Dr Nikhil Sharma 🇮🇳

@lg_ladakh @ashishkundra Sir I think you meant “ holy” not Holi

🩻Contrast-induced AKI: one of the biggest myths still shaping clinical decisions For decades we were taught: 👉 “Contrast damages the kidneys” 👉 “Avoid CT with contrast in CKD” 👉 “Hydrate, protect, delay imaging if needed” But what if… most of this is wrong?🤔 ->The uncomfortable reality Modern evidence shows: 👉 Low-osmolar contrast rarely causes true nephrotoxicity 👉 Even in CKD, AKI, and ICU patients 👉 The risk is often overestimated—or nonexistent So where did the fear come from? 📍 1950s high-osmolar contrast (actually toxic) 📍 Poorly controlled observational studies 📍 “Creatinine rise = contrast injury” assumption 👉 Correlation became causation 👉 And the dogma stayed ⚠️What recent data tells us ✔ No difference in AKI rates with vs without contrast ✔ No benefit from bicarbonate, NAC, or aggressive hydration ✔ Even ICU and AKI patients show no worsening outcomes ->Translation to real life 👉 The patient was going to develop AKI anyway...Not because of contrast!! ->The real problem: “Renalism” 👉 Avoiding necessary imaging 👉 Delaying diagnosis 👉 Choosing inferior tests And that leads to: ❌ Missed PE ❌ Delayed sepsis source control ❌ Worse outcomes ->Clinical mindset shift Instead of asking: 👉 “Will contrast harm the kidneys?” We should ask: 👉 “Will NOT doing the scan harm the patient?” ->Who still deserves caution? ✔ eGFR <30 ✔ Severe hemodynamic instability ✔ Multiple nephrotoxins Even then: 👉 Optimize volume 👉 Minimize dose 👉 Don’t delay critical imaging 🤓Bottom line ✔ Contrast nephrotoxicity exists… but is rare ✔ The fear is bigger than the risk ✔ The harm of NOT imaging is often greater In critical care 👉 We don’t treat creatinine 👉 We treat patients And sometimes… 👉 The most dangerous thing is NOT the contrast 👉 It’s hesitation. 📃Reference Florens N, Demiselle J. Kidney360 7: 445–449, 2026. doi: doi.org/10.34067/KID.0…

(Meant for my younger colleagues) 32 Years in Medicine: Lessons Beyond Guidelines I saw my first OPD patient on 1st Feb 1994, during internship. This is my 33rd year as a doctor. Over the years, I have followed the guidelines laid down by regulatory bodies. But some of the most valuable lessons in patient care are not written in any manual. They are learned, observed, and practiced daily. Sharing a few principles that have consistently improved my doctor–patient interactions, especially for younger colleagues: 1. Respect time. Keeping appointments on schedule builds trust. If delayed, inform early. If delay is due to an emergency, explain honestly. 2. Start with a smile. Patients often walk in anxious. A warm greeting can ease half their stress. 3. Speak their language. Even a few words in the patient’s language can instantly build rapport. 4. Listen; truly listen. A missed detail in history can lead to a missed diagnosis. Good listening is good medicine. 5. Be fully present and avoid distractions. The patient in front of you deserves your complete attention. 6. Be fair. If a patient has come to the wrong specialty, guide them appropriately and consider refunding the fee. 7. Know your limits. If someone else can offer better expertise, don’t hesitate to suggest a second opinion. 8. Respect colleagues. When a patient comes to you for second opinion and you find that prior treatment was appropriate, say so. There is no need to undermine another doctor. 9. Think from the patient’s perspective. If they have traveled far to consult you, help them find care closer to home or consider teleconsultation when feasible. 10. Communicate clearly. Explain diagnosis, treatment options, duration of treatment, possible side effects of medications, and follow-up plans in simple terms. 11. Promote healthy living. Never miss the chance to reinforce lifestyle measures. Healthy diet, exercise, and sleep matter more than most prescriptions. Medicine is both a science and an art. Guidelines teach us the science. These small, human touches define the art. To the younger doctors: Your knowledge will earn respect, but your empathy will earn trust. Dr Sudhir Kumar @hyderabaddoctor #MedTwitter

@volklub Brother , your opinion is invaluable

7th car of our community today! Sales worth 1 Crore+ easily 👌 That’s the impact of content by a customer for the customer. Kylaq it is by Abhi ji. Best car under 4m with Turbo AT for enthusiasts & quality lovers. Community for all… 6336 🌴 #volklub

@mantri_gaurav @volklub Congratulations boss, on road price?

@volklub thanks for the guidance. Got the Alcazar DCT peestige.

@volklub Good explanation, thanks

NA vs Turbo: There’s No Perfect Choice, Only Your Choice If you are driving a naturally aspirated petrol engine on highways and feel a lack of power during overtakes or while climbing hills, remember, you chose long-term reliability and slightly better city fuel efficiency over outright performance. If you chose a turbo petrol and see single-digit fuel economy in the city, remember, you bought it to avoid DPF and DEF headaches like diesel, for excellent performance, and for strong highway efficiency. You paid for torque and a decision that will serve you well for 7–10 years if maintained properly. Never feel bad about your purchase if you made an informed decision while buying a car.

@volklub Paaji hats off to MS for providing such value

Brezza LXi it is by a community member ✅ Practical, extremely VFM with 1.5 four cyl engine, reliable, resale value and Maruti’s support. Lxi MT at just 8.25 lakh (ex-showroom) and this too by paying 40% GST Community for all… 6321 🌴 #volklub

@volklub @ManOfFocus_ Hahaha

@ManOfFocus_ Main to namak bhi banen se nikalta hoon Bhai 😞

WARNING!!! As a man, Avoid showing off. always pretend you don't have money. You'll thank me later.

