Vera Ghali, MD

Medical Doctor 🩺 Pediatrician, Allergy & Immunology, Member of the Lebanese Order of Physicians & Lebanese Pediatric Society. AUB alumna. Views are my own.

[Vera Ghali, MD @veraghali]

@okker_k Thank you Julianna 🙏

[Vera Ghali, MD @veraghali]

A scoring system to predict life-threatening thrombo-ischemic events in patients with Acute Promyelocytic Leukemia
(APL). Developing and validating the Thromb-On Risk Score that may help decrease morbidity and mortality in APL.

[Haematologica @Haematologica]

Thrombo-ischemic risk in acute promyelocytic leukemia.
Can life-threatening thrombo-ischemic events in acute promyelocytic leukemia be predicted at diagnosis? The PETHEMA/PALG study explores a new risk-scoring approach.
https://t.co/iiaI1IARMj

[Vera Ghali, MD @veraghali]

Cystic Fibrosis (CF), the "65 Roses" disease, a nickname for this disorder that originated when a child mispronounced the actual name of the disease and is used to raise awareness. It is inherited as autosomal recessive and caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein which impairs clearance of mucus from lungs and results in recurrent infections lung damage, poor growth, cyanosis, coagulation disorders, diarrhea, fatty stools, and infertility in males. It also affects the pancreas, liver, and kidneys. Newborn screening within 2-5 days after birth using the heel prick test and detecting elevated levels of immunoreactive trypsinogen (IRT) followed by genetic testing to detect mutations. These initial diagnostic procedures must, nevertheless, be followed by the definitive chloride sweat test and detecting >60 mmol/L on 2 separate days. Infants with CF can't reabsorb chloride from skin and parents can taste salty sweat on their skin. Prenatal diagnosis in pregnant women with family history is also recommended. Management is with antibiotics, pancreatic enzyme replacement, and physiotherapy. Novel treatment with CFTR modulators that targets the underlying protein defect may improve quality of life and may prolong survival of patients with CF. In severe refractory cases, lung transplantation may be required.

[Carmelo Gurnari @CarmeloGurnari]

I am so thrilled to share our latest @TheEBMT guidelines on donor-derived hematological neoplasia: how to tackle these cases?? Read here👇 (link below) or listen to the @TheLancetHaem podcast! (Link below too)

[Vera Ghali, MD @veraghali]

Wishing you my friends a happy day ✨️
"Solar Heads"
Max Ernst

[Vera Ghali, MD @veraghali]

@okker_k Thanks Julianna 🙏 Have a good Sunday 🌸☀️

[Vera Ghali, MD @veraghali]

Cystic Fibrosis (CF), the "65 Roses" disease, a nickname for this disorder that originated when a child mispronounced the actual name of the disease and is used to raise awareness. It is inherited as autosomal recessive and caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein which impairs clearance of mucus from lungs and results in recurrent infections lung damage, poor growth, cyanosis, coagulation disorders, diarrhea, fatty stools, and infertility in males. It also affects the pancreas, liver, and kidneys. Newborn screening within 2-5 days after birth using the heel prick test and detecting elevated levels of immunoreactive trypsinogen (IRT) followed by genetic testing to detect mutations. These initial diagnostic procedures must, nevertheless, be followed by the definitive chloride sweat test and detecting >60 mmol/L on 2 separate days. Infants with CF can't reabsorb chloride from skin and parents can taste salty sweat on their skin. Prenatal diagnosis in pregnant women with family history is also recommended. Management is with antibiotics, pancreatic enzyme replacement, and physiotherapy. Novel treatment with CFTR modulators that targets the underlying protein defect may improve quality of life and may prolong survival of patients with CF. In severe refractory cases, lung transplantation may be required.

[JAMA Pediatrics @JAMAPediatrics]

Newborn screening for #CysticFibrosis is universal and enables early diagnosis and treatment, but further testing is required to confirm disease in infants with positive screens. https://t.co/DKFbPr48dl

[Vera Ghali, MD @veraghali]

@okker_k Thank you Julianna 🙏

[Vera Ghali, MD @veraghali]

Wishing you my friends a happy day ✨️
"Solar Heads"
Max Ernst

[Vera Ghali, MD @veraghali]

A case of Subacute Sclerosing Panencephalitis (SSPE) in a 7-year-old boy who contracted measles at 7-mo of age while living in Afghanistan where measles is endemic. SSPE is a serious, progressive neuroimflammatory diseases caused by persistent measles virus infection in the brain. After the initial infection at <2 years of age, the virus remains latent in the CNS over a span of years, mutates, and evades the immune system leading to chronic inflammation, coma, and eventually death. The child presented with cognitive deterioration and seizures. MRI of the head showed edema and restricted diffusion in the frontal lobes involving the white matter and extending into the corpus callosum. EEG showed bilateral, synchronous, symmetrical high-amplitude periodic discharges, a pattern called Radermecker complexes. CSF analysis showed elevated IgG levels and measles-specific IgG with optical density of 20.8 on immunoassay. Treatment of SSPE is symptomatic and palliative with use of antiviral and immunomodulators like interferon-alpha and ribavirin. However, the disease is mostly unresponsive to treatments. Unfortunately, the child died 12 months after the initial presentation of the symptoms. The only preventive measure is through vaccination. Measles virus infection is a vaccine-preventable disease which is a component of the Measles, Mumps, and Rubella vaccine (MMR).

