Discover and read the best of Twitter Threads about #Vasculitis
Most recents (19)
RITAZAREM ➡️ Rituximab (RTX) versus azathioprine (AZA) for maintenance of remission for patients with ANCA-associated vasculitis (ANCA-AV) and relapsing disease.
👀Thread👀
#vasculitis #rituximab #MedEd
ard.bmj.com/content/early/…
👀Thread👀
#vasculitis #rituximab #MedEd
ard.bmj.com/content/early/…
Design:
- Open label, randomized.
- Patients with relapsing GPA or MPA, ANCA +.
- Induction phase (4 months): RTX 375 mg/m2x4 doses.
- Maintenance phase (4-24 months). Randomized to RTX (1 gram every 4 months, 5 doses) vs AZA (2 mg/kg).
- Follow-up phase (12-24 months).
- Open label, randomized.
- Patients with relapsing GPA or MPA, ANCA +.
- Induction phase (4 months): RTX 375 mg/m2x4 doses.
- Maintenance phase (4-24 months). Randomized to RTX (1 gram every 4 months, 5 doses) vs AZA (2 mg/kg).
- Follow-up phase (12-24 months).
Results:
- 170 patients randomized.
- 72% anti-PR3 and 28% anti-MPO. 62% severe relapse on entry into trial.
- Glucocorticoid (GC) induction: 28% 1 mg/kg/day and 72% 0.5 mg/kg/day.
- 78% prior treatment with cyclophosphamide!
- 170 patients randomized.
- 72% anti-PR3 and 28% anti-MPO. 62% severe relapse on entry into trial.
- Glucocorticoid (GC) induction: 28% 1 mg/kg/day and 72% 0.5 mg/kg/day.
- 78% prior treatment with cyclophosphamide!
It's 🥶 & we're coming across many cases of peripheral ischemia/gangrene
🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑
🔁It's essentially a demand≠supply mismatch
#MedEd #MedTwitter #RheumTwitter
🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑
🔁It's essentially a demand≠supply mismatch
#MedEd #MedTwitter #RheumTwitter
The 📝 goes on & so that we can save ⏳ & 💰 on the tests, I like to broadly divide the pathology into:
1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia
2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)
3️⃣External compression
1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia
2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)
3️⃣External compression
Q1️⃣: How was the onset?
🐌Insidious onset, gradual progression is the most common
➡️peripheral vascular disease
➡️most vasculitides
➡️vasculopathy
#MedEd #MedTwitter
🐌Insidious onset, gradual progression is the most common
➡️peripheral vascular disease
➡️most vasculitides
➡️vasculopathy
#MedEd #MedTwitter
A 12-MO♀️ girl, immunization for hepatitis B, 2 weeks prior: a rapidly spreading, nonblanching, nonpalpable, purpuric rash over legs & cheeks surrounded by edema, 37.6°C, nontoxic in appearance
Leukocytosis,⬆️CRP
1/9
#dermatology #Emergency #Pediatrics doi.org/10.1093/cid/ci…
Leukocytosis,⬆️CRP
1/9
#dermatology #Emergency #Pediatrics doi.org/10.1093/cid/ci…
The next day, the hemorrhagic rash became palpable
Pharyngeal PCR:➕for enterovirus
🔬 of purpuric lesions: leukocytoclastic vasculitis, & DI studies showed vascular wall fibrinogen deposition, consistent with ACUTE HEMORRHAGIC EDEMA OF INFANCY (AHEI)
2/9
#pediatric #IDtwitter
Pharyngeal PCR:➕for enterovirus
🔬 of purpuric lesions: leukocytoclastic vasculitis, & DI studies showed vascular wall fibrinogen deposition, consistent with ACUTE HEMORRHAGIC EDEMA OF INFANCY (AHEI)
2/9
#pediatric #IDtwitter
Typical patient of ACUTE HEMORRHAGIC EDEMA OF INFANCY:
✔️6–24 months of age,
✔️during winter,
✔️nontoxic presentation,
✔️low-grade fever,
✔️abrupt onset of large purpuric skin lesions,
✔️and edema in face and extremities
3/9
doi.org/10.1093/cid/ci…
#MedTwitter #pediatria
✔️6–24 months of age,
✔️during winter,
✔️nontoxic presentation,
✔️low-grade fever,
✔️abrupt onset of large purpuric skin lesions,
✔️and edema in face and extremities
3/9
doi.org/10.1093/cid/ci…
#MedTwitter #pediatria
Nog steeds wordt er veel geschreven en veel beweerd over de mogelijke bijwerkingen na vaccinatie met de mRNA-vaccins van #Moderna en #PfizerBioNTech
Wellicht is het goed om een aantal zaken op een rij te zetten. Daarom een glanzend ragfijn draadje.
