xenwan
@xenwan.bsky.social
Internal medicine/Emergency Medicine 🏥
Echocardiography 🫀
POCUS 🎛️
Echocardiography 🫀
POCUS 🎛️
Reposted by xenwan
Daily Pearl:
Postpartum heart failure is not always peripartum cardiomyopathy. Also consider thyrotoxicosis, as pregnancy can trigger or unmask Graves disease.
Postpartum heart failure is not always peripartum cardiomyopathy. Also consider thyrotoxicosis, as pregnancy can trigger or unmask Graves disease.
December 24, 2025 at 10:00 PM
Daily Pearl:
Postpartum heart failure is not always peripartum cardiomyopathy. Also consider thyrotoxicosis, as pregnancy can trigger or unmask Graves disease.
Postpartum heart failure is not always peripartum cardiomyopathy. Also consider thyrotoxicosis, as pregnancy can trigger or unmask Graves disease.
Reposted by xenwan
🦠 Tamiflu: Worth It?
📉 Reduces flu symptoms by <1 day
🤢 Nausea, vomiting, headaches common
🚫 No reduction in death or hospitalization in mild cases
So… treat everyone? Maybe not.
📖 Read more: https://wp.me/pdrP8b-5sK
👥 @emswami @marco_propersi @mramzydo
#FOAMed
📉 Reduces flu symptoms by <1 day
🤢 Nausea, vomiting, headaches common
🚫 No reduction in death or hospitalization in mild cases
So… treat everyone? Maybe not.
📖 Read more: https://wp.me/pdrP8b-5sK
👥 @emswami @marco_propersi @mramzydo
#FOAMed
December 24, 2025 at 1:03 PM
🦠 Tamiflu: Worth It?
📉 Reduces flu symptoms by <1 day
🤢 Nausea, vomiting, headaches common
🚫 No reduction in death or hospitalization in mild cases
So… treat everyone? Maybe not.
📖 Read more: https://wp.me/pdrP8b-5sK
👥 @emswami @marco_propersi @mramzydo
#FOAMed
📉 Reduces flu symptoms by <1 day
🤢 Nausea, vomiting, headaches common
🚫 No reduction in death or hospitalization in mild cases
So… treat everyone? Maybe not.
📖 Read more: https://wp.me/pdrP8b-5sK
👥 @emswami @marco_propersi @mramzydo
#FOAMed
Reposted by xenwan
Early IV→oral switch works—and safer. In the pragmatic COPAT RCT (5 hospitals), early oral therapy cut adverse events vs IV-only (3.2% vs 6.5%; HR 0.24) with equivalent efficacy. #AntimicrobialStewardship
academic.oup.com/cid/advance-...
academic.oup.com/cid/advance-...
Using the Comparing Oral versus Parenteral Antimicrobial Therapy (COPAT) Clinical Trial to Influence Institutional Practice Transformation Towards Earlier Transition to Oral Antibiotics
Early IV to oral transition improves antibiotic treatment safety across many serious infections. In a rural health system, implementation of the COPAT Tria
academic.oup.com
December 22, 2025 at 2:26 PM
Early IV→oral switch works—and safer. In the pragmatic COPAT RCT (5 hospitals), early oral therapy cut adverse events vs IV-only (3.2% vs 6.5%; HR 0.24) with equivalent efficacy. #AntimicrobialStewardship
academic.oup.com/cid/advance-...
academic.oup.com/cid/advance-...
