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Aditya Ganguly MBBS MD Internist Profile picture
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Aug 28 • 4 tweets • 2 min read
I love deep dives and I mean it!

My latest focus --> Hodgkin's lymphoma.

This is the original series of 7 cases published by Thomas Hodgkin.

#MedTwitter
#HemeTwitter
#hematology
#Hodgkinlymphoma Image
For reference!

ncbi.nlm.nih.gov/pmc/articles/P…
@nihardesai7 you should read this.
I think the lymph nodes were called adsorbent glands in the past because they were thought to absorb humors.

Am I right?

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More from @AdiG1993

Aditya Ganguly MBBS MD Internist Profile picture
Aug 30
1) Pregnancy is a significant sociocultural event in human society.

It marks the sacred connection between one generation and its offspring.

This is what most people think.

Let me tell you why its not --> through the lens of evolutionary medicine. Image
2) Pregnancy is actually a vicious battle between two partially related genetic entities --> the mother and its fetus.

Neither side shows mercy or takes prisoners.

We will focus on the battle for fuel at the fetomaternal interface in this Tweetorial.
3) First of all --> the physiology.

The pregnant female usually experiences reset homeostasis --> with fasting blood sugar (FBS) gradually falling till the week 12 --> then it stabilizes till term.

But PPBS shows sharper, more sustained rise, along with rising insulin levels!
Read 33 tweets
Aditya Ganguly MBBS MD Internist Profile picture
Aug 29
1) The best thing about #MedTwitter is that a lot of hematologists and medical oncologists put out a lot of Tweetorials explaining what they do!

If you are gen med resident in India, these two subjects are most likely the ones you least focus on, in your curriculum.
2) Shrouded in mystery, they lead to many misconceptions and in many cases, therapeutic nihilism.

I might be wrong, but this is my experience, after having interacted with many residents over the past 3 years.
3) But this has changed in the past 6 months and I have definitely improved my knowledge --> this has been helpful in clinical practice as well!

I am no longer restricted to the Hodgkin vs non Hogdkin dichotomy!

I now understand what SUVmax is!
Read 5 tweets
Aditya Ganguly MBBS MD Internist Profile picture
Aug 27
1) Morning sickness --> another pearl from evolutionary medicine.

Nausea and vomiting (n/v) in early pregnancy are so common --> they are regarded as almost physiological.

But could they have an evolutionary benefit?
2) Firstly, its not called morning sickness anymore.

Its n/v of pregnancy aka NVP.

Why?

Because it takes place at all times of the day and night.
3) We have a graphical representation of the usual course of NVP here.
Read 16 tweets
Aditya Ganguly MBBS MD Internist Profile picture
Aug 26
1) Inspired by @AaronGoodman33

Middle aged male gets tired easily, had a hx of TLOC on sudden standing up, low grade fever × past 1 year

Clinical exam --> gradual darkening of skin and oral mucosa.

What is your diagnosis?

#MedTwitter
What are your differentials?

What labs +/- imaging would you request?
I am surprised nobody thought of hemochromatosis.

Unexplained fatigue and postural hypotension --> hemochromatic cardiomyopathy

Low grade fever --> hemochromatosis renders you susceptible to infection

Hyperpigmentation --> hemoCHROMATOSIS
Read 7 tweets
Aditya Ganguly MBBS MD Internist Profile picture
Aug 21
1) I am a big fan of evolutionary medicine --> the study of human evolution and how it can be harnessed for the practice of medicine.

I recently went in for a deep dive into an important topic --> HYPERURICEMIA

Here is what I learnt!
2) Uric acid is the endproduct of purine metabolism in humans --> this is an exception among mammals!

Why does this happen?

1. Lack of uricase
2. Avid renal reabsorption of uric acid
3) Why happened to uricase?

This ancient enzyme, present since bacteria, accumulated a number of mutations approx 10-30 million years ago and gradually lost its function in humans, some higher primates and some New World monkeys.

pubmed.ncbi.nlm.nih.gov/11961098/
Read 23 tweets
Aditya Ganguly MBBS MD Internist Profile picture
Aug 19
1) I'm no expert but the Dolo 650 controversy is either a meaningless or a malignant one.

PCM is an OTC drug --> it is almost never the only drug in a prescription.

Why?
2) PCM doesn't provide any significant analgesia unless you are taking 2-3 gm/day.

Its good for the myalgia and arthralgia of febrile illnesses especially if NSAIDs are contraindicated --> like dengue which has a risk of thrombocytopenia.
3) For everything beyond this, you will need an adequate dose of an NSAID +/- local or systemic glucocorticoid therapy --> even DMARDs if its rheumatological!

Most patients in India don't go to a doctor for mild aches and pains --> they will buy PCM directly!
Read 10 tweets

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