Pranav Penninti

@DannyLimanseta @petergyang N

@petergyang That door knob looks weird lol

So nice for Taylor to stop by this morning while I was writing my newsletter

👀

@md_myer @DocBharadwaj @drsanthoshe @IJG_Journal Wonder if there’s been any study of direct endoscopic treatment with gelfoam slurry? Think there’s some data in the EUS + coil setting, but wonder if this could be a temporizing measure in the case of an active bleed for those of not versed in EUS or glue.@SahajRathi thoughts?

@DocBharadwaj @drsanthoshe @IJG_Journal I gotta learn some direct cyanoacrylate injection

🚨New Article Alert🚨 @IJG_Journal 📢PSM Analysis of Direct glue v/s EUS-Interventions for 🩸 IGV-1 (n=133) With Algorithmic approach, Direct Glue 🟰 EUS-Intervention in 1⃣ Re-bleeding 🩸🩸 2⃣ In hospital Mortality 🏥 Access at: link.springer.com/article/10.100…

@ArgaizR Really interesting. There's some data in the form of case reports touting efficacy for refractory ascites, but now I wonder if these patients had concomitant, clinically significant cirrhotic cardiomyopathy. Thanks as always, interesting article!

@PranavPenn This is what I used to think. But increasingly, data in heart failure is showing the is is not the case (detailed in the editorial linked above) Certainly important data could come from this trial in Cirrhosis that might change our current thinking!

SGLT2 inhibitors are not good diuretics nor natriuretics! Direct cytoprotective effects and starvation mimicking (and NOT decongestion) are proposed to explain improved outcomes in HF drive.google.com/file/d/1zSkiaa…

A huge thank you to @ArgaizR for joining us for our @UPMC Hepatology Conference to talk about POCUS in cirrhosis and AKI! A masterclass in physiology and a paradigm shift in how to approach an incredibly common and challenging problem for our patients. #livertwitter

@DrHarryDOesHep @ReibergerThomas Any big clinical changes between the two biopsies? Rapid weight loss? Bypass surgery? Superimposed AH? Agree that the difference between the biopsies is the most interesting part of the story.

@ReibergerThomas I don’t know how biopsies months apart can be so discordant. I had the same concern as your number 2. But if the IR is getting HVPG >15 and you have a bleed I think that’s the answer: CSPH +/- cirrhosis. 100% will start HCC surveillance. Can push LDLT eval until sicker

Non cirrhotic portal HTN gradient of 18….. with only F3 fibrosis? Anyone else seen this? #gitwitter #livertwitter

An older man comes to the ED with abrupt onset nausea, & diarrhea He is joined by her daughter whom he is visiting from abroad Testing is below The diagnosis is unclear Until his daughter got just as sick too 🧵 #livertwitter #liverstory #MedTwitter

@ArgaizR @FH_Verbrugge Is there any data for SGLT2’s for decongestion in the context of cirrhotics with diuretic refractory volume issues?

When used as an add-on to Furosemide, SGLT2 was no different than Thiazide for decognestion However, their effect on serum sodium can help you pick your add-on drug: If Hyponatremia ➡️ SGLT2 If Hypernatremia ➡️ Thiazide doi.org/10.1093/eurhea… *acetazolamide up front 😉

Apps for GI Patients Mahana FDA CBT App for IBS 🔗apps.apple.com/us/app/mahana-… Nerva IBS & Gut Hypnotherapy 🔗apps.apple.com/us/app/nerva-i… Zemedy CBT App for IBS 🔗apps.apple.com/us/app/zemedy-… SynerGI VR-Delivered CBT 🔗virtualmedicine.org/ibsvr 🙏Christopher Almario @CedarsSinai #DDW2023

Nik Mazumder, @MichiganLiver super genius, built a hemodynamic model of #cirrhosis that is only getting started deepening our understand of how portal hypertension impacts patients Check it out @ACG_CTG : pubmed.ncbi.nlm.nih.gov/37092902/

You are a young #medicine resident !! A patient walks into your OPD and says he is absolutely fine but his CBC shows an ⤴️⤴️ platelet count He's done multiple CBC and it howers between 600-800k 😮 He is worried about it 😕 What do you do ?? Read on 👇🏻👇🏻 #MedTwitter 1/13

@scienceisstrat1 @sama @reidhoffman @FareedZakaria @DonnyDeutsch @SalmanRushdie @NewYorker @BillGates @nfergus @dansenor @OrlandoBravoTB @HarryStebbings Any chance this becomes a weekly post? Really enjoyed the whole selection.

Top podcasts of the week: ✅ Sam Altman (@sama) on @reidhoffman ✅ @FareedZakaria on @DonnyDeutsch ✅ @SalmanRushdie on @NewYorker ✅ @BillGates on Nicolai Tangen ✅ Niall Ferguson (@nfergus) on @dansenor ✅ @OrlandoBravoTB on @HarryStebbings Links below, enjoy!

I have a recommended reading list for Artificial Intelligence, and it hasn't changed since 2019. I give this list to my grad students, but all of the articles are broadly accessible if you're interested. Very short 🧵.

👋Let's talk about HCC and TACE vs SBRT! LRT have 2 keys jobs, downstage prior to transplantation, Overall, to date several RCTs(usually without MVI) have been done which all provide evidence for double LC with SBRT , although no OS benefit has been found to date.

What are the best history books about India?

Electrosurgical Settings for EMR from @Rex_colonoscopy at grand rounds today with @UTHealthGastro ▪️Piecemeal EMR ▪️Snare Tip Coag ▪️Hot forcep avulsion ▪️Underwater EMR ▪️Argon Plasma Coagulation #GITwitter

Often not easy to be sure what segment is drained in ERCP.

Renal injury in Patients with Liver Failure 🙏🏾@NephroP @VelezNephHepato @KidneydrChirag for the “money slides”from your articles in my ppt to Gastroentrology Fellows @SSMCAbuDhabi Also shared some our award winning work which is improving care with those with in Hospital AKI