iiinova — where your digital self keeps evolving

Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 18/07/2025

Love this idea. Especially for patients who don’t get transfused during the admission.

Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 17/07/2025

If endoscopists were paid by number of polyps removed instead of by number of procedures (with/without one polyp removed), would colon cancer rates go up or down (or be unchanged) ?

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 09/07/2025

Recommendation from me: Check iron levels in patients following up in your clinic after admissions for GI bleeding or where significant anemia is noted. It’s easy to have all the focus go to the decompensations or questions of TIPS and transplant, but iron repletion is a pretty easy win for patients

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Reposted by Prashanth Francis, MD, PhD

CU Division of Gastroenterology and Hepatology @cugastrohep.bsky.social · 08/04/2025

Bejan Saeedi, MD PhD received the Sunder J. Mehta, MD Memorial Lectureship Mehta-Makhijani Fellow Award for commitment to excellence in education, participation & contribution to Grand Rounds, clinical enthusiasm, & research potential! @prashanthfrancis.bsky.social @jchristiemd.bsky.social 💪🏆🥳

Bejan Saeedi, MD PhD receives the Sunder J. Mehta, MD Memorial Lectureship Mehta-Makhijani Fellow Award for commitment to excellence in education, participation & contribution to Grand Rounds, clinical enthusiasm, & research potential!

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/02/2025

This may be the paper that changes my worldview the most this year. One set of implications is how we approach clinical vs research training. Had never considered that what clinical reps under stress induce can be called habits…and how/why that’s the opposite setup needed for research ideation.

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Reposted by Prashanth Francis, MD, PhD

Elizabeth Jacobs, PhD @elizabethjacobs.bsky.social · 20/02/2025

The court ordered that NIH grant funding be unfrozen, so The Regime found a way around it. For NIH grants to be funded, a review panel must rank them. In order for a review panel to meet, they must post it on the Federal Register. Submissions to the Federal Register are now on hold “indefinitely”.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/02/2025

My only critique is in this part. My guess is that pretreatment antibiotics are likely always going to be needed/superior, so a better future study would be to have a comparison of FMT with bacteria producing beneficial compounds vs ones that don’t/just take up space.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/02/2025

I’m especially intrigued by this part as it opens the door to a new target/mechanism for those designing the FMT strains - namely, improving a patient’s stool through boosting what they already have. That seems more durable to me given high rates of recolonization/return to baseline.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/02/2025

Love this! It addresses so many of my frequent questions of FMT studies: Was it the abx or the FMT? Was there engraftment? What’s the mechanism? How long does it last? Really looking forward to seeing this with a larger n and new approaches/refinement to engraftment.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 18/02/2025

I suppose it’s better to replace a huge number of referrals for incidentally found low risk hepatic steatosis with a smaller number of referrals for elevated liver stiffness in setting of very elevated liver enzymes, but this still seems like an area we can improve upon.

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Reposted by Prashanth Francis, MD, PhD

CU Division of Gastroenterology and Hepatology @cugastrohep.bsky.social · 09/12/2024

All is merry and bright🌟 at CU Gastro Hep! We spent a festive 🎅evening together for fun 🎶, friends🎳 & fellowship🥂 to celebrate our hard work & accomplishments. Happy Holidays! 💩@swatipatelmd.bsky.social @bilalmohammadmd.bsky.social @frankiscottmd.bsky.social @prashanthfrancis.bsky.social

The CU Division of Gastroenterology and Hepatology celebrates the holiday season at Punch Bowl Social Denver.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 04/12/2024

Did a chalk talk on (how we arrived at) carvedilol for cirrhosis with portal HTN with the (Fellow/Resident) team and it's really surprising to me how quickly we were able to get MASLD/MASH/MetALD disseminated relative to this change in diagnosis and medical treatment of a large group of patients.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 04/12/2024

Ecstatic for this class! Congrats to all who matched today!

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Reposted by Prashanth Francis, MD, PhD

Hanna Blaney, MD, MPH @blaneymd.medsky.social · 03/12/2024

Happy to see more and more of my #livertwitter friends making the transition to #liversky! Let’s try to rebuild/improve upon the wonderful education/information sharing community here!

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 27/11/2024

I think part of it is that our main academic site had a quality initiative around it a few years ago. Between the procedure teams and eager residents, it usually gets taken care of within 12 hours.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 26/11/2024

In general, I find that our centers are pretty good at accomplishing this and the main reminder that our team has to recommend is to repeat a paracentesis at 48 hours to ensure adequate treatment.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 26/11/2024

I haven't seen any data for gaining back more weight after stopping. In general, the effects wear off over time, like they do for most medications. The long that patients are on it/the more weight they lose, the longer the benefit lasts.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 26/11/2024

It's a strange time where the indications for GLP1 medications are like to keep expanding (hello MASLD/MASH) but access to the medication and staying on the therapy long term remains poor - only ~20% at 2 years by one estimate. If a new medication can't actually be taken, are lives really saved?

