praveen valsalan
200 posts
praveen valsalan
@drpraveenvk
Doctor, physician, pulmonologist by profession, healer, liberalist, fitness enthusiast, loves basketball, F1, football
kochi, india Katılım Temmuz 2009
256 Takip Edilen45 Takipçiler
A 45-year-old patient presents with hemoptysis and weight loss, with a history of old tuberculosis.
What is the diagnosis?
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@ProfJDChalmers Congratulations for a great tenure as ERJ editor
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All good things must come to an end. After 10 years in the leadership of the ERJ I will step down next year.
Do you think you might be the next chief editor? Apply for the best job in respiratory medicine - details below and apply by 26th June 2026 ❤️
ersnet.org/news-and-featu…
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praveen valsalan retweetledi
#PLEURAL_PEARLS_WA 22
Pressure x Volume = constant (Boyle's Law). When airplane ascends, air expands. On descend, air (including pneumothorax in pleural cavity) will reduce in volume - just like in this water bottle - assuming no ongoing airleak. @PleuralPOCUS @ARNS_UK @ALATorax
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@ProfJDChalmers @tsanz_thoracic Wow.. Nice explanation...loved it..
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Todays highlight- the best description of DPP1 inhibition i've heard so far from Doug Forrester at @tsanz_thoracic
"Its like anger management for neutrophils - they still enter the room (the lung) but they don't kick over the furniture" - genius
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@shanaka86 More than 80 ships have already crossed the strait. No just India's two ships. Poor reflection of sycophancy
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India just executed the most sophisticated geopolitical manoeuvre of the 21st century and almost nobody in Western markets noticed.
While the Strait of Hormuz remains effectively closed to Western shipping, with Maersk, MSC, CMA CGM, and Hapag-Lloyd all suspending transit, India quietly revived Operation Sankalp. Visakhapatnam-class stealth destroyers and frigates are now escorting Indian-flagged tankers through the strait under a selective passage regime negotiated directly between External Affairs Minister Jaishankar and Iran’s Foreign Minister Araghchi.
Two state-owned LPG carriers, the Shivalik and the Nanda Devi carrying approximately 92,700 metric tonnes of LPG, have already crossed Hormuz under Indian Navy protection. Iran is letting Indian ships through while blocking US-allied vessels.
Read that again. The strait is closed to the West. It is open to India.
This is not an accident. This is the product of a decades-long non-alignment strategy being deployed at exactly the moment it matters most. India imports 40 to 50% of its crude oil and a significant share of its LNG through Hormuz. Energy security is existential. And India has no military pact with the United States. No pact with Israel. No treaty obligation to join any coalition. No skin in a war it did not start.
The timing of Modi’s Israel visit makes this even more remarkable. Modi landed in Tel Aviv on February 25 for a state visit. He addressed the Knesset on February 26, declaring that India stands with Israel. Three days later, on February 28, Operation Epic Fury began.
The diplomatic sequencing was surgical. Strengthen bilateral defence and technology ties with Israel at the highest level. Lock in the relationship. Then, when the war begins, deploy warships not to support the coalition but to escort your own tankers through the chokepoint that the coalition’s war created. India got the diplomatic credit in Jerusalem and the energy security in the Gulf of Oman simultaneously.
And the Western coalition? France and Spain denied airspace for US military logistics. Germany’s defence minister said this is not our war. The US and Israel are fighting alone. India is not joining them. India is threading the needle between every major power and coming out with its crude supply intact.
This matters for markets far beyond oil. Hormuz carries approximately one quarter of the world’s seaborne oil and one third of global fertiliser trade according to UNCTAD. The chokepoint closure has sent urea prices to $610.50 per short ton on CBOT, up 35% in a month, with spot barge quotes reaching $520 to $645 at NOLA. This feeds directly into the irreversible US Midwest corn-to-soybean acreage shift. USDA projects corn acres falling to approximately 94 million while soybean acres rise to approximately 85 million. The 15 billion gallon RFS ethanol mandate consumes roughly 43% of the corn crop. The US cattle herd sits at 86.2 million head, a 75-year low. Every one of these numbers is a pressure point that the Hormuz closure amplifies.
