Niranjan Ganesh

GLP-1 receptor agonists are increasingly used to treat type 2 diabetes and obesity, and trials have shown reductions in cardiovascular risk and slowing of kidney failure. Adverse events are mostly gastrointestinal. Read the Review Article “GLP-1 Receptor Agonists” by Clifford J. Rosen, MD, and Julie R. Ingelfinger, MD, from @tuftsmedschool and the Maine Medical Center Institute for Research: nejm.org/doi/full/10.10…

#WATCH | Jaisalmer, Rajasthan: The Desert National Park (DNP), located in Jaisalmer, is currently witnessing a significant congregation of raptors. This includes several species—most notably the Steppe Eagle—that are on the verge of extinction.

Important review on weight Weight Regain and Cardiometabolic Consequences After Discontinuation of GLP-1 Receptor Agonists GLP-1RA discontinuation should be considered a high-risk clinical transition rather than a treatment endpoint. Structured follow-up and multidisciplinary management are essential to preserve long-term cardiometabolic benefits. dom-pubs.onlinelibrary.wiley.com/doi/full/10.11…

In May 2019, FDA identified 82 completed suicides linked to montelukast, many with preceding neuropsychiatric symptoms. Reports span adults and children. Prompted by this, In march 2020 FDA issued a prominent boxed warning for serious neuropsychiatric events. These can include suicidal thoughts or actions, agitation, aggression, anxiety, depression, hallucinations, insomnia, vivid nightmares, sleepwalking, irritability, memory issues and obsessive-compulsive symptoms and suicidal ideations/behaviours. These can affect all ages, with or without psychiatric history, and may occur during use, after stopping, or rarely persist. In contrast, RCTs and meta-analyses typically show no major increase versus placebo, though some note modest rises in anxiety and sleep problems. Recent large cohort studies (e.g., Swedish pediatric data) often find no significant risk elevation compared to other asthma therapies. Causality remains debated due to confounding (asthma/allergies themselves link to mood/sleep issues) and detection challenges for rare events. The FDA notes animal data showing montelukast crosses the blood-brain barrier, supporting biological plausibility. While overall incidence is low, events can be severe. The FDA advises close monitoring, patient/caregiver education on symptoms, and prompt discontinuation if issues arise.

A high-level clinical roadmap designed to help healthcare professionals diagnose and manage common electrolyte imbalances. It breaks down complex physiological processes into logical flowcharts based on lab values and clinical signs. @DharSaty

Extrarenal Disease in ANCA-Associated Vasculitis: Challenges and Evolving Therapeutic Strategies on behalf of the Immunonephrology Working Group (IWG) of the ERA academic.oup.com/ndt/article-ab…

American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults With Type 2 Diabetes – 2026 Update This 2026 update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and T2D. It also provides guidance on the management of atherosclerotic risk factors of dyslipidemia and hypertension #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @DrMarthaGulati @hvanspall @CMichaelGibson @ankeetbhatt @cardioceptor @Hragy @SubodhVermaMD @vuralmg @AshuNephro endocrinepractice.org/article/S1530-…

📊 JAMA Clinical Guidelines Synopsis: The 2024 guideline from the @American_Heart and @ACCinTouch recommends continuing statins and β-blockers for patients undergoing noncardiac surgery. ja.ma/3NDhhRE

Free to Be in Peritoneal Dialysis: Without Kt/V? bit.ly/49Wyf4t (OPEN ACCESS) @IMWendyYe @JoanneBargman @PD_Perls

Alport :early 🧬 #ISNWCN

Anemia 2026

Retroperitoneal fibrosis is a rare immune-mediated disease which can be classified as idiopathic or secondary. A new Seminar provides an overview of retroperitoneal fibrosis focusing on pathophysiology, differential diagnosis, and management: spkl.io/6010AFXEE

📊 JAMA Clinical Guidelines Synopsis: The 2025 guideline for #ACS management recommends dual antiplatelet therapy with aspirin and a P2Y12 inhibitor, high-intensity statins, invasive revascularization, and radial access for angiography. ja.ma/4dc0QpH

Rituximab dosing and management for Nephrotic syndrome .

