Prem Thilak

Resident Doctor in Medicine at AIIMS, New Delhi. MBBS from B.J. Medical College, Ahmedabad. Man Utd Fan. Quizzing and crossword enthusiast. Que Sheriya Sheriya.

[AB⚕ @AbsoluteBruno]

No Messi Golden boot
No Messi top assister
No Messi all time scoring record
No Messi Golden Ball

[Tansu Yegen @TansuYegen]

The teacher challenged his students to remove a mandarin from a glass full of water without spilling a single drop.

[JAMA @JAMA_current]

#Hypothyroidism is a condition characterized by the insufficient production of thyroid hormones.

This Review summarizes the epidemiology, pathophysiology, clinical presentation, and treatment of primary overt hypothyroidism in nonpregnant adults.

https://t.co/HizirK6lQW

[CME INDIA @CMEINDIA1]

MASLD Pharmacotherapy – Clinical Pearls for Indian Physicians
@DrAshish_Kumar
Very illuminating article in JAPI , July 2025
1. Lifestyle: The Foundation

Hypocaloric, balanced diet:
• 50% carbs, 30% fat, 20% protein.
• Prefer whole grains, legumes, nuts, vegetables, fruits, lean proteins.
• Avoid sugar-sweetened drinks, refined carbs, processed foods, excess saturated fats.

Coffee (2–3 cups/day) → ↓ fibrosis risk, ↓ HCC risk.

Omega-3 rich fish (salmon, mackerel, sardines) → anti-inflammatory benefit.

Physical activity:
• 150–300 min/week moderate activity (walking, cycling, swimming).
• Encourage NEPA (stairs, chores, 8–10k steps/day).

Weight loss:
• ≥10% → 90% MASH resolution, up to 45% fibrosis regression.
• Even 5–7% ↓ weight → improves steatosis and liver enzymes.

2. Algorithm Tailored for India

Designed for noncirrhotic MASLD (F0–F3), to be applied by general physicians and diabetologists.

Cirrhosis (F4) → Refer to hepatologist (portal HTN, HCC surveillance, transplant consideration).

Bridges gap between evidence-based guidance and Indian real-world primary care.

3. Pharmacotherapy: Adjunct to Lifestyle

Insulin:
• No proven benefit on fibrosis or MASH.
• Use for glycemic needs but not for liver histology. Prefer drugs with dual benefit.

Nondiabetic MASLD (F0–F1, LSM <8 kPa):
• Pharmacotherapy not strongly recommended.
• Consider only if lifestyle fails:
– Vitamin E:
▸ PIVENS trial: 800 IU/day → improved steatohepatitis in nondiabetics.
▸ Concerns: prostate CA risk, long-term safety.
▸ Lower dose 300 mg/day × 96 wks → improved steatosis, inflammation, fibrosis with better safety.
– Omega-3 fatty acids: modest ↓ steatosis; inconsistent fibrosis benefit → weak recommendation.

4. India-Specific Practical Points

Unlike West (hepatologist-driven), in India MASLD is mainly managed by GPs & diabetologists.

No widely adopted simple pharmacological algorithm yet → this guidance fills the gap.

Pharmacotherapy decisions should be guided by fibrosis stage + diabetes status.

✅ Key CME Takeaway:
In India, lifestyle modification remains first-line for all MASLD patients.

Drugs are adjuncts, reserved for higher-risk or progressive disease.

Vitamin E (low-dose) and omega-3 may help in select nondiabetic, low-fibrosis cases.

Insulin should be used cautiously, prioritizing agents that improve both glycemic and hepatic outcomes.

Structured, India-specific algorithms can empower general physicians and diabetologists to manage MASLD effectively, reserving hepatology referral for cirrhosis (F4).
https://t.co/e84mSvGjGz

[WelBeast @WelBeast]

Ruben Amorim knows all the strengths and weaknesses of our striker. He trained him. We know nothing about his. Our striker was his first choice. His striker was our first choice. Everyone has a point to prove Manchester United vs Arsenal first game of the season.

Bring it on.

[Christian L. Horn, MD, DABOM @ChristianLHorn]

FibroScan interpretation guide using FibroScan cutoffs and recent guidelines!

[The Heart @ZHeart11768530]

🔴Modified Sgarbossa Criteria - Diagnostic Checklist for diagnosing MI in LBBB or Pacemaker⤵️ 🔹⚡️⚡️⚡️

#CardioMed #MedEd #MedX
#medtwitterWhat #MedTwitter #CardioEd #medx #medEd #CardioTwitter #cardiotwitter #MedX #MedEd #cardiology #cardiotwiteros #FOAMed #medicine

[Jasmine Sethi @JasmineNephro]

🫘❤️‍🩹Sequential Nephron blockade in diuretic resistance

https://t.co/JyML9X6tHe

@AJKDonline

[Jasmine Sethi @JasmineNephro]

🫘👍Managing asymptomatic Hyperuricemia in CKD

https://t.co/Ypm9qXYUag

@CKJsocial @hjanders_hans

[Medical Info @Medicalinfo111]

Approach to hypercalcemia vs hypocalcemia

[Dr sthanu subramanian @drsthanus]

Pulmonary CT Signs and Differential.

https://t.co/9428lLMGM0

[𝗇𝗂𝖺𝗆𝗁 @niamhutd]

“You look happier”

Thank you, Manchester United aren’t playing football for a few weeks

[CardiovascularCorner @TrackYourHeart]

Mastering ECG Interpretation: A Quick Visual Breakdown of the ◽Basics,
◽Blocks,
◽Axis,
◽Clues to Ischemia,
◽Electrolytes &amp; More.
Source: unknown

[ERA - European Renal Association @ERAkidney]

What is the best dialysis strategy for which patient?
For HD 🎙️: Casper F.M. Franssen
For PD 🎙️: Rumeyza Kazancioglu
Moderators : Björn Meijers,Lily Jakulj
✍️ : Vaibhav Tiwari @drvt87
#ERA25
#beyondnephrology

[Ravi Trivedi @Ackerman5100]

This has been my lunch and dinner place back in mbbs. Shaken to the core 😢
Prayers for everyone injured

[Prem Thilak @premthilak24]

Eerie similarities between Spurs and RCB this season. Trophyless for 17 years. Choker tag. Legends with names with K (Kane, ? Kohli) winning their first trophy (though the former won it at Bayern). 2nd season for head coach.

Only thing missing is an opponent like Utd 🥲🥲🥲

[Prashant @Prashanttired]

I’m 32, married, sat in a dark room, completely broken, staring at a TV screen at 3 am, bang in the middle of my work week.

Sport is bullshit.
Pick something else kids.
Live a better life.

[Dr. AK 🇮🇳 @docakx]

🌟 ECG - Significance of Lead aVR

[Dr Joshua Walinjom @walinjom]

Echo views in Acute PE.

[Dr. AK 🇮🇳 @docakx]

Dual Antiplatelet therapy in CAD

From @pyrl