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_

More from Health

Adam Wagner
Adam Wagner
@AdamWagner1
🚨Important changes to lockdown/self-isolation regulations from 5pm

The Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

£800 'house party' FPN & police can now access track & trace data

https://t.co/k9XCpVsXhC


“Large gathering offence”

As trailed by Home Secretary last week there is now a fixed penalty notice of £800 (or £400 if you pay within 14 days) for participating in an gathering of over 15 people in a private residence


Fixed Penalty Notices double for each subsequent “large gathering offence” up to £6,400

Compare:
- Ordinary fixed penalty notice is £200 or £100 if paid in 14 days
- Holding or being involved in the holding of a gathering of over 30 people is £10,000


Second big change:

Since September has been a legal requirement to sell-isolate if you test positive/notified by Track & Trace of exposure to someone else who tested positive

Police can now be given access to NHS Track & Trace data if for the purpose of enforcement/prosecution


This will make it easier for police to enforce people breaking self-isolation rules. Currently there has been practically no enforcement.

Data says only a small proportion of people meant to be self-isolating are fully doing so.
HEALTH
Aureliano Stingi
Aureliano Stingi
@AurelianoStingi
Controversial 3D. Probably none of you knows about Leber congenital amaurosis type 10, congenital blindness that affects 3 out of 100,000 children, condemning them to blindness for life. The only possible treatment is through gene therapy. 1/n


Thanks to Crispr-CAS9 technology we MODIFY the defective gene inside the patient eye ( they directly inject the treatment into the eye). Before CRISPR the treatment was based on Adenovirus carrying the correct form of the gene

In both cases, we MODIFY the patient DNA and that's the only way (today) to treat this disease. LCA10 is not the only genetic disease affecting kids unfortunately the list is long and the variety of diseases is terrifying.

Now think about a parent with a kid with a genetic disease, he/she would try and do anything to save him/her. ANYTHING and they would take some RISKS, gene therapy was a risk at the beginning, and any new experimental treatment shares a percentage of risk. 4/n

Now we come to #COVID19 and #vaccines. The new RNA vaccines are a HUGE scientific breakthrough, that may open new amazing therapeutic paths. And like ANY other human activity share a risk.
HEALTH
Advertisement
Ary Serpa Neto
Ary Serpa Neto
@a_serpaneto
The #RELAx trial has been published today in @JAMA. It was coordinated by Anna Algera. This thread is to explain the rationale, what we did, the findings and the meaning.
The rationale of #RELAx is based on the following

First, there is NO adequate evidence on the level of PEEP in non-ARDS patients. Most of the studies are old, conducted in post-surgical patients (short-term ventilation), and were not powered to detect differences in patient-centered

Second, despite the absence of evidence, the levels of PEEP used in non-ARDS patients increased over years, from 5 to 7/8 cmH2O, probably as a reflection of studies and practice in ARDS

Third, one IPDM showed that higher levels of PEEP could benefit more severe ARDS patients. However, opposite trends (higher mortality and longer ventilation) were found in mild ARDS with higher PEEP (despite not powered to be statistically

Fourth, most of the weaning protocols include PEEP ≤ 5 cmH2O as a criterion for readiness to wean. Theoretically, a standardized liberal strategy of higher PEEP could delay weaning in some
HEALTH
Pete Wharmby
Pete Wharmby
@commaficionado
Autistic behaviours that are generally discriminated against, despite being harmless and just how we are.

A thread🧵

1. Stimming - repetitive physical movement to help regulate our stress levels. They feel nice and are really helpful but people seem to hate to see it. #autism

2. No eye contact. We generally find this too intimate and intense, and will avoid. It can even cause pain if forced. But people don't trust us even though we inform them we're autistic. #autism

3. Sitting in 'odd' positions. We're often very bendable - remember Ehlers-Danlos syndrome is a common comorbidity - and loads of feel more comfortable in slightly contorted positions. People always comment 'you can't be comfy like that'.

Yes. Yes I can. #autism

4. Stammering when excited. We can get so passionate about some subjects that we struggle to get the words out as they all get caught in the annoying bottleneck of actually having to leave our mouths. But it irritates people, makes them assume we're somehow lesser. #autism
HEALTH
Momentswithbren Consulting
Momentswithbren Consul...
@MomentsWB
Pathways to Public Policy Careers for those interested and looking for global opportunities

Public policy is made when a governing body attempts to address an issue of widespread public concern, such as health care. The process often runs in cycles and can take years.

■After new laws are created, Policy Implementation occurs, often involving federal agencies, state and local governments, bureaucratic entities, and NGOs. Courts get involved as laws and policies are challenged on a variety of fronts.

■Analysis and Evaluation occurs throughout the cycle and involves many players. Policies may be changed — and the cycle begins again.

What is the best advice for someone pursuing a career in public policy?

People often find their way to public policy careers because of an

interest in a particular substantive area. Public policy work can be found in virtually any subject area.

Your ears should perk up when you hear the words “Center for,” “Institute,” “Association,” and “Foundation” because they represent potential employers.

Public policy majors work in the public, private, and nonprofit sectors, such as a government agency or advocacy group.

Continuing education, such as a certification or fellowship, can also advance your career as someone interested in public policy and politics.
HEALTH

You May Also Like

Jaya_Upadhyaya
Jaya_Upadhyaya
@Jayalko1
SRI LALITHAMBIGAI, THIRUMEYACHUR (TN)
#bharatmandir #navratri2021

Kshetram where Shiva is worshipped as Meghanatha and his consort is Lalithambigai seen in Abhay mudra.
Once, a demon Pandasura was harassing the Devas who went to Devi Parashakti for protection. 
@GunduHuDuGa


Devi rose from a Yaga Gunda, mounted on the Sri Chakra Rath with the name Lalithambika, waged a war against Pandasura and destroyed him.  When her fury did not subside, Shiva asked her to go to Earth, assume the name Manonmani, perform penance and shed her fury.


