Sony Thomas

@SeeFisch Alteplase versus tenectaplase?

No, thrombolytics in STROKE are NOT good after 4.5 hours. they make you bleed.

@Troubleswamy @prernabhardwaj_ @airindia So the airline would have to take the time to find his bag from the hold and take it out? Would that be easier than letting him in?🤔

@prernabhardwaj_ @airindia "My bag was checked in, which clearly means I can board the flight " Umm.. in entitlement land, that's true but in real life there's no such thing. Reach your boarding gate 25 mins before departure,THAT means you will board the flight Its mentioned multiple times.Follow rules

Extremely bad behaviour by the @airindia staff! I reached the airport, my bag was checked in. Which clearly means I can board the flight otherwise they don’t take the check-in baggage. I reached at the boarding gate at 5:22PM. my flight was at 5:40PM. As a matter of fact, they let 3 passengers board after me. I am still at the airport, there is no other flight to Bhopal now. All because the lady and the man at the counter couldn’t satisfy their egos. I challenge Air India to check the CCTV footage at the airport and tell me if I was wrong. @DGCAIndia @JM_Scindia

@Hragy Sir , if I may ask, how was the learning curve in IC for an established cardiologist at that time? Thank you

I have been a cardiologist since the first half of the 1980’s before IC became a solid subspecialty, i have seen first hand what good cardiac surgery does, last time today, a couple came to visit me, he is 90, she is 87, Sir Magdy Yacoub did her CABG 30 years ago! Asymptomatic!

@Jasonphilip8 Just wanted to know how you managed to be in two places at one time...suppose you were doing cystoscopy and a bladder injury call came, what would you do?

I read the Residency woes of most Indian Drs in Tw. I do feel for them, bc I walked the same path. Let me relate my experience as an MCh-Urology resident at Govt Stanley Medical College Hospital, yrs ago. I chose Urology, bc it ws the most sought after SS course in TN at that time. There were only 7 seats in TN, & only 1 at Stanley. I chose Stanley, as this is where I did MBBS,& hv an emotional attachment. The MCI had discontinued MCh Uro at Stanley earlier, & restarted it only then. So, I was a single PG for the entire large Dept of Urology, Stanley. The Male Urology ward was at 6th floor,NSB, Female at 7th floor, Uro Postop ward at 3rd floor,& Cystoscopy/ USG rooms at the Ground Floor. I had to run( Lift was always full) btw these wards atleast 20 times a day, up & down the stairs. There used to be 40 pts in male ward, 20 in female, 10 in male postop, 5 in female postop, 2 in Kidney Tx ward, 20 pts waiting for Ultrasound and 15 for cystoscopy on all days. As a single PG, only I attended to each one of them, every day. I never saw an Asst Prof enter the cystoscopy/USG room ever in my 3 yrs as PG. There were 5 Asst Profs, 1 Associate Prof,& 1 Prof/HOD. But of what use? Except one Asst Prof- Dr. Thiruvarul who was extremely sincere, punctual & devoted to pts,& this PG, all Asst Profs came at 9.30 -10 & left at 12 noon to practice at their clinics. The Associate Prof, came twice a month to the dept, claiming to be the brother of a Union Min. The other days, his driver signed the Attendance Register at the Dean's office. I know this ex-Union Minister,& talked to his PA even last month. He confirmed that the Dr was not a brother.Bluffing. So in effect, I, with limited experience in Uro ws managing the entire Urology dept. Urologists also hv to work with Gynaecs in many surgeries, & we have an allied Gynaec Hospital-RSRM. There were daily callovers from RSRM,& I had to drive my car to that hospital fr Uro work. Also, bladder injuries r inevitable during some Caesars,& I had to attend to on table bladder injury callovers. At 2.30 AM, 3.15 AM, 4.30 AM.. Not once during my 3 yr residency, do I remember an Asst Prof accompanying me for these on-table callovers. Except the kind AP, I referred to. I was on duty 6 days a week, with Sunday off. One of the APs took care of Sunday, when I insisted I hd to attend church. So 6 days, I wd sleep in the hospital Uro PG room without a bath/ change of clothes or shave. Food was a luxury to be taken, once a day when free, at the canteen. I lost 30 kilos in those 3 yrs. I considered suicide,& even hd a plan, to escape this hell. Somehow survived. The typical day started at 5 AM, when I wd finish Ultrasounds. Next ALL uro pts had to be examined, notes written, dressing done fr post op pts. Next wd be OT or OP. At 2 PM, I wd start cystoscopies which wd end at 5 PM. Next wd be 20-25 call overs/day from various wards. On-table callovers from Trauma ward or RSRM cd come at any time of the day or night. All were attended to, by me. This ws the routine- 6 days/ week. Add to this,the occasional night Cadaver Transplants. I endured all this to get my coveted MCh degree. To be fair, SS Pgs of other depts suffered hell too. The next yr, MCI expanded SS seats, & 5 extremely sincere Uro PGs came to my help. My suffering ws considerably eased. Today, my dept hs 24 MCh Urology PGs. All r gems. But, when someone says he is overworked, my memory flies back to my own single PG days, when I considered suicide. And smile gently. They cannot fathom the suffering,I underwent as a resident in another era. I promise u, there is not a single word of hyperbole. I hv related it, as life was then for a resident in TN. #MedTwitter

