Digambar Panchal

Hematologist and BMT - CART Physician . Asst Professor at LTMGH Sion . Consultant at H N Reliance Hospital .

[Sujay Rainchwar @SujayRainchwar]

I started using regularly after @nihardesai89 has introduced me to this last year. Specially for elderly patients due for chemo and it helps a lot to assess frailty. Even in general.

⭐️ Good Handgrip strength = Good Performance status and fitness = Improved ability to sail through any illness and Surgeries= Longevity

Stronger Hand grip strength is must for everyone 👍👍

We were not used to this concept but it’s really helpful for everyone to assess fitness and measure fitness frailty after focussed exercises.

[Ramanuj Mukherjee @law_ninja]

A doctor from Nagpur told me something about how she is implementing AI in her clinic that amazed me.

She runs a small clinic. 15 years of practice. 40 patients a day. Her biggest problem was never diagnosis. It was follow-up. Patients would come in, get a prescription, and disappear. Half would not complete their medication. Some would not come back for follow-up. A few would show up months later with the same problem, worse.

She tried everything. Reminder calls. SMS. A register. Nothing worked. Her assistant forgot. Patients ignored SMS. The register got outdated by Thursday.

Then she figured something out.

Her patients would not read text messages. But they would listen to a WhatsApp voice note in Marathi. Something about hearing a voice felt personal in a way text did not.

She also knew that in many homes the husband controls the wife's phone. So the message had to make sense if someone else opened it. Each patient chose their own follow-up phrase during the first visit.

And she knew compliance collapses between day 4 and day 7. Not later. The intervention has to hit on day 4. By day 7 it is too late.

She built this using Claude. No code. No developer. WhatsApp voice notes in Marathi on day 4, day 6, and day 10. Personalized. Follow-up compliance went from 40% to over 75%.

No engineer could have built this.

Not because it is technically hard. Any developer could build it in a weekend. Because no engineer would have known to build it this way.

Voice note instead of text. Marathi instead of Hindi. Husband controlling the phone. Custom phrase at first visit. Day 4 intervention window. Every design decision came from 15 years of watching patients in Vidarbha not come back.

That is domain knowledge. It does not exist in any dataset or AI course.

India produces 1.5 million engineers a year. Huge numbers learning AI. "AI/ML enthusiast." "Prompt engineering certified."

A lot of people know how AI works but have no idea how any industry actually works.

The engineer builds for the problem they imagine. The domain expert builds for the problem that exists.

I have seen this in legal. Engineers built beautiful AI tools for lawyers.

Technically impressive. Lawyers do not use them. Because a lawyer's real problem is tracking 150 hearing dates across 4 courts while managing a clerk absent half the time.

A CA who filed 500 GST returns knows where errors happen. A teacher who taught 10,000 students knows the problem is not content but attention. No engineer in HSR Layout designs for a student with a shared phone studying between 9 and 11 pm.

India has an advantage nobody talks about. Millions of English-speaking domain experts carrying decades of ground-level knowledge. Globally rare. And almost nobody is training them to use AI.

India does not have an AI talent shortage. It has domain experts who think they are not "technical enough."

They are wrong.

[Bread & Butter Haematology @MorphologyAmigo]

Thanks @UpToDate
My Honest Take on Thrombophilia Testing 😀
#hematology #hemepath #MedTwitter #MedEd @HaemBytes

[Lingaraj Nayak @lingarajnayak]

DELLI study - Ultra-low immunotherapy in cancer.

Please ready this Substack post from authors of the study.

Thinking differently can lead more access which really matters!!!

@VanitaNoronha @TataMemorial @ACTREC_TMC @Dr_AkshayBaheti

https://t.co/Qdm5sllmqg

[Raj Chakraborty @rajshekharucms]

Important question that will increasingly arise in the future. We must remember that ~40% of patients in the control arm of AQUILA did not require start of anti-myeloma therapy at 5 years! Also, there does not appear to be any tail in the curve in Dara arm, which implies its merely “delaying” rather than “preventing” SLiM-CRAB. I would be more convinced of it was a short duration BsAb monotherapy leading to universal MRD-negativity and no progressions in 4-5 years, which we might get in the future. Until then, active surveillance!

[Papa Heme @Papa_Heme]

Value in oncology or really anything we do in medicine!

Value = [how patient feel betters + live longer]/[cost]

If drug does neither things in the numerator it is not worth giving. Especially if denominator mega expensive (for example Selinexor)

[ALL Hub @ALL_Hub_]

CONGRESS | #SOHO2025 | PRESENTATION
@NicholasShortMD @MDAndersonNews discusses the impact of TP53 abnormalities on outcomes in ALL, and considerations for optimal treatment.
Data have demonstrated that the prognostic impact of TP53 mutations is dependent on age and VAF (VAF ≥45% = high risk). He notes that therapy-related myeloid neoplasms (t-MN), driven by TP53 clonal hematopoiesis, can occur following TP53m AML treatment, and that novel strategies are required to reduce relapse risk and prevent t-MN.
Follow our live feed for more updates: https://t.co/N9rgegvkAp
#ALLsm #leusm #MedEd #MedNews

[Karthik Balachandran @karthik2k2]

Hospital ranking by Revenue /Doctor 🤯 Does this surprise you?

@sundar_s1955 I just started reading the book you recommended a couple of days back sir 😊

[𝙍𝘼𝙅𝙀𝙎𝙃 𝙋𝘼𝙍𝙄𝙆𝙃 @imacuriosguy]

Nothing is working in India.
Never been this pessimistic about my beloved country.

