Thaddaus

[REBEL EM @REBEL__EM]

🚨 New on REBEL EM!
💨💉 Nebulized TXA for Hemoptysis
⚡ 72% stopped bleeding in 30 min (vs 51% w IV)
📉 Fewer procedures: 25% vs 48% BAE
🌬️ Easy, cheap, non-invasive
✅ Bottom Line: Neb TXA is safe, accessible & effective—but needs more validation.
👉 https://t.co/dgjwNG0F5M

[ACCP @ACCP]

Congratulations to ACCP member Amanda Massmann and co-authors on the recent publication of their article in JACCP! Access the abstract and/or article here: https://t.co/p1QlZFsvXP

#MakingAnImpact #ACCP #TwitteRx @JACCPJournal

[Thaddaus @hellwigpharmd]

@KazuhikoKido @WVUPharmacy @ACCP Congrats!

[Adam Grant @AdamMGrant]

Acts of kindness that feel small to us have a big impact on others.

Research: kids and adults underestimate how tiny acts of generosity lift others' moods.

There's no easier way to make someone's day than to offer a compliment, give a little gift, or send a handwritten note.

[TheLiverDoc™ @theliverdoc]

CIRRHOSIS

I urge every #MedTwitter student, graduate and young fellows of Gastroenterology and Hepatology to read this brilliant review on "Diagnosis & Management of Cirrhosis" in @JAMA_current by @ebtapper & @NDP1001

Here are some important & some additional points on cirhosis for non-medical people from the manuscript:

1️⃣ The major cause for cirrhosis is changing - alcohol use and non-alcoholic fatty liver [NAFLD] alone or in combination has surpassed hepatits C in the USA because hepatitis C infection is now curable. In India it is still alcohol, but NAFLD is catching up.

2️⃣ One does not NEED to be an "ALCOHOLIC" to develop cirrhosis. In the presence of other risk factors, such as diabetes, obesity and high blood pressure or even the presence of a specific gene mutation called PNPLA3, even mild to modest amount of alcohol use can promote cirrhosis. The amount of alcohol safest for your liver is zero ml.

3️⃣ The gold standard for cirrhosis diagnosis is a liver biopsy which is invasive, but confirmatory. But this is no more required as newer techniques such as Shearwave scan that measure liver stiffness (value >15) can do the same.

4️⃣ Cirrhosis is no more considered an irreversible disease. Early stages of cirrhosis and stable stages of advanced cirrhosis can undergo regression/reversal with correct treatment of its cause(s).

5️⃣ The major complications of cirrhosis include rupture of large veins (called varices) in the digestive tract that present as blood vomiting or black tarry stools; development of fluid in abdomen (ascites), brain dysfunction (from sleep disorders to confusion and coma, called encephalopathy), life threatening infections, kidney injury and liver cancer.

6️⃣ A large part of management of cirrhosis is still MEDICAL while major life threatening complications and those that are unmanageable with medicines & recurr require transplantation for cure.

7️⃣ Apart from major complications there are minor complications that are STILL major for the patient, resulting in poor quality of life. These need to be asked for, identified and addressed.

These include: [treatments based on small, but good quality trials]👇
➡️Severe recurrent itching
✅️Treatment: Moisturizers, hydroxizine
➡️Severe muscle cramps
✅️Treatment: Sipping pickle brine/juice at onset of cramps, vitamin E+carnitine, prevented using taurine 1000mg per day.
➡️Reversal of sleep, daytime sleepiness
✅️Treatment: Lactulose syrup.
➡️Sexual dysfunction in men, mostly among those who consume alcohol
✅️Treatment: Tadalafil.

8️⃣ Not all patients are diagnosed with cirrhosis at a stable stage. Approximately 40% are diagnosed during the time they present with a major complication. Some are even diagnosed with advanced liver disease and liver cancer on routine testing without any symptoms at all.

9️⃣ Remember alcohol use is an avoidable cause for cirrhosis. Alcohol in mild or modest amounts is also an avoidable cause for cirrhosis in those with additional risk factors and in those diagnosed with cirrhosis, no amount of alcohol is advisable. There should be lifetime abstinence.

🔟 Common concerns/myths⬇️

➡️Low platelet counts in cirrhosis does not need any treatment and low platelet counts does not lead to any symptoms. A count above 50,000 is adequate in cirrhosis patients.

➡️There is no liver detox. Liver detoxes are wellness frauds that can in all likelihood, harm the liver.

