rituximab

ordinary guy

[rituximab @limbicsystem_md]

@AlbatrosZB @nongjaireal แล้วกรณีนี้กวนคนอื่นยังไงค่ะ

[rituximab @limbicsystem_md]

@nongjaireal รู้ดีจังเลยนะคะ ขอให้ฉลาดแล้วได้เป็นหมอนะคะ

[rituximab @limbicsystem_md]

@nongjaireal Ok ค่ะ หมอยอมโง่ก็ได้ค่ะ ฉลาดแต่มึงเลยค่ะ

[rituximab @limbicsystem_md]

@nongjaireal ไม่ใช่ AI ใช่ไหมคะ

[rituximab @limbicsystem_md]

@jerriesberryy อีบ้า ใช้คำว่า creepy ได้สิ้นเปลืองมาก

[Aravind Palraj @Rheumat_Aravind]

Fever in SLE is a diagnostic challenge: flare, infection—or both?

Before escalating immunosuppression, look for objective organ activity, investigate infection appropriately, and interpret biomarkers in clinical context.

#Lupus #SLE #Rheumatology #ClinicalReasoning #MedEd @docakx @IhabFathiSulima

[Dr Rupam Manna MD @DrRupamOncology]

Dose-dense chemotherapy means maintaining standard doses while shortening the interval—usually from every 3 weeks to every 2 weeks—with prophylactic G-CSF.

Key applications: breast cancer, urothelial cancer, Ewing sarcoma and selected aggressive lymphomas.

#MedicalOncology #Chemotherapy #BreastCancer #UrothelialCancer #EwingSarcoma #OncologyEducation

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕✨🟢Clinical guideline highlights for the hospitalist: Updates on the treatment of drug-susceptible and drug-resistant tuberculosis
🔺2025 ATS/CDC/ERS/IDSA clinical treatment guidelines
🔺Rifampin exchanged for Rifapentine
🔺Elimination of Ethambutol, Addition of Moxifloxacin
🔺 Duration 🔽 from 4 month to 2 month continuation phase
🔺Logistical challenges related to rifapentine
🔺Further research is needed to identify predictors of treatment tolerability #idxposts
https://t.co/3GiysTAuL8

[Aravind Palraj @Rheumat_Aravind]

In SLE, glucocorticoids should be a bridge—not the destination.

Control active disease, introduce effective steroid-sparing therapy, taper toward ≤5 mg/day, and aim for withdrawal when clinically feasible.

#Lupus #Rheumatology #SLE #MedEd #PatientSafety @Lupusreference @DurgaPrasannaM1 @lupuscyclopedia @RheumNow @docakx @IhabFathiSulima

[Dr Rupam Manna MD @DrRupamOncology]

Hereditary colorectal cancer: know the pattern before ordering the panel. 🧬

Lynch, FAP, MAP, Peutz–Jeghers, juvenile polyposis and serrated polyposis—plus universal MMR/MSI screening.

Save for clinic and viva.

#ColorectalCancer #CancerGenetics #MedicalOncology

[Dr Rupam Manna MD @DrRupamOncology]

Cancer screening can appear successful—even when it has not reduced cancer mortality.

Understanding screening bias is therefore essential:

🔹 Lead-time bias: earlier diagnosis artificially increases measured survival without delaying death.
🔹 Length-time bias: screening preferentially detects slower-growing, less aggressive tumours.
🔹 Overdiagnosis bias: detection of cancers that would never have caused symptoms or death.
🔹 Selection/volunteer bias: people who participate in screening may be healthier and more health-conscious than non-participants.

The key lesson: improved 5-year survival after screening does not automatically prove benefit.

The most reliable endpoint is a reduction in cancer-specific or all-cause mortality, balanced against false positives, overdiagnosis, anxiety and treatment-related harm.

#CancerScreening #MedicalOncology #Biostatistics #Epidemiology #EvidenceBasedMedicine #OncologyEducation #DrNBOncology #CancerConceptsExplained

[MV Chandrakanth @ChandrakanthMv]

🧤 Hand-Foot Syndrome Prevention: A Network Meta-analysis

Can we finally prevent chemotherapy-induced Hand-Foot Syndrome?

Key findings:

🔹 19 randomized trials involving 2,192 patients compared 13 preventive strategies.

🥇 Topical diclofenac 1% gel had the strongest overall evidence, reducing both Grade ≥2 HFS and overall HFS.