Shiva blessed Devi to be Shanta nayagi. There is a sculpture here depicting Shiva pacifying Devi. If you observe closely, you can see that from your left hand side there will be a smile on Her face and if you see from your right hand side you can see anger in Her face.


Hayagriva taught the greatness of Lalitha Sahasranama to Rishi Agasthya. Pleased with his devotion, Ma Lalithambikai appeared before Agastya. He is believed to have then sung Lalita Navaratnamala in praise of Devi. He has also composed a hymn named Rahasyanamasahasram.
ALL
Anu Satheesh \U0001f1ee\U0001f1f3
Anu Satheesh 🇮🇳...
@AnuSatheesh5
Thirumalai Murugan Kovil
#Panpoli
#TamilNaduTemples 🚩

Thirumalai Murugan Temple is located in Tenkasi district of Tamil Nadu. Muruga is worshipped as Thirumalai kumarasamy. Temple is situated near Kerala border and known to be where Shri Murugan gave darshan to Rishi Agasthiar


Devi is worshipped in the temple as Thirumalai Kaali amman

Sthala Puranam says that, there was a priest named Poovanbhattar of Thirumalai Kaali amman. Murugar appeared in a dream of the bhattar and said to find a Vigraham, lying in particular place which is of Thirumalaikumaran


Bhattar conveyed the news to the Pandalam Raja and they went to find out the vigraham. Surprisingly ants showed the way to find the Vigraham. Thus Murugan vigraham was found and Prathista was done here. There is a lake with pure water on the top of the hill


which is said to be created by Agasthiyar. It is believed that kannaki of
Chilapathikaram visited here before going to Kerala. Sapthamathrukkal also worshipped Murugan here. Kanthashashti Thiruvizha is very famous here.

Om Muruga
Muruganukku Harohara
🙏🕉🙏
ALL
Advertisement
foone
foone
@Foone
So I was talking to @gewt about Job: A Comedy of Justice and I came up with a theory that I think explains why Heinlein's late-period work is so kinda-terrible and why I still enjoy it so much


So Heinlein had always been very interesting in the short parts of his novels, like the little snippets inside chapters. He had a very fun writing style, and wrote some fun dialogue with fun characters, right?>
It probably comes from how much of his early stuff was short fiction

And I think what happened with a lot of his longer works is that he'd just start writing fun bits and hope it would end up going somewhere or having a bigger plot by the end. like eventually he'd figure out where this was going, then go back and rewrite it into a cohesive whole

and I'm sure he had editors that'd help this process. No editor would let you publish something as rambly and changing-gears-every-other-chapter as The Number Of The Beast, for example... unless you were God-King Of Science Fiction 1980s Robert Heinlein.

so basically I think what happened is that by the 80s (when he was in his seventies!!) he lost the drive to go back and rewrite and he was too Untouchable for editors to make him.
CULTURE
Anu Satheesh \U0001f1ee\U0001f1f3
Anu Satheesh 🇮🇳...
@AnuSatheesh5
Bhoga Lakshmi Narasimha Swamy Temple
#Devarayanadurga
#Karnatakatemples 🚩

Bhoga Yoga Narasimha Swamy Temple, Devarayanadurga is located near Tumkur of Karnataka. There are two temples are here for Narasimha Swamy, one is at the base of the hill which is Bhoga Narasimhar and 👇


the other on the top of  hill which is Yoga Narasimhar.

Bhoga Narasimha swamy Temple Prathista is said to be done by Maharshi Durvasa who did tapasya here. While doing tapasya Muni wished to bath in river Ganga and decided to travel to Ganga river bank,


At that time Ganga Devi appeared here and said she will remain here in the temple pond.

Yoga Narasimha swamy Prathista is believed to be done by Bhrama Deva who did tapasya here for many years.


Narasimhar appeared with Lakshmi Devi here to give darshan to Bhrama Deva here.

उग्रं वीरं महाविष्णुं ज्वलन्तं सर्वतोमुखम्।
नृसिंहं भीषणं भद्रं मृत्युमृत्युं नमाम्यहम् ॥

Om Shri Narasimha Murthaye Namah
🙏🕉🙏
ALL
Simon DeDeo
Simon DeDeo
@SimonDeDeo
Donna Strickland, one of this year's Nobel Laureates, was not considered "notable enough" for Wikipedia as late as this May—reported by a number of sites, including the Independent. I dug into this a little. Here's the data—


This is the first deletion, back in 2014. A bit hard to read between the lines, but the basic story that an admin had Stickland's page "speedy deleted"—i.e., deleted without debate. The method was something called Copyright Jujitsu.

In particular, the admin had the page deleted not because of notability, but because it included a photograph of Strickland that had ambiguous copyright status. This is a method that people developed to get rid of content they didn't want, but also didn't want to debate.

"Copyright Jujitsu" because it is usually used against spam from companies; a PR officer uploads promotional material to Wikipedia. Instead of debating whether it's neutral, the admin can say "we'd love to have it, but the material appears to violate your company's copyright".

Usually the PR office and the IP office are separate in a company, and the idea of releasing promotional material under public domain is such a legal nightmare that the PR person goes away.
ALL