Alexander Lawandi

Physician specializing in ID/Med Micro/ Critical Care. Nemesis to Antimicrobial Resistance. Foiled by Spilled Coffee. Opinions my own.

[Alexander Lawandi @AlexLawandi]

This does not sound like the @WApplefeld that I know.

[Willard Applefeld MD @WApplefeld]

🎉 Congratulations to me! I just got myself a Mercedes GLE 63S. I want to take this moment to thank @rm_nehal for guiding me through the process of investing in Crypto trading. I really appreciate her for being honest and trustworthy.

[Alexander Lawandi @AlexLawandi]

@msiuba @ThinkingCC @DanRozenbaum Yeah the Pmus looks pretty dramatic.

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🫀 Hyperkalemic Cardiac Arrest: Is It Time to Reconsider Vasopressin?

Hyperkalemia remains one of the most reversible causes of cardiac arrest, yet survival rates remain disappointingly low despite adherence to current Advanced Life Support algorithms.

A newly published experimental study in Scientific Reports explored an intriguing question:

Can vasopressin improve outcomes in hyperkalemic cardiac arrest better than epinephrine?

Using a porcine hyperkalemic cardiac arrest model, investigators compared four strategies:

🔹 Epinephrine + placebo
🔹 Epinephrine + antihyperkalemic therapy
🔹 Vasopressin + placebo
🔹 Vasopressin + antihyperkalemic therapy

The results were interesting.

Vasopressin significantly improved coronary perfusion pressure (CoPP), cerebral perfusion pressure, and brain tissue oxygenation during CPR compared with epinephrine. Most importantly, vasopressin increased the odds of achieving ROSC approximately eight-fold.

Antihyperkalemic therapy also independently increased ROSC rates and improved coronary perfusion.

The most impressive finding?

The combination of vasopressin plus antihyperkalemic therapy achieved a 100% ROSC rate in this experimental model, compared with only 30% in the epinephrine-placebo group.

Interestingly, neither vasopressin nor antihyperkalemic treatment significantly reduced serum potassium levels during CPR. The benefit appeared to arise primarily through improved coronary perfusion rather than accelerated potassium clearance.

This observation challenges a common assumption in hyperkalemic cardiac arrest management:

Perhaps restoring effective myocardial perfusion is at least as important as lowering measured serum potassium during resuscitation.

Of course, these findings come from an animal model and should not immediately alter clinical practice. However, they provide a compelling physiological rationale for further human studies evaluating vasopressin in suspected hyperkalemic cardiac arrest.

So, should future cardiac arrest algorithms become more phenotype-specific rather than relying on a one-size-fits-all vasopressor strategy?

Reference📚

Heo WY, Lee HY, Mamadjonov N, Ahmad H, Heo Y, Jung YH, Ryu SJ, Lee BK, Jeung KW. Effects of vasopressin and antihyperkalemic treatments on hemodynamics, potassium concentration, and resuscitation success in a porcine hyperkalemic cardiac arrest model. Scientific Reports. 2026. DOI: 10.1038/s41598-026-55405-z.

#CriticalCare #CardiacArrest #Hyperkalemia #Resuscitation #ICU #EmergencyMedicine #ACLS #Vasopressin #Hemodynamics #Nephrology #IntensiveCare #ScientificReports #FOAMed #MedEd #CriticalCareMedicine

[Kevin Maro @KevInvestingYT]

My top 5 best AI stocks to invest in long-term:

These are my biggest positions, and I believe each of these will 10x or more over the next 5 years:

$NBIS: The man who built Russia’s Google, lost it to Putin, and rebuilt from nothing. $46 billion in contracted backlog from Microsoft and Meta. 684% revenue growth year over year. $9.3 billion in cash. ARR guided to $7 to $9 billion by end of 2026.  The fastest growing AI infrastructure company most people still haven’t heard of.

$AAOI: Every AI GPU cluster needs optical transceivers. $AAOI makes them. Revenue went from $210 million in 2023 to $456 million in 2025 to a $1 billion+ guide for 2026. $LITE is now $850. $COHR is at $370.  $AAOI makes the same products, growing faster than both, at a fraction of the valuation.

$CRDO: Revenue up 205% in fiscal 2026. Earnings up 805%. FY2027 guidance projecting 80%+ growth with optical products contributing over $600 million.  622 employees printing $40 billion in market cap. The AI connectivity play nobody is talking about loudly enough.

$MXL: Q1 2026 revenue up 43% year over year. Infrastructure sales surged 136% and became the core business.  Panther V targets AI inference bottlenecks across a $5 billion serviceable market. Benchmark just initiated with a Buy and a $125 price target.  Early innings of a full re-rating.

$MRVL: Jensen Huang called it the next trillion dollar company at Computex. They just joined the S&P on Friday. Q1 FY2027 revenue $2.42 billion, up 28% year over year. FY2028 revenue target of $16.5 billion.  Custom ASICs and optical interconnects. The custom silicon wave has barely started.

Five different companies. One common purpose. All of them are building the infrastructure the AI era runs on.

I am long all five. Not financial advice. Do your own research.

[Black Panther Capital @BlackPantherCap]

Return since 2024: +206,98%.

I don’t short.
I don’t dont leaps.
I don’t do options.
I don’t use leverage.
I don’t charge anything.
I don’t have a subscription.
I don’t get paid by X for my posts.
I don’t recommend anything I don’t own.