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 25/11/2024

Yeah, we would notice a large rise in myocarditis. Weird (and tired) take.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 25/11/2024

With apologies to Bradley Cooper and Jason Isbell, maybe it’s NOT time to let the old ways die. open.spotify.com/track/6jMbPs...

open.spotify.com

Maybe It's Time

Bradley Cooper · A Star Is Born Soundtrack · Song · 2018

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 25/11/2024

Like the radioactive spider, but more targeted/limited in scope.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 25/11/2024

Maybe one way to think about the size or activity of a field is to think about how often a podcast about the field would release an episode.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 22/11/2024

Saw iron dosed incorrectly so much that I made a SmartText to be able to quickly add it to my notes as a GI Fellow. Stop torturing patients with multiple times a day iron! Hepcidin is smarter than this and is often torturing the bowels as payback.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 21/11/2024

This argument always bugs me a little because these types of insulin are functionally and clinically distinct. This ingenuity (and the risk/trials/approval process taken on by Pharma) does deserve to be rewarded But the most important thing is for patients to get the meds they badly need, so whatev

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 21/11/2024

For my hepatologists wondering why I'm posting about children's cancers: The senior author, Dr. Crystal Mackall, was the primary mentor to my mentor, Dr. Terry Fry here at CU. And our lab neighbors are working on a different CAR for DIPG. =)

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 21/11/2024

DIPG is a brain tumor that is uniformly fatal in the children in whom it occurs with a median survival of 11 months. In a Phase 1 study of this CAR T cell therapy, they hit 20 months with 2 of 11 patients still alive 30 months later with resolved neurologic symptoms. Just truly remarkable results.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 21/11/2024

Are you telling me I as a Hepatologist have to close my distillery ?

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/11/2024

AASLD get on Blue Sky challenge (I asked our President Elect about this and she seemed positively inclined. Not sure who decides this, though)

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/11/2024

Usually. I realize data for clips is not great, but I figure if the risk of bleeding high enough to warrant epi…

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/11/2024

Agreed. Still very investigational. But already showing progress from the earlier attempts! In a few years they may have something, heh.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/11/2024

If it’s just a lil guy then seems like you should get to do whatever you want. On the bigger pedunculated ones I like to inject epi into the stalk on the way in. Usually don’t even need a big snare by the time you get back.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/11/2024

Perhaps! But you’re comparing 3rd/4th generation therapies to investigational therapies. And FWIW, these investigators realize the bar is higher here than for HCV creating a different risk tolerance. This, low dose immune modulator, careful monitoring, etc.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/11/2024

I think it’s going to be hard for the non-GLP-1RA agents given the data they have in multi-etiology mortality benefit and being later to market. Seems like a race to see if GLP-1RAs can improve their dreadful long term adherence rates vs others showing better tolerance+liver specific endpoints.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 20/11/2024

Many patients prefer to not be on daily medication for the rest of their lives for a variety of reasons. Plus, if you could be (functionally) cured of a disease instead of just suppress it, wouldn’t that hold some appeal?

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 19/11/2024

After those great MASLD late breakers, I’m left thinking this is a race by the different therapy teams/companies to define their territory/use cases. My inclination is to say GLP-1RAs for early disease and those with obesity/T2DM given broader benefits, but in lean pts and as fibrosis advances: TBD.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 19/11/2024

Dear San Diego, So long and thanks for all the fish! Regards, #tlm24

Ceviche, aguachile, and campechano in San Diego

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 19/11/2024

Now I will spend my flight back home trying to decide which star presenter is each Avenger.

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 19/11/2024

Somebody must’ve told them the Cardiologists were dosing diuretics without checking urine lytes over here

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 19/11/2024

Voters are clear on this: We want low taxes and a robust social safety net and we want it fast!

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 19/11/2024

The Late Breaking Abstracts delivered! The past few Liver Meetings have felt a bit like Avengers Infinity War. Lots of trials against MASLD/MASH as well as HBV/HDV, PBC, etc, that didn’t end up winning out. But this year? This year we’re back and it feels like Avengers Endgame. #tlm24 #liversky

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Prashanth Francis, MD, PhD @prashanthfrancis.bsky.social · 18/11/2024

No PSC researchers. We do have some biliary researchers but they haven’t made their way here yet!

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Reposted by Prashanth Francis, MD, PhD

CU Division of Gastroenterology and Hepatology @cugastrohep.bsky.social · 18/11/2024

🥳🎖️👏 @prashanthfrancis.bsky.social for his CU DOM Diversity, Equity, Inclusion & Justice Grant Award w/ Elena Lebduska MD for "Equidad por Todos: A Community-Focused Approach to Tackle Spanish-Language Disparities in CRC Screening" We💜Dr. Francis’s commitment to advancing DEI&J! @medsky.social #GISky

Photo: Prashanth Francis, MD, PhD at CU Anschutz Medical Campus
Please join us in congratulating Prashanth Francis, MD, PhD, and Elena Lebduska, MD, MS for their project "Equidad por Todos: A Community-Focused Approach to Tackle Spanish-Language Disparities in Colorectal Cancer Screening" being awarded a DEIJ Grant. This project has been selected for funding by the CU Anschutz Department of Medicine’s Diversity, Equity, Inclusion and Justice (DEIJ) grant program.

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