Mohanram S

Friends! We have a cool and unique paper published in the Journal of Clinical Medicine @JCM_MDPI (@MDPIOpenAccess) We looked to see if using healthy donor stool transplantation in end-stage alcohol-related cirrhosis patients (too sick for liver transplant) would help as a "palliative tool" to improve survival and quality of life (reduce dangerous clinical events). Here is what we found, in plain simple language: We compared the outcomes of patients with severe, end-stage alcohol-related liver cirrhosis who received a palliative healthy donor stool transplant (pFMT) alongside standard care, against those who only received best supportive care (BSC) Primary clinical outcome (survival vs. death): Improved Survival Trajectories: More patients in the stool transplant group survived to the 12-month mark (64.3%) compared to the standard care group (51.4%) But while this 12.9% difference was clinically meaningful, the small number of patients in the study meant it was not statistically significant (so primary outcome of survival failed here). Let us look at secondary outcomes: Massive Drop in Hospital Readmissions: The stool transplant group experienced dramatically fewer return trips to the hospital. Impressively, 44% of the FMT patients never had to be readmitted, compared to only 2.9% of those on standard care. Only 20% of the FMT group had multiple readmissions, compared to 73.5% of the standard care group. Strong Protection Against Organ Failure: The stool transplant successfully prevented new organs from failing (a) Kidney injury: Developed in only 7.7% of stool transplant patients, compared to a staggering 93.8% of standard care patients (b) Brain failure (Hepatic Encephalopathy): Developed in only 7.1% of stool transplant patients, compared to 68.2% of standard care patients Fewer Severe Infections: Patients receiving stool transplant had a significantly lower overall infection rate (53.6% vs. 83.8%). More importantly, they had far fewer infections severe enough to require hospital admission (17.4% vs. 66.7%). Reduction in Severe Complications: Beyond the 3-month mark, severe and unstable disease complications (like worsening jaundice, severe fluid buildup, or internal bleeding) occurred in only 14.3% of the stool transplant group, compared to 64.9% of the standard care group. Better Bridge to Liver Transplants: A higher percentage of patients in stool transplant group ultimately underwent a liver transplant (14.3% vs. 5.4%). We believe the stool transplant effectively stabilized these critically ill patients, allowing them to remain healthy enough to qualify for and survive the surgery. Reduced Need for End-of-Life Care: No patients in stool transplant group required the activation of dedicated palliative (end-of-life) care services, compared to 16.2% of the standard care group, indicating a drastically improved quality of life. Change in Gut Bacteria Affected Outcomes: Stool microbiome analysis revealed progressive expansion of (bad) Gram-negative bacteria (like Proteobacteria) in patients only on standard care, and increase in beneficial Actinobacteria in stool transplant-treated patients at 3, 6, and 12 months. Full paper (free to read): Palliative Healthy Donor Stool Transplantation (pFMT) in Patients with End-Stage Alcohol-Related Cirrhosis and Severe Unstable Decompensations—A Cohort Study: mdpi.com/2077-0383/15/7…

@denkmit Simon, will Jorge stay in Aprilia next year?

Marc Marquez long lap practice in warm up 😂

@iamdrdeva Whatever the crime may be, including heinous crimes like child rape, etc, punishment must be given by courts not by police. Encouraging extrajudicial police punishments lead to fake encounters and custodial deaths of innocent citizens.

காவல்துறையின் துப்பாக்கிக்கு வேலை வந்துவிட்டது..என்கவுண்டர் தான்.. திருநெல்வேலி நாங்குநேரி சம்பவம் நடந்த இடத்தில் நெல்லை சரக டிஐஜி சரவணன், மாவட்ட காவல் கண்காணிப்பாளர் பிரசன்ன குமார் உள்ளிட்டோர் விசாரணை மேற்கொண்டனர் 9 பேர் கொண்ட கும்பலை பிடிக்க 3 தனிப்படைகள் அமைக்கப்பட்டுள்ளது கொலை தொடர்பாக காவல்துறையினர் அனைத்து கோணங்களிலும் விசாரித்து வருகின்றனர் இதனிடையே இந்த கொலை சம்பவத்தில் தொடர்புடைய 6 பேரை பிடித்து ரகசிய இடத்தில் வைத்து போலீசார் விசாரணை நடத்தி வருகின்றனர்

@drvasusadineni @theliverdoc He is already a renowned hepatologist. Being a hepatologist is a great career. I am sure he would be doing good even if he didn't choose to be an online presence or call out pseudoscientific AYUSH practices in online.

@theliverdoc You just know to talk nonsense and go against INDIA. If ayurveda is removed from your posts, you are 0 nothing. You have built your career in Ayurveda. Very soon the ministry of external affairs will take care of everything don't worry. Until then talk all bullshit.

