iiinova — where your digital self keeps evolving

Erick Forno, MD MPH @efornomd.medsky.social · 17/05/2025

So excited to attend #ATS2025! 🩺🫁🩻🔬🧬 Among all the chaos and challenges, let’s take time to learn from, catch up with, and celebrate each other!! @ats-assemblies.bsky.social @atscommunity.bsky.social @ats-peds.bsky.social #Medsky #Pulmsky #PedsPulmSky

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Erick Forno, MD MPH @efornomd.medsky.social · 22/02/2025

Another example of what’s happening, this time @upenn.edu @upenn.bsky.social We should all worry about this; the downstream effects will impact everyone’s lives, sooner or later… #Medsky #Pedsky

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Erick Forno, MD MPH @efornomd.medsky.social · 25/12/2024

*Happy Holidays to everyone!!* And best wishes for 2025 #Medsky #Pedsky #PedPulmSky

Photo of window with Christmas lights and text that says “Happy Holidays and best wishes for 2025!”.

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Erick Forno, MD MPH @efornomd.medsky.social · 25/12/2024

Broken healthcare system… and broken AI-generated imaging. Apparently this combination leads to missing carpals and extra ulnae (or radii?) Bonus lesson: poor AI training/implementation could make health systems worse… #Medsky #Pedsky

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Erick Forno, MD MPH @efornomd.medsky.social · 11/12/2024

Very excited to see this finally in print! 🫁🧬🩺 I posted on "the other place" when it was published online, and now in the current issue of @ajrcmb.bsky.social

Volcano plot of genes whose expression changed after starting Trikafta

Area under the curve (AUC) showing classification performance of the nasal transcriptomic risk score (TRS) to predict improvement in FEV1. AUC with the TRS = 0.97, and 0.54 without.

Principal component analysis of nasal transcriptomics, showing separation of patients whose year-best-FEV1 improved on Trikafta vs those who did not.

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Erick Forno, MD MPH @efornomd.medsky.social · 10/12/2024

You can read her chapter on “Advocacy and Health Equity: the role of the #Pediatric #Pulmonologist” here, written along Drs Beverley Sheares and Anne Coates: www.chestmed.theclinics.com/article/S027... #Medsky #Pulmsky #PedPulmSky

Cover of the issue on Pediatric Respiratory Disease from Clinics in Chest Medicine

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Erick Forno, MD MPH @efornomd.medsky.social · 09/12/2024

Last, it has come up that shorter fellowships (2 instead of 3 yrs) could help. Might help interest due to quicker training, but won't do much for lifetime earning potential. Even with 2-yr fellowships, #Pediatricians still end up ~20% short in lifetime earnings compared to their adult counterparts.

Figure showing that shortening pediatric fellowship training from 3 to 2 years will increase lifetime earning potential, but nowhere near enough adult specialties.

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Erick Forno, MD MPH @efornomd.medsky.social · 09/12/2024

Study by Catenaccio et al (2021) looked at the "net present value" (NPV), which calculates total lifetime earnings potential taking into account that income earned earlier is worth more (interest etc). Directly comparing #Adult vs #Peds subspecialties, you can see the pronounced #disparities.

Study from Catenaccio et al (PMID 34330865) showing the lifetime earnings potential in adult vs pediatric specialties. On average, adult doctors made 25% more over their lifetimes than pediatric doctors in the same specialty.

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Erick Forno, MD MPH @efornomd.medsky.social · 09/12/2024

Next figure, borrowed from @jbcarmody.bsky.social. I simply added the average national salaries I could find online (yellow=adult med, blue= #Peds). Again the trend is clear. You can see the peds:adult salary ratio of ~53% for Heme/Onc, ~57% for GI, etc. Why do #Peds doctors make 40-50% less??

Figure from Dr Carmody showing the percent of fellowship positions filled by medical specialty. Towards the top of the scale (>90% success), mostly adult medicine, whereas pediatric specialties are towards the bottom of the scale (40-60% success). I added the mean national salaries I could find, showing again the disparity with some pediatric specialties making 40-50% less than adult ones.

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Erick Forno, MD MPH @efornomd.medsky.social · 09/12/2024

I wanted to get more data, but people have been asking/commenting, so here goes. (Disclaimers first: I'm no expert, and estimates based on what info I could find online). First, 20 highest & lowest paid specialties per @doximity.bsky.social. Green=surgical, yellow=adult medicine, blue= #Peds.

