Fernando Gutiérrez

🏥, intentando aportar algo al sistema

[Roland-Garros @rolandgarros]

THE WAIT IS OVER 🏆

#RolandGarros

[The Witcher @thewitcher]

Medallion's humming... that can only mean one thing! It's time to announce The Witcher 3: Wild Hunt - Songs of the Past! ⚔️

This brand new expansion for The Witcher 3: Wild Hunt will take you to the Path with Geralt of Rivia once more. It’s being co-developed with @Fools_Theory and is coming to PC, Xbox Series X|S, and PlayStation 5 in 2027. Stay tuned for more information in late summer. ⏰

[Dr. Chokri Ben Lamine @abouabdrahman0]

💊 Vincristine in Hematology — High-Yield Pearls 🧵

⸻

🧬 50 Pearls

1️⃣ Vincristine = vinca alkaloid
2️⃣ Mechanism: binds β-tubulin → inhibits microtubule formation
3️⃣ M-phase specific (mitotic arrest)

4️⃣ Backbone in:
➡️ ALL
➡️ NHL (e.g., R-CHOP)
➡️ Hodgkin variants
➡️ Pediatric regimens (but adult relevance remains key)

5️⃣ Standard dose: 1.4 mg/m² IV
6️⃣ MAX dose cap = 2 mg ⚠️ (neurotoxicity prevention)

⸻

⚖️ Dosing Principles

7️⃣ BSA-based dosing
8️⃣ Use actual body weight for BSA
9️⃣ Always apply 2 mg cap regardless of BSA

🔟 No renal dose adjustment
1️⃣1️⃣ Minimal hepatic metabolism → actually hepatic adjustment REQUIRED

⸻

🧠 Hepatic Adjustment

1️⃣2️⃣ Metabolized via CYP3A4
1️⃣3️⃣ If bilirubin ↑ → reduce dose
1️⃣4️⃣ Example:
➡️ Bili 1.5–3 → ↓ ~50%
➡️ Bili >3 → avoid or hold

⸻

⚠️ Toxicities (HIGH-YIELD)

1️⃣5️⃣ Peripheral neuropathy (dose-limiting)
1️⃣6️⃣ Stocking-glove pattern
1️⃣7️⃣ Motor neuropathy → foot drop
1️⃣8️⃣ Autonomic neuropathy → constipation 🚨

1️⃣9️⃣ Ileus = classic exam pearl
2️⃣0️⃣ Jaw pain (early sign)
2️⃣1️⃣ SIADH (rare but tested)

⸻

🚫 Critical Safety

2️⃣2️⃣ NEVER give intrathecally ❌❌❌
➡️ Fatal neurotoxicity

2️⃣3️⃣ Must be given IV ONLY
2️⃣4️⃣ Use minibag policy (safety strategy)

⸻

💊 Drug Interactions

2️⃣5️⃣ CYP3A4 inhibitors ↑ toxicity
➡️ Azoles (voriconazole, posaconazole) ⚠️
➡️ Macrolides

2️⃣6️⃣ Strong interaction in BMT patients on antifungals

⸻

🧬 Hematology Regimens

2️⃣7️⃣ R-CHOP (DLBCL)
2️⃣8️⃣ Hyper-CVAD (ALL)
2️⃣9️⃣ CVP regimen
3️⃣0️⃣ Pediatric-inspired ALL protocols

⸻

📉 Myelosuppression

3️⃣1️⃣ Minimal compared to other chemo
3️⃣2️⃣ Makes it ideal in pancytopenic settings

⸻

🧠 Neuropathy Management

3️⃣3️⃣ Dose delay or reduction
3️⃣4️⃣ No proven preventive therapy
3️⃣5️⃣ Duloxetine may help symptoms

⸻

⚖️ Special Populations

3️⃣6️⃣ Elderly → ↑ neurotoxicity risk
3️⃣7️⃣ Diabetics → worse neuropathy
3️⃣8️⃣ Prior neurotoxicity → adjust early

⸻

🔬 PK Pearls

3️⃣9️⃣ Large volume of distribution
4️⃣0️⃣ Hepatic clearance dominant
4️⃣1️⃣ Long terminal half-life

⸻

⚠️ Practical Pitfalls

4️⃣2️⃣ Forgetting 2 mg cap
4️⃣3️⃣ Giving with azoles without adjustment
4️⃣4️⃣ Missing constipation → ileus

