BC HEALTH
Saved by @CodyyyGardner

Cross-sectional imaging often reveals unexpected pancreatic cystic lesions, it is a frequent clinical problem, Should we observe or remove it? What's the diagnosis? Is our patient in danger of malignancy?
Don’t miss this @aegastro @my_ueg #EducAEG #UEGambassador twitter thread

 Importance of Pancreatic Cystic Neoplasms (PCN):
Most are asymptomatic at diagnosis, frequency increases with age
Symptoms: acute pancreatitis (Wirsung obstructed by the cyst or mucus), pain, obstructive chronic pancreatitis, jaundice
> symptoms, >malignancy risk!
Classification of PCN:
Mucinous: intraductal papillary mucinous neop. and mucinous cystic neop.
Nonmucinous: serous cystic neoplasm, solid pseudopapillary neoplasm and cystic neuroendocrine tumours
Endoderm- derived columnar epithelium is characteristic for mucinous lesions
👇
Intraductal papillary mucinous neoplasms (IPMN)
Characterized by papillary proliferation+mucus production. It may involve Wirsung (becomes dilated) and/or branch ducts (cysts connected to the ductal system). It may evolve to pancreatic cancer particularly if Wirsung is involved
IPMN subtypes :
Intestinal: main duct, head, 40%->coloid/tubular adenoca
Pancreatobiliary: main duct,head, 68%->tubular adenoca
Oncocytic: rare, nodules,50%-> coloid/tubular adenoca
Gastric: most frequent, branch-type, uncinate, 10%->tubular adenoca
https://t.co/CyvfrBGrXZ
IPMN: risk factors for malignancy
Main duct involvement (60% in resected specimens vs 10 to 30% in resected side branch IPMNs), specially>1cm
Contrast-enhanced mural nodules
Size>3-4cm
Symptoms
Pts at risk of PDAC even in other regions of the gland without involvement
👇👇👇
Intraductal papillary mucinous neoplasms -> management: follow these guidelines:
European guidelines 2018 @Gut_BMJ @chiaro_del @MarcBesselink https://t.co/x8waod12xr
Fukuoka 2017 @pancreatology@SalviaRobi https://t.co/PaEYljt5N9
Mucinous Cystic Neoplasms (MCN)
Characterized by mucinous epithelium and ovarian-type stroma, in body/tail
It is described as macrocystic, septated cyst with small number of cavities, it may have eccentric calcifications, no connection to ductal system
95% women, 5-7th decades
MCN:
>risk malignancy:
≥5cm
Nodules/mass
Thickened/irregular Wall
Calcifications
Management of MCN according to the European guidelines: a conservative approach is recommended for asymptomatic MCN measuring <40 mm without an enhancing nodule
https://t.co/x8waod12xr
@chiaro_del @MarcBesselink @Gut_BMJ
Serous cystic neoplasm (SCN). Cuboidal epithelium without dysplasia
70% women, 5-7th decades, NON-MUCINOUS solitary lesion
Classic SCN is microcystic (multiple small cysts, honeycomb-like) but can be macrocystic or solid. A central scar or calcification can be present
SCN management: remove only if symptoms, for example this case from @Dhgua, the patient had jaundice due to a a massive SCN, a Whipple procedure was performed
Cystic neuroendocrine tumor
It is a pancreatic NET with a central cystic changes. Solitary lesion, 5-6th decades, frequently with wall contrast enhancement, 10% malignant potential
Cystic neuroendocrine tumor management: asymptomatic and <2 cm you may follow the patient https://t.co/8EhhAet35T
It seems that these cystic NET are less aggressive than solid NET
Finally,solid pseudopapillary neoplasm
They have malignant potential(15%), >risk if >5 cm
Young women=90% (2-3rd decades),body/tail.Solid and cystic solitary masses, calcifications,often with intracystic bleeding.They can spread to the peritoneum or distant organs like the liver
This twitter thread was based on:
https://t.co/dAuGI0qzLK
https://t.co/x8waod12xr
https://t.co/Ywp7zQF2wE
And Pancreatic cystic neoplasms, several articles from @UpToDate Editors: JR Saltzman S Grover Authors: Asif Khalid, MDKevin McGrath, MD https://t.co/nYN3MKTnl8
If you liked this twitter thread, please retweet the first tweet and follow me! #PancreasTwitter

I hope you enjoyed it, it took me a lot of effort to do this! 😅
@drdalbir @BilalMohammadMD @KralJan @drkeithsiau @MZorniak @DCharabaty @RashidLui @SunilAminMD @SanchezLunaMD @stevenbollipo @Samir_Grover @RishadJkhan @drmoutaz @RodriguezParra_

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@tony_breu
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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
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Can any MP ask the government why early treatment kits to stop viral replication & infection are not made available cheaply & prescription free in pharmacies as they are in India? Is it lives we want to save or is it Big Pharma profits? Because the two are mutually exclusive.