@drsunita02 It's cold..more comfortable to wear suits as compared to got and humid India!

When I lived in UK, which was from 2004 to 2015, I used to admire the guys and women in London.... One just had to go to London Metro during the peak rush hour office traffic and stand there for an hour and one could see the sea of humanity rushing by.... Everyone looked so fit then... Guys were dressed smartly in suits. Ladies also wore professional wear with suits/blazers over pencil skirts or trousers. I could see them carry their professional heels in a bag while they wore sneakers to walk .... London was the financial capital of Europe then....not sure about now... Was there something in London air that made everyone entering the metro station look so fit and smart?? By the way, London Metro is majorly underground and it covers nearly 400 kms and the first metro started around 1870....yes, it was around 1870s....and nearly 2.5-3 million use it everyday ... I loved observing the people in the Metro stations. One of my favourite pasttimes.... And then there was a small column in the daily newspaper where some guy or gal would crush on some other anonymous person in a local metro and describe them in detail and ask out for date if they were interested ..... #Memoriesfromthepast

@Drkvheart @bhatia_nachiket Halsted, Cocaine

@bhatia_nachiket 24hrs + 12 hrs shift is a torture for all medicos . It should be revised & criticises not glorified . To some extent it is lack of doctors in yesteryears but not in today generation .

If we want to reduce toxicity , we need to ATTACK the reputation of the college/institute. The kind of msgs i am getting from JR1’s makes my blood boil in anger A structured attack is what we need 1. Send me your problem. I shall post without your name but highlighting the college/institute 2. Within a couple of Hours, the college gets to know( prior posts had that effect) 3. They shall call you or your CO JR’s to intimidate you or to write an apology letter 4. Go ahead and do it. We have already won. We are not here to erase toxicity in a single day, but to put fear in the minds of the consultant that someone is watching them and they shall think 10 times before ordering tea from a JR1 next time. #MedicoLivesMatter #EndToxicResidency #StopMedicoAbuse #DoctorsAreNotSlaves #MedicalToxicity #FixMedicalTraining #JRVoice #ResidentsRights #NoMoreRagging #HospitalAccountability #MedicoJustice #SpeakUpDoctors #EndHierarchyAbuse #SafeTraining #ReformMedicalEducation

@contentkunjamma @street_walker_ Any opinions about Hitachi?

@street_walker_ Sharp is pretty good

Which is the best Air conditioner suited for the Kerala climatic conditions or any recommended one from experience?

@Vincent5327827 Would it bepossible to see a tiny for truck coming and judge? Unless the fire truck is also fitted with TCAS...maybe that's a thought... although TCAS RA is by default inhibited below 1000... This needs a solution

Damn…. 100% of the time and ANYTIME when crossing any active runway or even one that’s not in use, I won’t start any runway crossing until “we” have looked both ways, sometimes twice to be sure nobody is rolling or about to land…. And I always ask for FO confirmation that his side is clear with certainty. We always expect that the clearance was in error. Also, I use the TCAS to look left and right beyond the boundary of the airport to have operational situational awareness of aircraft on approach, or on the runway. Praying for those involved, and also for the controller… this is a horrible event, and I hope we all learn from this.

@nileshnolkha Which brings the question...do we approach pulmonologist as allergy doctors? As most of rheumatology (although having immunology) don't deal with allergies...? Thank you!

