Hamza Qayyum

35 years male with c/o right side chest pain, O/E BP and pulse were not recordable, no past history. @ecgrhythms @AdiG1993 @RobertHermanMD @DidlakeDW @EM_RESUS @paramesh_mohan @Sthanu5 @Shaojiechen1 @ECG_Emily @DocNikko @UlhasDr @DrRajeshG1 @iamritu @DailyUrgencias @EPeeps_Bot

HbA1c is the standard long-term marker of blood sugar control in diabetes. But this measurement depends on one critical assumption: that red blood cells are living a normal lifespan of about 90–120 days. When that assumption breaks down, HbA1c either falsely reassures or falsely alarms. 🔴Conditions That Give a FALSELY LOW HbA1c (Blood sugar is worse than HbA1c suggests) 1. Haemolytic Anaemias — Red blood cells are destroyed prematurely (sickle cell disease, thalassaemia, autoimmune haemolytic anaemia, G6PD deficiency). Younger red cells have had less time to accumulate glucose coating, so HbA1c appears deceptively low. The ADA (American Diabetes Association) Standards of Care 2024 explicitly flags haemolytic conditions as a major source of HbA1c unreliability. 2. Iron Deficiency Anaemia (treated) — When iron deficiency is corrected and new red cells flood the bloodstream, the HbA1c can transiently fall even if sugars are unchanged. 3. Acute or Chronic Blood Loss — Heavy bleeding or frequent blood draws (e.g., in dialysis patients or critically ill patients) constantly replenish the circulation with fresh red cells, lowering HbA1c artifactually. 4. Erythropoietin Therapy / Blood Transfusions — EPO stimulates new red cell production; transfusions introduce donor cells. Both dilute the older glycated pool, pulling HbA1c down. The KDIGO 2024 CKD guidelines specifically caution against relying on HbA1c in dialysis and CKD patients receiving EPO or transfusions. 5. Haemoglobin Variants — Structural variants (HbS, HbC, HbE, HbD) interfere with several HbA1c assay methods, either falsely lowering or raising the result depending on the assay platform used. The IFCC (International Federation of Clinical Chemistry) and the ADA both recommend alternative monitoring methods when haemoglobin variants are present. 🔴Conditions That Give a FALSELY HIGH HbA1c (Blood sugar appears worse than it really is) 1. Iron Deficiency Anaemia (untreated) — This is the flip side: iron-deficient red cells live longer than normal, accumulating more glucose coating over time. Multiple studies and ADA guidance note this spurious elevation. Treating the anaemia can drop HbA1c by 1–2% with no real change in glucose. 2. Vitamin B12 / Folate Deficiency — These deficiencies slow red cell turnover and artificially prolong their lifespan, raising HbA1c. 3. Splenectomy — The spleen normally culls ageing red cells. After surgical removal of the spleen, old cells persist longer, accumulating more glycation and inflating HbA1c. 4. Aplastic Anaemia — Bone marrow failure leads to fewer new cells being produced, so the existing cells age longer and carry more glucose coating.

@LegitTargets @grok Is it true?

❌🇮🇱🇺🇸 BREAKING: US Ambassador to Israel claims "We DO NOT NEED ISRAEL'S approval to settle peace with YEMEN."

@gunsnrosesgirl3 The reaction of this sweet child with Down syndrome when he saw his brother touched our hearts. twitter.com/thebestvolkan/…

When I was in medical school I was taught that acute appendicitis requires surgery to prevent peritonitis, sepsis and death. This was taught to me as an absolute, unquestionable fact. Now we know many patients can be treated with antibiotics alone. Question everything you’re taught. Look up the data whenever you can. Drawn conclusions from the science itself not conventional practice.

Do you remember when you joined X? I do! #MyXAnniversary

@ZEUS_PSF Pakistan army zindabad 🇵🇰

Exclusive 🗡️☠️🇵🇰 Local afghans explaining how Pakistan Armed Forces struck TTP terrorists deep inside afghanistan. Please note that ttp terrorists are conducting terrorism activities inside Pakistan under the patronage of interim afghan taliban regime.

@modernHealthMe Basal Ganglia staining kernicterus feeling sad for the baby May he/she rest in peace, Ameen

Diagnosis?

@Mangojam01 @HaseebAhmadKT How?

