For the first time ever in my life, I actually did something that I'm very proud of.
I always wanted to make a difference. And now I just helped send medicine for 50 children in Africa.
Destiny fulfilled! @foodforhungryFH
What a start for a new new year? It just fe...
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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/
— Matthew Yglesias (@mattyglesias) January 30, 2021
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/
1/15
Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial
2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR
3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp
4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR
5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY
Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial
2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR
3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp
4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR
5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY
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Keep dwelling on this:
Further Examination of the Motif near PRRA Reveals Close Structural Similarity to the SEB Superantigen as well as Sequence Similarities to Neurotoxins and a Viral SAg.
The insertion PRRA together with 7 sequentially preceding residues & succeeding R685 (conserved in β-CoVs) form a motif, Y674QTQTNSPRRAR685, homologous to those of neurotoxins from Ophiophagus (cobra) and Bungarus genera, as well as neurotoxin-like regions from three RABV strains
(20) (Fig. 2D). We further noticed that the same segment bears close similarity to the HIV-1 glycoprotein gp120 SAg motif F164 to V174.
https://t.co/EwwJOSa8RK
In (B), the segment S680PPRAR685 including the PRRA insert and highly conserved cleavage site *R685* is shown in van der Waals representation (black labels) and nearby CDR residues of the TCRVβ domain are labeled in blue/white
https://t.co/BsY8BAIzDa
Sequence Identity %
https://t.co/BsY8BAIzDa
Y674 - QTQTNSPRRA - R685
Similar to neurotoxins from Ophiophagus (cobra) & Bungarus genera & neurotoxin-like regions from three RABV strains
T678 - NSPRRA- R685
Superantigenic core, consistently aligned against bacterial or viral SAgs
Further Examination of the Motif near PRRA Reveals Close Structural Similarity to the SEB Superantigen as well as Sequence Similarities to Neurotoxins and a Viral SAg.
The insertion PRRA together with 7 sequentially preceding residues & succeeding R685 (conserved in β-CoVs) form a motif, Y674QTQTNSPRRAR685, homologous to those of neurotoxins from Ophiophagus (cobra) and Bungarus genera, as well as neurotoxin-like regions from three RABV strains
(20) (Fig. 2D). We further noticed that the same segment bears close similarity to the HIV-1 glycoprotein gp120 SAg motif F164 to V174.
https://t.co/EwwJOSa8RK
In (B), the segment S680PPRAR685 including the PRRA insert and highly conserved cleavage site *R685* is shown in van der Waals representation (black labels) and nearby CDR residues of the TCRVβ domain are labeled in blue/white
https://t.co/BsY8BAIzDa
Sequence Identity %
https://t.co/BsY8BAIzDa
Y674 - QTQTNSPRRA - R685
Similar to neurotoxins from Ophiophagus (cobra) & Bungarus genera & neurotoxin-like regions from three RABV strains
T678 - NSPRRA- R685
Superantigenic core, consistently aligned against bacterial or viral SAgs