Pankti Mehta
@PanktiMehta24
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Clinical fellow @UHN @UofT | Immunology & Rheumatology| DSMC member @rheumjnl @IJRheum @IndianRheum | Alumnus @SGPGI (rheum) @KEMhospital (MBBS, Int Med)
Joined October 2019
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☺️☺️☺️
President Kovind graced the 26th convocation of the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Details:
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Ever thought of blood clots before
#smoking
? Then why before
#COVID19
#vaccine
? Everything needs a perspective!!
#COVIDIOTS
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☘️Antinuclear Antibodies (ANA)☘️
Here's a 🧵 on another
#rheumatology
test which can confuse>help if ordered without a 💭 (part 1)
Let's peek into the
#immunology
lab to learn more about the lab aspect of ANA 🥼🧪👀
(1/12)
#MedTwitter
#LupusAwarenessMonth
#MedEd
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Rheumatoid factor
One of the most used & abused tests in
#rheumatology
Let's learn a bit about its origin & utility!
#MedEd
#MedTwitter
#RheumTwitter
(1/15)
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🫁How to interpret pulmonary function tests ??🫁
I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists
(1/7)
#MedTwitter
#RheumTwitter
#MedEd
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😣Patient: "All my joints are painful & swollen!"😣
👩⚕️But when you examine the patient, you don't find any joint swelling
How to approach this scenario? 🤷
#MedTwitter
#RheumTwitter
#MedEd
🧵🧵🧵
(1/10)
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Doctor: Where is the pain?
Patient: Pain pain everywhere!
❔How do we approach a patient with multiple joint pains❔
(1/12)
#polyarthritis
#MedTwitter
#MedEd
#RheumTwitter
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I want to scream and tell the whole world,
Doctors are not Gods,
complications happen,
not everyone gets well.
AND this is despite every doctor's greatest wish, will & effort for their patient to recover.
Is this so difficult to understand?
#Justice_For_Dr_Archana
#RIP
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Congratulations
@nihardesai7
for living your dream !! DM Hematology it is❤️
A change in the bio is in order😄
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Hey
#MedX
!
👉For internists and med students, what clinical sign can you see here?
👉One step ahead for rheumatologists,
which subtype is it associated with?
#MedEd
#RheumTwitter
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19♀️
Woke up with weakness of all four limbs after a dinner party the previous night😩
Diagnosis?
#MedEd
#MedX
#RheumTwitter
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💭When we think of
#Rheumatoid
#Arthritis
, a mental image of this comes up 👇
But does it have to get to this🤔???
🙅NO! Definitely, NO! 🙅
#MedTwitter
#MedEd
#RheumTwitter
#Rheumatology
@MedTweetorials
(1/8)
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1st- Bonds shouldn't be there (that too only for medical professionals)
2nd- if there, it should be to the Indian government and not to any particular state!
3rd- bond amount should be based on how much the government has paid me as an individual over last 7 years.
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Some common 💊 combinations to AVOID:
🚫Iron & PPIs
🚫Iron & calcium
🚫Thyroxine & calcium
🚫Allopurinol/febuxostat & Azathioprine
Add more to this list!📝
@nihardesai7
@NicoGagelmann
@DrAnuraagJ
@sakir_rheum
@divyaa24
#MedEd
#MedTwitter
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☘️Antinuclear Antibodies (ANA)☘️ -Part ✌️
We learnt about the history and lab methods in part ☝️
Let's continue the story!!
#RheumTwitter
#MedEd
#MedTwitter
#rheumatology
(1/24)
☘️Antinuclear Antibodies (ANA)☘️
Here's a 🧵 on another
#rheumatology
test which can confuse>help if ordered without a 💭 (part 1)
Let's peek into the
#immunology
lab to learn more about the lab aspect of ANA 🥼🧪👀
(1/12)
#MedTwitter
#LupusAwarenessMonth
#MedEd
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⏫IgG4 🚫 IgG4 RD
Elevated IgG4 levels can be seen:
👉 Chronic infections like
#tuberculosis
👉Lymphoproliferative malignancies
👉 Bronchiectasis,
#asthma
👉 Primary sclerosing cholangitis
#RheumTwitter
#MedTwitter
#Rheumatology
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Everyone wants to know about
#myositis
. Here's a thread for an overview of the disease 👇🏻
#MedTwitter
#MedEd
#rheumatology
#patientawareness
@Samanthaprabhu2
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@nihardesai7
Congratulations hero 🧑🎓🧑🎓🧑🎓
It's surely been a long but beautiful journey !!
Love,
Wifey
#convocation
#Hematology
#milestone
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3
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Facial rashes that look like lupus but are not ! 🧵🦋
1. Rosacea 🥵
🔹Look for telangiectasia
🔹Involvement of the nasolabial folds 🔹Flushing with spicy foods, heat, & sun exposure
#MedTwitter
#RheumTwitter
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Thrombotic microangiopathies.