#COVID19 #vaccin
Wellicht is het goed om een aantal zaken op een rij te zetten. Daarom een glanzend ragfijn draadje.
#COVID19 #vaccin
Belangrijk is te beseffen dat een deel van de bijwerkingen van deze vaccins ook als klinisch symptoom optreedt bij #COVID19.
Dat is ook niet vreemd, gezien het spike-eiwit het meest reactogeen is, en het belangrijkste doelwit van de immuunrespons is.
Dat is ook niet vreemd, gezien het spike-eiwit het meest reactogeen is, en het belangrijkste doelwit van de immuunrespons is.
Zowel het virus als ook het vaccin zetten dit spike-eiwit op de celmembraan van menselijke cellen.
Maar er zijn zeker verschillen: ten eerste heeft het virus een receptor nodig, de welbekende ACE-II-receptor, om de cel binnen te komen.
Maar er zijn zeker verschillen: ten eerste heeft het virus een receptor nodig, de welbekende ACE-II-receptor, om de cel binnen te komen.
1/ Clear evidence of a circulation problem in #LongCovid. We know #SARSCoV2 causes a pan-vasculitis & hyper coagulability. Every long hauler whose blood has been tested has been +ve for microclots
⚠️Medics, pls note, a normal D dimer does NOT exclude the presence of microclots🧵
⚠️Medics, pls note, a normal D dimer does NOT exclude the presence of microclots🧵
2/ D-dimer measures fibrinogens degradation products (FDPs). Because the microclots are not being broken down, d-dimer will not be raised.
3/ Unfortunately a blood test for microclots is not yet currently available in the UK outside of the research setting.
⛄️Winter is coming, time for a 2nd 🧵 on cryoglobulins!
❄️What's a cryoglobulin?
❄️What causes cryos to form?
❄️When to suspect cryos are the culprit?
#medtwitter #meded @HRheuminations #immunology #vasculitis
❄️What's a cryoglobulin?
❄️What causes cryos to form?
❄️When to suspect cryos are the culprit?
#medtwitter #meded @HRheuminations #immunology #vasculitis
Cryoglobulins are antibodies that:
❄️precipitate at temps less than 37 degrees C
🌟dissolve after rewarming
(the last 🧵 demonstrates, it's not just temps that cause precipitation, but also changes in concentration, salinity and ph)
Why do they do this? We're not sure!
❄️precipitate at temps less than 37 degrees C
🌟dissolve after rewarming
(the last 🧵 demonstrates, it's not just temps that cause precipitation, but also changes in concentration, salinity and ph)
Why do they do this? We're not sure!
3 types!
but to make life easier:
❄️Type 1 driven by underling malignancy
❄️Type 2 and 3 (mixed): infection or rheumatologic condition
but to make life easier:
❄️Type 1 driven by underling malignancy
❄️Type 2 and 3 (mixed): infection or rheumatologic condition
Cryoglobulinemic Vasculitis
The #vasculitis where antibodies fall out of serum at ❄️ temps and cause all sorts of badness
follow this 🧵to learn the history of these strange proteins
#medtwitter #meded @HRheuminations @LCalabreseDO #rheumatology
The #vasculitis where antibodies fall out of serum at ❄️ temps and cause all sorts of badness
follow this 🧵to learn the history of these strange proteins
#medtwitter #meded @HRheuminations @LCalabreseDO #rheumatology
it starts in 1933
Dr. Wintrobe is studying the blood of a woman who would later be found to have multiple myeloma
Her WBCs were very low
YET....the buffy coat (where WBCs like to live) was very large.
if her WBCs were low, what was accounting for the large buffy coat?
