Marcus Lontra 🦦

ICU Physician, main interests: Onco-hematoICU, POCUS and Palliative Care

[可愛くノ一 🇯🇵🌸 @hokkori_buzz]

To all my Brazilian friends 🇧🇷

Thank you so much for that wonderful match ✨

Even though Japan scored the first goal, you surpassed us in every way ,with your brilliant individual skills, smooth passes, perfect traps, and sharp shooting accuracy. We ended up losing 2-1 in the round of 16.

From now on, I’ll be cheering wholeheartedly for Brazil 💛

Please go and win that 6th ⭐️! We’re rooting for you 🤝🇯🇵

And to everyone from America and all around the world who supported us —
Thank you so much 🙏✨

From now on, I’ll be cheering for your countries too 💪🌍

[Josh Farkas MD 💊 @PulmCrit]

Fresh Blog: Is oseltamivir assassinating ICU patients?

The REMAP-CAP trial has concluded with >98% certainty that oseltamivir is killing patients.

This is an extraordinary claim that requires extraordinary evidence.

#1/2... (link to blog in 2nd post)

[Eli Oliveira @EliazzOliv2]

⛳CRIE SEU SEGUNDO CÉREBRO COM O CLAUDE

Esta é, sem dúvida, a função mais
subestimada.

Adicione todos os dias o que acontecenna sua vida e no seu negócio.

Quanto mais souber sobre você,
melhores respostas te dará.

Guarde tudo no seu "vault”. Siga os
passos da imagem:

[Ishika Rawat @Ishh_021]

Claude FULL COURSE 1 HOUR (Build & Automate Anything)

[Rohit @ai_rohitt]

INSTEAD OF WATCHING NETFLIX TONIGHT.

Spend 1 hour with this.

Claude AI FULL COURSE that teaches you how to BUILD and AUTOMATE anything.

The people who watch this tonight will wake up tomorrow with a new skill.

Watch it and Bookmark it now

[Anuj @anujcodes_21]

🚨Anthropic just showed a 24-minute workshop on how to actually do prompts for Claude.

Taught by the people who built it.

Free. No registration. No paywall.

I've seen $300 courses that don't cover what they teach in the first 8 minutes.

Watch it and bookmark it now.

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

The most important paper of #ASCO26 just dropped in Nature Med! Or any other @asco or @myESMO meetings to be honest. When you hear someone present “the toxicities were acceptable”, please respond “downplaying toxicities is not acceptable”. Thank you @NatureMedicine for publishing this piece.

https://t.co/ydAfoTWVJ0

[Ouriço de cartola @cegadede]

O briefing para o pessoal da criação: "uma caixa de chocolates sortidos mas sem os que ninguém gosta"

[Josh Farkas MD 💊 @PulmCrit]

in ICU, the white coat is just a big walking fomite

ideally, every piece of external clothing should be industrially laundered daily by the hospital (e.g. scrubs, green hospital-issued warm-up jackets)

part of primum non nocere is not walking around covered in Cdiff spores

[Alasdair MacLullich @A_MacLullich]

The 4AT can be scored in patients who cannot speak or are too unwell to undergo cognitive testing. No patients are Unable To Assess (UTA) with the 4AT. This improves uptake and accuracy in diagnosis.

See the 4AT website for more details.

[Critical Care Reviews @CritCareReviews]

Rapid sequence intubation in high-risk patients: what clinicians and researchers must know – a narrative review

CCR Journal Watch 
https://t.co/Sp06oA6IDG

[Afshine Emrani MD FACC @afshineemrani]

In medical school, we are taught a golden rule: "When you hear hoofbeats, think horses, not zebras." It is a reminder to look for the common explanation before the exotic one. But after decades in cardiology, I’ve learned that if a patient is still suffering after the "horses" have been ruled out, a doctor must have the courage—and the curiosity—to go hunting for the zebra.

Sarah was a thirty-four-year-old marathon runner and a devoted mother who came to me after six months of being told she was "fine." She had been bounced from one specialist to another, each one pointing to her normal EKG and standard blood tests as proof that her crushing fatigue and racing heart were simply the result of "new mom stress." By the time she reached my office, she didn't just look tired; she looked invisible, as if the medical system had stopped seeing the woman and only saw the data.

Instead of re-reading the normal test results that had already failed her, I asked Sarah to walk me through her life. We talked about her training and her family, eventually landing on a backpacking trip she took to the Mendoza province of rural Argentina. She described staying in a charming, rustic cottage made of sun-dried mud bricks. She mentioned waking up one morning with a strangely swollen, purple eyelid that she assumed was a simple spider bite.

