𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗 Profile picture
Final year #Hematology fellow (DM) @SGPGI | MD Medicine➡️LTMC(Sion),Mumbai | Love @pinkfloyd | #Drummer, #photographer & #F1 fan | #Bombay boy | Tweets #MedEd
Dr. Ruby K R 💕 Profile picture The outlaw Profile picture 2 added to My Authors
Mar 3 11 tweets 7 min read
Hey #hematology aspirants, let's talk about #CMV today !! Post allogenic transplant CMV prophylaxis and pre-emptive therapy to be precise.

A short thread 🧵

1/n

#MedTwitter #MedEd #hematology CMV a DNA virus, one of the commonest causes of infections post HSCT

Has the largest genome of any known human virus [200 genes]

Most humans harbour latent CMV, infection aquired in childhood.

Site of latency in humans-❓
In murine models- hepatic sinusoidal cells.

2/n
May 16, 2021 10 tweets 7 min read
Want to know why #Mucormycosis is more common post #COVID19 and not so common after leukemia's or other illnesses treated with steroids ?

Read on !! These are the major reasons in my opinion:

1. The NUMBER of #COVID19 pts is far GREATER than the number of leukemia pts we treat in a year. Thus a lot more people are getting steroids at this point in time and thus a lot more are at risk of steroid related complications.
May 15, 2021 6 tweets 3 min read
So there are a lot of people asking about the risk factors for #mucor post #covid.

The biggest risk factor isn't the steroid itself, it's the hyperglycemia that it causes. If the sugars are well controlled using insulin the risk is almost negligible. So STOP freaking out !! The 2nd major risk factor is prolonged NEUTROPENIA but that's a problem in our #Hematology patient population and not in #covid patients, so we can safely ignore that for now.
May 11, 2021 7 tweets 2 min read
#MedStudentTwitter might find it useful. Some common case scenarios !!

Case 1

72, male, on routine CBC is found to have ⬆️ WBC count. Asymptomatic.
CBC: 12.2 / 77k / 215k
Lympho: 88%
No HSmegaly

This is most likely CLL.
Q now is, does he need rx? The answer in this case would be NO.

Always think about benefit vs risk when u want to start Rx. CLL many a times may not need rx at all.

Important learning point➡️DON'T get ALARMED by a ⬆️TLC.
May 8, 2021 9 tweets 5 min read
CELLS in Hemat 💪🏻

Sickle cell=Drepanocyte➡️SCD
Tear drop=Dacrocyte➡️MF
Spur cell=Acanthocyte➡️Liver ds
Burr cell=Echinocyte➡️Uremia/PK def
Target cell=Codocyte➡️Hb'pathies
Bite cell=eccentrocyte➡️G6PD def
Pencil cell=ovalocyte➡️IDA
Pincered cell➡️Band 3 def
Prickle cell➡️PK def @HaryaxPathak @AlishaAkhani @pankti4299 @VedangDesai02 @shreya__kataria @HemOncFellows @hard_dil @nitsoccer @docsamdeshmukh @BloodAdvances #MedTwitter #hemetwitter
May 7, 2021 7 tweets 4 min read
#FERRITIN is being widely ordered these days. Let's dive into the details and learn more about this protein. A short thread for those interested. Covers some history, biology and practical aspects about FERRITIN.

1/n
It was discovered in 1937 by Laufbérger but it wasn't until 1972 that an assay was devised to measure serum ferritin.

Ferritin is present in 2 forms
👉 Intra-cellular (in the cytosol)
👉 Extra-cellular

2/n
May 4, 2021 8 tweets 5 min read
So mucor is on the rise, time for a quick revision. A short thread for those interested.

It's a bad infection with an unreasonably high mortality(40-80%) which depends on the organ involved.

Risk factors: DM/ neutropenia/ HSCT

DM=rhino-orbital mucor
Neutropenia=pulmonary mucor Mucormycosis is caused by fungi of order "MUCORALES" which includes rhizopus/mucor/licthemia/cunninghemela species. But DON'T WORRY species identification doesn't change treatment so we don't need to get to that.
May 1, 2021 9 tweets 5 min read
Got #covid ? Don't worry it's not a death sentence.

Step 1: Isolate and monitor

I assume u must have started isolating even before you tested + , if not, do so immediately. Get the others at home tested ASAP. Monitor your temperature and oxygen saturation.

1/n
Step 2: Managing Co-morbidities

If u have any co-morbidity continue to take the meds you were already on. Don't STOP meds for ur diabetes or hypertension or thyroid d/o.

2/n
Oct 9, 2020 11 tweets 7 min read
#MedTwitter how often do you use 𝐏𝐫𝐨𝐜𝐚𝐥𝐜𝐢𝐭𝐨𝐧𝐢𝐧 ?

A thread on 𝐏𝐫𝐨𝐜𝐚𝐥𝐜𝐢𝐭𝐨𝐧𝐢𝐧 for those interested 😉

#MedEd #MedStudentTwitter #oncology #hematology #tweetorial ⚡️Procalcitonin as the name suggests is a precursor of the hormone calcitonin

⚡️Coded by the CALC 1 gene on Chr 11,its a 116AA peptide

⚡️PrePCT >> PCT >> Calcitonin

⚡️Bact inf=⬆️IL6⬆️TNFa⬆️IL1b=⬆️Productn of PCT
Jul 20, 2020 10 tweets 7 min read
Humanity has always struggled to fight #viruses , best exemplified by the ongoing #Covid_19 #pandemic ,so I thought of doing a thread on a #virus which frequently troubles #hematology patients

It's called #CMV or #HHV5
It wrecks havoc #posttransplant

#MedTwitter @BloodJournal ⚡DNA virus ,1 of the MC infections post SCT

⚡It has the largest genome of any known human virus [230kb /200 genes]

⚡Most humans harbour latent CMV, infection MC aquired in childhood.

⚡Site of latency in humans- Not Known
In murine models - hepatic sinusoidal cells
Jun 28, 2020 13 tweets 7 min read
So how safe is #Ibrutinib ?
A very relevant question given that it needs to be administered indefinitely.
41% discontinuation rate in the "real world", most d/t toxicity.

Thread [1/12] So what are the major adverse events anyway ?
1. A fib
2. ⬆️ Risk of bleeding
3. ⬆️ Infections
4. Arthralgias
5. Htn
6. Diarrhoea
7. Pneumonitis

[2/12]