Dr. Wintrobe is studying the blood of a woman who would later be found to have multiple myeloma
Her WBCs were very low
YET....the buffy coat (where WBCs like to live) was very large.
if her WBCs were low, what was accounting for the large buffy coat?
he can't figure it out, so what does he do?
he puts the blood in the freezer so he can ponder why the buffy coat is so thick.
the next day...
A strange precipitate in the tube
...that dissolved away when warmed back up
he puts the blood in the freezer so he can ponder why the buffy coat is so thick.
the next day...
A strange precipitate in the tube
...that dissolved away when warmed back up
THABETA protocol
To treatment #COVID vaccine #side_effect
This protocol is designed to detox from the #spike_protein amyloid after the #mRNA vaccine to avoid #long_Covid and to remove triggers for #autoimmune disease after vaccination.
To treatment #COVID vaccine #side_effect
This protocol is designed to detox from the #spike_protein amyloid after the #mRNA vaccine to avoid #long_Covid and to remove triggers for #autoimmune disease after vaccination.
1837 patients with different side effects post COVID mRNA vaccine or suffering from long Covid symptoms have and are using this protocol
Efficacy = 97%
Against: #Myocarditis, #pericarditis , #MS , #Billy's palsy , #insulin_resistance #vasculitis , and other autoimmune conditions
Efficacy = 97%
Against: #Myocarditis, #pericarditis , #MS , #Billy's palsy , #insulin_resistance #vasculitis , and other autoimmune conditions
1. N-acetyle cysteine: 2000 mg daily
NAC works as antidote for amyloid spike protein and removes proteins produced from ORF3a embedded in cell surface.
NAC works as antidote for amyloid spike protein and removes proteins produced from ORF3a embedded in cell surface.
1/10
It is nice when you see a brain #MRI and instantly jump to a unique diagnosis in your mind.
A #tweetorial about #CLIPPERS Chronic Lymphocytic Inflammation with Pontine Perivascular enhancement Responsive to Steroids. #Neurology #NeurologyRF #NeuroRad #MedEd #NeuroTwitter
It is nice when you see a brain #MRI and instantly jump to a unique diagnosis in your mind.
A #tweetorial about #CLIPPERS Chronic Lymphocytic Inflammation with Pontine Perivascular enhancement Responsive to Steroids. #Neurology #NeurologyRF #NeuroRad #MedEd #NeuroTwitter
2/10
CLIPPERS is a #rare #disease being increasingly recognized. We saw a case here @UHhospitals @cwru @CwruNeuro
(The coronal brain MRIs in this tweetorial are from a published case report other than but similar to our patient- I chose to use here instead given better quality)
CLIPPERS is a #rare #disease being increasingly recognized. We saw a case here @UHhospitals @cwru @CwruNeuro
(The coronal brain MRIs in this tweetorial are from a published case report other than but similar to our patient- I chose to use here instead given better quality)
3/10
Middle age patient presenting with emotional liability, subacute bilateral lower extremity weakness/numbness/spasms, ataxia and pan-sphinctric dysfunction over 4 months #NeuroRad
Middle age patient presenting with emotional liability, subacute bilateral lower extremity weakness/numbness/spasms, ataxia and pan-sphinctric dysfunction over 4 months #NeuroRad
#SíndromePulmónRiñón: Ayudas diagnósticas
Radiología: infiltrados con patrón alveolar de distribución simétrica, predominio central y en bases pulmonares; sin embargo, hay casos en los que los hallazgos pueden ser focales – unilaterales y discernir con otras entidades puede ser difícil.
Gasimetría arterial: hipoxemia (PaO2 menor de 60mmHg); el mecanismo de esta condición es secundaria a “shunt” y alteración de la difusión, lo que explica la pobre respuesta al oxígeno a alto flujo en la mayoría de los casos.
So excited to watch this interview between @polybioRF s @microbeminded2 and @MS_SouthNassau’s @RuhoyMD that I’m going to live tweet it. Dr. Ruhoy is a neurologist with a Ph.D in environmental medicine who works with #longCOVID #mecfs #EDS patients.
