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Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

@DharSaty

Mar 26

@ImproveDX

Pseudomonas aeruginosa (PA):

Gram-negative bacillus found widely in nature, in soil and water.
/1

#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor @ImproveDX

The genus Pseudomonas >140 species,> saprophytic & >25 species are associated with humans. Most known to cause disease in humans are associated with opportunistic infections.

⬆️ MR : ⬇️ host defenses, resistance to ABX & production of extracellular enzymes & toxins.
/2

Often found in water in sinks & can contaminate respiratory equipment, which can serve as an environmental reservoir, especially in ICUs. Is the most serious pathogen causing ventilator-associated pneumonia & remains the most important pathogen in patients with CF.
/3

Read 15 tweets

Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

@DharSaty

Mar 26

Ischemic penumbra:
The part of an Ac ischemic stroke that is at risk of progressing to infarction but is still salvageable if reperfused. Located around an infarct core which represents the tissue which has already infarcted or is going to infarct regardless of reperfusion.
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In this small cohort, the penumbra system was able to revascularize the site of primary occlusion in all of the treated subjects enrolled into the study, resulting in a revascularization rate of 100%.
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ajnr.org/content/29/7/1…

Saving the penumbra is the goal of acute ischaemic stroke therapy. Reperfusing the brain before infarct growth is completed will salvage the residual penumbra and reduce final infarct size.

academic.oup.com/brain/article/…

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Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

@DharSaty

Mar 25

@SocietyHospMed

Q: 50 y M, lung ca diagnosed 2 months ago, work up in process fit possible resection, presents with pain and swelling in LLE. Of note- Covid in Jan. Duplex: Ac DVT popliteal and tibial. Is IVC filter indicated? @SocietyHospMed @SatyaPatelMD @tony_breu @grepmeded @drmiketodorovic

An IVC filter is a small device that is placed in your inferior vena cava to prevent blood clots from moving through your blood into your lungs .

Prophylactic use: patients undergoing bariatric surgery, multi-trauma & with spinal cord injury. Note that despite the widespread use of IVCF for prophylaxis, there is a growing body of evidence pointing to lack of benefit & actual harm.

acc.org/latest-in-card…

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Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

@DharSaty

Mar 18

Dementia
Acute cognition change with altered consciousness & impaired attention that fluctuates over time. Often unrecognized & unRx. May be preventable & early detec/ facilitates urgent assessment &Rx 1/16
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor

The criteria for delirium listed in the Diagnostic and Statistical Manual of Mental Disorders vs Confusion Assessment Method (CAM) 👇👇. CAM has a sensitivity of 94% to 100% and a specificity of 90% to 95%.
2/16

Features:
disturbances of sleep, altered psychomotor activity, and changes in emotion (eg, anxiety, apathy, lability, irritability, or anger). Subtypes of delirium are hyperactive, hypoactive & mixed. Hypoactive form >> hyperactive form. Inattention is hallmark. 3/16

Read 17 tweets

Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

@DharSaty

Mar 17

The HPA Axis and Adrenal Fxn.
Typical excretion of cortisol ➡️diurnal pattern with peaking in the a.m, ⬇️toward the afternoon, & ⬆️ in the early p.m. The basal adrenal production of cortisol is 10-15 mg daily. #MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor

Physiologic & psychological stress can boost daily production of cortisol to 3 or more times typical levels.
Adrenal insufficiency: caused by a disease involving the adrenal gland itself (primary AI) or one altering its regulation by the hypothalamus and pituitary (secondary AI)

Primary AI results from destruction or replacement of the adrenal cortex. Addison’s disease (autoimmune destruction of the adrenal cortex) accounts for 80% to 90% of primary AI.

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Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

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Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

Satyendra Dhar, MD MHA FHM 𑆱𑆠𑇀𑆪𑆼𑆁𑆢𑇀𑆫 𑆣𑆫

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