Nihar Ranjan Nayak
@nihar_nayak2
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DM Cardiology trainee(YR-1)-AIIMS, New Delhi MD Medicine- AIIMS, New Delhi. MBBS- AIIMS Bhubaneswar
New Delhi
Joined April 2012
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Completed MD Medicine today (12.01.2024) from AIIMS, New Delhi. I will be forever thankful & grateful for the support & guidance of my parents, friends & teachers.
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Biggest lie in medicine: Thanks for the referral.
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Patient was taking some drug for his cardiac condition...
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Can someone guess the Dx? Why this surgery done in this case? Hint: zoom the pic n see closely.
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Thick vs thin smear in malaria...from parasitology symposium.
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The saddest part while sitting in OPD is when the patient says he or she can't afford the medications😔
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Antibiotic resistance
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This won't clear the darkness which medical fraternity is facing.
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Heart failure with reduced ejection fraction (HFrEF) treatment:
1. Three beta blockers improve survival. Carvedilol, bisoprolol and metoprolol succinate extended release. Not other beta blockers.
2. For ACEi and ARB, it's a class effect. All improve survival.
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Gave CPR to a 3 year child. First time giving CPR to a child. We couldn't save him. Very traumatic for us and the family.
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Doxycycline is a wonder drug. Tell one disease where you use it as first line.
#IDTwitter
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Tab Atorvastatin 40 mg OD.
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Courtesy: Dr sunil solar, aiims delhi. After consent.
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Causes of troponin elevation other than ACS:
1. Heart failure
2. Tachyarrhythmia
3. Myocarditis
4. CKD
5. Anemia, hypoxemia
6. Shock
So clinical context is important.
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IV MgSO4 is recommended for both severe exacerbation of asthma & COPD.
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Backstabbing by FORDA.
Union Health Minister, Shri
@JPNadda
met with the Federation of Resident Doctors Association (
@FordaIndia
) delegation today.
He welcomed their decision to call off the strike in the public interest and assured them that the Ministry of Health & Family Welfare will address all
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CPR machine. Wow.
Would be great if all professional and college sports had one of these on the sidelines.
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4th Convocation
@aiimsbbsr
.Received MBBS degree & Gold medal in microbiology from Honourable Minister of Health Shri Mansukh Mandaviya Ji.
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Indian healthcare system is the best in the world. Both in terms of affordability and quality.
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Please don't give piperacillin-tazobactam to patients to treat CNS infections. It has poor CNS penetration.
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New DM branches in INI-SS:
1. DM Pediatric emergency medicine
2. DM Geriatric psychiatry
3. DM Metabolism medicine
4. DM Acute care emergency medicine
5. DM Medical & forensic toxicology
6. DM Pain medicine
7. DM Trauma anesthesia
8. DM therapeutic nuclear medicine
@Rajatpsoge
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Switching from ACEi to ARNI requires 36 hour washout period to prevent risk of angioedema. No such gap is required when switching from ARB to ARNI, and the ARNI can be taken at the time of next ARB dose.
#cardiotwitter
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The person who takes medicine must recover twice, once from the disease and once from the medicine.
— William Osler
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My whole MBBS fee was 5800₹. My entire MD fee was 1600₹. And 3yr DM fee is ₹125. Had I not been born in India, I would have not been able to become a doctor or pursue my dreams & for this I will always be indebted to my country ♥️🇮🇳
My annual fee for MBBS was 48,000 PKR. My entire MBBS for 2.5 lacs which is equivalent to 900$ with so many scholarships too. Had I not been born in Pakistan, I would have not been able to become a doctor or pursue my dreams & for this I will always be indebted to my country ♥️🇵🇰
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All patients with chronic stable angina should receive at least 4 drugs.
1. Beta blocker
2. Aspirin
3. Statins
4. Nitrate
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With INI SS Medonco AML rank- 01
Grateful to have bro. Like u..
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Antiplatelet therapy (DAPT) in STEMI:
1. All patients must receive aspirin ASAP. 300 mg load f/b 75 mg OD
In addition to aspirin:
2. If doing PCI: ticagrelor (180 load f/b 90 BD) or prasugrel (60 load f/b 10 OD) is preferred over clopidogrel (600 load f/b 75 OD)
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🛑 Clubbing of the digits is not a sign of COPD, if present in COPD patients then it should alert for searching another cause like CA lung.
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25/F, known case of rheumatoid arthritis on treatment. Presented with this swelling in the neck. Possible etiology?
#MedTwitter
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Both pyridoxine (vit B6) deficiency and excess can cause peripheral neuropathy.
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A patient removed granules from her iron capsule n did this n showed to me. Is this normal?
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Understanding fever is the most difficult thing in clinical medicine.