🔹Not so rare
🔹Difficult to treat
🔹Must know everything about them no matter your specialty!
Thanks
@NicoGagelmann
for the crisp recap !
#MedTwitter
#MedEd
Differential of DIC:
-includes other conditions associated with bleeding and hypercoagulability, and other causes of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia
-some conditions, such as liver failure, can be either a cause or consequence❗️
14/20
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I almost missed the diagnosis of
#takayasu
arteritis in a young♀️ who had vague aches & pains, thankfully checked her pulse 🫢
Claudication is one of the most frequently misinterpreted symptom!
#MedEd
#MedTwitter
#RheumTwitter
#vasculitis
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It's always a pleasure teaching undergraduate students full of curiosity!
Discussed a case of Rheumatoid
#Arthritis
today and one of them asked me an interesting question:
👉Why does IgM RF persist in RA but IgM antibodies don't in infections?
#MedTwitter
#MedEd
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❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️
My wife's on a roll ❤️😍
Meet the recipient of the Prof. R.K.Sharma award for best DM resident
@SGPGI
👏🏼👏🏼
The best
#rheumatologist
in town 😎
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🩸Cytopenias in lupus🦋
🔹Common
🔹Can involve all blood cells
🔹It can range from just an incidental finding to a life-threatening scenario 💀
Let's break this down starting with white blood cells first :)⚪
(1/11)
#MedEd
#MedTwitter
#RheumTwitter
#Lupus
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Classic clinical features of anti synthetase syndrome:
🔹
#Myositis
🔹
#Arthritis
🔹
#ILD
🔹Mechanic's hand
🔹Fever
🔹
#raynaud
's
All of them needn't be + at presentation and incomplete forms are very common !
#MedTwitter
#MedEd
#RheumTwitter
#rheumatology
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📖A textbook case! 📖
🔹13 boy
🔹Unwell for a month
🔹🌡️+ arthritis + dyspnea
🤷What's the diagnosis???
#MedX
#MedEd
#RheumTwitter
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Sad state of affairs,
#Medicine
in
#India
. Something one should AVOID as a career choice!!!
#MedTwitter
@PMOIndia
@mansukhmandviya
@rashtrapatibhvn
@nihardesai7
@UPGovt
@CMOMaharashtra
@myogiadityanath
@myogioffice
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Even a day with someone on leave is difficult during
#residency
, that's how tight it is. 6 months, UNIMAGINABLE !
#Doctorsstrike
#DoctorsProtest
@nihardesai7
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Join the dots!!
1. What's the diagnosis?
2. Single most important next test?
#MedTwitter
#MedEd
#RheumTwitter
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Tips if you're on
#methotrexate
💊 to avoid GI discomfort.
- consume on weekends i
- bed time dosing to 😴 off the side effects
- subcutaneous 💉 is worth a try!
- can combine with tea/coffee☕
- can use anti-emetics with it
#MedTwitter
#RheumTwitter
#Rheumatology
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Tried to recreate this photograph clicked on our engagement day ❤️
@nihardesai7
#Mumbai
#Watercolor
#artwork
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The things that make me love what I do☺️
A 14 year old girl with takayasu arteritis got me twin ❤️ rings today!
#patientlove
#MedTwitter
#love
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Medicine ward 11, KEM hospital 🤭
@nihardesai7
❤️
where did you meet your first love ??
Honest ans only !!
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🤓 Join the dots....!
🔸Whats the diagnosis?
🔸How does axial disease in this entity differ from classic spondyloarthritis?
#MedTwitter
#MedEd
#Rheumatology
#RheumTwitter
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28♀️
Presented with polyarthritis👐, malar rash☺️, and retrosternal chest pain 😧
👉What does the 🩻 show?
(Clue: 💰)
👉Likely diagnosis?
#MedEd
#MedTwitter
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Please strike a balance in favouring the reserved instead of the deserved!
☹️
#NeetPGcounselling2021
#SupremeCourt
#India
#NEETPG
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Back to basics!
No matter the specialty, this checklist📝 holds importance not only in ICUs, but in wards as well !
Thanks
@grepmeded
for the infographic🙂
#MedTwitter
#MedEd
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Why is it not enough to have daughters?
When women come with the unapologetic desire for a male child it literally breaks my heart 💔
Let's make it a better world for our daughters, Happy Women's day !!
#WomensDay2022
#womenempowerment
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•Long post alert •
When I first came to
#Lucknow
to pursue
#rheumatology
, I had no idea that my affection for this city would grow so much!