India’s pragmatic neutrality is not just smart diplomacy. It is a structural advantage that sustains its economy while the chokepoint reprices agriculture, energy, and fertiliser for everyone who cannot navigate the strait.
The consensus frames this as India hedging. That dramatically understates what is happening. India is exploiting a selective passage regime that no Western economy can access, while maintaining relationships with every side of the conflict simultaneously.
What kills this thesis: India formally joins the US/Israel coalition, or the Hormuz disruption resolves within weeks, or USDA March 31 Prospective Plantings show minimal acreage shift.
Until then, the warships, the diplomacy, and the energy arithmetic speak for themselves.
open.substack.com/pub/shanakaans…
Shanaka Anslem Perera ⚡@shanaka86
JUST IN: An Indian tanker just docked at Mundra port carrying 80,886 tonnes of crude oil. Indian media celebrated it as proof that energy keeps flowing. Look closer. The tanker never entered the Strait of Hormuz. The Jag Laadki is not a state vessel. It is privately owned by Great Eastern Shipping, a publicly listed Mumbai firm. It loaded Murban crude at Fujairah port, which sits east of the strait in the Gulf of Oman. It departed March 16, sailed south through the Arabian Sea under Indian Navy escort, and reached Gujarat on March 18. The entire voyage stayed outside the 21-mile chokepoint that has paralysed global shipping since February 28. No IRGC provincial command needed to grant clearance because the ship never entered their waters. No VHF radio hail. No AIS transponder permission protocol. No call from Jaishankar to Araghchi. Fujairah is on the safe side of the bottleneck. The Jag Laadki did not break the blockade. It drove around it. The Indian Navy provided the escort under Operation Sankalp, a standing maritime security deployment with destroyers positioned in the northern Gulf of Oman. Three warships are currently assigned to protect India-bound vessels in the corridor between Fujairah and the Indian coastline. The Navy is not charging a commercial fee. But the costs are real and they compound elsewhere. Maritime war risk insurance tells the financial story. When P&I clubs cancelled Gulf cover on March 5, commercial shipping lost its legal ability to transit. Single-voyage buy-back policies are available through Lloyd’s and specialty markets, but at Additional War Risk Premiums that have surged from roughly 0.25 percent of hull value pre-war to 0.5 to 5 percent or higher. For a Suezmax tanker valued at $70 to $90 million, that is a single-voyage insurance cost potentially running into the millions. That cost does not disappear when the crude reaches Mundra. It is baked into the delivered price. It flows through refinery margins. It arrives at the pump. Every Indian motorist paying elevated fuel prices is absorbing the war-risk premium of a strait their tanker did not even enter. The Jag Laadki loaded at Fujairah during an active drone attack on the terminal. It departed under naval escort through contested waters. It carried insurance bought at wartime rates from a market that has priced the entire Gulf as a combat zone. One tanker. One voyage. One cargo. The infrastructure required to move 80,886 tonnes of crude from a port 1,800 kilometres from India included three warships, a head-of-state diplomatic relationship, single-voyage specialty insurance, and a route that deliberately avoided the strait entirely. That infrastructure does not scale. It cannot move the 24 to 37 tankers per day that used to transit Hormuz. It cannot move a single urea vessel because urea loads at ports inside the Gulf, west of the strait, where the permissioned chokepoint applies. The Jag Laadki succeeded by avoiding the problem. The fertiliser cannot avoid it. The molecules load at Ruwais, at Ras Laffan, at ports that require passage through the 21 miles of mined, uninsured, permissioned water that the Jag Laadki was routed specifically to never touch. One tanker reached Mundra. The urea that 22 million Sri Lankans need for Yala did not. The crude that fuels Indian industry found a way around. The nitrogen that feeds Indian agriculture has no way around. The headline is the arrival. The story is what still cannot arrive. Full analysis: open.substack.com/pub/shanakaans…
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@hyderabaddoctor Great study.. Unknown benefits of weight training
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Lifting weights does not just build muscle; it rebuilds your gut from the inside out
A new study reveals that resistance training can fundamentally reshape your microbiome in as little as eight weeks.
