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Ashwin Rajenesh, MD

@ashwinrajenesh

Mar 8

https://twitter.com/ashwinrajenesh/status/1633132231597395969

As promised, let's go...
Breaking this X-ray down systematically (armed with hindsight and ofcourse me peeking at her cross sectional CT imaging sequences)

We have a scary looking X-ray of a 78 year old lady:
AP view, reasonably well centred and exposed.
(1/n)

https://twitter.com/ashwinrajenesh/status/1633132231597395969

Superficial to deep:
A. Soft tissue shadows are un-remarkable.
B. Bony cage appears osteopenic and shows degenerative changes that would be expected at her age.
C. 🟢 Diaphragm hump sign seen bilaterally, most likely due to basal atelectasis; costo-phrenic angles are clear.
(2/n)

D. The Costo cardiac angles however are obscured 🟡 - here epicardial fat pad.
E. Lung fields appear hyperinflated and emphysematous (I can count 9 anterior ribs)
F. Note the plate atelectasis at the base of Rt UL 🟣 and thickened horizontal fissure.
(3/n)

Read 9 tweets

Ashwin Rajenesh, MD

@ashwinrajenesh

Nov 29, 2022

@nuri_numinous

@nuri_numinous @MeganDeVelvis @TraceySpicer Thanks for the tag.
(1/3)
ORS is great when dealing with replacement of GI tract fluid losses such as in diarrheal disease.
However, when purposed for fluid+electrolyte loading in POTS / other forms of dysautonomia, it may actually worsen the fluid volume due to the following:

@nuri_numinous

@nuri_numinous @MeganDeVelvis @TraceySpicer (2/3)
The glucose content of the ORS may alter
1. Distribution dynamics of fluids among the various body compartments
2. Glucose shifts causing intracellular + intravascular dehydration and interstitial pooling.
3. Prevent water absorption across the bowel by osmotic diffusion.

@nuri_numinous

@nuri_numinous @MeganDeVelvis @TraceySpicer (3/3)
Hence glucose containing hyper-osmotic fluids may ideally be avoided for the purpose of fluid+salt loading in dysautonomia as it may counterintuitively worsen intravascular plasma volume.
Fluid loading with salt/electrolyte solutions are preferred for volume expansion.

Read 4 tweets

Ashwin Rajenesh, MD

@ashwinrajenesh

Jan 28, 2022

Shared with permission:
This is the sort of abnormal postural variation of heart rate due to #Dysautonomia in #POTS.
This previously athletic, fit and healthy young man has been suffering with these symptoms ever since his #LongCovid set in nearly 8 months ago, with no respite.

#POTS or Postural Orthostatic Tachycardia Syndrome is a form of Orthostatic Intolerance (OI).
Due to abnormal autonomic function, a dramatic and sustained increase in heart rate occurs with postural change, without a significant fall in blood pressure.
24 hour holter also shown.

The patient's heart rate shoots up from a resting rate of 70-80/ minute to 130-140/minute within moments of getting up to standing from a supine position, as shown in the video before gradually decelerating.
The holter shows regular such spikes in heart rate throughout the day.

Read 9 tweets

Ashwin Rajenesh, MD

@ashwinrajenesh

Jan 10, 2022

🧵
VE vs omicron
"Among those who had
received 2 doses of AstraZeneca, there was no effect against #Omicron (against symptomatic disease) from 20 weeks after the second dose."

That's among those who have completed their 2nd #COVISHIELD (AZ) dose before Aug 22nd of 2021.
(1/8)

#HCWs were vaccinated earliest in India, with majority completing their second dose of AZ as early as April 2021. (That's >35 weeks since 2nd dose)

They currently face greatest exposure risk as noted in many large outbreaks in hospitals and affect delivery of healthcare.
(2/8)

At-risk population were vaccinated next in India, and so were the elderly. Vaccine efficacy has shown to have more profound immune waning in elderly individuals.

These populations are an urgent priority, to prevent severe disease & death (The 2x dose still does that well).
(3/8)

Read 10 tweets

Ashwin Rajenesh, MD

@ashwinrajenesh

May 28, 2021

(1/n) Thread: Epi-immuno-pathogenesis of #BlackFungus, misnormer for #Mucormycosis.
As of 26th of May 2021, India had noted close to 12,000 cases of Mucor along with the #COVIDSecondWave.
The centre has advised it a notifiable disease under Epidemic act.
pib.gov.in/PressReleseDet…

(2/n) Pre #COVID19India, Mucor in India was almost exclusive to patients with uncontrolled diabetes, and usually presented along with DKA.
The other subset was among profoundly immuno-compromised hosts and iron overload states.

(3/n) Interestingly, different etiological risk factors cause various clinical presentations of mucor.
- Diabetes with Rhino-orbital disease
- Solid organ transplant recipients with pulmonary disease
- Disseminated disease in hematological malignancies
doi.org/10.1016/j.cmi.…

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