My time at
@SGPGI
over three years was truly invaluable 🙏
#goodbyes
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Near empty OPD at 11:30 in the morning!😀😀😀
Exaggerated Thursday or pre Diwali effect??
#happyholidays
#Diwali2021
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167
The series of 'endings' in
#Lucknow
: the last morning class, the final OPD, the last day at the office...
@kgmu_medical
Clinical Immunology & Rheum dept,
You'll be sorely missed 😭
#farewell
#bittersweet
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She Looks Too Pretty
Try To Catch Her ! 😍
S- Scaphoid
L- Lunate
T- Triquetrum
P- Pisiform
T- Trapezium
T- Trapezoid
C- Capitate
H- Hamate
#MedTwitter
My Favorite Medical Mnemonic of All Time!
Feel free to share yours
Causes of Pancreatitis
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma (steering wheel)
Steroids
Mumps/Malignancy
Autoimmune
Scorpion sting (from Trinidad!)
Hypertrygliceridemia/Hypercalcemia
ERCP
Drugs
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Was quite amazed to see this, thanks to my great team of residents ! Guess the TSH value? 😉
@ankushpm101
@drMsayan
@nihardesai7
@NicoGagelmann
#RheumTwitter
#rheumatology
#Endocrinology
#MedEd
#MedTwitter
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Autoinflammatory syndromes by Dr Dan Kastner at
#ACR22
!
1️⃣FMF🏖️
🧬AR, pyrin mutation, evolutionary resistance to Y pestis
🌡️Fever 1-3 days
😣Peritonitis (severe)
🫁Pleurisy unilateral
✊Mono or oligoarthritis
2%-->Amyloidosis
⚕️ colchicine, anti IL1 💉
#MedTwitter
#MedEd
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📝A great compilation of newer treatment options for
#Lupus
Nephritis by a senior and friend!
@SayaliBThakare
#SLE
#RheumTwitter
#MedTwitter
#MedEd
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Hey
#MedTwitter
!
We come across a lot of target signs in
#medicine
🎯
Let's enlist them in this thread 🧵 with an appropriate image !!
1️⃣Starting with target sign seen in enteritis associated with
#lupus
, vasculitis, infections etc on a CT abdomen
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🤓 Join the dots ....!
🔸What's the diagnosis?
🔸Next most appropriate investigation?
#MedTwitter
#Rheumatology
#RheumTwitter
#MedEd
@MedTweetorials
@nihardesai7
@JosephMerolaMD
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As a
#Mumbai
-ite I always thought Alphonso
#mangoes
taste the best and never really tried any other type. After >3 years in
#Lucknow
, I'm starting to believe that Alphonso is probably overhyped!
My favourites are Chausa and Safeda! What are yours ???
#mango
#UttarPradesh
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Livedo reticularis!
Lacy 🥅 like pattern of erythema due to stagnation of deoxygenated blood in the cutaneous venous areas
🔹Physiologic: cold exposure
🔹Pathologic: thrombosis, vasculitis
🔹Erythema ab igne: 🔥 damage to superficial venous vessels
#MedX
#RheumTwitter
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#Paraneoplastic
syndromes
⭐Don't forget
#dermatomyositis
and
#scleroderma
presenting as a paraneoplastic syndrome⭐
⭐Age and sex appropriate cancer screen ⭐
#rheumatology
#RheumTwitter
#MedTwitter
#MedEd
#ACRambassador
@ACRheum
@MedTweetorials
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Diagnosing
#scleroderma
is hardly ever difficult but its management is the tricky bit!
A quick and simple recap on what one needs to assess at the first visit🩺🥼
#RheumTwitter
#Rheumatology
#MedTwitter
#MedEd
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How ridiculous is this, medical education in the country is going to the dogs. Crazy
#reservations
? Unreasonable bonds? Inhumane work hours and living conditions?
#neetpgreservation
#India
#medicine
👎
I got AIR 3 this time in Neet PG 2021 and I still cannot get dermatology seat in MAMC, VMMC, KEM Mumbai and MMCRI Karnataka.
@OfficeOf_MM
@mansukhmandviya
@MoHFW_INDIA
@PMOIndia
@INCIndia
@EduMinOfIndia
@republic
@ndtv
@IndiaToday
@publictvnews
@NbeIndia
#neetpg
#neetpg2021
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Spotter!!
1️⃣ What is this sign
2️⃣ Name three autoantibodies commonly associated with it.
#RheumTwitter
#Rheumatology
#MedEd
#MedTwitter
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27
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🚗CAR-T cells in rheumatic diseases🚗
#Chimeric
antigen receptor T cells or better known as CAR-T cells target a specific antigen by combining the antigen recognition capacity of B cells 💪 with effector functions of cytotoxic T cells 💪
#MedEd
#MedTwitter
#MedX
(1/7)
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Varanasi is where life goes on, just like the everflowing mighty Ganga on which the city thrives.