As she spoke, a memory surfaced from a biography I had read years ago about Charles Darwin. Most people know Darwin for his theories on evolution, but medical historians have long puzzled over the mysterious, debilitating illness that plagued him for decades after he returned from his voyage on the HMS Beagle. Darwin had written in his journals about being bitten by the "great black bug of the Pampas" while sleeping in mud-walled huts in South America. He spent the rest of his life suffering from heart palpitations and exhaustion that the Victorian doctors of his time could never explain.

I realized then that Sarah wasn't suffering from stress; she was likely hosting the same "silent killer" that may have haunted Darwin: Chagas Disease.

The "Kissing Bug" lives in the cracks of those mud-brick walls. It bites its victims—often near the eyes or mouth—while they sleep, passing a parasite called Trypanosoma cruzi into the blood. The danger of Chagas is that the initial symptoms disappear quickly, but the parasite can hide in the body for years, slowly weaving itself into the muscle and electrical "wiring" of the heart.

To confirm this, I moved beyond the standard tests. I ordered a specialized "Strain Rate" ultrasound, which doesn't just look at whether the heart is pumping, but at how the individual muscle fibers are stretching. We saw that while her heart looked strong to the naked eye, the fibers were "stuttering," a sign of early parasite-induced scarring. A specific blood test for the parasite's antibodies confirmed the diagnosis.

Treatment required a difficult, sixty-day course of anti-parasitic medication to stop the infection, paired with a protective heart regimen to keep her electrical system stable while the inflammation settled. Because we caught it before her heart was physically damaged or enlarged, the recovery was a success.

Months later, Sarah returned to my office, her vibrant energy restored. She brought me a leather-bound copy of The Voyage of the Beagle with a note tucked inside. She wrote that while other doctors had looked at her charts, I had looked at her. This case remains a vital reminder for my memoir: in a world of high-tech scans and AI, the most sophisticated diagnostic tool we possess is still the human story. When we truly listen, we don't just find the disease—we find the patient.

Good morning.

[Doutor Prepúcio @doutorprepucio]

Considerando que o Maduro ganhou uma garrafa de água de 500 ml, um fone com cancelamento de ruído e uma máscara de dormir, conclui-se que o serviço de bordo da Gol é pior do que o dispensado a prisioneiros mundo afora.

[AbdAllah Othman @CardioBeat_]

https://t.co/Y9SVtblYdb
FDA has approved the Edwards Sapien M3 Transcatheter Mitral Valve Replacement System for prohibitive-risk patients with severe mitral regurgitation. #FDA #MedicalDevice #Cardiology #StructuralHeart #MitralValve #TMVR #SapienM3

[Aravind Palraj @Rheumat_Aravind]

CRP and procalcitonin are not infection-only markers in autoimmune disease.

Key pitfalls to remember:
• CRP can rise in serositis, vasculitis, RA flares
• Procalcitonin can be high in MAS/HLH and severe inflammation
• Discordance > absolute values
• When in doubt, treat infection first

#MedTwitter #RheumTwitter #NephTwitter #Immunology @DrAkhilX @IhabFathiSulima #AutoimmuneDisease #SLE #FOAMed #MedEd

[CardiovascularCorner @TrackYourHeart]

Activate the Cath Lab: ECG patterns that matter even without classic STEMI
Not every coronary occlusion announces itself with obvious ST-segment elevation.
Some ECG patterns are quieter, atypical, and easy to miss, yet they represent the same emergency.
Thread below ⬇️

[Jonathan Haidt @JonHaidt]

All schools in Brazil went phone-free last February. Early research shows test scores rising, conflicts and discipline problems falling.

May Brazil be an inspiration to other countries.
We can reclaim childhood and education in the real world.

https://t.co/BHPrCy36QO

[Laura Vater, MD, MPH @doclauravater]

Please remember that patients on ventilators can often hear you.

Speak how you would if they were awake. Introduce yourself. Say what you're doing ("I’m going to listen to your heart and lungs.") Tell them the plan for the day.

[Cliff Reid @cliffreid]

Interactive Holistic Four-Interface Shock Model based on the work of @ThinkingCC and friends thanks to @GeminiApp https://t.co/gbhZ56T175

[João Pimenta @jaoseupimenta]

Bloquinho do gado 1.0