17 year girl with history of recurrent brief fainting episodes (> 8) preceded by palpitations & "anxiety". Normal vitals + physical exam on arrival at the ED.
Dismissed as panic attacks by multiple doctors, her first ever ECG.

Would you diagnose the same?
#MedTwitter Consent ✅ Her ECG shows short PR intervals with slurred upstroke on the QRS complexes: Delta waves - signifying the presence of an accessory pathway which may lead to aberrant conduction & electrical "short circuits"
This is NOT a panic attack.
This is Wolff-Parkinson-White syndrome (WPW).

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)

@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 @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.

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.

🧵
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)

(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.