Ashwin Rajenesh MD Profile picture
Consultant physician & Associate Prof - Internal medicine | Chief of Emergency + Acute care medicine, NSMIMS | MD alumnus @offcmcvellore | #COYS
Sep 27 4 tweets 1 min read
Back while at @OffCMCVellore, I would have patients coming into OPD often only requesting a paracetamol prescription. Now drugs in CMC cannot be dispensed without a doctor's prescription. I used to ask them why go through the bother of waiting in line to see a doctor...
1/🧵 ... when they could just get the paracetamol over the counter from a local pharmacy. They always said the medication doesn't quite work like it does as when it's purchased from the CMC pharmacy or supplies.
I thought they were just being silly and superstitious until...
(2/4)
May 18 21 tweets 9 min read
Quick, basic primer🧵- Decompressing a tension pneumothorax
A tension pneumothorax is a life-threatening emergency which will lead to death without immediate intervention. Understanding and recognizing one is vital to time dependent intervention.
(1/n)
Patho-physiology of a closed pneumothorax is discussed here: which occurs when air accumulates between parietal & viscera layers of pleura- usually from a defect in the integrity of lung-pleural interface causing air to leak from alveoli into the pleural space.
https://www.amboss.com/us/knowledge/pneumothorax
https://www.amboss.com/us/knowledge/pneumothorax
Apr 24, 2023 4 tweets 4 min read
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 ✅ Image 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). ImageImage
Mar 8, 2023 9 tweets 4 min read
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) 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)
Nov 29, 2022 4 tweets 4 min read
@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.
Jan 28, 2022 9 tweets 6 min read
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.
Jan 10, 2022 10 tweets 12 min read
🧵
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) Image #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) Image
May 28, 2021 25 tweets 12 min read
(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…
Image (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.