Most useless way to drown your money is doing this whole panel food allergy tests without an allergist advice. Read why you should never do any allergy test without consulting an expert (most routine doctors don’t’ understand allergy)

@DrRajeshG1 Always wanted to ask this... would you do CAG considering " CIN is a myth" or is raised creatinine a contraindication?🤔 Thank you very much

58 yr old male admitted to a peripheral hospital with chest pain, developed cardiac arrest there and was resuscitated. his creatinine was 3.8 mg. What is the probable arrhythmia which developed while the patient was in CCU? Baseline ECG attached below.

@Hragy Sole cardiology resident..24x7 for one year?

I started watching The Pitt, found it amazing, in 1984/85 I was the sole cardiology resident in Sohag teaching hospital in southern Egypt, I actually lived in a room in the hospital on the 4th floor for a year, I wish there was a way to write my story there, it was unbelievable.

@Medzonetv @LorickFoxPA Agree with the Global part....used to not sit as standing was one way of not falling asleep

@LorickFoxPA It’s interesting to see that this isn't just a Nigerian problem, but a global one. However, the difference is the institutional shift you mentioned. In many places, we are still waiting for that “social and professional change.”

It is 8:00 AM on a Tuesday. The post-call Senior Registrar hasn't slept in 32 hours. 🕒 His scrubs are stained with amniotic fluid and dried blood. He personally managed 4 emergency C-sections and 6 complicated vaginal deliveries overnight. He saved 10 lives while the rest of the city slept. Now, he stands at the front of the seminar room for Morning Review. His eyes are bloodshot, his hands are shaking from caffeine and exhaustion. The Consultant sits in the front row, arms folded, eyes cold. "Case 3," the Consultant interrupts. "Why did you use a 22G cannula instead of an 18G? Why was the oxytocin started 4 minutes late? Do you want to kill this woman?" The Registrar tries to explain: "Sir, the patient had extremely tiny veins. I spent 15 minutes trying to get a bigger line, but the 22G was the only one that would pass." The Consultant doesn't want to hear it. He starts bashing him in front of the house officers and students, calling his clinical judgment into question.💔 A grown man, a surgeon-in-training, stands there with tears welling up, being disgraced in public after a night of saving lives. If this is “training,” why does it feel like a public execution?

@cliffreid Perhaps the next part of the algorithm should be...🤔

I was trying different vagal manoeuvres today while treating a patient with SVT and a colleague suggested I try a testicular squeeze. However, after about 30 seconds the patient got really uncomfortable and said “Doctor can you please stop squeezing your testicles?”

@TRE_320 What do you think will finally happen Sir? Is it necessary to keep abreast of manual flying skills? Or for payment...keep skills on manual gear in vehicles current??

Baby Boomer Captain : Manual flying skills will deteriorate with over dependence on automation. Gen-Z BotHead : Manual flying skills will disappear with your replacement by automation 👨🏻‍✈️ #pilot #pilotlife #Training #SafetyFirst

@JoeM7687369 @zebrahoofbeat @DocPriyamMD And give them the option of doing it without the burden of work..

@zebrahoofbeat @DocPriyamMD Make them. That’s great.

The 2026 guidelines effectively say: If your CAC is > 1000, you are a heart attack patient who just hasn't felt the chest pain yet. Targeting LDL < 55 in someone who feels 'perfectly fine' is the new frontline of primary prevention The 2026 ACC/AHA PREVENT targets are extreme. Are we over-medicalizing primary prevention, or finally getting serious about eradicating ASCVD? 👇 Drop your take: Is < 55 the new gold standard or a step too far

@robinwjsia May I ask regarding lactate?

Withholding metformin for all hospitalized patients is no longer recommended, unless absolute contraindication in severe renal impairment.

@saikatmitra05 Kussmaul's sign? Right heart dysfunction?

Please poll here

@MerlinLarsonMD1 Any link to the original article?

Measurement of blood pressure was performed with this method for over 50 years. Now a lost art. It also worked if the cuff was placed on the calf. Described in 1924.

@ASanchez_PS Dupuytrens contracture? Cholesterol emboli? Vasculitis?

Single photo clinical reasoning challenge! 📸 1. What is patient's major past medical history? 2. What symptoms could they have presented acutely with? 3. How can you tie PMHx & acute symptoms together?

@bhaveshecho @DrRajeshG1 May I please have the reasoning as well please?

@DrRajeshG1 Constrictive pericarditis,Restrictive cardiomyopathy

Look at the JVP of this patient with heart failure of 3 months duration, apex beat normal, S3+, no S4, short systolic murmur at lower left sternal border. ECG shows low voltage complexes. JVP interpretation and 2 differentials based on this data.