Dr Future

[Dr Future @talkSoccerr]

I've built MediBook with @base44!

[Dr Future @talkSoccerr]

#Cerebral hemorrhage #ich

[The Neuroradiologist @theneuroradguy]

Cerebral hemorrhages on MRI, an overview of signal characteristics according to age/stage. #MEDed #FOAMed #RADed #FOAMrad #radres #neurorad

[Dr Future @talkSoccerr]

#Ibd #Crohn's dieses

[Keith Siau @drkeithsiau]

Azathioprine no longer recommended for use in Crohn’s disease as of the latest IBD guidelines #BSGLive25

[Dr sthanu subramanian @drsthanus]

Approach to Diagnosis and Management of Hematuria.

https://t.co/oiNCEdFhHt

[Dr Future @talkSoccerr]

#Right sided weakness with #muculopapular rashes

[Dr Future @talkSoccerr]

#Tnf

[Conrad Fischer @SeeFisch]

If TNF treatment fails, check TNF level:
° If level is adequate and there is insufficient TNF effect, look for antibodies
against a particular drug
° If there are antibodies, switch to a different drug in same class
° If there are no antibodies, switch to another medication in another
class

[Dr Future @talkSoccerr]

#Prednisone #steroid

[Conrad Fischer @SeeFisch]

Prednisone >20 mg a day for a month needs PNEUMOCYSTIS prophylaxis.

my my! Master the Boards book is amazingly current

[Dr Future @talkSoccerr]

#Arthritis

[Conrad Fischer @SeeFisch]

Rheumatoid Arthritis THerapy
If methotrexate and TNF inhibitors do not work, third-line agents are used
as follows:
• IL-1 antagonist: anakinra
• IL-6 antagonists: tocilizumab
• Anti-CD20: rituximab, ocrelizumab
• Janus kinase (JAK) inhibitors (tofacitinib, baracitinib): associated with clots
• Hydroxychloroquine: used in mild disease; patient will require a regular
eye exam to check for retinopathy
• Sulfasalazine (same drug used in the past for UC); safe in pregnancy

[Dr Future @talkSoccerr]

#Diabetes

[Conrad Fischer @SeeFisch]

So in diabetes Metformin is first for sure, but what are the 2nd, 3rd, 4th drugs? NOT CLEAR
If CKD/CHF=SGLT2
If very Obese=DPPIV inhibitor or GLP agonist
If CHF=NO Pioglitazone
If MASH (NASH) = YES pioglitazone

[Dr Future @talkSoccerr]

#RBC Shape

[Dr. AK 🇮🇳 @docakx]

🌟RBC morphology abnormalities in a peripheral blood smear - A list👇

[Dr Future @talkSoccerr]

#Duodenal biopsy

[Keith Siau @drkeithsiau]

How to take duodenal biopsies for coeliac disease:

✅ 4x D2 biopsies
✅ 2x D1 biopsies
✅ D1 biopsy from 9 and 12 o’clock
✅ Single bites (less distortion)
✅ Separate pots - D1 has more Brunner’s glands and shorter villi
✅ Should be on gluten

From @2guystalkingit podcast 👍👏

[Dr Future @talkSoccerr]

#Sle

[Dr.Mukesh , MD , DM @dr_immuno29]

📊 **Study Snapshot: Lupus Nephritis (LN) vs. Non-LN SLE Patients** 🩺
🏥 **Overview**:
- **Conducted by**: Kosałka-Węgiel et al. (2024)
- **Participants**: 921 SLE patients; 331 (35.94%) with LN.
🔍 **Key Findings**:
- **Demographics**: LN patients are typically younger and have a higher male presence.
- **Clinical Features**:
- LN patients exhibit severe SLE manifestations (serositis, hypertension, etc.)
- **Autoantibody Profiles**:
- Higher prevalence in LN:
- Anti-dsDNA: 84.44% (LN) vs. 62.48% (non-LN)
- Anti-nucleosome: 45.89% vs. 28.62%
- Anti-histone: 37.66% vs. 22.1%
- **Treatment**: More frequent use of immunosuppressants in LN patients.
- **Risk Factors**: Female sex, younger age, specific autoantibodies linked to flare-ups.
⚰️ **Mortality**: Similar rates (5.57%) in both groups; primary causes include infections and SLE exacerbations.

📝 **Conclusions**: Significant clinical differences highlight the need for tailored approaches in managing LN.
🔗 **Limitations**:
- Retrospective design & single-center context necessitating further diverse studies.
🌟 **Implications**: Early recognition & personalized treatment for better patient outcomes in LN.
**#LupusNephritis #SLE #Autoimmunity #ClinicalResearch #Immunology #Rheumatology**

[Dr Future @talkSoccerr]

#Sle

[Dr.Mukesh , MD , DM @dr_immuno29]

### Key Points on B Cell Depletion Therapies in SLE
- **Rituximab Overview**:
- Targeted therapy for CD20 B cells.
- Limited by residual B cells and immunological reactions.
- Enhances understanding of B cell biology.

- **Emerging Therapies**:
- **CAR T-Cell Therapy**:
- Targets CD19.
- Shown to have promise in severe lupus cases.
- **Bispecific T Cell Engagers (BiTEs)**:
- Simultaneously engage T cells and target cells (e.g., blinatumomab).
- Same or enhanced efficacy compared to monoclonal antibodies.
- **Combination Treatments**:
- Targeting the BAFF pathway (belimumab) may improve outcomes.
- Combination with CAR T cell approaches under investigation.
- **Clinical Results**:
- Genentech's Gazyva demonstrated efficacy over standard treatments.
- Notable cases of deep B cell depletion improve symptoms in SLE patients.
- **Future Directions**:
- Need for well-powered studies comparing CAR T cell therapies and monoclonal antibodies.
- Personalized approaches based on genetic biomarkers to optimize treatment outcomes.

- DOI: (https://t.co/0fgZIxV1Zp)

#SystemicLupusErythematosus #BCellDepletion #CAR_TCells #BiTEs #LupusNephritis #Genentech #BAFF

[Dr Future @talkSoccerr]

#Ana

[Dr. AK 🇮🇳 @docakx]

🌟 ANA for diagnosis of connective tissue diseases

From Rheumatology secrets textbook, 4ed.

[Dr Future @talkSoccerr]

#Clostridium diffcile

[Jasmine Sethi @JasmineNephro]

👍Clostridium difficile infection risk with antibiotics

From @1min_IDconsult

[Dr Future @talkSoccerr]

#Vancomycin #montelukast

[ERM @Owner_X429]

Conclusion ✅
- Montelukast offers a promising adjuvant strategy to combat vancomycin-associated nephrotoxicity, reducing patient harm and healthcare costs 💡.
- Further multi-center studies are warranted to validate findings and optimize protocols 🌍.

[Dr Future @talkSoccerr]

#Nephrotic syndrome

[Jasmine Sethi @JasmineNephro]

💯🫘Indications of Prophylactic anticoagulation in nephrotic syndrome

@goKDIGO guidelines

[Dr Future @talkSoccerr]

#Endocarditis

[Conrad Fischer @SeeFisch]

Endocarditis Prophylaxis for Dental Procedures
*Amoxicillin or Cephalexin or Azithromycin or Doxycycline

NOT ERYTHROMYCIN
NOT ERYTHROMYCIN

[Dr Future @talkSoccerr]

#Milirinone

[Dr Future @talkSoccerr]

#Hbv #hepatitis

[Dr sthanu subramanian @drsthanus]

Algorithm for therapy indication in chronic HBV infection

https://t.co/B6EXxD5qlJ