Badal Gondane, MD (@badalgondane) 's Twitter Profile
Badal Gondane, MD

@badalgondane

MD Internal Medicine

ID: 1667118240

calendar_today13-08-2013 07:52:34

308 Tweet

1,1K Followers

175 Following

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💡It is a good practice to correlate positive Urine Albumin with Specific Gravity. 👉🏻As SG >1.030 can lead to falsely Positive Urine Albumin ✅Better to go with ACR #Medtwitter

💡It is a good practice to correlate positive Urine Albumin with Specific Gravity.

👉🏻As SG >1.030 can lead to falsely Positive Urine Albumin

✅Better to go with ACR

#Medtwitter
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Leukodepleted vs. Irradiated Blood ✅Leukodepleted:Removes most WBCs → Prevents febrile reactions, CMV transmission & alloimmunization ✅Irradiated:Inactivates lymphocytes → Prevents TA-GVHD ⚠️TA-GVHD is still a risk in leukodepleted🩸 Immunocompromised pts need irradiated🩸

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Saw a pt with Aortic valve calcium (Agatston unit) report IDK why it was advised It has very specific indications Criteria for SEVERE AS - AVA <1 cm² Mean gradient >40 (depends on AV flow) In HFrEF or severe MR - ⬇️Flow leading to ⬇️Mean grad (<40) discordant finding - do AVC

Saw a pt with Aortic valve calcium (Agatston unit) report
IDK why it was advised
It has very specific indications

Criteria for SEVERE AS -
AVA &lt;1 cm²
Mean gradient &gt;40 (depends on AV flow)

In HFrEF or severe MR - ⬇️Flow leading to ⬇️Mean grad (&lt;40)
discordant finding - do AVC
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NT pro BNP in heart failure 💎 Good negative predictive value ♦️Falsely low in Obesity ♦️Falsely high in Renal Failure ♦️Increases with Age ♦️Raised in AF even without HF #Medtwitter

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Sigmoid volvulus How to manage ? 👉🏻Take care of Airways 👉🏻IV fluids ✅ No peritonitis / no perforation → Endoscopic decompression followed by Elective sigmoidectomy ⚠️ Unstable / peritonitis / gangrene / perforation → Emergency resection (primary anastomosis or Hartmann’s)

Sigmoid volvulus 
How to manage ?
👉🏻Take care of Airways
👉🏻IV fluids

✅ No peritonitis / no perforation 
→ Endoscopic decompression followed by Elective sigmoidectomy

⚠️ Unstable / peritonitis / gangrene / perforation
→ Emergency resection (primary anastomosis or Hartmann’s)
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In a patient of hepatic encephalopathy, ⚠️avoid animal proteins rich in AAA (red meat, organ meats, fish) ✅ prefer vegetable & dairy proteins or BCAA formulations Why ? Animal proteins are rich in Aromatic Amino Acids which ⬆️ false neurotransmitter production and ammonia load

In a patient of hepatic encephalopathy,
⚠️avoid animal proteins rich in AAA (red meat, organ meats, fish)
✅ prefer vegetable &amp; dairy proteins or BCAA formulations

Why ?
Animal proteins are rich in Aromatic Amino Acids which ⬆️ false neurotransmitter production and ammonia load
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Now what ? ✅Calculate FIB-4 FIB4 = <1.3 👉🏻 reassess periodically (in 1-2 years) But if >1.3 go for VCTE (Fibroscan) LSM <8 = reassess periodically ⚠️ LSM >8 or FIB4 was >2.67 refer to Gastroenterologist/Hepatologist ✅Lifestyle modification for all #Medtwitter #AASLD #EASL

Now what ?

✅Calculate FIB-4 
FIB4 = &lt;1.3 👉🏻 reassess periodically (in 1-2 years)
But if &gt;1.3 go for VCTE (Fibroscan)
LSM &lt;8 = reassess periodically

⚠️ LSM &gt;8 or FIB4 was &gt;2.67 refer to Gastroenterologist/Hepatologist

✅Lifestyle modification for all
#Medtwitter 
#AASLD 
#EASL