BruceWolffenbuttel

UMCG/RUG, endo/meta/diab; “Non vi sed saepe cadendo .. “ - samen beslissen - orig. 010 - Farbenschmelz - part-time pensionado - i.m;

[Dr. Annie Andrews @AnnieAndrewsMD]

JD Vance thinks you should have to speak English to receive care at a hospital. Wait until he hears about neonatal intensive care units.

The audacity of those babies expecting care when they don’t even speak the language.

[BruceWolffenbuttel @bhrw]

Met name dat zeer ernstige ijzertekort is van belang, want hoe láger de ijzerwaarde (ferritine) hoe gróter de kans op ernstige hypofosfatemie na Ferinject. https://t.co/p8ZLH1zD7v

[BruceWolffenbuttel @bhrw]

Het waarschijnlijke mechanisme waarmee intraveneuze ijzerbehandeling met ferricarboxymaltose leidt tot verlaagd fosfaat en hypofosfatemie syndroom. https://t.co/WMYtiGPxj0

[BruceWolffenbuttel @bhrw]

In de medische literatuur zijn meerdere factoren aangewezen die de kans op een ernstige of symptomatische daling van fosfaat verhogen:
– gebruik van ijzercarboxymaltose (Ferinject) als ijzerpreparaat
– herhaalde infusies of hoge cumulatieve doseringen
– al bestaand laag serum fosfaat
– zeer ernstig ijzertekort
– vitamine-D tekort
– verhoogde bijschildklieractiviteit, oftewel hyperparathyreoïdie
– ondervoeding of laag lichaamsgewicht
– malabsorptie, bijvoorbeeld door coeliakie, inflammatoire darmziekte of een gastric-bypassoperatie
– geneesmiddelen die de tubulaire functie van de nier of de botstofwisseling beïnvloeden, waaronder sommige antiresorptieve middelen
– normale nierfunctie; een verminderde nierfunctie lijkt juist gedeeltelijk beschermend, omdat de nieren dan minder fosfaat kunnen uitscheiden.

[BruceWolffenbuttel @bhrw]

No effect on outcome; pelacarsen. https://t.co/sjqdtriHCF

[BruceWolffenbuttel @bhrw]

Nice summary of a short intensive study. https://t.co/GrSNHLLs56

[BruceWolffenbuttel @bhrw]

@HawksDandelion @drsthanus I don’t think it has to do with aggressive replenishing therapy, as the side-effects -especially hypophosphataemia- with ferriderisomaltose (Monofer) are much less frequent.

[Dr sthanu subramanian @drsthanus]

The 6H Syndrome (also referred to as iatrogenic 6H-syndrome) is a fascinating but potentially debilitating side effect uniquely associated with intravenous iron products like Ferinject (ferric carboxymaltose).

While highly effective at treating severe iron-deficiency anemia, it triggers a dramatic domino effect in mineral metabolism.

●The sequence follows this precise physiological cascade:

*High Fibroblast Growth Factor-23 (FGF23):

FCM uniquely impairs the normal cleavage of FGF23, allowing active, intact FGF23 to accumulate.

*Hypophosphatemia:

High FGF23 forces the kidneys to dump phosphate aggressively.

*Hyperphosphaturia:

The actual spilling of excess phosphate into the urine.

*Hypocalcitriolemia:

FGF23 halts the renal activation of Vitamin D.

*Hypocalcemia:

The lack of active Vitamin D impairs intestinal calcium absorption, dropping serum calcium.

*Hyperparathyroidism (Secondary):

The falling calcium levels signal the parathyroid glands to overproduce Parathyroid Hormone (PTH) in an attempt to pull calcium from the bones.

■This PTH-driven response compounds the phosphate wasting, creating a cycle that can persist for weeks or even months.

Severe cases can present with profound fatigue, severe bone/muscle pain, and put patients at risk for osteomalacia or fractures.

**Recognizing this cascade is critical because trying to treat the hypophosphatemia with high-dose oral or IV phosphate alone is often ineffective and can actually worsen the hypocalcemia and secondary hyperparathyroidism.