I have been off Twitter for a while because I was investing my free time in creating comics for Instagram that really hurt pseudoscientific practices and it's practitioners promoting them to vulnerable patients, caregivers and public. It's total chaos there. These quacks have no idea how to deal with critical thinking scientific content against unscientific practices in comic format. So they are investing their time in character assassinating me. Just to remind you, these are students, graduates and post graduates who are making these posts on me. Imagine the 100s of thousands of students who are brainwashed into this deception called alternative medicine and then left to defend themselves in the most pathetic way. India truly needs a critical thinking revolution. There has to be some way to protect these children from going into Ayush and wasting their lives like this. Political parties are least bothered. Educational system is a rot. I don't think India will ever become a super power again, if this is what the future student community will be looking like. The whole thing started after an Ayurveda post graduate was challenged to a medical debate. Initially they were afraid. But had to yield to public pressure. It's happening on 14th March, Saturday as YouTube LIVE Stream. I think it will be a waste of my time. But it will also be the best chance to showcase how low level their thinking is and irrational they are - and they are legitimized by Govt. as "doctors" to treat patients. instagram.com/reel/DVBN96fgZ… I hope I can see some change before my time is done here.

குண்டுகள் முழுங்கும் அரசு மரியாதையை விட தங்கள் உரிமைகளுக்காக போராடி வரும் தூய்மைப் பணியாளர்கள், மாற்றுத்திறனாளிகள், செவிலியர்கள், ஆசிரியர்கள், பேராசிரியர்கள் போன்றோரின் கோரிக்கைகளை நிறைவேற்றுவதே தோழர் #நல்லகண்ணு அவர்களுக்கு செய்யும் மிகப்பெரும் அரசு மரியாதையாகும்..@CMOTamilnadu

Most common prescription I give to my patients in the outpatient currently is not a medicine, but whey isolate protein. Adding anywhere from 23 to 46g of highly digestible protein along with timed use also helps them enter into a exercise routine. This helps immensely.

@malpani Trump is doing what Modi did by creating PM cares fund during covid pandemic.

Looks like Americans are as impotent as Indians

@askdheeraj Police is not a judgmental body, the court is the judgment body, Police's job is to investigate properly, arrest all the criminals and produce the criminals before court with evidence and get the punishment to the criminals including the death penalty if the crime is heinous(2/2)

@askdheeraj Sir, whatever the crime may be, including heinous crimes like child rape, etc, punishment must be given by courts not by police. Encouraging extrajudicial police punishments lead to fake encounters and custodial deaths of innocent citizens. Police is a law enforcement agency(1/n)

There was a time when cops took criminals to recreate their crime scenes and shot them dead in the trip saying he was trying to escape. This was bad press for them. After all the guy was in their custody and was supposed to be secured well and there were options to shoot to incapacitate and not kill. These days, it looks like the cops have changed the tactic. They capture and stage suicide. Their actions may be illegal, however they seem to resonate with the closure population wants regarding some cases.

@drcnpkaran1 Rosalind Franklin rightly deserved the nobel prize for DNA double stranded helical structure discovery. Watson and Crick are the shameless thieves.

Watson bagged the Nobel Prize for Intellectual Robbery, with Crick and Wilkins as his co-conspirators. x.com/i/status/19869…

@manianarun @drcnpkaran1 Actually Ultrasonagram(USG) machines are not complicated, it just produces ultrasonic waves and reads the waves that are bounced back, with current technology and advanced microchips hand held USG machines are developed.

My question. How a complicated machine with a specialized technician and specialized degree can be overlooked by a small hand held device. Something is a miss. Please enlighten to the extent of this information not emanating information that the same quacks can monetize or put to bad use. 😔

If left unchecked, quacks will inevitably purchase this and exploit it to run a highly profitable illegal trade one that could tragically lead to the systematic elimination of female fetuses. Unless CDSCO sets clear, enforceable guidelines, dangerous misuse will follow.

நம்மூர் ஆண்ட பரம்பரைஸ்: IAS IPS ல வேணும்னா நீங்க இருக்கலாம்… Insta ரீல்ஸ் ல நாங்கதான் டி..

1️⃣ What is a Myofascial Trigger Point? 🎯 A small, tender “knot” inside a tight band of muscle 💪 that hurts when pressed and can send pain to another area. It’s a muscle pain generator, not a joint problem. ⸻ 2️⃣ How does it cause pain? ⚡ The muscle fiber gets stuck in contraction ➡️ poor blood flow ➡️ release of pain chemicals ➡️ nerve sensitization. Result: local pain + referred pain + stiffness. ⸻ 3️⃣ Trigger Points vs Fibromyalgia 🔎 🔹 Trigger points = localized muscle knots 🔹 Fibromyalgia = widespread pain due to central pain sensitization 🧠 They can coexist — and untreated trigger points can worsen fibromyalgia pain. ⸻ 4️⃣ How do we treat them? 🛠️ ✔ Posture & load correction ✔ Stretch + strengthen ✔ Manual therapy ✔ Dry needling/injections (selected cases) ✔ Sleep & stress optimization Break the pain–spasm cycle 🔁 ⸻ 5️⃣ Clinical Takeaway 📌 Not all chronic pain is inflammation. Sometimes the pain source is muscular — and treatable without escalating systemic drugs.

