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Nov 9 • 4 tweets • 3 min read
1/ 🚨 #5Pearls on Alcohol-Associated Hepatitis 🚨

Why is it an immune response?

✔️Direct EtOH insult ➡️ inflammation

✔️Disruption of the gut barrier ➡️ bacteria & inflammatory cells go up portal vein ➡️ to hepatocytes

🎧 link.chtbl.com/AlcHep
Sponsor: @Pan_Financial Image
2/ Now, What else may be going on & what imaging and labs would you send off for ddx for Alc Hep?

Listen to the episode to hear a powerful story from @etapper differentiating Alc hep and worsening #cirrhosis Image
3/ What interventions are most linked to improved mortality?

Alcohol cessation and nutrition!

Alcohol leads to⬇️absorption of proteins, carbs, and fats as well as impaired absorption of micronutrients = Alc Hep induces catabolic state

See some tips below for daily targets! Image
4/ Abstinence of alcohol after episode of alcohol associated hepatitis positively impacts long term survival📈;⬇️ risk of mortality by close to 50% !

We can look to the STOPAH RCT for a decision to treat with steroids- But remember to r/o infection first! Image

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More from @COREIMpodcast

CORE IM Profile picture
Nov 3
1/ Today on #StatswithCoreIM, let’s talk about #bias
2/ Let’s get started with a question: What type of bias do you think is present in this example?
3/ The answer is Verification bias! Verification bias is present when:

✔️The reference standard (gold standard) is not used for all cases [= emoji] partial verification

✔️there is more than one reference standard 🟰 differential verification
Read 8 tweets
CORE IM Profile picture
Oct 11
1/ Welcome back to #ReadingRoom with Core IM!

Have you ever been confused about what contrast #protocol to order?! 💭

“Protocols” = which phase of contrast is best evaluate the structure you are trying to see 🔎

Keep an eye on the white contrast being injected in this 🧵 Image
2/ What are some different contrast protocols?

Compare and contrast the different protocols below ⬇️ and think about which clinical situations we use them in Image
3/ Use this table to order the right study for the *right* pathology. There are many protocols with timings and combinations to best evaluate specific pathologies.

& don’t forget to check in with your radiology team when stuck and making a decision about which study to order! Image
Read 4 tweets
CORE IM Profile picture
Sep 29
1/ 🚨NEW PATIENT!🚨 66 y/o M found in his home unresponsive and hypothermic.

What abnormalities do you see in this EKG? Image
2/ Did you notice sinus bradycardia? What about intraventricular conduction delay?

Check out this slide with all 5 EKG findings! Image
3/ With these EKG findings and hypothermia, what else should you order?! Image
Read 6 tweets
CORE IM Profile picture
Sep 15
🚨Your pager is going off!🚨 80M w h/o CAD on the inpatient medicine floor reporting burning epigastric pain after eating.

Here is his EKG:
Take a look…any notable findings on this patient’s EKG?!
The patient is given an antacid and you order a repeat EKG.

Your repeat EKG looks exactly like the patient’s baseline (based on chart review). What’s going on?!
Read 6 tweets
CORE IM Profile picture
Aug 17
1/ What are 3 Qs you can ask yourself when looking at non-inferiority trials?

Q1) Was the trial planned i.e. pre-specified as comparing an intervention which is non-inferior to control?

WHY?

Bc changing the analysis *afterwards* introduces bias #StatswithCoreIM
2/ Q2) was the control treatment administered to the full std of care?

The trial relies on strict adherence to full standard of care for the control arm, otherwise the whole confidence interval shifts with a relative⬆️in benefit of the intervention compared to control
3/ Q3) Did investigators perform both a per protocol and intention to treat analysis?

Per protocol:
Exaggerates group difference when intervention is inferior
Less likely to result in false positive

Intention to treat:
Makes groups prognostically 🟰
Benefit of randomization
Read 9 tweets
CORE IM Profile picture
Jun 21
1/ Let’s dive into #noninferiority trials for this edition of #StatswithCoreIM

But first, take a look at this figure for what superiority trials aim to assess: What’s better?
2/ So how are NON-inferiority trials different?

They ask if a treatment is much worse than standard of care.
3/ Let’s look at the possible outcomes of a non-inferiority trial.
✔️Superior and non-inferior
✔️Non-inferior
✔️Not non-inferior
✔️Inferior and not non-inferior
✔️Inferior and non-inferior
Read 5 tweets

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