Gilbert (Taylor’s Version)

[Gilbert (Taylor’s Version) @Gilbert_1313]

need this thread

[lu @thelasstime]

obsessed with taylor swift describing words, like instead of "wedding" it’s "white veil occasion"

[Bee Haber @beehaber]

Taylor Swift ve Travis Kelce’nin Temmuz ayındaki düğünlerinin bütçesi 20 milyon dolar.

🔹 Düğün için Madison Square Garden 3 gün kapatılacak.

🔹 Geceliği yaklaşık 2 milyon dolar.

🔹 Arena, lüks bir botanik düğün alanına çevrilecek.

🔹 Taylor Swift, 6 farklı gelinlik hazırlatıyor fakat yalnızca birini giyecek.

🔹 Diğer 5 gelinlik, magazincileri şaşırtmak için sipariş edildi.

🔹 Gelinliklerin maliyeti 1 milyon dolar.

🔹 Misafirler için Manhattan’da 4 otel kapatılacak.

🔹 Otel odalarının geceliği 1.500 ila 3.000 dolar arasında.

🔹 Konaklama faturası 2 milyon doları geçecek.

🔹 Konuklar, salona yeraltından girecek.

🔹 Drone ve görüntü sızıntılarına karşı sinyal kesiciler kullanılacak.

🔹 Güvenlik operasyonu, yaklaşık 5 milyon dolar tutacak.

🔹 Düğünde mini festival havasında özel performanslar bekleniyor.

🔹 Ed Sheeran, Lana Del Rey ve HAIM gibi isimler konuşulan konuklar arasında.

🔹 Yemek ve ikramlar için 2 milyon dolar harcanacak.

🔹 Çift, hediye kabul etmeyecek.

[Updates in Medicine @medic_updates]

When upper GI bleeding meets antithrombotic therapy, knowing what to stop—and when to restart—can change outcomes.

[Aya 🦉 @aya__R7]

اقسم بالله حقيقة أكثر صورة واقعية.

[Austin Camp @austincamp]

How many antibiotics treat anaerobes? I’m an ICU pharmacist and let’s see how many anti-anaerobic agents we can cover in 60 seconds!

#pharmacy #medicine

[Aravind Palraj @Rheumat_Aravind]

The greatest challenge in Rheumatology isn’t recognizing disease. It’s recognizing when a disease is pretending to be something else.

SLE, vasculitis, sarcoidosis, IgG4-related disease, Adult-onset Still’s disease, and antiphospholipid syndrome can present across multiple organ systems and mimic infection, malignancy, neurological disorders, endocrine disease, and many other conditions.

🩺 Clinical Pearl:
When a patient has unexplained multisystem involvement, constitutional symptoms, elevated inflammatory markers, or unusual combinations of organ manifestations, think beyond the obvious diagnosis.

The diagnosis often lies in connecting seemingly unrelated clinical clues.

Which rheumatologic masquerader has fooled you the most in clinical practice?

#Rheumatology #ClinicalImmunology #AutoimmuneDisease #Vasculitis #SLE @IhabFathiSulima

[Aravind Palraj @Rheumat_Aravind]

Muscle weakness in SLE is not always myositis.

When an SLE patient presents with weakness and a normal CK, broaden the differential.

Consider:
🔹 Steroid myopathy
🔹 Peripheral neuropathy
🔹 Myasthenia gravis overlap
🔹 Neuropsychiatric lupus
🔹 Hydroxychloroquine-induced myopathy
🔹 Electrolyte and endocrine disorders
🔹 Constitutional lupus fatigue

Clinical Pearl:
Normal CK does not exclude clinically significant weakness.

In a steroid-treated patient, proximal weakness with normal CK should raise strong suspicion for steroid myopathy.

A careful history, medication review, neurological examination, and targeted investigations are often more informative than CK alone.

#Lupus #SLE #Rheumatology #MedEd #ClinicalPearls @IhabFathiSulima

[Dr sthanu subramanian @drsthanus]

Prednisolone and Neutrophils.

Prednisolone causes marked neutrophilia by mobilizing neutrophils into the bloodstream and preventing their exit into tissues.

It does this by forcing cells to detach from blood vessel walls (demargination), releasing marrow reserves, and delaying programmed cell death (apoptosis).

Consequently, counts often double within hours of a dose.

●The reason this can mimic an occult bacterial infection on a complete blood count (CBC) is that the influx consists of both mature and, occasionally, immature neutrophils (like band cells).

**However, steroid-induced neutrophilia can usually be distinguished from a true bacterial infection by a few key hematological features:

1. Concomitant Lymphopenia and Eosinopenia:

While neutrophils are elevated, prednisolone simultaneously causes a drop in lymphocytes and eosinophils. Bacterial infections generally do not cause eosinopenia.

2. Presence of Monocytosis:

An increase in monocytes often accompanies steroid-induced neutrophilia.

3. Absence of Toxic Changes:

Steroid-induced neutrophils typically lack "toxic" features on a peripheral blood smear (e.g., toxic granulation, Dohle bodies, or marked vacuolization), which are classic hallmarks of severe bacterial infection.

https://t.co/ByAJrF7IKK

[Internal Medicine @pgMedicine]

Iron Studies Made Simple: A Pattern-Based Approach to Microcytic Anemia

[chart data @chartdata]

Billboard Hot 100: #1(new) we can’t be friends (wait for your love), Ariana Grande.