Ruhoy describes her long-standing interest in integrative medicine, natural approaches, and environmental medicine. She’s even a certified medical acupuncturist! She now helps lead a neurosurgery practice. 😍😍😍
Ruhoy: “I was an environmentalist from when I was very young and I believe that the world around us plays a role in our health. Even before I was a doctor, I would always try to find ways of living a healthier life. I saw no reason why I couldn’t combine it.”
IMPORTANT 🇮🇹 study🔴 -> "Vascular uptake more marked in the examinations of the patient who developed #longCOVID. These findings suggested that vascular inflammation and its duration are responsible for the clinical course of the disease and the development of long COVID."👇
Published by .@BeyondRheumatol .@CollegioCrei
CC @CNRsocial_ @Doom3Gloom @LazzariAmbrogio @SIRreumatologia @RheumatologyUK @Daltmann10 @VirusesImmunity @Istamina 👇
CC @CNRsocial_ @Doom3Gloom @LazzariAmbrogio @SIRreumatologia @RheumatologyUK @Daltmann10 @VirusesImmunity @Istamina 👇
This matches with @MartaEsperti and @JasmineHayer documented cases.
#Vasculitis-like explains at least a subset of #longhaulers?
In which extense this can happen also in other organs and especially brain?
CC @apresj20 @long_covid @LongCovidSOS @apuakoronaan @ZeroCovAlliance
#Vasculitis-like explains at least a subset of #longhaulers?
In which extense this can happen also in other organs and especially brain?
CC @apresj20 @long_covid @LongCovidSOS @apuakoronaan @ZeroCovAlliance
A metal ion orients SARS-CoV-2 mRNA to ensure accurate 2′-O methylation of its first nucleotide
» doi.org/10.1038/s41467…
The #SARSCoV2 #coronavirus is able to utilize the changes in metal ion concentrations to disguise itself in the human host body thus evading immune responses.
» doi.org/10.1038/s41467…
The #SARSCoV2 #coronavirus is able to utilize the changes in metal ion concentrations to disguise itself in the human host body thus evading immune responses.
Efficacy of #clarithromycin on #COVID19 pneumonia without oxygen administration; protocol for multicenter, open-label, randomized-controlled, 3-armed parallel group comparison, exploratory trial #CAMECOVID
» doi.org/10.1101/2021.0…
Japan Registry of Clinical Trials jRCTs071210011
» doi.org/10.1101/2021.0…
Japan Registry of Clinical Trials jRCTs071210011
The influence of #HLA genotype on the severity of #COVID19 infection
» doi.org/10.1111/tan.14…
A genetic link has been discovered explaining why some people catch #Covid but don't get sick. The gene is found three times as often in people who are #asymptomatic.
» doi.org/10.1111/tan.14…
A genetic link has been discovered explaining why some people catch #Covid but don't get sick. The gene is found three times as often in people who are #asymptomatic.
🔝5 Concerns about #SARSCoV2 #Biology: A Call to Pause, Deliberate, and Revise Policy─This review is intended both as a basic resource and to initiate an open and critical dialog about SARS-CoV-2 biology for an independent and public call to action. jjcouey.medium.com/5-concerns-abo…
Structural basis of ribosomal #frameshifting during translation of the #SARSCoV2 #RNA #genome
» doi.org/10.1126/scienc…
A unique feature of the SARS-CoV-2 genome controls protein synthesis and presents an "Achilles heel" of the virus.
» doi.org/10.1126/scienc…
A unique feature of the SARS-CoV-2 genome controls protein synthesis and presents an "Achilles heel" of the virus.
Brainstem neuropathology in two cases of #COVID19: #SARSCoV2 trafficking between #brain and #lung
» doi.org/10.1007/s00415…
Neuropathologic evidence strongly suggests that the pathophysiology of COVID-19 related respiratory failure includes a neurogenic component.
» doi.org/10.1007/s00415…
Neuropathologic evidence strongly suggests that the pathophysiology of COVID-19 related respiratory failure includes a neurogenic component.
Reducing #COVID19 #Airborne #Transmission Risks on #PublicTransportation Buses
» doi.org/10.1101/2021.0…
Wearing of #facemasks reduced the overall particle count released into the bus by an average of 50%, the dispersion distance by several feet and #aerosol particles by 84.36%.