📍Chet Singh Ghat, Varanasi
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All the very best my dear, already missing you ! ❣️
Thrilled to share that I'm embarking on an incredible journey from 🇮🇳➡️🇨🇦
I'll be joining
@pmcancercentre
, Toronto as a BMT/Cellular therapy fellow 🩺
Grateful for this opportunity and excited to learn 🙏🏻💪🏻
#MedTwitter
#DadWouldBeProud
♥️
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In layers of PPE we forget talking to the patients, anxious patients do not recover! So counsel and reassure :)
#StayHomeStaySafe
#COVID19India
#coronavirus
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I had a fabulous february with a getaway to the Andamans and learned something incredible - scuba diving !
PS: I disappear when I'm on holidays unlike my better half whom I have to threaten, "Twitter or Me? 😠"
@nihardesai7
@diveindia
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Dear
@GoAirlines
, kindly stop calling at 3am for information on rescheduling for a flight which is a month away.
Thanks and regards,
An irritated customer
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Nihar: please read my thread
Pankti: No
Nihar: why?!?
Pankti: cuz I'm no longer a "young medicine resident" 😅
You are a young
#medicine
resident !!
A patient walks into your OPD and says he is absolutely fine but his CBC shows an ⤴️⤴️ platelet count
He's done multiple CBC and it howers between 600-800k 😮
He is worried about it 😕
What do you do ??
Read on 👇🏻👇🏻
#MedTwitter
1/13
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Here's a spotter!
1. What are the clinical findings?
2. What's the diagnosis?
#MedTwitter
#MedEd
#RheumTwitter
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#RheumPearls
Common causes of PAINFUL oral ulcers:
🔹herpes simplex
🔹Candidiasis
🔹
#Behcet
's disease
🔹
#IBD
🔹 Idiopathic apthous stomatitis
#MedTwitter
#RheumTwitter
#MedEd
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One of my most favourite ANA patterns 🔬💡
1. Name the pattern
2.Associated disease
#RheumTwitter
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Was happy to teach some
#rheumatology
to undergraduates today on doctor's day, got reminded of the (mostly sweet) bitter sweet journey !
🍻 To enthusiasm, persistence and curiosity,
Happy doctor's day to all my fellow doctors! ❤️
@nihardesai7
#MedTwitter
#doctorsday
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Which country other than
#India
mandates doctors to work for the government after completion of their degree?
Genuine doubt !
#MedTwitter
#doctors
#bond
@nihardesai7
@ProfSomashekhar
@reallyrudi91
@HaryaxPathak
@DoctorLFC
@ArmenYuri
@DrPujaMehta1
@ShashvatDesai
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An excellent review on a much needed topic !!
🔹Efficacy and safety of DMARDs in RA ILD🔹
#MedX
#RheumTwitter
#ILD
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Hey
#MedTwitter
!
35♀️
2-week h/o bilateral pedal + unilateral hand/forearm non pitting edema (📷 cureus)
Referred for an expert opinion after work up for renal/cardiac/liver disease was negative
What are your differentials??
#MedEd
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In summary,
✅Joint pain without ❎swelling
💭 of
🔹Episodic
#arthritis
🔹Drug modified arthritis
🔹Non inflammatory arthritis
🔹Regional/widespread
#pain
syndromes
🔹Systemic diseases with polyarthralgia!
(10/10)
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A patient with spondyloarthritis & filariasis &
#tramadol
dependence.
What are these recurrent ulcers related to? Any guesses?🤔
#MedTwitter
#MedEd
#RheumTwitter
#arthritis
#rheumatology
16
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👇A common cause of pain around the ankle in patients with inflammatory arthritis
📷 Peroneal tenosynovitis in a patient with Rheumatoid
#arthritis
#MedEd
#medtwitter
#RheumTwitter
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Hey
#MedTwitter
!
Middle aged ♀️
Bilaterally symmetrical ✋, knee, & back pain + stiffness >1 hour🕜
🧪ESR, CRP, RF, Anti CCP negative
🧪TSH 22
📝What's the likely diagnosis?
#RheumTwitter
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Chest imaging in a patient suffering from rheumatoid
#arthritis
What are your differentials???
#MedTwitter
#RheumTwitter
#MedEd
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"Your diagnosis is elevated uric acid. You need to stop eating 🍅🥗🥦🥪🥩🫘, basically everything"
Beware of these!!
Elevated uric acid doesn't always 🟰 gout
#MedEd
#MedTwitter
#gout
#Uricacid
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What's with ola drivers refusing to switch on the AC ?
@Olacabs
time to mention clearly- normal vs cool cabs and not fool customers.
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