Nirav Valand @NiravValand30 Twitter profile

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Nirav Valand

6 months

Last day at @NakaseroHosp . Will always cherish the 2 years I have spent at this great hospital! Ciao for now, till next time!! Thank you very much

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Nirav Valand

@NiravValand30

5 months

Today marks the end of my 22 year period in Uganda as my home (will always be my home). I would like to thank GOD, my family and everyone else as I look forward to moving to a new home in a foreign land. Change is definitely scary but worth it.

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Nirav Valand

@NiravValand30

11 months

@Ur_Dr_Ayush Going to share this image, from a patient who had an ectopic pregnancy.

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Nirav Valand

@NiravValand30

1 year

@drkeithsiau Hypocalcemia. Has a positive chvostek sign. hypocalcemia due to vitamin D deficiency from ileal involvement of Crohn

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Nirav Valand

@NiravValand30

10 months

Coming back to Uganda just after 2 months feels like coming after a lifetime 😅. Back home finally

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Nirav Valand

@NiravValand30

6 months

@NicoGagelmann The X-ray of many people I know. Heartless syndrome, very common these days, the management depends person by person by counseling really might help 😅

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Nirav Valand

@NiravValand30

5 months

A very interesting evening and meeting fellow Ugandan Doctors in the UK. An incredible night. Plus of course London Lights.

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Nirav Valand

@NiravValand30

8 months

Came to work and received this appreciation! Just made my day today. It’s always been my passion to motivate the young to what they want to pursue. (Not only medicine 😅).

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @dr_evenakato @DrOlweny @DrOribaDan @DrOtileUg @damshae87 @ACCESS_UG @27Jipman Sharing these images to make understanding it a bit easier.

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @dr_evenakato @DrOlweny @DrOribaDan @DrOtileUg @damshae87 @ACCESS_UG @27Jipman This can happen after strenuous muscle training causing leakage of myoglobin -> Rhabdomyolysis, can Causing the false Hb on urine dipstick. Can do creatine kinase to confirm. Rx - IV fluids, but would want to do RFTs + Electrolytes.

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Nirav Valand

@NiravValand30

1 year

It was a great deal passing the PLAB exams, now a greater deal to get a position to work in the NHS. Don’t know why it’s so difficult to get one, yet many are needed. Very demotivating. I wish it was like Uganda, go through contacts 😅😂

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Nirav Valand

@NiravValand30

9 months

When diagnosing hyponatremia we usually classify it with fluid status of the patient. Sharing this image with (short summary) some information about urine electrolytes and osmolality which is not commonly done in Uganda. Quite easy to understand. You can add more details.

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Nirav Valand

@NiravValand30

9 months

I have always wanted to pursue surgery, but when you are mentored by greats like prof @rkalyes1 , it’s hard not to look at internal medicine as a career. So now having a fight of Brain vs heart. What would your advice be for me? (Open to all) @DrOribaDan @mbiineron @ErasmusMD

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Nirav Valand

@NiravValand30

7 months

This is for those who are working so hard but feel like they are getting nowhere, hang in there, something good is coming your way. I am talking this from my experience, very frustrated with the developments I had until recently. Have faith, He will not fail You. Blessed day!

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Nirav Valand

@NiravValand30

6 months

Embryology has always been very fascinating. How did you like it during med school and even now? (This is for the heart ❤️) @DrOribaDan I remember when you used to teach anatomy partly during med school. Very interesting topic.

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Nirav Valand

@NiravValand30

8 months

@aruaclinic @BrownJHM @ChefKarim02 @dermatology @DrCindyCooper @drkeithsiau @DrOribaDan @IAmTheOlum @PeterItebimien @rkalyes1 Neonatal sepsis with ?Staphylococcal skin scalded syndrome

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Nirav Valand

@NiravValand30

11 months

Making applications for working in the UK can be so depressing especially the rejections of the applications that come along 😒😂. But anyone who’s interested in the UK, want some advice with regards to the exam, please message me, will help out.

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Nirav Valand

@NiravValand30

2 years

Something amazing. Don’t get to see this everyday!

Avraham Z. Cooper, MD

@AvrahamCooperMD

2 years

Cool case of a heart with THREE atria (aka cor triatrium) ⬇️ 🎥 @DrFuisz #MedTwitter

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Nirav Valand

@NiravValand30

11 months

@rkalyes1 @DrOribaDan @DrSerunjogiEmma @JosephOgavu @DrOtileUg @DrOlweny @dr_evenakato @damshae87 @27Jipman This article was very helpful for this. For those who want to read.