***The mainstay of clinical management revolves around screening at-risk patients (like those with underlying bowel disease or severe baseline Vitamin D deficiency), monitoring phosphate and calcium levels post-infusion, and considering alternative IV iron formulations for future treatments.

https://t.co/qQzg4Klte6

[Occupy Democrats @OccupyDemocrats]

BREAKING: Hakeem Jeffries dances on Mike Johnson’s political grave with the perfect trolling taunt after last night’s blue tsunami.

It’s time to put these fascists in their place…

“Mike Johnson was correct. The polls were wrong. It wasn’t simply a blue wave; it was an American tsunami!” Jeffries mocked at a press conference.

Republicans like Johnson insisted right up to Election Day that the polls were wrong and that their party would overperform at the ballot box. Instead, we witnessed the greatest collapse of a political movement in modern history as MAGA crumbled and Democrats swept the night.

Johnson has already signaled that he will not seek the role of House Minority Leader after Democrats take control of the chamber. In fact, he’s even floating the idea that he might retire from government and start a “lawn business.” He can’t possibly be any worse at that than he was at being Speaker.

“The American people have chosen the economy over extremism,” said Jeffries, who is the frontrunner for the gavel. “The American people have chosen House Democrats because they want to see a dramatic change in direction, and that’s exactly what House Democrats will deliver on Day One.”

He vowed that Democrats will use their mandate to tackle the issues that Americans most care about: solving the affordability crisis, expanding ObamaCare subsidies, reversing MAGA cuts to Medicaid, cutting of Trump’s tariffs, and ending the disastrous war with Iran.

“Democrats promised a new path forward, and last night, the voters delivered a mandate for it,” said Jeffries.

Now that the sun is setting on Johnson’s reign, let’s briefly enumerate his “accomplishments.” He rubber-stamped a pointless war that skyrocketed gas prices, oversaw the coverup of the Epstein files, and handed Texas to Democrats. He will go down as one of the most spineless, ineffective Speakers in American history.

Please ❤️ and share to wish Johnson good riddance!

[Gene Trevino @GenoVeno73]

Kudos to whomever made this video.

It's accurately hilarious.

👇😂👇😂👇

[Karen Piper @PiperK]

What's interesting about the book on Jared Kushner is that the massive corruption it exposes, verifiable at so many levels, is now simply understood as the U.S. "doing business" to make "peace deals"... except the business benefits the Trump family, not the U.S.

[Jay in Kyiv @JayinKyiv]

More scenes from Kyiv overnight where Russians once again poured ballistic missiles onto the city, targeting university dormitories, killing people, injuring many, all in partnership with the White House that refuses to deliver air defenses that Europe paid for.

This isn't about countries, this is the Trump family, Musk and Putin against global democracy.

[Rob Wüst @RobWust]

Gisteren verscheen er een stukje in Men's Health @MensHealthMag over ons onderzoek, en waarom ook profatleten long covid kunnen ontwikkelen (en hoe je het kunt onderscheiden van overtraining/gewone vermoeidheid):
https://t.co/cAAQNyig56

#coverboy :)

[Peter Neehus @PeeNee2]

"Artsen kritisch op #LongCovid beleid minister Hermans:
'Funest voor patiëntvertrouwen' "

Niet één betrokken beroepsgroep of organisatie begrijpt dit beleid van @MinVWS. Niet één.

Artikel NOS @Zurhake 🙏
https://t.co/SRZXV2uEWx

Reactie @ministerVWS
https://t.co/CkjH6H60vM

[jim faas 🍀 @JimFaas]

🟦 EEN JAAR VERDER 🟥 NOG STEEDS ONZICHTBAAR

🟩 Een jaar na het PAIS-protest op het Malieveld: Q-support en C-support dicht. Expertisecentra onzeker. De minister wijst naar de huisarts. Duitsland investeert € 500 miljoen.

🟧 Wie onzichtbaar is in de zorg, is dat ook nog eens veel te vaak in in het keuringsdossier.

https://t.co/YhhrEhosYE

[BruceWolffenbuttel @bhrw]

Veroudering van de huid afgemeten aan een ‘endogene’ en een ‘exogene’ klok…… https://t.co/Sdx9aZFM8U