General Internal Medicine | Clin Pharm & Tox | Quality Improvement @UofTDOM

Toronto
Joined April 2014
Alex Kumachev retweeted
This case illustrates common error in the treatment of drug-induced Torsades. A patient presents with drug-induced Torsades, most commonly methadone or dofetilide. They get treated with a bolus of 2-4 grams IV magnesium sulfate and get better. What happens 4-6 hours later? The magnesium wears off (mostly excreted in the urine). Meanwhile, the methadone or dofetilide is still there (it has a much longer half-life than IV magnesium bolus). So the patient has another episode of Torsades. ☠️ I'm tempted to call this an "error" but it's so commonly done that it's basically the standard of care. So perhaps the term "mishap" is more reasonable. Repeat episodes of drug-induced Torsades can be prevented using a protocoled magnesium infusion. We started using this about a decade ago. It's safe and easy to do. It makes these cases really boring. The patient sits around on a Mg infusion for 24 hours allowing Mg to soak into their cardiomyocytes while the methadone/dofetilide levels fall. (#1/2)
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Alex Kumachev retweeted
1/14 Why can't you use direct oral anticoagulants (DOACs) in patients with mechanical valves (MVs)? DOACs have been one of the most important advances in my career. And yet, the presence of a MV is one of the few contraindications. The reason highlights the unique nature of thrombus formation in those with a MV and provides insights into the evolution of human hemostasis.
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Alex Kumachev retweeted
The 6 victims of today’s terror attack in Jerusalem. Sarah (Saritah) Mendelson, 60 Rabbi Levi Yitzhak Pash Yaakov Pinto, 25 Rabbi Mordechai Shteintzag, 79 Israel Mencer, 28 Rabbi Yosef David, 43 May their memories forever be a blessing.
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Alex Kumachev retweeted
Gadi Haggai, 72, and Judi Weinstein-Haggai, 70, moved to Kibbutz Nir Oz 30 years ago. According to the kibbutz, Judi was volunteering there when she first heard Gadi playing the flute, and fell in love. They had four children and seven grandchildren. Judi, a dual American-Israeli citizen, was an English teacher specializing in children with special needs. She worked with children suffering from anxiety, using meditation and mindfulness techniques. She loved writing poetry and was also an entrepreneur. Gadi was a gifted musician from the age of three, a talented chef, and a man deeply connected to the land. Together with Judi, he led a healthy, active lifestyle. Both were devoted believers in peace and coexistence. On the morning of October 7, while on their regular walk near the kibbutz, Hamas terrorists opened fire. The couple sought shelter under a tree in the fields. Gadi was shot and killed. Judi, severely wounded, managed to call for help. An ambulance was dispatched, but it was hit by a missile and never arrived. Gadi and Judi died in that field. Shortly afterward, the terrorists returned and took their bodies into Gaza. The terror cell responsible for this atrocity is the same unit that kidnapped and murdered Shiri, Ariel, and Kfir Bibas. Today, thanks to intelligence efforts, the IDF recovered Judi and Gadi’s bodies in the Khan Younis region. May their memories be a blessing. 🕯️
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Alex Kumachev retweeted
1/2 In today's Morning Report, I learned that DRESS is associated with the reactivation of herpesviruses, particularly HHV-6. Whether this or other herpesviruses are part of the pathogenesis of DRESS or a consequence of DRESS remains unsettled. pubmed.ncbi.nlm.nih.gov/1785…
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Alex Kumachev retweeted
Rachel Goldberg-Polin: "Ok sweet boy, go now on your journey. I hope it's as good as the trips you dreamed about because finally, my sweet boy, finally, finally, finally, finally you are free. I will love you and I will miss you every single day for the rest of my life, but you're right here. I know you're right here. I just have to teach myself how to feel you in a different way. And Hersh there is one last thing I need you to do for us. Now I need you to help us stay strong and I need you to help us survive"
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14 women are still being held hostage in Gaza.
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Jonny Siman Tov, a wheat farmer, and his wife Tamar, a women’s rights activist, were hiding in a safe room w/ their 4 yo son and 6 yo twin daughters. Jonny texted his sister: "They're here. They're burning us. We're suffocating." The whole family was burned alive, to ashes. #IStandWithIsrael #HamasRapists #BringThemHomeNow #BelieveIsraeliWomen #NeverAgainIsNow
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Alex Kumachev retweeted
I am in New York but heart and soul with the March Against Antisemitism in London today - my Jewish brothers and sisters and all our many non Jewish friends - Am Yisrael Chai. – at Briarcliff Manor, NY
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Alex Kumachev retweeted
Hamas executed 33 children on 10/7. They tortured some, cutting off fingers and limbs. They burned others alive. Dozens of Israeli children remain hostages. Today the @UN celebrates #WorldChildrensDay for every child except the children of Israel. #BringThemHome
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