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Treatment of Hypercalcemia:
🔵 Mild (<12 mg/dl): don't require immediate treatment. Avoid thiazides, Lithium, hypovolemia, vitamin and calcium supplements
🟣 Moderate (12-14 mg/dl): may not require immediate therapy if asymptomatic. Treat as severe case if symptomatic.
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D/D for this image. Courtesy: Dr Karthik E, aiims delhi. After consent.
#MedTwitter
#dermatology
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Sunday challenge...
Connect the dots... Diagnosis?
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Remember: Chest X ray is not required for the diagnosis of bronchial asthma. A good history, auscultation, spirometry with reversibility will be sufficient in most cases. 😁
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Amebic vs pyogenic liver abscess from parasitology symposium...
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No one qualified. INI-SS. Questions are so tough in ID!!!
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Iron metabolism & IDA:
1. Transferrin (iron binding protein in plasma) has two iron-binding sites & exists in 3 forms: apotransferrin (not bound to iron), monoferric & diferric forms: diferric has the highest affinity for Tf receptors.
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Role of nitrates in ACS:
1. Reduces preload & afterload, increases coronary blood flow. Hence reduces ischemic discomfort.
2. Indicated in patients with normal BP or HTN, HF, chest pain.
3. Can be given sublingually in ED.
4. IV infusion for persistent symptoms.
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The pain of discipline is uncomfortable but the pain of regret is unbearable.
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Modi 1.0 MBBS AIIMS Bhubaneswar
Modi 2.0 MD Medicine AIIMS Delhi
Modi 3.0 DM Cardiology AIIMS Delhi
Waiting for Modi 4.0👌
Modi 1.0 MBBS GMCS
Modi 2.0 MD Internal Medicine NHLMMC
Modi 3.0 DM Neurology AIIMS, New Delhi.
3 terms, 3 degrees.
His oath taking ceremonies are my humble reminder of academic progress.
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Acute management of ICH🩸
1⃣ET intubation for GCS < 9
2⃣NSx consult: cerebellar ICH > 3 cm2 or causing brainstem compression, IVH with obstructive HCP, hemispheric ICH with life-threatening brain compression.
3⃣Reverse anticoagulation with a specific agent.
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During in-hospital cardiac arrest, many residents panic to intubate the patient ASAP. But the key to a good outcome is high quality CPR. Delay in intubating is acceptable, but CPR must be given with full effort.
Expert comment from
@drmohansai
#MedTwitter
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Tab Rosuvastatin 20 mg OD.
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36/M, newly diagnosed T2DM not on treatment, dry cough for 1 month with significant weight loss. Thoughts?
#MedTwitter
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Approach to ascites. SAAG has very high sensitivity to diagnose portal HTN. High SAAG means ascites is caused by portal HTN. Low SAAG means ascites due to causes other than portal HTN.
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Heparin induced thrombocytopenia (HIT) :
1. Risk with UFH>LMWH
2. Thrombocytopenia develops 5-10 days after exposure, may develop rapidly if prior exposure is there, rarely delayed for >2weeks
3. Incidence is around 1% in critically ill patients, overdiagnosis is common.
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Connect the dots... Explain each image... What's the diagnosis???
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@MoHFW_INDIA
@JPNadda
@FordaIndia
@PMOIndia
@AnupriyaSPatel
@PIB_India
@MIB_India
@mygovindia
@DDNewslive
@airnewsalerts
Shame on FORDA
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Tuberculosis can involve virtually every body site, except enamel, hair and nails. 🤯🤯🤯
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For treatment of venous thromboembolism:
1. Dabigatran and edoxaban require 5 days of parenteral anticoagulation before starting
2. Apixaban and rivaroxaban can be started directly but require higher dose for few days
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A patient of retroviral disease.
1⃣Possible diagnoses for these lesions??
2⃣Lab diagnosis needed??
3⃣Treatment options??
#MedTwitter
#MedEd
#IDtwitter
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Patients with HIV can present with GBS during seroconversion. How do you differentiate from idiopathic GBS. In HIV related GBS, CSF pleocytosis will be seen. Whereas in idiopathic GBS, CSF protein will be high without pleocytosis.
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Hypophosphatemia & Hypomagnesemia can cause respiratory muscle weakness leading to acute hypercapnia Or Type 2 respiratory failure.
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In a world full of insulin resistance, be someone's metformin. Good morning🌞🌞🌞
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Supportive treatment for icu patients which are often missed:
1. Thromboprophylaxis
2. Nutrition
3. Avoiding positive fluid balance
4. Position change, care of pressure sores
5. Head end elevation
6. Check cannula, central line sites
7. Adequate analgesia or sedation as required
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Aspergillosis (disease spectrum, Dx, Rx):
1. Refers collectively to all invasive and allergic disease caused by aspergillus species
2. A.fumigatus: causes most of the invasive & chronic aspergillosis & allergic disease
3. A.flavus: sinus, cutaneous infection & keratitis
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