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Prikvačeni tweet
Goals for the new year: 1. Be nicer, always 2. CHILLLLLLLLL 3. Stop taking things so personally 4. CHILLLLLLLLL 5. Convince at least one medical student that the physical exam is meaningful
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Why’s it gotta be this way First Aid?
#lungschoolpic.twitter.com/VCQ6rP2m00
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Back to the basics, VAN!
#neverforget#lungschool@EmoryDeptofMedpic.twitter.com/dU9tbFgP7J
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Ohhh boyyy first day of lung school tomorrow lettt's go!
pic.twitter.com/hcnP1E7QjaHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Things happening today that I care about, in order: 1. Palindrome Day (02022020) 2. Groundhog Day 3. Superb Owl Sunday 4. Actual Super Bowl
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Haiii everyone good evening my IRB got approved and I just submitted my book chapter for review wowww y'all I am so relieved I can't even! Time for
#TheBachelor
! #earnedit #
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To clarify, this is for large volume thora, the idea being that you don’t have to wait, are just draining to gravity, if it’s parapneumonic or there’s an incidental ptx then perfect you already have a tube in.
@laxswamy@virenkaul@GallodeMoraesMD@msiuba@medevidenceblogPrikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Liking this idea of pigtail over thora but wondering how
#pulmtwitter feels about it... @emcrit @PulmCrit @awtpulmdoc @MaldonadoFabien @OtisBRickman @Donicmehttps://podcasts.apple.com/us/podcast/emcrit-podcast-critical-care-and-resuscitation/id314020330?i=1000448589264 …Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
I used West zones in real life last night and...pic.twitter.com/Uso7AZXuHb
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20/ Alright, I hope you found this helpful, please feel free to drop questions below, and if you’re interested in learning more here is a super helpful website!
https://www.clinlabint.com/detail/clinical-laboratory/anca-iif-still-the-screening-method-of-choice/ …Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
19/ And in this case, if they do, ELISA is the next best step for differentiating PR3 vs MPO, but just remember – vasculitis isn’t the only thing that can cause a positive ANCA so BE WARY, and as always,
#clinicallycorrelate.Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
18/ SO, when you order an ANCA (and please do this wisely), remember what you’re doing. Just dumping your patient’s blood on neutrophils that have all the things of a neutrophil (and also a cell) and seeing if any antibodies stick.
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17/ These are abs to basically ANY of those neutrophilic enzymes, things like EGPA, drug-induced/associated vasculitis, Goodpasture’s, Buerger’s, CF, IBD, autoimmune hepatitis, (pre)eclampsia, subacute bacterial endocarditis, cGVHD, malaria, and even leprosy can cause +ANCAs!pic.twitter.com/9vzjg6AZro
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16/ But you MIGHT think about ordering an ANA (IF CLINICALLY INDICATED ONLY AS ALWAYS, rheumies plz don’t hate me). As if things couldn’t get worse, there is a long list of things other than just AAV (GPA/MPA) and +ANA associated diseases that can cause positive ANCAs, remember:
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15/ Well, what the heck do we do now?! Okay, either way, if you have a positive ANCA (c or p) you should do an ELISA test which will specify if it’s really PR3 or MPO. If you have a positive p-ANCA specifically, see if your lab does formalin comparison?
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14/ If it’s perinuclear on ethanol but NOT on formalin, there’s a good chance that it’s an ANCA. If it’s “perinuclear” on both, then we might have an ANA on our hands, ie it’s actually in the nucleus. DISCLAIMER: I am deffo not addressing the cytoplasmic "ANAs" right now bc…pic.twitter.com/WrEYg0Hldy
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13/ Welp, turns out, formalin fixation does NOT make things positive and cuddle up next to the negative nucleus. SO if you’re REALLY feeling savvy, what you can do is dump your patient’s blood on some ethanol-neutrophils AND some formalin-neutrophils, and see what happens!
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12/ So how do we know if these are really perinuclear or nuclear? UGH.pic.twitter.com/tySyuttpRL
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11/ While this is a great idea, it’s not always correct, and there are “in between” patterns as well, making things even more confusing. So, you’ve done your IF, and you got a positive p-ANCA using ethanol-fixation…but remember! There are antigens in the nucleus too (
#ANA)...Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
10/ PR3 is not positively charged, so it remains chillin’ in the cytoplasm, hence it’s “cytoplasmic”.pic.twitter.com/06an2aLqkr
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9/ These aren’t just ANY neutrophils on a plate, they’re “ethanol fixed” neutrophils. What this does, is make all of the positively charged proteins in the cytoplasm migrate toward the nucleus as the nucleus is negatively charged. Like MOTHS TO A FLAME, MPO becomes “perinuclear”!
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