paul evan bunce, md

A great and informative discussion of peer review. I have too many opinions to go into depth here.

My general solution is to better value, in all senses, both peer and editorial review. If peer review was formally counted as work by an academic that might encourage more engagement.

Statin use in people with HIV Despite advancements in treatment and HIV viral suppression, people with HIV experience a risk of myocardial infarction that is 1.73 times higher than in people without HIV.[1][1] Believed to be in pa...

statin use in PLWHIV, a routine question in outpatient HIV care.

this brief review covers the key points (rationale + recommendations).

IMO, starting a statin in all PLWHIV should be a shared decision, not just for those at moderate CV risk.

www.cmaj.ca/content/197/...

#idsky @cmaj.ca

turns out what The Host Response really needed to make it great was... a new host (well, guest host).

brooke fraser joins the show as we dig into a few topics on the teaching and practice of ID.

pretty sure we’ll be making a habit of this type of episode.

of the many reasons patients with pneumonia fail to improve, the one i encounter most often is a complicated parapneumonic effusion.

easy to overlook but important to catch.

(and trust me, you need to look at the CT with your own eyes to appreciate them)

YouTube video by FirstcallID FirstcallID - How to do an Infectious Diseases Consultation: Non-Resolving Pneumonia

New FirstcallID Teaching Video 🎥

Approach Non-Resolving Pneumonia 🫁

A practical framework for ID consultations; covering history, exposures, investigations, and when to consider further interventions.

Watch now(and share often)!

#InfectiousDiseases #MedEd #AntibioticStewardship #idsky

i'll admit that i fall back on this strategy routinely.

the "mulligan", when thoughtfully deployed, is a helpful way to manage cases where you aren't sure where to turn next.

the art is knowing when best to take this approach, but the timing (and optics) need to be weighed carefully.

i really enjoyed this discussion with nick daneman and rob fowler on the #Communicable & #Breakpoints podcasts, where the lead investigators break down the journey of the BALANCE trial.

the story behind this epic study is almost as compelling as the results.

YouTube video by FirstcallID FirstcallID - How to do an Infectious Diseases Consultation: Gram-negative Bacilli Bacteremia

Gram-neg bacteremia is common, important, and often the reason ID is called.

It's not just about picking an antibiotic, but also asking why it happened, and what else to do?

This FCID session reviews an approach to the patient with GNB bacteremia.

#MedEd #InfectiousDiseases #FOAMed #idsky

as a hospital based internist, i find my physical exam skills are elite.

mind you, i’ve usually reviewed the blood work and imaging prior to seeing the patient.

having been on both sides, i wanted to highlight this dynamic and ways to improve the sync between trainee and attending.

in hindsight, i think this one may speak more to staff than trainees…

interesting. i was halfway through it but lost track with other life stuff.
i will pick it up again.

job posting: clinician scientist in infectious diseases at UofT (UHN/Sinai Health), with a focus on TB research.

it’s a great academic environment, full of supportive colleagues, engaged learners, and all the energy of toronto.

spread the word!

#idsky #clinicianscientist #tuberculosis

as a longtime proponent of calculating or noting the anion gap, this case was fascinating.

it also puts my personal record for “lowest AG” to shame.

if of interest, this case of Li toxicity includes summary of causes of a negative AG.

www.cmaj.ca/content/176/...

ICYMI - FirstCallID is a growing collection of free, focused ID teaching videos made for rounds, clinics, and learners at all levels.

🌐 Website: www.firstcallid.ca
📺 YouTube: www.youtube.com/@FirstcallID
🎧 The Host Response podcast also available via Apple/Spotify

Use it, share it, teach with it.

115. The Yeasts: PCP/Pneumocytis jirovecii - ID:IOTS - Infectious Disease Insight Of Two Specialists Listen to this Pretty Comprehensive Pod on PCP. Alyssa and Callum cover:EpidemiologyTaxonomy (PCP vs PJP?)Diagnosis TreatmentNote this pod episode also includes some Positively Jolly Puns on...

call it PCP - you might come across as a relic

call it PJP - you may seem cleverish

either way, don't call it PCP-pneumonia or PJP-pneumonia - you will come across as redundant redundant

this @idiots-pod.bsky.social is a great review of the clinical aspects of pneumocystis infections.

#idsky

i am thinking of “the lives of others”(2006).

“people who tell the truth can re-formulate things, and they do. a liar has prepared sentences, which he falls back on when under pressure.”

“the truth is in the details. a liar’s story is too consistent.”

congrats to drs. hugh huang and manreet dhaliwal, coauthors on this brief cmaj review.

the result of much thought, effort, and fine-tuning.

we hope it's helpful to clinicians.

