Shreya Bhat

Joined as Faculty (Senior Resident) in my Alma Mater xD🌸

@dr_mandaknalli Congratulations 🎉🎉

Life update - MD Medicine ✔️ Graduated 🎓 NEET SS AIR : 24 (CCM) | 686 (Medical Group) Secured DrNB Nephrology, Manipal Bangalore 10 years at HBTMC & Dr RN Cooper Hospital wrapped 🥹 Onto the new chapter! ❤️

Today in the ER, we treated a 36-year-old who came in struggling to breathe, his legs heavy with swelling. We eventually diagnosed him with heart failure, stabilized him, and started the necessary treatment. But as the shift settled, the most incredible part of the day wasn't the clinical case-it was the man sitting by the bedside. ​His grandfather, a man well into his 90s, had been the one to bring him in. Watching him move, I realized he was remarkably fit, so I struck up a conversation with him later. It turned out he doesn't suffer from a single chronic ailment. No hypertension, no diabetes, and in nearly a century of life, he’s never once been admitted to a hospital. ​There is something surreal about seeing a 90-year-old who is by almost every medical metric "healthier" than his 36-year-old grandson. It was a stark, sobering reminder of the shift in our collective health. In an era of rising metabolic disease, I truly doubt many of us will ever reach our 90s without carrying at least one chronic illness. A rare glimpse of what pristine aging actually looks like.

“Patidar itna khoobsoorat batsman hai, uski batting dekhke kisi ko bhi uski batting se pyaar ho jayega” - Venky Iyer 🤌 We second it Venky Bhai, we second it! 🥹

Defending champions starting new season with a bang

Now confirm it properly Because OSA is not a “clinical guess” It’s an objective diagnosis Gold standard: Polysomnography (PSG) Alternative: Home Sleep Apnea Testing for high-probability patients without complex comorbidities Severity is defined by AHI: <5 → Normal 5–14 → Mild 15–29 → Moderate ≥30 → Severe Management is where most mistakes happen First-line: CPAP in moderate–severe OSA It works by simply keeping the airway open But real-world issue: Poor adherence, not poor efficacy Before calling CPAP failure: • Check mask fit • Treat nasal obstruction • Reinforce early use Other options: • Mandibular advancement device • Weight loss • Positional therapy • Surgery in selected cases Important clinical rule: Drugs do NOT treat OSA Modafinil / Solriamfetol Only for residual sleepiness after adequate CPAP If you remember one thing: OSA is not just a sleep disorder It’s a cardiovascular risk factor you can actually treat

Rituximab dosing and management for Nephrotic syndrome .

Meree bache- mere bache bolkr dono ne pura samrajya khatam krdiya:

Even though, systemic sclerosis as a whole has a strong female preponderance, risk factors for development of ILD include *male gender*, african american race, diffuse skin involvement, severe GERD, positive anti-topo antibodies, low FVC and DLCO. #rheumat

Idiopathic Inflammatory Myopathies made simple 🔥 Autoantibodies are not just diagnostic — they define the disease. 🧵 Key patterns you must know: • MDA5 → Rapidly progressive ILD (high mortality) • TIF1-γ → Malignancy (adult DM) • HMGCR → Statin-associated necrotizing myopathy • SRP → Severe myopathy + cardiac involvement • Jo-1 → Classic antisynthetase syndrome Clinical mapping = exam gold: ILD dominant → PL-7, PL-12, MDA5 Cancer → TIF1-γ, NXP2 Good prognosis DM → Mi-2 ⚠️ ANA can be negative (cytoplasmic staining) Negative ANA ≠ No myositis This is precision rheumatology in practice. #Rheumatology #Myositis #Dermatomyositis #Pulmonology @DrAkhilX @IhabFathiSulima #MedTwitter #NEETPG #INI #MRCP

So true.