[Vera Ghali, MD @veraghali]

"Though wise men at the
end know dark is right
Because their words had
forked no lightning they
Do not go gentle into that
good night.
Good men, the last wave
by, crying how bright
Their frail deeds might
have danced in a green
bay,
Rage, rage against the
dying of the light.
Wild men who caught and
sang the sun in flight,
And learn, too late, they
grieved it on its way,
Do not go gentle into that
good night.
Grave men, near death,
who see with blinding
sight,
Blind eyes could blaze like
meteors and be gay
Rage, rage against the
dying of the light."
From "Do not Go Gentle Into that Good Night"
Dylan Thomas

"Twilight"
Wassily Kandinsky

[Vera Ghali, MD @veraghali]

@okker_k Thank you Julianna 🙏

[Vera Ghali, MD @veraghali]

A case of Subacute Sclerosing Panencephalitis (SSPE) in a 7-year-old boy who contracted measles at 7-mo of age while living in Afghanistan where measles is endemic. SSPE is a serious, progressive neuroimflammatory diseases caused by persistent measles virus infection in the brain. After the initial infection at <2 years of age, the virus remains latent in the CNS over a span of years, mutates, and evades the immune system leading to chronic inflammation, coma, and eventually death. The child presented with cognitive deterioration and seizures. MRI of the head showed edema and restricted diffusion in the frontal lobes involving the white matter and extending into the corpus callosum. EEG showed bilateral, synchronous, symmetrical high-amplitude periodic discharges, a pattern called Radermecker complexes. CSF analysis showed elevated IgG levels and measles-specific IgG with optical density of 20.8 on immunoassay. Treatment of SSPE is symptomatic and palliative with use of antiviral and immunomodulators like interferon-alpha and ribavirin. However, the disease is mostly unresponsive to treatments. Unfortunately, the child died 12 months after the initial presentation of the symptoms. The only preventive measure is through vaccination. Measles virus infection is a vaccine-preventable disease which is a component of the Measles, Mumps, and Rubella vaccine (MMR).

[NEJM @NEJM]

Subacute sclerosing panencephalitis (SSPE) is a progressive neuroinflammatory disease associated with persistent measles virus infection and can have a latency of many years. In this video, NEJM Editorial Fellow Katerina Lin, MD, describes a clinical case involving a 7-year-old boy. Read the full case details: https://t.co/3rKpjywx2G

[Vera Ghali, MD @veraghali]

Wishing you my friends a happy day ✨️
"Dawn on Mount Fuji From Lake Yamanaka"
Kawase Hasui
Masterpieces of Japan

[Vera Ghali, MD @veraghali]

Pneumocystis jirovecii Pneumonia (PCP) is a serious opportunistic infection affecting patients with immunosuppression and risk factors like HIV/AIDS with CD4 cell count <200 cells/microL, organ and hematopoietic stem cell transplantations, cancers like leukemia and lymphomas, and long-term use of corticosteroids. Infection with Pneumocystis jirovecii causes significant morbidity and mortality in immunocompromised patients. Recent studies explore breakthrough immunotherapeutic interventions like PD-1/PD-L1 inhibitors, IL-7 inhibitors, and ALW-II-41-27, a potent small molecule tyrosine kinase inhibitor that targets ephrin receptors with high selectivity for ephrin-2 receptors, which enhance pathogen clearance and reduce lung injury by modulating pro-inflammatory signaling pathways.

[Vera Ghali, MD @veraghali]

An algorithm for the evaluation of thrombocytopenia.

[Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi]

Look at these beauties lining up and posing for my camera
Monoblast ➡️promonocyte ➡️ mature monocyte.

With all the hype about #RAS I think they know the hemepath paparazzi is hunting for them 📸

[Vera Ghali, MD @veraghali]

An algorithm for the evaluation of thrombocytopenia.

[Papa Heme @Papa_Heme]

Thrombocytopenia all you need to know!

3 mechanisms

1. ⬇️production =
Marrow disorder = decreased megakaryocytes
Liver dz = decreased TPO production

2. Destruction
= Immune-mediated (ITP), Non-immune (drugs)

3. Sequestration = Splenomegaly

Pseudo (clump due to EDTA)

[Vera Ghali, MD @veraghali]

Wishing you my friends a happy day ✨️
"Compulsory Education"
Briton Riviere

[Vera Ghali, MD @veraghali]

Wishing you my friends a happy day ✨️
"Compulsory Education"
Briton Riviere