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May 14 • 4 tweets • 3 min read
Grateful to @AASLDFoundation,@AASLDtweets for recognizing our work @DDWMeeting & choosing us as one among ten to receive the prized Foundation Fellow Award globally

AASLD's recognition has been instrumental in progression of our clinical research in our State & Nation+
#DDW2022
Our featured works to be presented at the @DDWMeeting, San Diego May 21-24 include:

A. Use of high dose probiotics in patients with severe alcohol-liver disease where we discuss novel findings associated with intestinal microbiome and their interactions after probiotic therapy +
& B. The changes in fungal communities in intestines of patients with severe alcohol-liver disease treated with high dose probiotics (Poster of Distinction)

Were the changes beneficial?
How did bacterial communities interact with fungal communities?

#medtwitter #livertwitter +
Congratulations to this year's investigators who will present their award-winning abstracts at Digestive Disease Week May 21-24, 2022.

For a complete list of @AASLDFoundation winners, please see this link

aasldfoundation.org/2022-aasld-fou…

💯🙏🤝✌️

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More from @theliverdr

TheLiverDoc Profile picture
May 16
28 y old young mother is referred for evaluation of progressive jaundice

Docs are mind-boggled

Patient is getting sicker - increasing jaundice/persistent itching 2 mo after delivering healthy baby girl

She's scared, of the possibility that she wont get to see her baby girl... Image
...bcoz her primary care GP, while referring to our tertiary center, also hinted at the possibility of liver failure and need for liver transplant

Their diagnosis - post delivery unknown cholestatic viral hepatitis, possibly hepatitis E infection

But it didnt seem right... Image
...cholestasis means stagnation of bile inside liver - due to issues within the liver (hepatitis, bile duct damage) or outside liver (block in bile ducts due to stone, tumor)

This young mother had no obstructive features to bile flow, but her liver tests had shown... Image
Read 27 tweets
TheLiverDoc Profile picture
May 15
I received these samples for analysis

Formula 1
Batch: A221752B04
Mfg:date-DEC2021
Exp:date-NOV2023

Personalized Protein
Batch: A221726G21
Mfg:date-NOV2021
Exp:date-OCT2023

Afresh Energy Drink
Batch: E821712A27
Mfg:date-NOV2021
Exp:date-OCT2023

Here are results, discussion... Image
...Analysis was done by an independent lab approved by the central and state government for food analysis and NABL accredited for general testing in chemical and biological parameters

Gas Chromatography/Mass Spectrometry, method was used to identify different substances... Image
...rather than conclude based on analytical findings, I wud like to know whether these findings r NORMAL for a protein supplement?

Herbalife supplements unlike other pure proteins, use herbal components 2, mayb this would have led to complex results...
@minicnair @PriyankaPulla
Read 9 tweets
TheLiverDoc Profile picture
May 14
58y old man with chronic liver disease is rushed to ER very early morning after multiple seizures, loss of consciousness

Blood glucose was 32mg!

A diabetic since long, he was on the same oral medications since last 2y

Why did a stable diabetic go into severe hypoglycemia...
...and why was his liver tests highly abnormal with jaundice and hepatitis
Bilirubin 4.8
AST 346
ALT 228
ALP 444
GGT 288

Even though abnormal liver tests are common after seizures, jaundice is unexpected, very rare

Which meant, this was more than just a hypoglycemic seizure...
Overweight and with diabetes, he was advised low calorie diet, weight loss and blood glucose control to prevent worsening of underlying chronic liver disease/cirrhosis

In early cirrhosis, controlling or treating cause(s) of cirrhosis helps prevent disease progression...
Read 18 tweets
TheLiverDoc Profile picture
May 12
A 6y old girl is rushed into ER in unresponsive state

Chubby & cute, her prettiness is mauled by the deepest jaundice

As I watch ER docs intubate the child to protect her airways, my heart races, palms sweat

Bcoz I knw this is a different ball game called

Pediatric Hepatology
...the child was healthy & playful until 6 wks back

She started having cough and low grade fever

Nothing serious,

The local physician said & prescribed her cough syrups and low dose paracetamol as required

Fever settled, but the cough did not,
Cough syrups were changed...
...but after 2 weeks, the child started losing appetite and refused play time, resting on bed most of her time

And then, a week later, she was jaundiced

She was rushed to the nearby clinic where they evaluated her for causes of jaundice

Viral hepatitis was negative...
Read 22 tweets
TheLiverDoc Profile picture
May 10
A🧵

Weird things as medicines (GRAPHIC)
#MedTwitter

1. Cockroach

- dried worms or fresh 'adults'

Traditional Chinese Medicine

Used for - digestion, leg swelling, tonsillitis, insect bites🥲, infant malnutrition, blood pressure and cancer🙄
cmjournal.biomedcentral.com/articles/10.11… Image
2. Maggots (Fly larva)

US FDA approved - larva of common green bottle fly

- fresh live worms (disinfected)

Classical Ayurveda
Ancient Mayan Medicine

Used for - wound healing, wound disinfection, healthy wound stimulation
mdpi.com/1660-4601/17/1… Image
3. Bee venom

- as local injections

Traditional Chinese Medicine

Used for
- arthritis (animal study)
- acute pancreatitis (animal study)
- multiple sclerosis (animal study)
- neurogenic pain - as APIPUNCTURE or venom injection
sciencedirect.com/science/articl… Image
Read 18 tweets
TheLiverDoc Profile picture
May 10
30y old man with abnormal liver tests

His eyes are yellowish
Bilirubin 3.5
AST 338
ALT 682

He feels weak, appetite poor

Recently joined a gym
Not on supplements
No other diseases

He is underweight
Liver is huge
Ultrasound shows severe fatty liver

In a thin man?...🤔
...tests for acute hepatitis with jaundice were performed

Viruses, infections, autoimmune diseases, Wilson's disease (copper overload can cause fatty liver), steroid screening, tox screening EVERYTHING NEGATIVE

So we did the next best thing there is...a liver biopsy
...the biopsy proved what the ultrasound had showed

NEVER SEEN SUCH A SEVERE FATTY LIVER IN A THIN MAN...

All the white round/bubbly stuff that you see in the pic below, that's fat globules within liver cells....his biopsy was full of it!

But what was cause of fatty liver?...
Read 9 tweets

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