@SultanMahmoodMD @GI_Guy @RodriguezParra_ @DrHarryThomas @TennysonMD @AustinChiangMD @KralJan @thomaskroner @alinkmd #GITwitter
1/ The implementation of screening and surveillance programs can reduce the incidence and mortality of CRC
https://t.co/P0SCUGxmne
2 / But for these to be effective and to guarantee protection against CCR, they must meet a series of conditions. One of them is the correct indication for endoscopic studies for both screening and surveillance.
3 / According to a recent meta-analysis, the minority of patients who undergo colonoscopies have a correct indication, with less than 50% adherence to the surveillance intervals proposed by scientific guidelines.
https://t.co/ysjo3zRhXb
4/ In a survey of different clinical scenarios on CRC surveillance carried out in 1432 physicians by Patel et al., Only 37% correctly answered the questions according to the recommendations (CPG9)
https://t.co/RYPlT6hKnA
5/ This revealed that the knowledge of gastroenterologists about CPG was poor. Although there are many reasons for lack of adherence, adequate knowledge of their recommendations is essential to achieve an acceptable level of adherence.
6/ Lack of adherence can manifest itself in the form of overindication as well as underindication, and both can undermine the effectiveness of a prevention program.
7/ Regarding overindication, a retrospective study of 1500 patients showed a shortening of the surveillance interval in almost 30% of the sample and up to 50% in those patients who had adenomas detected in the index colonoscopy
https://t.co/gwxKqC6euL
8/ Although colonoscopy is a safe study, it is not exempt from complications such as perforation (0.05%), bleeding (0.25%) and death (0.003%), and its overindication generates a net increase in these adverse events
https://t.co/07geSpoUA2
9/ Overuse then generates an increase in costs with marginal benefits ...
https://t.co/ZBT321p0T9
10/ ... and only contributes to the overload and subsequent fatigue of endoscopy units that must attend a higher percentage of patients under unnecessary surveillance.
https://t.co/rIo3OLKFvT
11/ Overindication can also generate a delay in screening, follow-up, or surveillance studies in patients with the correct indication, threatening the effectiveness of CRC prevention.
12/ In order to incorporate new individuals into the programs and perform colonoscopies in this naive population, unnecessary repetition of studies should be avoided, the overuse of the practice should be minimized ...
13/ ... and put more energy into also identifying people at increased risk of CRC who have not yet performed screening procedures.
4/ On the other hand, underindication also carries significant risks, since we can delay the control of patients at high risk of developing metachronous lesions and cancer
15/ A longitudinal cohort study showed that 76% of deaths from CRC were due to failures in the indication of screening and surveillance studies, and that patients with delays in surveillance studies …
16/ .... showed up to 7 times increase the risk of developing CRC
https://t.co/JI4yU3NTbl
17/ For all the aforementioned, the adequate indication for colonoscopic surveillance is considered a quality marker of endoscopy units and represents a key element in achieving an effective prevention program.
https://t.co/90wfYZYUns
That's all folks!

More from Health

1/16
Why do B12 and folate deficiencies lead to HUGE red blood cells?

And, if the issue is DNA synthesis, why are red blood cells (which don't have DNA) the key cell line affected?

For answers, we'll have to go back a few billion years.


2/
RNA came first. Then, ~3-4 billion years ago, DNA emerged.

Among their differences:
🔹RNA contains uracil
🔹DNA contains thymine

But why does DNA contains thymine (T) instead of uracil (U)?

https://t.co/XlxT6cLLXg


3/
🔑Cytosine (C) can undergo spontaneous deamination to uracil (U).

In the RNA world, this meant that U could appear intensionally or unintentionally. This is clearly problematic. How can you repair RNA when you can't tell if something is an error?

https://t.co/bIZGviHBUc


4/
DNA's use of T instead of U means that spontaneous C → U deamination can be corrected without worry that an intentional U is being removed.

DNA requires greater stability than RNA so the transition to a thymine-based structure was beneficial.

https://t.co/bIZGviHBUc


5/
Let's return to megaloblastic anemia secondary to B12 or folate deficiency.

When either is severely deficient deoxythymidine monophosphate (dTMP*) production is hindered. With less dTMP, DNA synthesis is abnormal.

[*Note: thymine is the base in dTMP]

https://t.co/AnDUtKkbZh
No-regret #hydrogen:
Charting early steps for H₂ infrastructure in Europe.

👉Summary of conclusions of a new study by @AgoraEW @AFRY_global @Ma_Deutsch @gnievchenko (1/17)
https://t.co/YA50FA57Em


The idea behind this study is that future hydrogen demand is highly uncertain and we don’t want to spend tens of billions of euros to repurpose a network which won’t be needed. For instance, hydrogen in ground transport is a hotly debated topic
https://t.co/RlnqDYVzpr (2/17)

Similar things can be said about heat. 40% of today’s industrial natural gas use in the EU goes to heat below 100°C and therefore is within range of electric heat pumps – whose performance factors far exceed 100%. (3/17)


Even for higher temperatures, a range of power-to-heat (PtH) options can be more energy-efficient than hydrogen and should be considered first. Available PtH technologies can cover all temperature levels needed in industrial production (e.g. electric arc furnace: 3500°C). (4/17)


In our view, hydrogen use for feedstock and chemical reactions is the only inescapable source of industrial hydrogen demand in Europe that does not lend itself to electrification. Examples include ammonia, steel, and petrochemical industries. (5/17)
I think @SamAdlerBell in his quest to be the contrarian on Fauci gets several things wrong here. 1/


First, the failure last year actually was driven by the White House, the #Trump inner circle. Watch what's happening now, the US' scientific and public health infrastructure is creaking back to life. 2/

I think Sam underestimates the decimation of many of our health agencies over the past four years and the establishment of ideological control over them during the pandemic. 3/

I also am puzzled why Tony gets the blame for not speaking up, etc. Robert Redfield, Brett Giroir, Deb Birx, Jerome Adams, Alex Azar all could have done the same. 4/

Several of these people Bob Redfield, Brett Giroir, Alex Azar were led by craven ambition, Jerome Adams by cowardice, but I do think Deb Birx and Tony tried as institutionalists, insiders to make a difference. 5/

You May Also Like