Hepatitis B sucks
1⃣About 3-4 in every 100 people have it
2⃣It causes liver cancer, #cirrhosis
But the vaccine rocks!
1⃣Prevents liver cancer!
2⃣Was first recombinant vaccine!
So let's get into it
Jul 3, 2021 • 4 tweets • 3 min read
I don’t get the vitamin k thing. There is no known benefit (pubmed.ncbi.nlm.nih.gov/23080365/). And the harm is that It sends mixed signals. It undoes the teaching about the #cirrhosis coagulopathy. Because iv vit k is special and novel, it’s a consult rec that sticks. Needs reconsidering
Jun 29, 2021 • 17 tweets • 10 min read
WHY are steroids used for alcoholic hepatitis?
WHAT is the deal with prednisolone vs prednisone?
WHERE did the discriminant function come from?
ARE you ready for a #tweetorial
Every year in the US alone, >50,000 acetaminophen overdoses are reported to poison centers, causing >110 deaths. Overdose can be intentional, though often accidental, always tragic.
There's an antidote: NAC. It saves lives.
Want to know how it was discovered?
Jun 1, 2021 • 4 tweets • 3 min read
We wanted to⬆️engagement with @JHepatology research
🤔Hypothesis: people are ⬆️ likely to connect with the people behind the research than the research itself
🧐Plan: Randomize papers to personal story tweets or graphical abstracts
🧐Primary Outcome: paper downloads #livertwitter
We found that story tweets garnered more downloads and tweet impressions
We conclude that showcasing the authors and their motivations in paired tweets is an effective strategy for research engagement
First, I have mentors to thank. Dr Michelle Lai who gave me my start and launched me. @SenguptaNeil who taught me everything I know. And the reason I moved my family from Boston to a suburb of Detroit known away from good food, Dr Lok, the greatest mentor I will ever know
Jan 18, 2021 • 4 tweets • 3 min read
Most fun study I have ever done:
We asked clinicians why they tested NH3, their pre-test prob of HE, and what they planned to do while they were blinded to the result
tl/dr: Clinicians are good at diagnosing HE in the ED, so no need for Nh3 doi.org/10.1016/j.cgh.… #livertwitter
We find that a clinicians' pre-test probability of HE is the same as the post-test probability. But! not only does Nh3 add nothing diagnostically, when high it leads to excess lactulose use even when tested in people without #cirrhosis
Now we need to design the QI intervention
Dec 26, 2020 • 4 tweets • 2 min read
There are many potential causes of high ALT
But what are their pretest probabilities? Everyone is thinking broadly which is good but if you want to go where the money is, you rob banks
And which fall back to normal?
And what prompts multiple tests? A symptom?
Dec 15, 2020 • 15 tweets • 9 min read
WHERE does ascites come from?
HOW do diuretics treat ascites?
ARE you ready for a #tweetorial?
👋Described~60 yrs ago by Adams/Foley
👋Methods:60pts w/impending hepatic coma vs controls
👋Flapping flexion/extension, best @ the🤚but happens even 2 the 👁️lids! Has intervening tremor (mini-asterixis)
Look 4 it while checking handgrip! #livertwitter 1/4
3⃣Precipitating factors? Asterixis, like HE itself, is a biomarker of badness: bleeding, infection, sedatives(Fig2)
4⃣They looked @🧠; swollen astrocytes! Particularly in the basal ganglia!(Fig3) #livertwitter 2/4