Acute Severe Hypertension | NEJM

Acute severe hypertension accompanied by acute target-organ injury (hypertensive emergency) requires immediate treatment with IV antihypertensive agents (based on the type of target-organ damage) i...

www.nejm.org

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Nirav Valand

@NiravValand30

4 months

So as promised this is the PLAB Breakdown *Disclaimer - The conversions are according to current USD-UGX conversion, and additionally these are estimates. @RomLawrence @DrSsebambulidde @arthur_atyam

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Nirav Valand

@NiravValand30

1 year

One thing I learnt today and want to emulate in my career and life ahead is being selfless and help others as much as I can voluntarily without expecting to get anything back. Not everything in life should be dictated by money. What do you think?

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Nirav Valand

@NiravValand30

11 months

@rkalyes1 @DrOribaDan @DrSerunjogiEmma @JosephOgavu @damshae87 @27Jipman @DrOtileUg @HilderKoriang @conradlubwama @graekan Sharing these images to understand the management better.

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Nirav Valand

@NiravValand30

4 months

This video by Dr Vishal Gabale (channel ) is so nice to understand the heart murmurs. Check it out to understand. ⁦ @HilderKoriang ⁩ ⁦ @rkalyes1 ⁩ ⁦ @DrOribaDan ⁩ ⁦ @TSM_Humanist ⁩

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Nirav Valand

@NiravValand30

10 months

@SpireJim @EnockArts Just like most things we take, if taken in small amounts, it’s good. When excessively taken, it has detrimental effects as the caffeine in it affects your blood pressures, heart rate, mental aspects as well. However, not good for pregnant mothers and children

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Nirav Valand

@NiravValand30

7 months

So from this, I will talk about Urinary Tract Infection (UTI). So what is a UTI? As the name suggests, it is an infection in the URINARY TRACT. What do we know about it? It is common in the ladies, why?-> we shall see below. So that said, this is a picture to show the tract.

Nirav Valand

@NiravValand30

7 months

I wanted to come up with a series of health-related topics to discuss for the general pubic to understand better. (which are very much misunderstood) I want your suggestions on which topics you want more clarity

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Nirav Valand

@NiravValand30

1 year

Since we are discussing cases. 29/M came to the emergency with paraparesis with an acute onset of 6 hours which was of a gradual onset. This was ass. with a 2/12 h/o low grade fevers, fatigue, myalgias. O/E- both lower limbs were cold, compared to upper limbs with no distal pulse

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Nirav Valand

@NiravValand30

5 months

@DrSerunjogiEmma So well put up, I graduated from KCU as well. Every university has a small group of students who aren’t good but doesn’t mean to subject all students to a harsh decision because of being a private university. Yes it has its own negatives. It’s not only unis but also NCHE at fault

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Nirav Valand

@NiravValand30

11 months

@rkalyes1 @DrOribaDan @DrSerunjogiEmma @JosephOgavu @DrOtileUg @DrOlweny @dr_evenakato @damshae87 @27Jipman Hypertensive Emergency - for the start labetalol to bring the SBP to 140mmHg. He’s very young most likely secondary hypertension - r/o renal artery stenosis, pheochromocytoma

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @lubulwaabdu @DrOribaDan @DrOtileUg @LancetLabsUg @AndreaLConroy @dr_evenakato @DrEtolu @DrOlweny @faith_nabushawo @27Jipman @conradlubwama @ACCESS_UG For those who want to see a magnified view of the malaria parasites - The small rings you see in the dull colored cells (red blood cells) Also added an image for the mnemonic for complications for malaria.

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Nirav Valand

@NiravValand30

8 months

@rkalyes1 @DrOribaDan @Dreadful45 @dr_evenakato @ANSM3971 @ChefKarim02 @conradlubwama @DrOlweny @DrAkhilRaghavan @DrOtileUg @faith_nabushawo @Niwavictor @27Jipman Reiters triad or reactive arthritis. Seen usually after a UTI or GI infection. Commonly caused by Chlamydia, Salmonella.

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @Ug_kidneyf @balamu_NCD @DrOribaDan Leukonychia usually seen with hypoalbuminemia. Could be from chronic liver disease, can also be seen with GI malignancies like gastric Ca as well as chronic kidney disease.

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Nirav Valand

@NiravValand30

11 months

@rkalyes1 @ACCESS_UG @Ug_kidneyf @JosephOgavu @DrOribaDan @DrOtileUg @DrSerunjogiEmma @graekan @27Jipman @HilderKoriang @dr_evenakato @conradlubwama @damshae87 Coming up as usual with a short summary.

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Nirav Valand

@NiravValand30

8 months

I wanted to have this thread on hypertension. I recently was involved in the management of a patient with a bleed within the brain due to very high blood pressure which had not been controlled well. What is blood pressure would be the question and why is it important to control

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Nirav Valand

@NiravValand30

4 months

I came across this video, and this is what exactly I was told by Prof @rkalyes1 I remember asking why I feel like this to him. And this is what he explained. I know there are many who feel similar, and this video is for you.