Dette så på ekte litt artig ut da, noen som har erfaring med det? publishorperish.games
Publish or Perish: A Humorous Party Game about Academic Publish
Welcome to the chaotic life of academic publishing. In this game, you are a clueless researcher trying to do the one and only thing that matters in your academic life: churning out publications, fast....
publishorperish.games
December 23, 2025 at 7:51 AM
Reposted by xenwan
Leave-it-floxacin. Check out this week’s KASIC pearl to learn how to Pick Your Poison: Legionella Pneumonia kymdro.org/kasic/?p=8753
#IDsky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
#IDsky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
December 20, 2025 at 4:41 PM
Leave-it-floxacin. Check out this week’s KASIC pearl to learn how to Pick Your Poison: Legionella Pneumonia kymdro.org/kasic/?p=8753
#IDsky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
#IDsky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
Reposted by xenwan
The planned hepatitis B birth-dose trial in Guinea-Bissau raises serious ethical concerns. Withholding a proven, life-saving vaccine from newborns to answer speculative questions is an absence of equipoise with real downstream harms for trust in vaccines.
bktitanji.substack.com/p/how-unethi...
bktitanji.substack.com/p/how-unethi...
How Unethical Research Seeds Medical Mistrust
The absence of equipoise can turn research into harm
bktitanji.substack.com
December 18, 2025 at 9:18 PM
The planned hepatitis B birth-dose trial in Guinea-Bissau raises serious ethical concerns. Withholding a proven, life-saving vaccine from newborns to answer speculative questions is an absence of equipoise with real downstream harms for trust in vaccines.
bktitanji.substack.com/p/how-unethi...
bktitanji.substack.com/p/how-unethi...
Reposted by xenwan
Daily Pearl:
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
December 19, 2025 at 10:00 PM
Daily Pearl:
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
Reposted by xenwan
RFK Jr. should have paid more attention to the comics in 1968.
December 20, 2025 at 12:43 AM
RFK Jr. should have paid more attention to the comics in 1968.
Reposted by xenwan
This also makes the renal outcomes of tirzepatide even *more* impressive IMHO. That it was so effective at lowering the rate of poor renal outcomes & with less SGLT2i usage has me thinking it's just flat out the superior drug for diabetics at high risk for CVD and CKD.
December 18, 2025 at 1:40 AM
This also makes the renal outcomes of tirzepatide even *more* impressive IMHO. That it was so effective at lowering the rate of poor renal outcomes & with less SGLT2i usage has me thinking it's just flat out the superior drug for diabetics at high risk for CVD and CKD.
Reposted by xenwan
Don't go to bed yet! SURPASS CVOT data is officially published! I already wrote about it in my blog however there are a couple interesting nuggets in the appendix worth commenting on especially because they may have been confounders! CC: @hswapnil.medsky.social @mikejohansenmd.medsky.social
The long-awaited SURPASS-CVOT is here, just in time for the holidays #T2D #CVD #Tirzepatide www.nejm.org/doi/full/10....
Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes | NEJM
Tirzepatide, a dual incretin agonist of the glucagon-like peptide-1 and glucose-dependent
insulinotropic polypeptide receptors, has favorable effects on glycemic control and
body weight. The effect...