@theswapnilsri Nanny services?

Raising a baby in India costs more than most people admit. Here’s a real breakdown for urban parents in the first 3 years: Diapers and wipes: ₹35,000 to ₹70,000 over 2–2.5 years (5 diapers/day × 900 days = 4,500 diapers At ₹8–₹15 per diaper, the math lands here) Vaccinations and pediatric visits: ₹50,000 to ₹80,000 in early years (Depends on private hospital + optional vaccines) Baby food and formula: ₹60,000 to ₹1.2 lakh (Higher if formula-heavy or premium brands) Clothing, gear, essentials: ₹60,000 to ₹1.5 lakh (Clothes, crib, carrier, toys, etc.) Hospital delivery: ₹50,000 to ₹2.5 lakh (Private hospitals in urban India) And this is before daycare, preschool, and that random late-night purchase. A broader estimate suggests raising a child in India costs ₹30 lakh to ₹1.2 crore by age 18. For metro families, you’re much closer to ₹1 crore than you think. Indian parents today are spending more on their children than any generation before. Always bullish for this category. 🚀

@lg_ladakh @ashishkundra @ashishkundra ji at the forefront , constructive steps, many congratulations

Launched the Indus River Green Corridor Initiative, today at the banks of River Indus in Leh, with plantation of 1000 indigenous trees. Species like Sea buckthorn, Oleaster, Black Poplar, Indian Willow and White a willow among others, were planted through collaborative efforts of civic administration, army, paramilitary forces, police and local communities, especially Spituk Gonpa and its monastic fraternity. Also, for the first time, 1000 saplings of Apricot and Cherry Blossom were planted along the roadside in Leh city, aimed at enhancing city’s green aesthetics. Aimed at achieving multiple objectives - restoring the ecological integrity of the Indus riverbanks, creating green buffers in a fragile desert landscape and enhancing eco-cultural tourism - this initiative is a one of its kind Cold Desert River Bank Restoration Project in India. Exhorted upon the government agencies and people to expand this initiative throughout Ladakh, and increase the forest cover from less than 1% at present to at least 5% in 2 years, to ensure a sustainable future for Ladakh. I am hopeful that with support of the local communities, this project would emerge as an instrument of resilience, stability and a global model for high-altitude river ecosystem restoration.

@NIKHILLJHA @vijay99803982 GIPSA restrictions not good

@vijay99803982 Not agree

Who is the worst health insurer in India ? ACCORDING TO ME .... ⭐️AND 🫂 GUESS THE NAME

@ashishkundra We need experts like @Espressobae1 to help conserve water in these precarious environments

#Worldwaterday - a view of the majestic confluence of Indus and Zanskar. A sobering reminder for humanity- climate change is real, Glaciers are receding - and the very rivers which sustain life must not be taken for granted. #Ladakh

@suritalreja @harsh_vardhhan is a vietnam expert i guess

What would be the ideal itinerary for Vietnam for 10 days? Can we cover North Vietnam and Phu Qoc both ? For Phu Qoc, how many days are sufficient?

@Espressobae1 Congratulations

Honored to speak today at a World Glacier Day symposium hosted jointly by Snow Leopard Conservancy Trust and Ladakh University. I presented on the groundwater systems of Leh town, sharing insights with fellow researchers and conservation experts. The discussions were incredibly

@Espressobae1 Wonderful

It’s snowing in Ladakh in March, a season that should be transitioning to spring. The winter snowfall that once recharged our groundwater and fed our springs is arriving late and disappearing fast. The shift is not subtle. Climate change is rewriting the hydrology of the Himalayas, and mountain communities are living it every day. #snowfall

@volklub Bhaiji what about AT ?

This pricing from Hyundai is crazy! ✅ Creta Turbo Manual (N-Line) - ₹19L ✅ Alcazar Turbo Manual (Executive) - ₹14.49L Both get the same 1.5 Turbo Petrol engine with 253 Nm torque. But Alcazar gives you: • 5+2 seating • Much more space • 3-row AC vents • 4 disc brakes • Cruise control • Digital cockpit • Alloy wheels • LED headlamps • 6 airbags All for ₹4.5L For someone with 50:50 or 60:40 usage, Alcazar Executive is probably one of the most underrated value picks today from Hyundai’s stable. Must check if you are looking for performance, practicality, support and reliability as a package. Much better than buying a Creta and Seltos or Hyryder/GV in MT with Naturally Aspirated Petrol with 144 nm torque for highways where we need torque for overtakes and smooth driving with full load. Most buyers simply don’t notice this variant because in the showroom they look nothing else than Creta 😉

In an international, randomized trial involving patients with acute venous thromboembolism, the risk of clinically relevant bleeding was significantly lower with apixaban than with rivaroxaban during the 3-month treatment period. Full COBRRA trial results: nejm.org/doi/full/10.10…

@SurgeryBro Thanks for your response!

@nikhilnihil It knew Rutherfords so I told it to give me a crash course ABSITE quiz. Got 15/20. Gave me the answers and explanations. Then I told it I was rusty on endo and told it to guide me from micropuncture access to angioplasty. Did so with wire measurements, names, ACT time, etc.

Using chatGPT to review vascular surgery topics and cross-referencing it with Rutherford’s. Works amazingly well😎🩸

@yuejianing Great! PFA to ATA ?

Heparinized whole blood is always the best solution for preserving the harvested GSV during a bypass procedure. #bypass #distalbypass