We wrote a thing!
Arbitrary discharge time doesn't really help hospital flow. As with all things in medicine, it's just more complicated than that.

Things We Do for No Reason™: Discharge before noon - Dunn - Journal of Hospital Medicine - …mpublications.onlinelibrary.wiley.com/doi/10.1002/jh…

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Ever wonder: Why are abdominal aortic aneurysms (AAAs) more common than thoracic aortic aneurysms (TAAs)?

I have!

Follow this thread to see how the answer to this question makes use of long-forgotten medical classes. And there’ll be an appearance by The Great Mimicker.

⁦Joe Thomas, MD⁩ ⁦Tony Breu⁩ ⁦Adam Rodman⁩ ⁦Shreya P. Trivedi MD, MHPE⁩ journals.lww.com/academicmedici…

And take a look at how many of the sodiums were above 120

13 out of 15 cases

Also note that only 2 patients had rapid correction of sodium😳

Malnutrition, hypokalemia, and alcohol continue to represent as they do in every study. 4/4

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Amazingly, blood vessels express different pathogen-sensing toll-like receptors (TLRs) and therefore respond differently.

Vessels located around the gut may be primed to deal with different pathogens than those around the head. How cool is that!

ncbi.nlm.nih.gov/pubmed/18765390

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Why does giant cell arteritis (GCA) have a predilection for the temporal artery?

There are many medium/large-sized vessels in the body, and yet GCA hones in on early branches of the aorta.

As you might guess, I think the answer is pretty cool...

For decades, the use of β-blockers in heart failure was contraindicated.

Then, Finn Waagstein made a bold move, successfully treating a single patient. Thus began a miraculous 180.

To read the full story, see my latest post on Origin Stories.

open.substack.com/pub/tonybreu/p…

1/16
How does diabetes mellitus (DM) lead to an increased risk of infection?

I'll often hear this referenced on rounds or in morning report, but I don't recall having heard the mechanism.

As you might guess, there are many potential explanations; let's look at one of them...

Excellent Tweetorial by Tony Breu describing #SGLT2i effects on ameliorating anemia

Curiously, similar observations w #ARNI sacubitril/vasartan in #PARADIGMHF

Might many effective HF therapies reduce hepcidin & improve systemic iron utilization?

sciencedirect.com/science/articl…

👇🏾

Excellent tweetorial from Tony Breu on hemoglobin change after sglt2i initiation!

We were recently able to show this exact phenomenon in patients with T2DM using nationwide data pubmed.ncbi.nlm.nih.gov/38594550/

Tor Biering-Sørensen, MD, MSc, MPH, PhD Michael Fralick Manan Pareek, MD, PhD, FAHA, FESC

1/12 - Mystery #1

You are seeing a patient recently diagnosed with heart failure and started on GDMT. You notice that their hemoglobin (HGB) has increased (12 → 13 g/dL) in the intervening weeks.

🤔Which medication is the likely cause of this increase in HGB?

1/15
Why are statins administered at night?

In this tweetorial I'll discuss the mechanistic and historical reasons for the frequently used QHS dosing schedule. And why it's often unnecessary.

But before we get there, I'm curious: when do you prescribe/order/take statins?

I think the proposed answer to this question is surprising people.

1/14
How does fever help us fight infections?

For millennia, fever has been recognized as a beneficial response to invading pathogens.

If this is so, why don't we have a resting temperature of 102°F (38.9°C)? Wouldn't that protect us even better?

Let's have a look.

I've updated my list of tweetorials again. Have a look!

docs.google.com/spreadsheets/d…

Here is an updated list of my tweetorials.

docs.google.com/spreadsheets/d…