Elias Said, MD, FACEP

Emergency Medicine Physician. Fellow-American College of Emergency Physicians, Board-Certified by The ABEM
Critical Care-Tweets are my view and opinion

[Elias Said, MD, FACEP @MdFacep]

Following up on this pressing idea that we need a multivalent vaccine, or a pan-Coronavirus Vaccine, is important since global progress towards this end is taking place.

This study results indicate it may be efficacious against 99% of 365 coronaviruses.
https://t.co/9eoQl59biF

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Massive left kidney full of stones
Normal right kidney

[Elias Said, MD, FACEP @MdFacep]

Treponema pallidum hemagglutination assay

A Treponema pallidum hemagglutination assay was positive, A diagnosis of syphilitic pharyngitis — a manifestation of secondary syphilis — was made.
Treated with Benzathine PCN....
F/u..full recovery

[Elias Said, MD, FACEP @MdFacep]

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A 40-y.o. man w/ Sore throat for without fever, URI Sx, lymphadenopathy, genital lesions, and Neg for HIV.
was referred to the otorhinolaryngology clinic with a 1-month history of a sore throat. He reported no upper respiratory symptoms, fever, rash, or genital lesions.

[Elias Said, MD, FACEP @MdFacep]

Congo red stain of the biopsy specimen

Flow cytometry of the biopsy specimen

Grocott’s methenamine silver stain of the biopsy specimen

Serum protein electrophoresis

Treponema pallidum hemagglutination assay

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Priferation of villous lipomatous tissue within the synovial lining of joints, often seen in the knees results in soft tissue swelling, symmetric joint effusions, and limited range of motion w/ normal labs.

MRI supports this Dx when fatty lobulations are seen along the tendons.

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 A patient who consumes excessive tea and displays dense bones on vertebral X-ray:

Dagnosis is fluorosis.

Fluoride in tea leads to deposites in bones, causing them to become dense and brittle. The vertebral changes seen on X-ray would support this diagnosis.

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Wow!

NLRP12-autoinflammtory Dz.

Autoinflammatory conditions, like polychondritis, are associated w/ NLRP12-autoinflammatory disease-which is characterized by recurrent episodes of fever, arthralgia, and inflammation, typically w/ normal WBC, CRP, and ESR.

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Polyarteritis Nodosa
One characteristic feature of PAN on angiography is the "beaded" appearance of affected arteries (microaneurysmal dilatation) w/segmental involvement

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Radiograph--> Bowel Obstruction
CT--> Intussusception.

R/O Meckel's Div., Gariatirc surgery complication, lesions/adhesions, and IBD (esp Crohn's Dis.)

Emergency Medicine Board question!

[Elias Said, MD, FACEP @MdFacep]

@MayoClinicINFD Exampless of #1 include E. Coli, Salmonell and Yersinia sp.--> found in environment i.e. water, soil, GI tract.

However Eikenella corrodens, found in teeth, oral and resp. tract is known for causing #2-5 above.

50% corrode agar (unique)

slow growing_> hard to culture (missed)

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Manipulation of the urinary tract during the procedure can facilitate the entry of Candida organisms into the bloodstream.

Transurethral resection of the prostate involves urethral instrumentation, which can lead to candidemia esp is DM and immunocompromised individuals.

[Elias Said, MD, FACEP @MdFacep]

@nihardesai7 Exactly!

Erythropoietin (EPO) is produced by the kidneys and stimulates RBC production in the bone marrow.

Thrombopoietin (TPO) is primarily produced in the liver and regulates the production of platelets in the bone marrow.

Impaired kidney function = anemia
Impaired liver=TCP

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 T2DM is recognized as the most impactful risk factor for Metabolic dysfunction–associated steatotic liver disease (MASLD).

MASLD, AKA [non-alcoholic fatty liver disease (NAFLD)], and MASLD are strongly associated with insulin resistance and metabolic syndrome.

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Meckl's diverticulum (MD)- an expression of the failure of the complete involution of the omphalomesenteric duct which later results in:

GI bleed, bowel obstruction, volvulus, intussusception, and neoplasia

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Flatened diaphragms with moderate bilateral, L>R, atelectatic changes in a markedly rotated patient position with L 6th rib fracture and consider left basilar hemothorax.
Rec. CT chest angio for further evatuation for blunt trauma

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Snowflake cataracts, AKA cortical cataracts, are multiple small, white opacities scattered throughout the lens cortex, resembling snowflakes. that resemble snowflakes.

In Down syndrome, snowflake cataracts are relatively common & related to the genetic abnormalities of
Tri 21

[Elias Said, MD, FACEP @MdFacep]

@Sthanu5 Viral pyostomatitis

HSV is primary consideration

HZV (Shingles typically afftects dermatomal hemiglossitis (not supported here)

[Elias Said, MD, FACEP @MdFacep]

@BrownJHM Anhydrosis, ptosis, and miosis on one side of the face are classic symptoms of Horner's syndrome.

Anhydrosis---> impaired sympathetic innervation to sweat glands.

Ptosis---> paralysis of the levator palpebrae superioris due to sympathetic denervation.

Miosis-->iris sphincter

[Elias Said, MD, FACEP @MdFacep]

@nihardesai7 @BrownJHM @Innov_Medicine @NicoGagelmann @CPSolvers @DxRxEdu @KirtanPatolia @HemOncFellows @TheEBMT_Trainee This patient's recent allogeneic transplant for AML puts her at increased risk for PRES due to the immunosuppressive therapy and potential endothelial dysfunction.

Tx:
Modify the therapeutic regimen
BP control
Seizure control
Supportive care