The study followed 150 sedentary adults through a supervised lifting program. While the "average" changes across the group were subtle, the high responders (those who achieved ≥33% strength gains) saw remarkable shifts:
✅ Enrichment of "Elite" Bacteria:
Significant increases in Faecalibacterium and Roseburia hominis microbes legendary for reducing inflammation and protecting metabolic health.
✅ The Strength-Gut Connection:
Within-individual changes in the microbial community significantly correlated with improvements in physical strength.
✅ Mirroring Endurance:
These results suggest that resistance training can drive the same gut-health benefits typically associated with running and cycling.
▶️Clinical Significance
We have long known that exercise is medicine for the heart and lungs. We now have longitudinal evidence that strength training acts as a powerful intervention for the gut microbiome, provided the training is intense enough to drive physiological adaptation.
✅The takeaway
Don't just "lift." Aim for progressive overload. Your gut health might depend on the weights you choose.
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L&T Technology Services launches NVIDIA-powered AI lung digital twin platform biospectrumindia.com/news/16/27489/… via @BSI_social
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Yesterday I had the pleasure to meet with Father Custodio Ballester.
He is facing up to three years in prison for writing an article named “The Impossible Dialogue with Islam” and for talking about Islam on a TV program.
Apparently, hate speech is just a speech they don’t like.
He said the only judgment he fears is God’s judgment, though. A true inspiration.
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Then......... and....... Now
✅What is common: Smiling and happy face😊
✅However, beyond the weight loss (100 to 72 Kg), several parameters improved over the past 5-6 years.
▶️Resting HR reduced from 72 to 42 bpm
▶️BP reduced from 130/85 to 110/65
▶️HbA1C reduced from 6 to 4.8
▶️TG reduced from 300 to 45
▶️HDL increased from 32 to 52
✅Three key factors responsible for these changes:
1. Running (consistently)
2. Healthy diet
3. Improving sleep duration from 4-5 hours to 7-8 hours.
✅It is never too late to start the journey for a healthier life.
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@radiologistpage Is there a dot like foreign body on right LZ, just below the hilar area
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A male in his 40s presents to his GP with fatigue and has a chest X-Ray. This was called normal but looking back was there an abnormality looking back?
Let me know what you think in the comments - answer will be posted on this account tomorrow
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Male in his 20s presents with fever, cough and abdominal pain. What does the X-Ray show and what is the differential?
Answer will be posted tomorrow
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Let's offer one Hail Mary for the repose of the soul of Fr. Alois Cheruiyot Bett, who was shot and killed in Kenya while on his way to offer the Holy Mass.Please comment Amen as a response. #OneHailMarycampaign
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A deep learning framework for the segmentation and quantitative analys... sciencedirect.com/science/articl…
our study on deep learning in PE to diagnosis PE from non contrast CT
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Pulmo 360 was an amazing programme.. Literally 360 degree comprehensive programme.
Kudos to Harvard team for getting it to Kochi..
Was a part of the ILD discussion along with Dr Binu Krishnan, Dr Rob Hallowell (brilliant talk) and Dr Raja Elle abdulnour (Editor in Chief NEJM journal watch clinical development and AI innovation)
Congrats to Dr Arjun Khanna who spearheaded the whole programme
#Harvard
#pulmonology
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Excellent review.. must read on biologics in severe asthma.. how to choose.
pubmed.ncbi.nlm.nih.gov/39245321/#:~:t….
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In Trump’s Alternate Reality, Lies and Distortions Drive Change nytimes.com/2025/02/23/us/…
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Congratulations Dr Raja Dhar for bringing ERS to Kochi.
With Prof Omar Usmani, Prof Monika Gappa, Prof Judith García, Prof Hilary Pinnock, Prof DJ Christopher, PK Thomas sir, and my friends Nagarjuna V. Maturu , Viswesvaran Balasubramanian , Paramez Ayyappath , Shyam Krishnan
Suomi
Excellent initiative by ICS to bring the ERS to India.. Kochi ERS ICS programme was a huge succes with amazing faculty and packed audience. Thanks to cipla.
Special thanks to Dr Raja Dhar sir for bringing this programme to India..
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