➡️Swelling of the legs in cirrhosis is not a complication of cirrhosis, it is a feature of the disease due to multiple reasons such as low protein/albumin, varicose veins, slow lymphatic drainage from legs etc.

➡️There is no specific diet for liver health. Overall general health also includes good liver health. Any person who prescribes, advertises or sells specific liver health solution only wants your money.

➡️Whey protein does not damage the liver. It is safe for use.

➡️Fruits and veggies combinations as juices or blended infusions or as a predominant dietary component compromising protein in diet does not improve "liver health." There are no specific fruits or vegetables that specifically improve liver health.

➡️Processed and ultraprocessed foods, sugary diets, fructose-based foods (including an overconsumption of fruit in diet) are ours and our children's greatest enemies when it comes to fatty liver disease.

FULL PAPER LINK HERE
https://t.co/tD45rvQQFY

[Tony Breu @tony_breu]

1/18
🤔Why is the BUN/Cr elevated in upper gastrointestinal bleeding?

This question has been covered by @AdamRodmanMD and @WilliamAird4 but the literature is SO FASCINATING that I had to review it myself.

[Sam Ghali, M.D. @EM_RESUS]

Here’s a video I made breaking down my perspective on what happened to Damar Hamlin on January 2nd, 2023. He has now officially come out and confirmed the diagnosis. Retweet to spread awareness.

[Thaddaus @hellwigpharmd]

@KyleHessPharmD @IDdocAdi @Stevens_AK @kjkpharm @MayoClinicINFD Congrats!

[Kyle Hess @KyleHessPharmD]

My PGY-1 research project just got published! Thankful for my amazing research mentors ⁦@Stevens_AK⁩ and ⁦@kjkpharm⁩ as well as all of ⁦@MayoClinicINFD⁩! https://t.co/KjJPXlcN2F

[Mushtaq Bilal, PhD @MushtaqBilalPhD]

A challenge that every graduate student faces: how to read difficult research articles.

Here's how to understand research articles better using an AI-powered app (no cheating although it may feel like it 😀):

[Tony Breu @tony_breu]

1/15
🤔Why do antibiotics reduce the risk of rebleeding after acute variceal hemorrhage?

I understand why antibiotics reduce infections, but the mechanism by which they reduce rebleeding is not immediately apparent.

Let's have a look.

[David Aguilera Alonso @DavidAguileraAl]

Surprised by the recommendations from the National guidelines from the UK on the treatment of BSI by MRSA: linezolid as alternative to vancomycin, before daptomycin. Many physicians refuse to use linezolid for BSI during the first days of treatment, yes for oral step-down therapy

[Josiah Johnson @KingJosiah54]

Dolphins doing Tua concussion test https://t.co/0S5nGBh6vh

[Nayan Arora,MD @captainchloride]

Diuretic management in decompensated heart failure has been stagnant for years but recently we have some new tools to help us out.

Let's review the Rise of the Proximal Tubule Inhibitors in preparation for the #nephjc discussion on ADVOR tonight.

#MedTwitter @MedTweetorials

[Alexander Verbeek 🌍 @Alex_Verbeek]

🎨

The best way to see Van Gogh's "Starry Night" is to stare at the center of the spiral for 20 seconds and then look at the painting.

RT when it works for you.

[Elliot Tapper @ebtapper]

Timely publication and a must read on acute kidney injury in #cirrhosis

https://t.co/w0CFzBZFLB
Highlights
1. Tailor treatment to physiology. Be precise.
2. #POCUS
3. Beautiful figures

Authors: @RegnerKR_Neph, @SwethaKanduriMD, @VelezNephHepato #livertwitter #terlipressin

[Fixing Education @FixingEducation]

My students AFTER I provide CLEAR, PRECISE directions...😜😔

[Cherylee W.J. Chang, MD, FACP, FNCS, FCCM @SCCMPresident]

🫘today someone asked for a list of 💊💉that ⬆️ serum creatine without affecting GFR. Mnemonic to help remember... THRU Secretion Inhibition Action On Tubules

https://t.co/fEpbkC8fdi

https://t.co/0Y26O2yGgH

@SCCM_CPP #TwitteRx #ICUPharm

[Rodger Sherman @rodger]

people learning to drive in Ireland have to put a big N sticker on the back of their car (“novice”) that is functionally identical to the Nebraska helmet. Huskers fans are gonna get here and think there are hundreds of thousands of Irish Nebraska fans