For the average citizen, it feels like a slow collapse wrapped in noise and selfies.

https://t.co/tAB4QDdjhc life is punishment
Potholes. Garbage. Waterlogging. No planning. No shame.
2.Courts are time machines
They take you back decades. Justice crawls while the powerful fly free. Cases move slower than snails. Justice is a myth unless you are rich or powerful.
https://t.co/E9YaGfnJeB are a joke
Degrees everywhere. Jobs nowhere. Young people are tired.
4.Hospitals bleed you dry
One illness and a middle class family sinks. The VC backed hospital chains are thriving.
Rural care is a cruel joke.
5.Schools teach nothing
Government schools are empty. Private ones sell certificates. Children are not learning.
6.Politics is everywhere
Movies. Food. Clothes. Cricket. Everything is a warzone. Real issues buried.
7.Prices keep rising
Fuel. Rent. Food. Fees. Salaries stay still. Middle class is gasping.
8.Big business owns it all
A few giants control everything. Small players are crushed.
https://t.co/rzhbNXdy2S trust left
Police. Media. Elections. Everyone has an agenda. No one cares.
10.Society is tearing apart
Hate is normal. Facts are jokes. Unity is dead. Caste is the deciding factor for voting, not the work.
11.Foreign policy is a fog
No clarity. No consistency. One day chest thumping, next day silence.
No one takes us seriously.
12. Environment is under assault
Climate change is real, but no one cares.
Mitigation is sidelined. Prevention is forgotten.
Mindless construction in the name of development is destroying land, hills, rivers, and coastlines.

I voted for change in 2014. That belief is shattered.
There’s no hope from an opposition that chants only caste census slogans.

The most agonising part is the utter disdain with which common people’s complaints are dumped in the trash.

Time is a great leveler.
Hope the tide turns.

[Nico Gagelmann @NicoGagelmann]

Maybe THE debate in transplant at the moment⁉️

Does HLA matter in the PTCY era?

Join @COSTEMCongress from September 25–28 for this exciting controversy!

Register here:
https://t.co/Ot94IQJ3FE

For the full program:
https://t.co/g6fqenENKd

DM if you need support...

[Digambar Panchal @DigambarPanchal]

Govt 🏥 residency: Volume> quality. See everything, do everything, learn to survive
Pvt 🏥: Quality⬆️ bt volm⏬ Perfect the craft, but see ⬇️variety
You need both to become a complete 👨🏻‍⚕️, but the tenacity, resilience and decisiveness that govt teaches, no pvt can match! #neetpg25

[Nico Gagelmann @NicoGagelmann]

We are all witnessing it here on X and in reality. Conscientiousness in free fall, neuroticism increasing.

[Jayastu Senapati @jayastuMD]

➡️ Check out our manuscript, just published in @JournalCancer describing the "Contemporary outcomes of octa‐nonagenarians with ND-AML,👴🏼 " possibly the largest analysis in this high-risk but commonly encountered age group in AML ✅
https://t.co/UH3B9AzGBp
@MDAndersonNews #leusm

[Satya Prakash Yadav @Satyayadav__]

Handy for BMT physicians considering BMT for older kids with Thalassemia

Liver damage is common due to Iron overload in Thalassemia

[Deepak Malgutte @DMalgutte]

The Man Who Never Got a Nobel, But Gave the World Methotrexate
— A story of forgotten genius, cancer, arthritis, psoriasis… and hope. 💊💔🧬

[Shashikant Kore @kshashi]

आपण स्वतः दिवसभर "please do the needful" आणि "I will revert back" चे इमेल पाठवतो हे विसरून विमानातील फ्युएल कंट्रोल स्विच कसा वापरायचा यावर मत ठणकावता आले पाहिजे.

[Prashant Mehta @Prasshmehta]

Excellent summary of #ICML2025

for R/R DLBCL ‘Three regimens. Three new paths forward. All better than what rituximab plus GemOx could offer’
POLARGO- STARGLO-SUNMO

and then the newer DLBCL Classifiers

LymphoMAP particularly of interest in the context of CAR-T efficacy

[Talha Badar @TalhaBadarMD]

Subcutaneous blinatumomab in adults with relapsed or refractory B-cell acute lymphoblastic leukaemia: post-hoc safety and activity analysis from a multicentre, single-arm, phase 1/2 trial - The Lancet Haematology https://t.co/2B1MDyDZ7B

1. CR/CRi rate 77% in RR B-cell ALL (compared to 42% with IV Blin), MRD 91% among responders.
2. Debulking required pre-Blin for BM blast > 50%.
3. Interval b/w cycles 1 weeks compared to 2 weeks with IV Blin.
4. GIII neurological adverse events were comparable.
5. Neurological AEs of any grade occurred at a higher frequency in the 500 μg/1000 μg group, the dose level of 250 μg/500 was RP2D #leusm

[Digambar Panchal @DigambarPanchal]

Very imp study esp for countries like India where infection related mortality during HIDAC is high

[Fadi Haddad, MD @FadiHaddad_MD]

📢 Out in @NEJMEvidence

👫N=1132 pts; age 18-60
🔹ND #AML
🔹Consolidation with IDAC vs HIDAC
🔹5-yr OS = 59% vs 58%
🔹Lower incidence of myelosuppressio & AEs with IDAC
➡️ IDAC non inferior to HIDAC

#leusm @OncoAlert

https://t.co/mtooZ8M270

[Digambar Panchal @DigambarPanchal]

@PanktiMehta24 @nihardesai89 @UHN @UofT @UofT_DoM @ZahiTouma @vichicarrizoa @DrPoddubnyy Congratulations ma'am! 👏🏻 🎉