Gastroenterology through a gender lens: Clinical and professional perspectives @docMPK @UshaPGIMER #ProfKochhar link.springer.com/article/10.100…

@rahulsbelkoppad @itisprashanth @ApolloClinics 🤣🤣

@itisprashanth @ApolloClinics Just a simple hunger, Went to the Taj Mahal palace hotel to have lunch. Total bill 7500 rupees. Chicken butter masala, garlic naan etc etc etc. Plus water bottle worth 500 rupees. Absolutely not worth it.

Just a simple fever - went to @ApolloClinics for consultation . Total bill - 9000 rupees . Blood test , swab test etc etc etc . Plus tablets worth 900 rupees . Absolutely not worth it .

The rash of DM classically affecting the knuckles and dorsum of hand and the rash of SLE sparing the knuckles but present on the phalanges. Subtle things of rheumat xD ❤️

@shreyosaur Feeling probably lasts for a day, tomorrow you'll be back to loving medicine xD

I should’ve just gone with radiology, I never should’ve picked medicine

MRI patterns in Autoimmune encephalitis

The Diagnosis Was in the Story One lesson we learn slowly in medicine: Sometimes the history is the key. Actually… it is almost always the history. A 40-year-old lady with Systemic Lupus Erythematosus came with a long story. Her lupus had always been mild. No major organ involvement. She was doing well on Methotrexate and Hydroxychloroquine. Then a year ago, a new symptom began. Chest pain. Not severe. Not constant. Sometimes on the right side, sometimes on the left. She underwent many tests. ECG normal Echo normal Blood tests including cardiac markers and ddimer normal A CT thorax only showed mild pleural effusion. So she was treated symptomatically. Months passed. The chest pain slowly settled, but breathlessness began. At first during exertion. Then gradually she noticed something unusual. “Doctor, I feel more breathless when I lie down. When I sit up, it becomes better.” That single line changed everything. Breathlessness worse in supine position is not a common complaint. So we started again. We repeated the basics. A chest X-ray. It showed something subtle — an elevated left dome of diaphragm and mild bilateral pleural effusion. Then we performed spirometry. In sitting position it showed a restrictive pattern. But when we repeated spirometry in supine position, the FVC dropped by 18%. A decline more than 15%. That was an important clue. HRCT thorax showed: • Normal lung parenchyma • Mild bilateral pleural effusion • Small areas of atelectasis Nothing severe enough to explain the symptoms. Respiratory muscle testing showed reduced inspiratory and expiratory pressures. Phrenic nerve conduction and EMG were normal. Fluoroscopy showed reduced diaphragmatic movements. Everything slowly pointed toward one rare diagnosis. A condition many of us remember only from exam preparation. Shrinking Lung Syndrome In this condition: • Lung parenchyma is mostly normal • The diaphragm becomes elevated • Lung volumes reduce • Patients develop progressive breathlessness And the key clue is often breathlessness when lying down. When we looked back, the diagnosis had been hiding in plain sight. The recurrent pleural pain. The mild effusions. The elevated diaphragm. And most importantly - the patient’s history. Medicine often makes us chase investigations. But sometimes the most important test is still the simplest one. Listening carefully. Because in many patients like her, the diagnosis is already in the story they tell us. @DrAkhilX @IhabFathiSulima @CelestinoGutirr @Urchilla01 @DurgaPrasannaM1

Latest targeted therapies in systemic lupus erythematosus. The treatment landscape is evolving rapidly with therapies targeting key immune pathways: • Belimumab – BAFF inhibition • Anifrolumab – type I interferon blockade • Obinutuzumab – next-generation B-cell depletion • BTK inhibitors under investigation • CD40–CD40L pathway targeting • CAR-T therapy in refractory disease Precision immunomodulation is shaping the future of lupus treatment. #Rheumatology #Lupus #MedTwitter #ClinicalImmunology @DrAkhilX @IhabFathiSulima #AutoimmuneDisease

Bumrah’s greatness lies not in the fact that he can turn a match on its head within a few deliveries, but that he can do it again and again and again

Shivam Dube absolute CHAD.

That cameo by Shivam Dube (after a mini collapse of sorts) is as special as any in this innings. Incredible mental fortitude.