Figure showing 20 highest and 20 lowest paid specialties. The top 20 mostly surgical or adult medicine, the bottom 20 mostly pediatrics. The figure also shows that the top 20 fill close to 99% of their training slots, whereas the bottom 20 only fill 40-60% of their slots.

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Erick Forno, MD MPH @efornomd.medsky.social · 06/12/2024

CONGRATS to the amazing #doctors who matched into a #Peds fellowship during Match Day! We look forward to getting to know you and working together. We are *thrilled* to welcome our incoming #PedsPulm fellows at IUSM/Riley Children's, Drs Ada Reyes and Pauline Kamau!! #Pedsky @ats-peds.bsky.social

Photos of the newly matched Pediatric Pulmonology fellows at Riley Hospital for Children, Drs. Ada Reyes and Pauline Kamau, who will start fellowship in July 2025

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Erick Forno, MD MPH @efornomd.medsky.social · 28/11/2024

Coincidentally, recently published review making similar points on treatments for the various subtypes/endotypes of #bronchiolitis (written with colleagues Drs Castro-Rodriguez, Astudillo, Puranik, Brown, and Custovic) doi.org/10.1016/j.pr... #Pedsky #PedsPulmSky @ats-peds.bsky.social

Publication in Paediatric Respiratory Reviews: “New paradigms in acute viral bronchiolitis: Is it time to change our approach?”

Abstract: Viral bronchiolitis is the most common pediatric acute respiratory infection leading to hospitalization, and it causes a significant healthcare burden worldwide. Current guidelines recommend supportive management after many clinical trials on specific therapies failed to demonstrate benefits. However, several studies in the past decade have revealed that bronchiolitis may not be a homogeneous disease, but instead may constitute an umbrella comprised of different "endotypes" and "phenotypes" based on patient characteristics, etiology, pathophysiological mechanisms, and clinical presentation. In this extensive review, we summarize the current evidence that several different types of bronchiolitis ("bronchiolitides") coexist, with different short- and long-term consequences on respiratory health and the risk of asthma development. Disease pathobiology, immune response, and clinical characteristics may differ between the two most prevalent viral agents, respiratory syncytial virus and rhinovirus.
Recent randomized trials have shown that some subgroups of children may benefit from the use of systemic corticosteroids and/or bronchodilators. These findings also suggest that some children may benefit from individualized therapeutical approaches for viral bronchiolitis rather than following broad recommendations for treating all patients uniformly using only supportive management.

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Erick Forno, MD MPH @efornomd.medsky.social · 28/11/2024

ABRA RCT: Treating eosinophilic exacerbations of #asthma & #COPD with benralizumab. www.thelancet.com/journals/lan... Compelling effect on primary outcome, and in several subgroup analyses (eg separately asthma and COPD). #Medsky #Pulmsky @ats-aii.bsky.social @thelancet.bsky.social

Published in the Lancet Respiratory Medicine: “Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial”.

Study authors listed below the title.

Kaplan-Meier plot of time to first treatment failure event in the PRED and pooled-BENRA treatment groups, showing marked reduction in treatment failure among the pooled-BENRA group.

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Erick Forno, MD MPH @efornomd.medsky.social · 27/11/2024

And also happy to share recent work showing the potential of transcriptomics as clinical biomarkers, in this case drug response in Cystic Fibrosis, officially published @ajrcmb.bsky.social @atscommunity.bsky.social Great work by a phenomenal team of collaborators! #Medsky #Pulmsky #PedPulmSky

Published in the AJRCMB: Nasal Epithelium Transcriptomics Predict Clinical Response to Elexa/Teza/Ivacaftor

Volcano plot showing differentials expressed genes before vs after initiation of ETI treatment

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Erick Forno, MD MPH @efornomd.medsky.social · 27/11/2024

Excited to share that our review on the management of obesity-related asthma is now published @atsblueeditor.bsky.social Outstanding work by @atsearlycareer.bsky.social Drs Meghan Althoff and Kristina Gaietto and (less-early career 😂) Dr Fernando Holguin #Medsky #Pulmsky #PedPulmSky

Published in the AJRCCM: Obesity-related Asthma: A Pathobiology-based Overview of Existing and Emerging Treatment
Approaches

Diagram showing various pathways involved in asthma that may be modified by GLP1-RA medications in obesity-related asthma

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Erick Forno, MD MPH @efornomd.medsky.social · 19/11/2024

Congratulations to all new members elected to the Society for Pediatric Research (SPR)!! 🩺🎉 #Medsky #Pedsky @atsearlycareer.bsky.social

Text describing that the Society for Pediatric Research announced 126 new SPR members for 2025

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