🌿 Topical silymarin showed the greatest efficacy signal but needs larger confirmatory trials.

💊 Celecoxib was effective; 400 mg pyridoxine showed benefit, whereas lower doses did not.

⚠️ Urea cream alone showed no consistent benefit, and Mapisal was associated with increased HFS risk.

Bottom line: For patients starting capecitabine, topical diclofenac 1% gel is currently the best-supported strategy to prevent Hand-Foot Syndrome.

#MedicalOncology #SupportiveCare #Capecitabine #HandFootSyndrome #NetworkMetaAnalysis #JAMADermatology #EvidenceBasedMedicine #CancerCare #MVOnco

[Norah Asiri 🔬 @NA_Microbiology]

🔬 What Are ESBLs?

ESBLs are β-lactamase enzymes capable of hydrolyzing:

💊 Penicillins

💊 Third-generation cephalosporins

💊 Fourth-generation cephalosporins (some)

💊 Aztreonam

💡 ESBLs are usually inhibited by β-lactamase inhibitors such as clavulanic acid.

━━━━━━━━━━━━━━

🧬 Common ESBL Families

The three major ESBL families are:

🔹 CTX-M (most common worldwide)

🔹 TEM

🔹 SHV

💡 CTX-M enzymes have become the predominant ESBL type globally.

━━━━━━━━━━━━━━

🦠 Which Bacteria Produce ESBLs?

Most commonly:

🦠 Escherichia coli

🦠 Klebsiella pneumoniae

Less commonly:

• Proteus mirabilis

• Enterobacter spp.

• Citrobacter spp.

• Serratia spp.

━━━━━━━━━━━━━━

⚠️ Clinical Importance

ESBL-producing bacteria commonly cause:

🚽 Urinary tract infections (UTIs)

🩸 Bloodstream infections

🫁 Pneumonia

🩹 Wound infections

🏥 Hospital-acquired infections

These infections are associated with:

❌ Limited treatment options

❌ Increased treatment failure

❌ Longer hospital stays

━━━━━━━━━━━━━━

🧪 How Are ESBLs Detected?

Clinical laboratories detect ESBL production using:

✅ Antimicrobial susceptibility testing (AST)

✅ Combination disk tests

✅ Double-disk synergy test (DDST)

✅ Molecular methods (PCR)

💡 CLSI and EUCAST provide recommendations for interpretation.

━━━━━━━━━━━━━━

💊 Treatment

Treatment depends on:

• Infection site

• Severity

• AST results

Common options may include:

💊 Carbapenems (for severe invasive infections)

💊 New β-lactam/β-lactamase inhibitor combinations when appropriate

⚠️ Treatment should always be guided by antimicrobial susceptibility testing and local guidelines.

━━━━━━━━━━━━━━

🧠 Interesting Facts

🔹 ESBL genes are commonly carried on plasmids, allowing rapid spread between bacteria.

🔹 ESBL-producing organisms are frequently resistant to multiple non-β-lactam antibiotics as well.

🔹 CTX-M enzymes have largely replaced older TEM and SHV ESBLs in many parts of the world.

[1-min ID consult @1min_IDconsult]

【Aspergillus galactomannan false positive】

It's important to understand that there are various potential causes of false positives for Aspergillus galactomannan!

Level: Intermediate to advanced

#IDMedEd #IDFellow #IMResident #Aspergillus #TxID #HemOnc

[Benlazar S M A @smbenlazar]

The evolution of treatment-free remission https://t.co/Wko8XyWS6U #CML #leusm

[rituximab @limbicsystem_md]

@luv66610 เหตุผลหลักๆสปสช ไม่จ่ายเงินตามที่รักษาจริงค่ะ เปิดได้ไม่เท่าที่ควรจะเป็น ถ้าโรงบาลติดลบๆเยอะ คนที่จะได้รับผลกระทบก็คือคนไข้นั่นแหล่ะค่ะ เพราะเครื่องมือการรักษากับยาก็จะถูกจำกัดค่ะ

[rituximab @limbicsystem_md]

@nyymphia_eve ความคิดโง่ๆแบบมึงก็ไปเป็นแม่บ้านนะคะ

[rituximab @limbicsystem_md]

@democracracy เขาอาจจะมี empathy นะคะแต่ใช้กับคนไข้ที่น่ารัก