#idsky

Ten Practical Tips for A Successful Presentation at Infectious Diseases Clinical Case Conference Abstract. This mini review provides ten practical tips for Infectious Disease (ID) trainees presenting at ID Clinical Case Conferences. These tips, grounde

this is so good! i'd like to staple this article (and graphic) to the wall in every ID trainees' room.

these tips for ID case presentations are useful, easy to enact, and high value.

nice work @takamatsuo-id.bsky.social et al.

#meded #idsky

academic.oup.com/ofid/advance...

Eosinophilia — The Intern at Work Written by: Dr. Shreyash Dalmia (Hematology Fellow) Reviewed by: Dr. Siraj Mithoowani (Hematology & Thrombosis) & Dr. John Neary (General Internal Medicine) Infographic by: Lily Yu (Medical...

a classic ID consult: unexplained eosinophilia.

i fall back on my usual diagnostic framework:
- infectious
- inflammatory
- malignant
... 🤔

(in this case drugs, primary heme, endocrine, etc.)

Great review + infographic via The Intern at Work:
🔗 www.theinternatwork.com/infographics...

98. Meningitis Masterclass - ID:IOTS - Infectious Disease Insight Of Two Specialists Jame and Callum are joined by Dr Fiona McGill, lead author of the 2016 Joint Specialist Societies Meningitis Guidelines.Listen to hear an overview of the epidemiology, presentation, diagnosis and mana...

for incoming internal medicine trainees, i would suggest this @idiots-pod.bsky.social episode on meningitis:

idiotspodcasting.buzzsprout.com/1782416/epis...

it is comprehensive, clear, evidence-based, and palatable.

i have respect for clinicians who sit with “box 2” — getting better, diagnosis unknown — without rushing to claim credit. it takes humility to accept improvement you can’t fully explain.

“despite our efforts, the patient recovered…”

got my first recombinant shingles vax—partly for the benefits (less shingles, maybe less dementia), partly to experience what i recommend

12h: sore arm, subjective fever
24h: back to baseline

boldly following the footsteps of marshall, kean, carrion…

is there a nobel prize coming my way?

#idsky

122: StAR: Protect the Macrolide! NTM Pulmonary Disease Quickly and easily listen to Febrile for free!

Protect the Macrolide!™

this @febrilepodcast.com episode is an excellent overview of commonly faced dilemmas in NTM treatment—concise, practical, and clinically relevant. excellent discussants as well.

player.captivate.fm/episode/ad81...

#idsky #NTM #meded #pulmsky

having just recorded/released a teaching video on HIV that highlighted these OI guidelines as an invaluable resource - i was saddened to see this shared by dr. sax. the potential loss of this living, practical, evidence-based tool is a huge step backward
grateful to those who built and maintained it

Measles in pregnancy [See related editorial at www.cmaj.ca/lookup/doi/10.1503/cmaj.250820][1] Pregnant people with measles are at higher risk of pneumonia, hepatitis, and hospitalization and have a 10-fold higher risk of...

an unfortunate issue that we can expect to see more frequently - measles during pregnancy.

this is a great summary of the condition and patient management.

@cmaj

#idsky

thanks for the feedback

i prefer targeted Rx if the pathogen is capable of monomicrobial infection (e.g., S. aureus, S. pneumo, GAS), and there is micro concordance (gram stains and cultures)

each case is unique, but there are downsides to indiscriminant anaerobic coverage

#idsky

question for the ID community:

do you continue anaerobic coverage for all pleural space infections once micro is available?

a) always

b) if no pathogen or low-virulence/mixed oral flora isolated

c) only if anaerobes ID'd (e.g., PCR)

thoughts and comments welcomed!

#idsky

🧠 The Host Response is now on more platforms!

A podcast about thinking, learning, and practicing infectious diseases — not just the grey zones, but the growth, the joy, and finding your way.

🎧 Ep 1: “Open”

📱 Apple: podcasts.apple.com/us/podcast/t...

#firstcallID #idsky #medsky #IDtwitter

Doxycycline postexposure prophylaxis to prevent bacterial sexually transmitted infections DoxyPEP involves taking a single dose of oral doxycycline 200 mg within 72 hours after condomless sex (maximum dose: doxycycline 200 mg per 24 h). The US Centers for Disease Control and Prevention rec...

“doxy-PEP” is safe, (moderately) effective, and well-known in the communities that stand to benefit most.

now it’s time for clinicians and prescribers to catch up.

here is a short primer from @cmaj.ca

www.cmaj.ca/content/197/...

It’s a cruel irony that the specialty attracting the most neurotic, detail-oriented clinicians also forces them to manually italicize every microorganism they mention in their notes.

#idsky