⭕ Reduce near-field and side-lobe artifacts
⭕ Improve endocardial border definition
⭕ Improve visualization of LV segments
⭕ Help with more reliable LV border tracing and EF assessment

This can be particularly helpful when the fundamental-frequency image is poor.

But there is a trade-off:
✅ Better lateral resolution, but poorer axial resolution.

Valves and other thin structures may therefore appear thicker with harmonic imaging, so measurements must be interpreted carefully.

The controls matter

Good echo imaging isn't just about the machine. Operator settings matter.

Key controls include:
🟥Power: How much ultrasound energy is transmitted.
⬜Gain: How strongly returning echoes are displayed.
🟦TGC: Adjusts gain at different depths to compensate for attenuation.
🟧Depth: Determines how much anatomy is displayed and influences PRF and frame rate.
⬜Dynamic range/compression: Determines how the range of echo amplitudes is converted into grayscale.

One practical rule:
- Too much depth = lower frame rate.
- Too wide a sector = fewer opportunities for rapid scanning.

Reducing depth or narrowing the sector can increase frame rate and/or scan-line density, improving the temporal detail of cardiac motion.

The next time you adjust the echo machine, remember:

You are not simply changing the picture.

You are changing how ultrasound data are acquired, processed and displayed.

Image: The basics of ultrasound image generation.
Courtesy of BE bulwer, MD

[Codigo Mental @CodigoMental777]

TU MASA MUSCULAR EXPLOTARÁ EN TAMAÑO CUANDO ENTIENDAS ESTA LEY BIOLÓGICA:

Ir al gimnasio a sudar no sirve de nada. Tu cuerpo odia construir músculo porque gasta demasiada energía. Si quieres forzarlo a crecer, tienes que aplicar estas reglas innegociables:

[CardiovascularCorner @TrackYourHeart]

Can you identify this skin condition?
Management?

[Dr Ihab Suliman @IhabFathiSulima]

A 28-year-old man presents with recurrent fragile skin and blistering over the backs of his hands after sun exposure. He also notices that his urine becomes dark reddish-brown after standing.

What is the most likely diagnosis?

[Dr sthanu subramanian @drsthanus]

This is a a 6-year-old boy with cough and fever.

Findings?

Diagnosis?

[Dr.Haitham Hamoud | د.هيثم @hemo_shk]

Two diagnoses. One patient. Can you spot them both?

[C.Alberto Ortega @albertoortegana]

Clinical Challenge — Dr. Harinder Singh Sandhu
An 18-year-old patient presents with a long-standing, slowly progressive eruption of monomorphic follicular papules over the bilateral cheeks, associated with erythema, follicular plugging and subtle atrophic scarring.
Dermoscopy demonstrates numerous follicular keratotic plugs with surrounding erythema.
What is the most likely diagnosis?
A) Keratosis pilaris rubra
B) Acne vulgaris
C) Keratosis pilaris atrophicans faciei (KPAF)
D) Discoid lupus erythematosus
E) Lichen spinulosus

[El Arte De La Vida @ElArteDeLaVidaX]

La CREATINA es la Drog4 Legal más Poderosa del Mundo.

Aun asi, la mayoría de los hombres no tienen idea de lo que realmente hace.

Eh aqui como aprovecharlo al 100%:

[C.Alberto Ortega @albertoortegana]

A 40-year-old patient presents with a chronic, progressive swelling of the foot and ankle, multiple firm nodules, draining sinuses, hyperkeratosis, and progressive architectural distortion. Granular material expressed from the sinuses shows both black and yellow grains.
The classic triad of tumefaction, multiple draining sinuses, and granular discharge, together with the characteristic grain colors, is highly suggestive of mycetoma (Madura foot).
🔬 Question: What is the most likely diagnosis, and what do the black and yellow grains suggest regarding the possible etiologic organisms?
Image/clinical case: Dr. Harinder Singh Sandhu

[Dr Ihab Suliman @IhabFathiSulima]

Severe headache.
What is happening?