Dr.Uddhav kinhal

@ChekrishnaCk NTA incompetency at it's peak. There seems to be no hope for this country anymore.

NTA screw up again. "The OMR sheet has been changed" Father has come with a proper copy from NTA. In which the name is different, the child's name is different. We just show the truth, and whatever doesn't suit you people starts to seem like a lie.

@DrShauryaGarg Garden variety Porphyria.

A 27 yr old woman with no psychiatric history develops 6 days of near-total insomnia, grandiosity, persecutory delusions & third person auditory hallucinations. She remains oriented, but her pulse is 126/min and BP 168/102 mmHg. For 10 days, she has also had severe diffuse abdominal pain, vomiting & constipation. CT abdomen is normal. Serum Na+: 119 mmol/L Examination now shows proximal limb weakness with reduced reflexes. She is diagnosed with first-episode mania and started on valproate. Over the next 48 hours, her abdominal pain and weakness worsen. What is the investigation you will send? What is the diagnosis?

@ElieNaddaf3 Pediatric/adolescent perspective: -Fibrodysplasia ossificans progressive -Polymyositis

Mimickers (in no particular order) that are often misdiagnosed as fibromyalgia or #MEFS, which I see as a neuromuscular medicine specialist: 1️⃣ Myotonia congenita 2️⃣ Early stage (subclinical) myositis 3️⃣ Some inherited myopathies especially RYR1 or DYSF 4️⃣ Metabolic myopathies mainly myoadenylate deaminase deficiency 5️⃣ Myopathy with tubular aggregates Add yours 👇 @mayoneurores #MedEd

@DrNikitaMehra 🙏👍

thank you for your note. We spoke to the patient’s father, & requested him to see a neurologist suggested by someone who has been in the SMA space for a while. The child has crossed 3 yrs of age. I will share the clinical note with his father. Important to choose what works best

@kritika_k__ Yes. Delhi is far better. Better if people stay back and never come to Bangalore and those already in Bangalore should consider moving back to Delhi (or respective home towns)

I have been in Bangalore for the last month. I suggest not coming to Bangalore. Delhi is way better than Bangalore. P.S only weather is good.

@YashmiAdani Agreed but it would be lot better without the migrants.

I repeat, nothing. bengaluru cafe is still goated. jayanagar is still the best neighbourhood

@Vsahsau101 Preserve it forever. One of the most important document. Not just for PG admission,it will sometimes decide your seniority as faculty.

The internship completion certificate we get, is it a certificate to be kept forever or just in PG addmissions and post MBBS exams?

Most empathetic doctor is the one who shows no emotions or sympathy. He gives you diagnosis & prognosis with a straight face and advices the most appropriate treatment. World is spoilt and suffering because of the importance given to soft skills, ability to do partisan politics and boot licking the people in power. Best doctor is stubborn, straight forward, frank and does not know how to sugar coat.

@OversLife My favorite player. Nathan Astle

Can you identify this cricketer from memory alone? 🤔 He once blasted 222 against England, reaching what was the fastest double century in Test cricket…off just 153 balls. 🏏

@kadalcippi Nice! Pls let us know when you are next ready for reading charts. TIA.

I looked at the charts of my childhood friend’s two children, and it truly felt wonderful. She told me how she met an astrologer today who would answer only her specific questions for Rs. 200 and wouldn’t say anything voluntarily. So she wanted me to examine her children’s charts and share my perspective. Both of her children truly feel like the Goddess’s own! She is the same friend who used to say I was talking kooky whenever I shared my dreams and paranormal stories.

@rishikagupta__ Glad. Stay back. Thanks.

Delhi is much much much better than bangalore

@mufaddal_vohra Mediocre player pushed by pure PR and Mumbai lobby.

🚨 NO ROHIT SHARMA FOR WORLD CUP. 🚨 - Lord’s could be Rohit’s final ODI as the selectors have conveyed him he’s not part of the 2027 World Cup plans. (Express Sports).

@strangesugarC Over night soaking helps. Reduces cooking time significantly. If interested read about 'Hard to Cook' phenomenon of legumes. There are a lot of food quality enhancing processes like Milling,soaking, parboiling,sprouting etc. Food science is interesting.

what's with this rajma kaaLu? yesht kudsidru kudiyadhe ilaa. 😶 ashten chenagila bere

On seeing it carefully: Symmetric, homogenous hyperintensity (the texture of hyperintensity is same across all the affected structures in T2/FLAIR) with very well demarcated sharp edges and visible sparing of the external capsule is often a venous thrombosis. Cerebellar affection is a clue that favours CSVT but is variable depending on the vessel involved. In viral encephalitides - Typical MRI picture is symmetric, but heterogeneous hyperintensity involving BG and thalami with jagged-ragged edges in T2/FLAIR and most often has subjacent white matter changes with variable thalamic involvement. Other close mimics are Osmotic demyelination and Rabies rhombencephalitis but clinical picture will be whole lot different.