⸻

🧾 Monitoring

4️⃣5️⃣ Neuro exam each cycle
4️⃣6️⃣ Bowel movement tracking
4️⃣7️⃣ LFTs before dosing

⸻

📚 Guideline-Based

✔️ National Comprehensive Cancer Network
✔️ American Society of Clinical Oncology

⸻

🧾 MCQ 🎯

Q: Max safe vincristine dose per cycle?
A) 1 mg
B) 1.4 mg/m² unlimited
C) 2 mg
D) 3 mg

✅ Answer: C — 2 mg cap
📌 Prevents severe neurotoxicity

⸻

🩺 OSCE Scenario

👨‍⚕️ Patient on R-CHOP develops constipation + foot weakness

👉 Your action:
✔️ Suspect vincristine neurotoxicity
✔️ Hold or reduce dose
✔️ Start aggressive bowel regimen

⸻

🚀 Take-Home

✔️ Vincristine = potent, non-myelosuppressive agent
✔️ Neurotoxicity = dose-limiting
✔️ ALWAYS cap at 2 mg
✔️ NEVER intrathecal ❌

⸻

#Hematology #Vincristine #DLBCL #ALL #Chemotherapy #Oncology #ASCO #NCCN

[Nico Gagelmann @NicoGagelmann]

🧐Rarity in hematology🧐

Blastic Plasmacytoid Dendritic Cell Neoplasm (#BPDCN)

Rare but aggressive blood cancer with a name as complex as its behavior

Let's break it down in an educational🧵

[JB JawBreaker @JB_Jawbreaker]

Novigrad
#TheWitcher3

[Dr. AK 🇮🇳 @docakx]

🌟Thrombocytopenia in sepsis - Approach

[En Júpiter @En_jupiter_]

Comparte este perrito del dinero para que te vaya bien económicamente lo que resta del año 🙌🏻🙏🏻

[Oncology Brothers @OncBrothers]

#HemeSeries: This is the #Algorithm we have used during our discussion with @doctorpemm for #myelofibrosis:

- Keep an 👀 out for Clinical Trials & Allo Transplant
- JAKi can/should be used irresepctive of JAK2 mut.

#OncTwitter #MedTwtitter @CancerNetwrk #MPNSM #HemeTwitter

[cony @iDUA95]

ay weon amo a sergio freire y los bunkers

[Nico Gagelmann @NicoGagelmann]

Happy Valentine's Day to you all!

❤️🩸❤️

[HBO Max Latinoamérica @HBOMaxLat]

Estamos muy tristes al enterarnos de la muerte de Angus Cloud. Era inmensamente talentoso y parte de la familia Euphoria. Extendemos nuestras más sinceras condolencias a sus amigos y familia en este momento difícil.

[Nishant Rajendra Tiwari @Nischistocyte]

Educational 🧵 on chronic myelogenous leukemia (CML). Not medical advice. I am a big fan of Dr. Druker, Dr. Cortes (@GCC_Cortes), Dr. Radich, and multiple others for their work in CML. Always open for feedback and corrections. #Medtwitter #hematology #leukemia #CML

[Vive con Propósito. @PropositoyVida]

10 Imágenes Impactantes sobre la Psicología y la Vida:

1.

[Pablo Evans @PabloEvans0]

7 COSAS QUE HACER ANTES DE LAS 7⌚️

🧵HILO🧵

[Hombre Divino @hombre_divino_]

Sé privado, Siéntete solo, Crece en silencio.

Aquí tienes 9 señales de que eres mentalmente más fuerte de lo que crees:

🧵Hilo🧵

[Nico Gagelmann @NicoGagelmann]

What causes hypercalcemia?
Before you think malignancies, think Chimpanzees:
Calcium supplementation
HCT
Iatrogenic
Myeloma, milk-alkali syndrome, medics
Parathyroid hyperplasia/adenoma
Alcohol
Neoplasm
Zollinger Ellison
Excessive vitamin D
Excessive vitamin A
Sarcoidosis
2/17

[Ricardo Temple | Marketing 🧲 | Ventas 💰 | IA 🤖 @RicardoTemple_]

10 Inteligencias Artificiales que te harán sentir CULPABLE por ser el único en tener acceso a ellas.

Lee este hilo en 2 min y ahórrate 2000 horas de trabajo.

[ H I L O ] 🧵