» doi.org/10.1101/2021.0…
Wearing of #facemasks reduced the overall particle count released into the bus by an average of 50%, the dispersion distance by several feet and #aerosol particles by 84.36%.
🔝#SARSCoV2 Infects Human Engineered Heart Tissues and Models COVID-19 Myocarditis
» doi.org/10.1016/j.jacb…
#COVID19 can kill heart muscle cells, interfere with contraction. Details of how #coronavirus infects #heart: models of tissue damage may help develop potential therapies.
» doi.org/10.1016/j.jacb…
#COVID19 can kill heart muscle cells, interfere with contraction. Details of how #coronavirus infects #heart: models of tissue damage may help develop potential therapies.
High-content screening of coronavirus genes for innate immune suppression reveals enhanced potency of SARS-CoV-2 proteins
» doi.org/10.1101/2021.0…
196 protein products of seven coronaviruses: the genes encoded by #SARSCoV2 are generally more potent immune suppressors than others
» doi.org/10.1101/2021.0…
196 protein products of seven coronaviruses: the genes encoded by #SARSCoV2 are generally more potent immune suppressors than others
⚠️#Ocular #MRI Findings in Patients with Severe #COVID19: A Retrospective Multicenter Observational Study
» doi.org/10.1148/radiol…
All patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region. Screening needed.
» doi.org/10.1148/radiol…
All patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region. Screening needed.
⚠️🔝New-Onset #IgG #Autoantibodies in Hospitalized Patients with #COVID19
» doi.org/10.1101/2021.0…
An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues.
» doi.org/10.1101/2021.0…
An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues.
⚠️🔝Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance
» academic.oup.com/eurheartj/adva…
Damage to the heart found in more than half of #COVID19 patients discharged from hospital who show raised levels of troponin.
» academic.oup.com/eurheartj/adva…
Damage to the heart found in more than half of #COVID19 patients discharged from hospital who show raised levels of troponin.
Today is #InternationalDayOfWomenInScience womeninscienceday.org Here are a small number of the many very awesome #WomenInScience, relevant to #RespEd 1/n
Marie Krogh, a Danish physician & scientist published a series of papers with her husand & collaborator, August, proving the mechanism of diffusion of oxygen across the alveolar-capillary membrane en.wikipedia.org/wiki/Marie_Kro… #RespEd #WomeninScience 2/n
Rosalind Franklin, chemist & xray crystallographer, whose work was fundamental to understanding the structure of DNA. Without this we would know almost nothing of CF, viral replication, alpha1antitryspin, lung cancer, LAM.... en.wikipedia.org/wiki/Rosalind_… #RespEd #WomeninScience
It's #tweetorial time! Read on for a #medthread on:
Cutaneous Small Vessel #vasculitis (CSVV)!
#MedEd #FOAMEd #dermtwitter #dermatology #medtwitter #rheumtwitter pc: @dermnetnz
1/
Cutaneous Small Vessel #vasculitis (CSVV)!
#MedEd #FOAMEd #dermtwitter #dermatology #medtwitter #rheumtwitter pc: @dermnetnz
1/
I've heard different ways to organize the vasculitides over the years, but by the far the most common is by vessel size. As a #dermatologist, I see the small vessel vasculitides most often, so we'll focus on that today. Yes, Takayasu's important, but I'll save that for later!
2/
2/
There is a relatively limited list of possible diagnoses with CSVV. I've included the most common below.
The blue I lump together as they are similar, and biopsy results help you differentiate.
The red are the ANCA-associated.
The green are the unique ones.
3/
The blue I lump together as they are similar, and biopsy results help you differentiate.
The red are the ANCA-associated.
The green are the unique ones.
3/
(1) Pr. Raashid Luqmani just gave today an incredible presentation about the treatment of #ANCA associated #vasculitis at #EULAR2019
(2) Pr. Raashid Luqmani just gave today an incredible presentation about the treatment of #ANCA associated #vasculitis at #EULAR2019
(3) Pr. Raashid Luqmani just gave today an incredible presentation about the treatment of #ANCA associated #vasculitis at #EULAR2019
Is glucocorticoid-free maintenance possible?
Is glucocorticoid-free maintenance possible?