✅ Grand: Seldom we see, often misidentify Deep CVT vis-a-vis the commoner, Superficial CVT. @mehtanikhil has enlightened us for those who work in the tropics lest we mistake them as Flavivirus Encephalitides: 🔺Dengue 🔺JE 🔺KFD 🔺Murray Valley 🔺WNV 🔺Zika 🔺Omsk ... ♥️🙏

I can see the atrophy is quite advanced with fixed contractures and there is also mild deformational changes to the spine. He is not SMA type 1, seems like type 2(although type 1,type 2,type 3 categorisation is now getting obsolete and being replaced by number of copy number variants of SMN2 gene with advent of genetic testing nowadays-SMA is to be seen as a continuum than a categorised division of motor ability). SMA has typically 3 therapeutic options: 1.ZOLGENSMA (the much talked about gene therapy costing 16 crores- which is a one time IV infusion) It is recommended for children under 2 years of age. So in this child with (by his length I am assuming he is above 2 years or going to be 2 years very soon) As such there is no absolute contraindication for ZOLGENSMA but practically speaking with his severe advanced atrophy/contractures and spinal deformation - he is not likely to have much benefit. Only expected outcome would be that the child will maintain whatever muscle is still left out and prevent progression to respiratory muscles and bulbar muscles in the foreseeable future. 2. Intrathecal NUSINERSEN- approx cost of 96 lakhs per vial: dosing scheduled as - 4 loading doses,each given 1 month apart and there after one dose every 4th month - indefinitely (life long). Not readily available in India, has to be imported and takes a lot of bureaucratic help. Although a theoretical possibility in this child,but practical possibility is bleak (owing to lot of bureaucracy involved with clearances from airport authority ,maintenance of cold chain). Realistically child will maintain whatever left over muscles are there and might show mild improvement in hand functions(smaller muscles). 3.Oral RISDIPLAM - weight based dosing(comes as 80ml dry powder to be converted to suspension by adding purified water). Manufactured by SWISS company ROCHE. Till recently each bottle costed about 5 to 6 lakhs but since the last year (with intervention from the Supreme Court, the drug is now allowed for local manufacturing and dispensing), cost of Risdiplam (Natco) is about 12,000 to 16,000 INR. Each bottle will last about 20 to 30 days (actually depends on the weight of the child). Practically in this child (assuming he is more than 2 years), I would only recommend Oral RISDIPLAM, physiotherapy, respiratory therapy and influenza vaccine every year. If he is less than 2 years, considering his advanced atrophy with fixed contractures- I would still recommend oral Risdiplam alone and not try the 16 crore Zolgensma(which has no real world results to see in such advanced atrophic cases). Combination therapy even though feasible is not a practical option here. People emotions often run high for childhood illnesses and some governments do respond to it,which is sometimes good as it can give impetus to push the government to think and invest in rare diseases,which is a win for rare disease enthusiasts like @aditya_gan3500 and @Neuroptimist23 Personally, I would request the Govt to invest efforts and money on prenatal carrier frequency testing of SMA along with Thalassemia, Sickle cell anemia.

@DrNikitaMehra @CMOTamilnadu @TVKVijayHQ @arunraajkg The muscles are already grossly atrophied I doubt there is any benefit of therapy anymore @UddhavaKinhal plz opine

I met a lovely boy with spinal muscular atrophy (SMA), a life-threatening condition, & his father from Coimbatore at the TN Secretariat. I humbly seek the support of the Hon’ble @CMOTamilnadu @TVKVijayHQ & Hon’ble Health Min @arunraajkg to help this child access life-saving Rx

@chesscom_in @DGukesh @Chennai_GM @imsahiltickoo @itherocky @mgd1_esports Gukesh looks all set ,to lose the world championship.

Team Chess.com India X Gukesh

@DrAyubaD Osmotic demyelination.

Patient with altered sensorium after correction of severe hyponatremia . What is your diagnosis ?#MedX like and repost this case 🙏🙏

@MANSAFAB It happens in PICU. Pediatric ICUs typically calculate everything weight based. Dengue is managed with extreme caution and meticulously in most PICUs. I am not sure of what happens in Adult ICU.

@UddhavaKinhal I have never seen or heard anyone calculating according to weight and telling nursing staff. It’s either 1 pint or 2 pints or just a specific number of pints.

Okay. But is this really followed word by word? I really need an answer.

@bhatnaturally Sir it is best to respond with facts to such tweets. So go on; list the development work(s) and basic amenities that has transformed the ease of living.

A senior executive at Cognizant tweets ‘democracy in India 🇮🇳 is finished ever since Modi figured out all you need to win is Hindu-Muslim rivalry and bribes to voters directly via Aadhar accounts’. Imagine this is their understanding of why voters have given their mandate thrice in national elections. Absolutely no recognition of the development work, providing basic necessities, and so much more. Frankly they will shut out any fact or stats that doesn’t validate their bias. Anyway not surprising because he engages with the likes of that Behere fellow