Steroids save lives. They can also harm every organ system. Before prescribing, remember: • Hyperglycemia & dyslipidemia • Osteoporosis & AVN (even after short high-dose exposure) • Infection risk - fever may be absent • Steroid psychosis (can occur within days) • Hypertension & accelerated atherosclerosis • HPA axis suppression Use the lowest effective dose. Taper properly. Monitor aggressively. #Rheumatology #SteroidSafety @DrAkhilX #MedEd #InternalMedicine #Immunology #MedicalEducation

@himanshutyagi I have been saying this since day 1. Serum B12 is not reliable. Corelate with MMA. Also, even folate deficiency can give you falsely high B12 levels.

Elevated serum #B12 can be a sign of B12 deficiency! Pseudo-hypercobalaminaemia occurs because circulating B12 is bound to inactive proteins or immune complexes (e.g. macro-B12), leaving intracellular delivery via transcobalamin impaired, so functional deficiency persists despite high total B12. This matters because clinicians may falsely reassure themselves, missing deficiency & underlying disease while neuropsychiatric symptoms continue. In our preliminary UK survey of 46 GPs examining responses to raised B12, not a single respondent identified pseudo-hypercobalaminaemia, revealing a major blind spot in clinical reasoning. Survey was led by Hamza Mahmood @FrimleyHealth & co-supervised by @dr_pratimasingh @HPFT_NHS Read it in full here: cureus.com/articles/44530… #openaccess @neuropsych_ucl @uclh @UCLIoN

Always check ongoing drugs before prescribing Azithromycin. Recently a patient of mine got admitted in ICU for atrial fibrillation with heart failure. She was taking quetiapine as well( not disclosed) . Niv , diuresis and what not. Be careful guys

@RemaNagarajan There must be stricter laws for the surrogacy eligibility and procedure, to stop abusing the surrogacy option but outright banning surrogacy is not correct.

@RemaNagarajan Then what is the option for couples in which the woman has a medical condition that makes her incapable of carrying a fetus? Surrogacy is an option for the above mentioned couples to have children. We can encourage adoption but we can't force them to adapt.(Continued)

Surrogacy is as ugly as buying and selling of organs👇🏽

Is HbA1c Still the "Gold Standard"? Recent reports have cast doubt on the reliability of the Glycosylated hemoglobin (HbA1c) test, leaving many patients (and some doctors) confused. As a neurologist, I see how vital this number is; not just for diabetes management, but for long-term vascular and brain health. ✅The Verdict: Yes, HbA1c remains our most reliable "time machine" for tracking blood sugar over the last 3 months. However, it is not an absolute truth; it is a proxy. ▶️The "120-Day Rule" HbA1c assumes your Red Blood Cells (RBCs) live for exactly 120 days. If that biological clock speeds up or slows down, the "sugar coating" (glycation) on those cells will give a false reading. ▶️When HbA1c "Lies" to You: For my colleagues in the wards and junior doctors, remember these three scenarios where you should trust the patient's logs over the lab result: 1. The False High (Slow Turnover): In Iron or B12 deficiency anemia, RBCs live longer than average. They spend more time in the "sugar bath" of your blood, resulting in a deceptively high HbA1c. 2. The False Low (Rapid Turnover): Conditions like Hemolytic Anemia, Pregnancy, or erythropoietin (EPO) therapy (common in Chronic Kidney Disease) cause a rapid churn of young RBCs. These "new" cells have not had time to get glycated. Result? A "perfect" HbA1c that masks high sugar levels. 3. The Dialysis Trap: In advanced Kidney Disease, uremia and altered RBC survival make HbA1c notoriously shaky. ✅The Takeaway Don’t discard the test, contextualize it. 🔸For Patients: If you have anemia or kidney issues, your HbA1c might not tell the whole story. Don't panic over a single number; look at the trend. 🔸For Junior Medicos: If the HbA1c doesn't match the patient’s clinical picture or glucose logs, check the CBC and Reticulocyte count. In these "gap" cases, use Fructosamine or Continuous Glucose Monitoring (CGM) to find the truth. Confidence in a tool comes from knowing its limits. Let's practice precision medicine, not just "protocol" medicine. Dr Sudhir Kumar @hyderabaddoctor