There could even be competing kits, & the decision which to take could be left to doctors & patients, as happens with most medicines. The problem is that there is not one of these kits available cheaply & prescription free anywhere in the West.

Doxycycline, Ivermectin, Azithromycin, Hydroxychloroquine, Zinc, Vitamin D, Vitamin C, omega-3s, all approved as safe drugs decades ago. This is clearly not an issue of safety. It should be left to a doctor's experience & judgement whether they are effective or not, not academia.

A GP could simply state on his website: of all the kits I recommend Kit Z, then Kit Y etc. No need to wait hours for consultations, as soon as the symptoms are clear the self administered treatment begins, and thousands of lives are saved, as well as hospitals remain underwhelmed

There is no need to go to ER or ICU if people can buy early treatment kits from pharmacies. There is no need for any hospital to be overwhelmed. This problem could be resolved in days. There is simply no political will to save lives as it means to go against Big Pharma profits.
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12 things you should look out for before buying health insurance

A thread 🧵

It’s a good idea to make sure your health is protected under an insurance policy so that you don’t shell out large sums of money for hospitalization and treatment. But buying an individual health insurance policy can be daunting in itself.

Websites and policy documents can be overwhelming. There’s a lot of loaded terms, there’s a whole bunch of things that your policy may or may not cover. It’s important to know and understand the details though, so you’re not surprised later.

In this thread, we'll talk about the things you absolutely need to watch out for when buying an individual health insurance policy for yourself or your family members :)

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Southern Anti-Racist | Abolition Now
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While #Tulane school of medicine is rightfully being exposed for its contemporary racism towards faculty, staff, students (and patients) due to the racist firing of Dr. Princess Dennar, it’s important to call out the deeply anti-Black history of this school, specifically... 1/

The way #Tulane became a private institution (originally was a public university) at the end of Reconstruction to avoid having to desegregate. The school charter says it was founded for “white men” only... but there’s more (much more) to this story... 2/

cw: medical racism

Tulane’s school of medicine rose to national prominence for its collection of human “specimens” in their anatomy museum “rivaled only by Harvard”. How did it acquire these “specimens” you might ask?

The collection was “curated” by a Dr. Edward Souchon... 3/

Dr. Souchon was mentored by the late James Marion Sims, the “father of modern gynecology”, who himself had started collecting body parts, organs, and skeletal remains from enslaved Black people during slavery. Souchon continued “curating” his own collection in horrific ways. 4/

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Nyx
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Ashtangha Yoga or the eight limbs of Yoga-


Many people think Yoga is just an Indian physical exercise but that's wrong. Yoga is a way to connect with the Supreme in Hinduism and attain Moksha(liberation).
The proper yoga as described in Hindu scriptures consists of 8 limbs:

1) Yamas- They are the 5 ethical rules of Hinduism. The 5 Yamas are:
i) Ahimsa: Nonviolence (this also includes not eating meat)
ii) Satya: truthfulness
iii) Asteya: non-stealing
iv) Brahmacharya: chastity, sexual restraint
v) Aparigraha: non-avarice, non-possessiveness

2) Niyamas- They are the 5 "do's". The five Niyamas are:
i) Shaucha: purity of mind, speech and body
ii) Santosha: contentment
iii) Tapas: austerity, self-discipline
iv) Svadhyaya: study of Vedas(Holy books of Hindus)
v) Ishvarapranidhana: contemplation of the Ishvara (God)

3) Aasana or the physical yoga-
Asana is a posture that one can hold for a period of time, staying relaxed, steady, comfortable and motionless. The aasana postures are believed to have been given by Mahadeva (Hindu God) himself. Hatha Yoga Pradipika mentions 84 aasanas.
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We're basically fucked.

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“We don’t negotiate salaries” is a negotiation tactic.

Always. No, your company is not an exception.

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Listen to Aditya


And by the way, you should never be worried that an offer would be withdrawn if you politely negotiate.

I have seen this happen *extremely* rarely, mostly to women, and anyway is a giant red flag. It suggests you probably didn’t want to work there.

You wish there was no negotiating so it would all be more fair? I feel you, but it’s not happening.

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