bhishak

hobbyist language dabbler • internist

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

🔥🔥IDSA AMR Guidance 2026🔥🔥

🔺Notable Updates from the 2024 IDSA AMR Guidance Document

IDSA 2026 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections

🔺ESBL, AmpC Enterobacterales
🔺CRE
🔺DTR P. aeruginosa
🔺CRAB
🔺Stenotrophomonas maltophilia

Including updates in antimicrobial selection, dosing strategies, and management approaches.

🔺Meropenem dosing update: individualized dosing approach (1–2 g IV q8h) with higher doses considered in selected clinical scenarios.

Info inspired / credit to @RabeaAgeeli , #IDXposts
https://t.co/lfAjZU2zHQ

[bhishak @stethophony]

@RealMed3 Girl work it!!! Even if no one noticed it YOU know you have a haircut and a sharp jawline

[bhishak @stethophony]

@cobbaltt There's a little funny Sanskrit there. Schwa deletion leads people who speak IA languages to read the English viksit (विकसित Skt. vikasita) as वीक्षित् (vīkṣit) too often

[bhishak @stethophony]

@RealMed3 I'm a doctor too but i fully agree that evil eye is real like anecdotally speaking there's no way it isn't. Lack of RCTs be damned

[bhishak @stethophony]

@RealMed3 Frrr I was waiting for gardasil 9 to become available lol
Now that it's available i haaaave to get jabbed i must

[bhishak @stethophony]

@RealMed3 Luckily on leave. And i have to get my HPV and JEV vaccines as well at some point LOL!

[Paul Sax @PaulSaxMD]

@JWatch https://t.co/9nbimtSnNx

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

🔥Just published
The GAME CHANGER RCT
Among patients with a hospital-acquired or health-care-associated Gram-negative bloodstream infection, cefiderocol resulted in non-inferior but not superior 14-day mortality compared with standard of care #IDXposts https://t.co/jLWmphItGK

[bhishak @stethophony]

@RealMed3 How old is she 😭😭 I thought Shakespeare was taught widely in schools that provide an English education

[bhishak @stethophony]

@pjcotera @IM_Crit_ What's being highlighted is the machine response lol not the poll results. The LLM has just said '1.' and nothing else

[bhishak @stethophony]

@cobbaltt You say that as if we don't have வில்லன்~வில்லி right at home haha

[bhishak @stethophony]

@WilliamAird4 Filters are the thoughts and prayers of LL VTE

[Elliot Tapper @ebtapper]

Potassium and hepatic encephalopathy

1⃣K-wasting diuretics can trigger HE
2⃣K-wasting diuretics can⬆️ammonia(Nh3)
3⃣K repletion can⬇️nh3

Why?
⭐️Renal recapture of K+ by H+/K+ exchange needs glutamine's Nh4+ which gives h+ AND nh3

So, if HE:
1⃣fluids
2⃣replete K
#livertwitter

[The Wolf of College Street @aditya_gan3500]

THE EVOLUTIONARY BASIS OF THE COMMON FAINT

Syncope (or faint) is a very common presentation in medicine, especially neurology.

Syncope = transient loss of consciousness with loss of postural tone --> may lead to falls +/- convulsive jerks if the event is prolonged

The commonest cause of syncope in the world is reflex syncope ie RS (also known as vasovagal syncope or VVS)

[Vasovagal as we see later is only a part of reflex syncope]

RS starts in childhood to adolescence and dominates the early decades.

The American Heart Association estimates that nearly 35% of the American population experiences syncope at some point in their lives.

The mechanism reflex syncope involves

Trigger --> sudden inhibition of the medullary vasomotor and cardiostimulatory centers +/- stimulation of the cardioinhibitory centers --> transient loss of BP (vasodepressor) +/- heart rate (vasovagal) --> syncope

Triggers may be

1. External - sudden press on the carotid bulb/tight collars/stimulation of the pharynx or larynx

2. Internal - this may be emotional like stress or sight of blood or situational like micturitional

Reflex syncope is almost exclusively a human phenomenon even though the evolutionary mechanisms which are talked about below exist in all vertebrates.

These evolutionary theories of reflex syncope include

FIRST THEORY - The violent conflicts hypothesis - it states that RS during a violent conflict allows the human homologue of the alarm bradycardia.

What is alarm bradycardia?

Most animals under stress exhibit a 'fight or flight' response which we all know about.

But others exhibit the 'death feint' where they go into a state of tonic immobility with very low BP and HR.

Thus they 'play dead' till the predator leaves or it may allow some relief when escape is impossible.

Catatonia is a form of this 'tonic immobility' or 'death feint' as proposed by @AbhiLenka11 and others!

SECOND THEORY - Clot production hypothesis - RS allows the BP and HR to drop during hemorrhage.

Suppose you are bleeding out from a bad injury.

The low BP and HR reduces tissue perfusion and allows the coagulations system to arrest a bleed.

THIRD THEORY - Heart defense hypothesis - RS stops sympathetic excess from overwhelming the heart

Suppose you are facing intense emotional stress --> sympathetic surge --> huge rise in BP and HR --> massive stroke or heart attack --> RS acts as a safety valve for the autonomic nervous system --> saving your life

Why are humans so uniquely susceptible to reflex syncope?

1. Large brain of humans which requires nearly 20% of cardiac output

2. The recent bipedalism of humans with weaker leg muscles than other animals --> so there is significant pooling of blood in the legs in the erect posture --> basically the peripheral pump of soleus is much weaker compared to other animals

As you can see, reflex syncope is not a disease but an evolutionary conserved phenomenon.

It must have played some positive role in natural selection --> coupled with the unique and sensitive stresses that our erect posture places on us hus humans --> it persists as a common malady.

We cannot study medicine without a study of evolution.

#MedTwitter
#NeuroTwitter
#Syncope
#ReflexSyncope
#Dysautonomia
#MovementDisorders

[bhishak @stethophony]

@nntaleb @MatheusPetter2 Counterpoint: Lance Armstrong
Cyclists are not immune to anabolic steroid use
Would've been nice if article specifically mentioned whether steroid/EPO/other performance enhancing drug use was screened for

[Deepak Malgutte @DMalgutte]

The Man Who Never Got a Nobel, But Gave the World Methotrexate
— A story of forgotten genius, cancer, arthritis, psoriasis… and hope. 💊💔🧬

[bhishak @stethophony]

@MomsPostingLs Addicts deserve good things in their lives too. If she's been clean for 3.5 years straight (which requires MONUMENTAL self control) then I think she's shown that she's capable of caring for her kid. If they want to celebrate overcoming a quagmire of a hardship like that, let them

[Jake Scott, MD @jakescottMD]

@EM_RESUS “Finish the whole course or risk resistance!” is one of modern medicine’s favorite zombies. But there’s no evidence behind it - and oftentimes shorter is actually better.

[bhishak @stethophony]

@umpiwarrior @thenerdnxetdoor They are not doctors in the same way that nurses are not doctors or paramedics are not doctors. Let us also uplift them, recognise that they do a lot of good work for horrendous compensation and do better by them without clubbing everyone together into one homogeneous group.