Obinutuzumab

India’s first-born cheetah, ‘Mukhi’, turns 3. Her journey, from a tiny cub to a confident mother stands as a powerful symbol of the success of Project Cheetah. This achievement paves the way for a new direction and growing confidence in MP's wildlife conservation efforts: Chief Minister of Madhya Pradesh @DrMohanYadav51

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of chronic kidney disease. A Review focuses on current approaches to diagnosis, treatment, and specific aspects of clinical management. Read more: spkl.io/6013AF8kV

Indian Consensus Guidelines on Adult Immunization 2026 Update 🔹 Adult vaccination in India remains a major missed opportunity, despite excellent gains in pediatric immunization. Adult coverage for influenza, pneumococcal and hepatitis B remains alarmingly low. 🔹 This 2026 update simplifies adult vaccine practice by grouping patients into 12–18 years, 18–49 years, and ≥50 years, with added focus on at-risk, high-risk, immunocompromised, lifestyle-related, pregnancy, and special situations. 🔹 Every adult visit should become a vaccine review visit. Prevention should no longer be restricted to childhood schedules alone. High-impact practice takeaways 🔹 Influenza vaccine should be annual for all adults, especially older adults, pregnancy, diabetes, CKD, chronic heart/lung/liver disease, and immunocompromised states. 🔹 Pneumococcal vaccination is now much simpler: Use single-dose PCV20 for all adults ≥50 years and for 18–49 years with risk factors/comorbidities. 🔹 Tdap/Td remains underused in adults. Give one Tdap in adulthood, then Td/Tdap every 10 years, and one Tdap in every pregnancy (27–36 weeks). 🔹 Hepatitis B vaccination should be strongly considered routine adult preventive care, particularly in diabetes, CKD, dialysis, liver disease, HCPs, and high-risk adults. 🔹 Shingles vaccine is no longer optional thinking in older adults. Recombinant zoster vaccine is recommended for all ≥50 years, and earlier in selected high-risk individuals. 🔹 COVID-19 vaccination remains relevant in adults, particularly during pandemic/local epidemic settings, and should continue to be prioritized in older adults, obesity, and comorbidity clusters. Special populations matter 🔹 Diabetes is now clearly recognized as a vaccine-relevant condition. Core adult vaccine basket in diabetes includes: Influenza, Pneumococcal, Tdap/Td, Hepatitis B, COVID-19, Shingles, and selected MMR/Varicella/HPV where indicated. 🔹 CKD, dialysis, transplant, malignancy, HIV, rheumatologic disease and immunosuppression need structured vaccine planning, not opportunistic prescribing. 🔹 Pregnancy is a key window for prevention. Routine focus should include Influenza, Tdap, COVID-19, and Hepatitis B when indicated. 🔹 Healthcare professionals must be fully vaccinated, not only for self-protection but for patient safety and institutional infection control. Practical India-focused message 🔹 Adult immunization should now be treated like BP, HbA1c, and lipid review—a standard part of chronic disease management. 🔹 If the patient has diabetes, CKD, CVD, CLD, COPD, cancer, transplant, or age >50 years, think vaccines proactively—not reactively. 🔹 In Indian OPD practice, the “Big 6” to routinely think of are: Influenza, Pneumococcal, Tdap/Td, Hepatitis B, COVID-19, and Shingles. Bottom line Adult vaccination is no longer preventive luxury — it is standard chronic care. Source: Indian Consensus Guidelines on Adult Immunization 2026 Update

It took more than 6 months to get the jump start executed. The female bird in Naliya, Gujrat was ringed. The bird gave an infertile egg. Incubated fertile at 37 degree C was taken from Sam, Rajasthan to Naliya by road covering 770 kms in 19 hours. The sterile egg was swapped with incubated fertile egg. It was nuanced and challenging task. Kudos to team WII, FD Gujarat and FD Rajasthan.

Steroidal versus Nonsteroidal Mineralocorticoid Receptor Antagonists in CKD Finerenone is guideline-recommended because of its efficacy and safety. Spironolactone may be a cost-effective alternative, but additional safety data are needed. Demonstrating noninferiority in a head-to-head trial would establish spironolactone as an alternative, while finerenone superiority would validate its cost and potentially reduce inertia in clinical uptake #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @mvaduganathan @JavedButler1 @DrMarthaGulati @hvanspall @safchat @ankeetbhatt @cardioceptor @goKDIGO journals.lww.com/jasn/fulltext/…