[Rheumatology update @aabdogafar]

2026 AHA/ACC Guidelines for the Evaluation and Management of Acute Pulmonary Embolism in Adults. 1

[Rheumatology update @aabdogafar]

2025 BSR csDMARD Clinical Blueprint

[Rheumatology update @aabdogafar]

Sacroiliitis: MRI Diagnostic Criteria, Pitfalls, and Clinical Assessment 2

[Ravi Kumar @RheumattDoc]

🚨 Infliximab vs Cyclophosphamide in Severe Behçet’s Syndrome

This multicenter phase 2 Bayesian randomized controlled trial compared infliximab with cyclophosphamide in patients with severe Behçet’s syndrome.

🧪 Study Design

• 52 patients with severe Behçet’s syndrome
• Major vascular involvement: 71%
• Neuro-Behçet’s syndrome: 29%

Patients were randomized to receive:

🔹 Infliximab 5 mg/kg at weeks 0, 2, 6, 12, and 18
OR
🔹 Cyclophosphamide IV pulses every 4 weeks

All patients received glucocorticoids.

🎯 Primary Outcome

Complete response at week 22 defined as:
✅ Clinical remission
✅ Biological remission
✅ Radiological remission
✅ Prednisone dose ≤0.1 mg/kg/day

📊 Results

✅ Complete response achieved in:
• 81% with infliximab
• 56% with cyclophosphamide

📉 Overall adverse events:
• 29.6% with infliximab
• 64% with cyclophosphamide

⚠️ Serious adverse events were similar between groups.

💡 Key Takeaway

Infliximab demonstrated superior efficacy with fewer adverse events compared with cyclophosphamide, supporting TNF inhibition as a preferred induction strategy in severe Behçet’s syndrome with vascular or CNS involvement.

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Noroژa | Niloufar Ebrahimi @n0r0zha]

Today learning points from the “Lupus Nephritis: Management beyond guidelines confirmation” @UKKidney

[Dr.Mukesh , MD , DM @dr_immuno29]

🧬 VEXAS Syndrome — The Game-Changer in Adult Autoinflammation

• 🔥 First described in 2020 → bridges rheumatology + hematology + genetics
• 🧬 Caused by somatic UBA1 mutations (hematopoietic stem cells)
• ⚙️ Defective ubiquitination → proteotoxic stress + systemic inflammation

👤 Who to suspect?
• 👴 Men >50 yrs (predominant)
• 💊 Steroid-dependent inflammation
• 🩸 Macrocytic anemia + cytopenias
• 🦠 Recurrent fevers, skin lesions, chondritis, lung involvement

🔬 Hallmark clues
• 🧫 Bone marrow vacuoles (erythroid + myeloid precursors)
• 🧬 Confirm with UBA1 mutation testing

⚠️ Clinical spectrum
• 🧴 Neutrophilic dermatoses (≈80%)
• 🌬️ Lung involvement (>60%)
• 🦴 Arthritis/chondritis
• 🧠 Vasculitis mimic
• 🩸 MDS in ~30–60%

📊 Epidemiology pearls
• ~1 in 4,000 men >50
• Rare in women (often with X monosomy)

💀 Prognosis
• ⚠️ <50% 10-year survival
• High risk: infections, thrombosis, marrow failure

💊 Treatment (still evolving)
• 🥇 Steroids = rapid control (but dependence common)
• ➕ JAK inhibitors / IL-6 / IL-1 blockers (partial benefit)
• 🧬 Azacitidine → ↓ clone + inflammation
• 🧫 Allogeneic HSCT = only potential cure

💡 Key concept
👉 First adult-onset disease driven by somatic mutation → paradigm shift in inflammatory diseases

📌 Think VEXAS in:
“Unexplained inflammation + cytopenia + steroid dependence in elderly”

🔗 DOI: 10.1038/s41572-026-00695-w

#VEXAS #Rheumatology #Hematology #Autoinflammatory #PrecisionMedicine #MDS #MedTwitter

[Dr hanady manasfi @hanadymanasfi]

CTD-ILD
ACR/Chest Guidelines #immunosuppressives #antifibrotics

[Pop Crave @PopCrave]

‘American Idol’ announces its first-ever Taylor Swift night for next week.

The Top 7 contestants will perform songs by the singer to celebrate her “chart-topping hits and defining eras.”

[William Aird @WilliamAird4]

4 IRON TESTS --&gt; 2 COMPARTMENTS

Ferritin → storage

Circulating iron (transferrin-bound):

✅ Serum iron = cargo
✅ TIBC = capacity
✅ TSAT = saturation
These three define the transport system.

(TSAT = serum iron / TIBC)

[Ravi Kumar @RheumattDoc]

🧬 A Phase 2 Randomized Trial of Mezagitamab in Primary ITP

💊 What is Mezagitamab?

•Anti-CD38 monoclonal antibody
•Targets:
•Plasma cells (↓ autoantibodies)
•Plasmablasts
•NK cells

🧪 Study Design

•Phase 2, multicenter, double-blind RCT
•Adults with persistent/chronic primary ITP
•Platelets: <30,000/µL

Arms:

•Mezagitamab: 100 / 300 / 600 mg
•Placebo
•Weekly SC × 8 weeks

🎯 Key Outcomes

•Primary: Safety
•Secondary: Platelet response
✔ ≥50,000/µL
✔ ↑ ≥20,000 from baseline
✔ ≥2 visits (up to week 16)

📊 Results

⚠️ Safety
•Similar to placebo
•No major safety signal
👉 Well tolerated

📈 Efficacy
•600 mg dose:
→ 91% response
•Placebo:
→ 23% response

🧠 Take Home

•CD38 targeting → plasma cell depletion
•May work where steroids, TPO-RAs, rituximab fail
•Potential future option in refractory ITP

#RheumattDoc #MedTwitter @NEJM #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Sayed S Rahman @SayedSRahman1]

Furosemide Stress Test(FST):
Clinical Protocol and interpretation .
#KDIGO AKI Guidelines 2026