گورنر راج لگا دیں، بہت فائدہ ھو گا تحریک انصاف کو

@RealWalkingbush @Naeem_ch111 Do you still use loperamide with metformin?

@Naeem_ch111 Diarrhoea is the most commonly associated side effect of Metformin. I've been taking the stuff for 7 years, and the first 6 months I was on it, I had to use Loperamide as an adjunct in order to allow me to benefit from it!

PharmaMed✨💊 Which #side_effect is most commonly associated with #metformin treatment? A. Hypoglycaemia B. Diarrhoea C. Headaches D. Dry cough #Diagnosis #MedX #MedEd

@DrRajeshG1 @ecgrhythms @AdiG1993 @RobertHermanMD @DidlakeDW @EM_RESUS @paramesh_mohan @Sthanu5 @ShaojieChen1 @ECG_Emily @DocNikko @UlhasDr @iamritu @DailyUrgencias @EPeeps_Bot I followed the case EP study showed avrt

@CardioNerd1 @ecgrhythms @AdiG1993 @RobertHermanMD @DidlakeDW @EM_RESUS @paramesh_mohan @Sthanu5 @ShaojieChen1 @ECG_Emily @DocNikko @UlhasDr @iamritu @DailyUrgencias @EPeeps_Bot A FL

55 y female, atypical chest pain, no risk factor @ecgrhythms @AdiG1993 @RobertHermanMD @DidlakeDW @EM_RESUS @paramesh_mohan @Sthanu5 @Shaojiechen1 @ECG_Emily @DocNikko @UlhasDr @DrRajeshG1 @iamritu @DailyUrgencias @EPeeps_Bot

@DrRajeshG1 @ecgrhythms @AdiG1993 @RobertHermanMD @DidlakeDW @EM_RESUS @paramesh_mohan @Sthanu5 @ShaojieChen1 @ECG_Emily @DocNikko @UlhasDr @iamritu @DailyUrgencias @EPeeps_Bot Sir your opinion in this SVT with aberrancy or Atrial flutter 2:1?

@CardioNerd1 @ecgrhythms @AdiG1993 @RobertHermanMD @DidlakeDW @EM_RESUS @paramesh_mohan @Sthanu5 @ShaojieChen1 @ECG_Emily @DocNikko @UlhasDr @iamritu @DailyUrgencias @EPeeps_Bot If available Simultaneous 12 channel ECG is always better.

@btysonmd @drkeithsiau You are entitled to your opinion. But it's pity that such a brilliant doctor takes side in a war between hamas and Israel when it's humans who are suffering.

@drkeithsiau Folliculitis decalvans causing Keloid formation.

Patient from Tanzania with this scalp issue for >1 year. What’s the diagnosis? #TwitterConsult #WithConsent

@ammarzakki Did he ever had seizures before?

بچھڑا کچھ اس ادا سے کہ رت ہی بدل گئی وہ اِک شخص سارے شهر کو ویران کر گیا A nice guy, gem lost . What a person think and what's the God's decisions. May Allah bless him with higher rank in jannah and give patient to his family 🥹😭😭

2 episodes of syncope, BP 70/40 @flozinatorMD @ecgrhythms @AdiG1993 @RobertHermanMD @EcgOxford @paramesh_mohan @Sthanu5 @Shaojiechen1 @ECG_Emily @DocNikko @UlhasDr @CardioAPFerrol @DrRajeshG1 @iamritu @DailyUrgencias @NicoGagelmann @EPeeps_Bot @DidlakeDW

Here’s a video I made breaking down another very impressive Chest X-Ray from the ER #FOAMed

Do you remember when you joined Twitter? I do! #MyTwitterAnniversary

Chest pain @ecgrhythms @AdiG1993 @RobertHermanMD @DidlakeDW @EM_RESUS @paramesh_mohan @Sthanu5 @Shaojiechen1 @ECG_Emily @DocNikko @UlhasDr @DrRajeshG1 @iamritu @DailyUrgencias @EPeeps_Bot

Increased QRS voltage in chest leads can occur in LV dilatation (Dilated cardiomyopathy) not only hypertrophy. Watch this one minute video: youtu.be/P_OJIF0TfQw

Congenital syphilis (wimberger sign) radiopaedia.org/cases/congenit…