www.nejm.org
December 18, 2025 at 1:40 AM
Don't go to bed yet! SURPASS CVOT data is officially published! I already wrote about it in my blog however there are a couple interesting nuggets in the appendix worth commenting on especially because they may have been confounders! CC: @hswapnil.medsky.social @mikejohansenmd.medsky.social
Reposted by xenwan
Vapes, pouches, heated tobacco, shisha, cigarettes: nicotine in all forms is toxic to the heart & blood vessels
Experts call for Europe-wide action to stem new wave of youth addiction https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf1010/8377624
#EHJ #Nicotine
Experts call for Europe-wide action to stem new wave of youth addiction https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf1010/8377624
#EHJ #Nicotine
December 18, 2025 at 10:35 AM
Vapes, pouches, heated tobacco, shisha, cigarettes: nicotine in all forms is toxic to the heart & blood vessels
Experts call for Europe-wide action to stem new wave of youth addiction https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf1010/8377624
#EHJ #Nicotine
Experts call for Europe-wide action to stem new wave of youth addiction https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf1010/8377624
#EHJ #Nicotine
Reposted by xenwan
Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In the latest episode of Beyond Journal Club from @coreimpodcast.bsky.social and NEJM Group, we walk through the BALANCE trial and use it as a lens for treatment guidance. nej.md/3XNgajK
December 13, 2025 at 5:02 PM
Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In the latest episode of Beyond Journal Club from @coreimpodcast.bsky.social and NEJM Group, we walk through the BALANCE trial and use it as a lens for treatment guidance. nej.md/3XNgajK
Reposted by xenwan
End of an era, you will not be missed
December 11, 2025 at 1:49 AM
End of an era, you will not be missed
Reposted by xenwan
It took us a while to recognize euglycemic diabetic ketoacidosis (euDKA) in patients treated with Na-glucose cotransporter-2 inhibitors. It seems that we may have to be on the lookout for euDKA in patients treated with glucagon-like peptide-1 receptor agonists (#Ozempic #Zepbound)
December 2, 2025 at 10:40 PM
It took us a while to recognize euglycemic diabetic ketoacidosis (euDKA) in patients treated with Na-glucose cotransporter-2 inhibitors. It seems that we may have to be on the lookout for euDKA in patients treated with glucagon-like peptide-1 receptor agonists (#Ozempic #Zepbound)
Reposted by xenwan
NLR needs to be interpreted in clinical context
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
a close up of a man 's face with the words dr.doctor.tumblr visible in the corner
ALT: a close up of a man 's face with the words dr.doctor.tumblr visible in the corner
media.tenor.com
September 22, 2025 at 1:35 PM
NLR needs to be interpreted in clinical context
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
Reposted by xenwan
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
November 17, 2025 at 1:30 AM
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
Reposted by xenwan
New paper out! 🚀 This study presents a model combining B-mode ultrasound (BMUS) and CEUS for accurate prediction of the macrotrabecular-massive (MTM) subtype of HCC, and explores its potential to predict recurrence-free survival (RFS).
November 15, 2025 at 4:12 PM
New paper out! 🚀 This study presents a model combining B-mode ultrasound (BMUS) and CEUS for accurate prediction of the macrotrabecular-massive (MTM) subtype of HCC, and explores its potential to predict recurrence-free survival (RFS).
Reposted by xenwan
There’s now a “Google for doctors.” OpenEvidence is fast, eerily good, and sometimes confidently wrong — so still needs supervision. Here’s how it works, and how it compares to the existing 10,000 Pound Gorilla of Medical Information, UpToDate. #IDSky open.substack.com/pub/paulsaxm...
Yes, There's Now a Google for Doctors
How AI finally delivered on my colleague’s joke — and how it’s changing the way clinicians look up medical information.
open.substack.com
October 31, 2025 at 2:28 PM
There’s now a “Google for doctors.” OpenEvidence is fast, eerily good, and sometimes confidently wrong — so still needs supervision. Here’s how it works, and how it compares to the existing 10,000 Pound Gorilla of Medical Information, UpToDate. #IDSky open.substack.com/pub/paulsaxm...
Reposted by xenwan
TRUE ‼️
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
October 28, 2025 at 11:10 AM
TRUE ‼️
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
Reposted by xenwan
It feels like there has been a sea change in studies on PRBC transfusion, with newer studies often tending to favor more liberal transfusion.
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
Three recent RCTs in acute brain injury show a consistent trend favouring liberal red cell transfusion, with fewer unfavourable neurological outcomes and less cerebral ischaemia or vasospasm than restrictive thresholds. zurl.co/rtzpF
October 26, 2025 at 1:08 PM
It feels like there has been a sea change in studies on PRBC transfusion, with newer studies often tending to favor more liberal transfusion.
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
Reposted by xenwan
“Antibiotic stewardship-induced syncope. It's a new diagnosis.”
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28
October 21, 2025 at 7:02 PM
“Antibiotic stewardship-induced syncope. It's a new diagnosis.”
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28