I do this for my kids.
I do this for my wife.
I do 100% transparency.
I do it out of pure love for the game.
I do share every move I make for free.
I train patience as my most valuable asset.
I work full-time and still show up here daily.
I do spend my time studying markets so you don’t have to.

No guru. No gatekeeping. No games. No ego.

Made a pact with my daughter. 365 days.

No excuses.

Goal 1: To show her the power of consistency and compound.

Goal 2: 50K followers. 24,000 to go.

That’s it.

If I ever provided you value somehow, you can support me by sharing my post.

Not for me. For her.

Show her what consistency builds.

For that, I would be grateful.

—BP.

Note: This is NOT financial advice.

$IREN $NBIS $CIFR $ONDS $RKLB $OUST $AAOI $ASTS $NOK $PNG.V

[Nick Mark MD @nickmmark]

TL/DR: At the American Diabetes Association (ADA) meeting, ADA leadership called the police to forcibly remove their own editor in chief for distributing a pamphlet critical of the Trump administration.

Today is a great day to resign from the ADA if you are a member!

[Alexander Lawandi @AlexLawandi]

@nickmmark I mean… that can’t be a real quote. Something must have been edited out.

[Alexander Lawandi @AlexLawandi]

@retail_mourinho Just about done with this stock (though the open today was terrible across the board).
I believe in the company and management but with the market being as hot as it is, this is just dead capital. Similar to kraken. Love the company, but holding it now is wasting growth elsewhere

[Kraken Robotics @KrakenRobotics]

Kraken Robotics has been named to @TIME and @StatistaCharts World’s Growth Leaders of 2026, ranking 161st out of 1,000 companies globally and 20th in the Engineering, Manufacturing & Medical Technology category.

View the full ranking: https://t.co/McgNvkHTdd

[K.Ishikawa, MD, Ph.D, MPH, MSc @hiro_0921jp]

緑膿菌を直接の標的としない非抗緑膿菌薬（エルタペネムやセフトリアキソンなど）への曝露が、メロペネムやセフタジジムといった抗緑膿菌薬に対する多剤耐性を引き起こすこと研究で示されています。直接的な標的への作用がなくても、抗菌薬のストレスそのものが典型的な耐性メカニズム（多剤排出ポンプやβ-ラクタマーゼの制御遺伝子の変異など）の進化を促すことがゲノム解析によって判明しています。これは、臨床において「非抗緑膿菌薬なら緑膿菌への選択圧を避けられる（温存できる）」という従来の考え方を覆す非常に重要な報告です

[Josh Farkas MD 💊 @PulmCrit]

great illustration about how our approach to antimicrobial stewardship is painfully obtuse

everyone assumes that ABX with a narrower spectrum of activity cause less resistance, but this is often wrong

TBH its hard to find solid EBM about which ABX induce the least resistance😢

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

Pseudomonas sparing’ antibiotics, is it time to rethink this notion?
🆕💥🟢Study
Prolonged in vitro exposure of P. aeruginosa to subinhibitory concentrations of antibiotics lacking intrinsic antipseudomonal activity (Ceftriaxone,moxi,Erta) selects for stable,heritable resistance to antipseudomonal agents #idxposts https://t.co/xcJcYfa9ci

[Alexander Lawandi @AlexLawandi]

@ABsteward @BradSpellberg And the ast from that day 0 culture had a low mic to ceftaz, does my 3 days of ctx have implications for the ast on day 3? Is ceftaz still the best option? I like Brad’s points, and I would still use ceftaz, but will keep our paper in the back of my mind in case.

[Alexander Lawandi @AlexLawandi]

@ABsteward @BradSpellberg My thoughts are similar.
I always advocate for empiric narrow spectrum when indicated and this study doesn’t change that. What these results have me questioning is, if I start ctx on day 0, and then on day 3 I find it is pseudo…

[Linus ✦ Ekenstam @LinusEkenstam]

My buddy Jeremy just sent me this.

@FedEx your guys just harassed $20.000 worth of equipment just like that.

not cool guys, not cool at all

[Alexander Lawandi @AlexLawandi]

@AliSMV7 @ABsteward @DrToddLee 100% agree though I’ve never seen anyone not order blood cultures on a septic patient. But our true aim was to introduce microbiological testing beyond simple culture that can aid in the identification of microbial etiology of sepsis. BC is low hanging fruit.

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥🟢Rapid Microbiological Diagnostics for Sepsis: Narrative Review of Current and Prospective Approaches #idxposts
https://t.co/lRvKn4nhbl

[The Market Matrix @MarketMatrixs]

Rank these 10 stocks based on how confident you are for them to hit $100’s in the next 4-5 years OR LESS

1 = extremely confident.

- $ONDS - $9
- $KRKNF - $5
- $OSCR - $22
- $ZETA - $18
- $PATH - $11
- $HIMS - $22
- $SOFI - $15
- $ADUR - $14
- $EOSE - $8
- $CIFR - $21

[Alexander Lawandi @AlexLawandi]

@IM_Crit_ For absolute transparency, I trained in systems with both 24 hour call and night float call. I hated the nights no matter what. But hated night float more

[Alexander Lawandi @AlexLawandi]

@IM_Crit_ The work and hours didn’t change but perhaps our place in society did? Curious to understand how things compare for residents pre and post Libby Zion.