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Nirav Valand

@NiravValand30

6 months

@rkalyes1 @DrOribaDan @ddunguh @aruaclinic @Asadthegeek @DMavine @dr_evenakato @DrOlweny @DrMutungaEA @DRKEN100 @faith_nabushawo @ps_lukwago @InternalmedMak @27Jipman Multiple Myeloma is an abnormal proliferation of “monoclonal plasma cells” in the bone marrow. This means they produce monoclonal proteins e.g IgA, IgG and free light chains e.g kappa. These images give a small summary about it.

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Nirav Valand

@NiravValand30

9 months

@rkalyes1 @DrOribaDan @damshae87 @AttoGladys @graekan @DrOtileUg @dr_evenakato @conradlubwama @27Jipman @ChefKarim02 @MarkariusK @DrOlweny @DMavine @DrEtolu @SharifMutabazi Classic temporal Arteritis, and it’s associated usually with polymyalgia rheumatica. Sometimes it can be associated with amyloidosis which can cause the proteinuria. ESR and start prednisone high dose. Temporal artery biopsy Urine ACR,

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Nirav Valand

@NiravValand30

9 months

@rkalyes1 @ASOU_Official @DrOribaDan @DrOtileUg @faith_nabushawo @DrOlweny @DrMutungaEA @aruaclinic @Asadthegeek @ChefKarim02 @dr_evenakato @DrEtolu @IAmTheOlum @27Jipman @MakSurgResident @DennisPhd1 These two images give a good overview of these injuries. Erbs palsy symptoms has a very interesting name - waiters tip position.

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @DrOribaDan @JosephOgavu @conradlubwama @henry_isiko @27Jipman @damshae87 Pulmonary Edema, bochdalek diaphragmatic hernia. It’s a AP , however would love to know the tracheal centrality. PE could be from CKD or HF. Would be good to do an echo, ?chest physio + CTS r/v. Lasix IV for the edema, Oxygen, Prop up. She could be obese so the position will help

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @DrOribaDan @DrOtileUg @SemitalaFred @27Jipman @DennisPhd1 @dr_evenakato @DrEtolu @faith_nabushawo @AsasiraIgnatiu2 @NSengoobaa @DrOlweny @ChefKarim02 @conradlubwama These are interesting pictures that talk about shingles.

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Nirav Valand

@NiravValand30

5 months

This summary is so good for switching to orals from IV, I think we need to adopt something similar at our hospitals. Sometimes, we tend to continue IV for a long period, which could have had the same effect with orals.

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Nirav Valand

@NiravValand30

8 months

@rkalyes1 @IDIMakerere @InternalmedMak @DrOribaDan @Asadthegeek @dr_evenakato @DrAkhilRaghavan @DrEtolu @DrOlweny @faith_nabushawo @ps_lukwago @ChefKarim02 @DrSerunjogiEmma I loved the name given to this worm - Loa loa - this is loaiasis, management would physical removal and diethylcarbamazine

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Nirav Valand

@NiravValand30

1 year

Since there’s not so many posts about prostate health. Let me just post a few things. Prostate is a small organ ~20g found just below your urine bladder. It’s what contributes to the fluid part of semen - which is very important for sperm survival.

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Nirav Valand

@NiravValand30

2 years

This is quite interesting! Interesting how are bodies develop in such a way! Thanks Doc for the post!

Avraham Z. Cooper, MD

@AvrahamCooperMD

2 years

Ectopic kidney in the right chest (from a Bochdalek hernia) 😳 #MedTwitter

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @damshae87 @dr_evenakato @DrOribaDan @DrOtileUg @27Jipman @ASOU_Official @DrOlweny @faith_nabushawo @DrSerunjogiEmma Gyn - uterine fibroid Renal - AKI secondary to ? Hydronephrosis from ?tumor compression as a pressure effect on the ureters Is there any ultrasound scan ? Would be good to monitor this ptient following this removal especially the kidney function.

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @DrOribaDan @damshae87 @DrOtileUg @Ug_kidneyf @AJOHNSON1219 @conradlubwama @dr_evenakato @DrOlweny @DrSerunjogiEmma @JosephOgavu @kibirigedavis @InternalmedMak @27Jipman @graekan Diabetes Dermopathy DDx - also looks like erythema nodosum. - early lesions of necrobiosis lipodica Usually a clinical diagnosis but a biopsy for histology can also be considered.

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Nirav Valand

@NiravValand30

1 year

@rashlessdoctor What happened is not the first time it has happened in India, Doctors are often a target for violence by the general public. Unless something isn’t done in unison by all Doctors, this will keep continuing. This is just very sad, death of a young doctor

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @DrOribaDan @JosephOgavu @DrOtileUg @DrOlweny @Dreadful45 @DrSerunjogiEmma @luggya @damshae87 @27Jipman Tension pneumothorax on the left. Emergency thoracostomy using thoracostomy needle on 4th ICS anterior axillary line (as per the new ATLS guidelines. ) then chest tube

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Nirav Valand

@NiravValand30

8 months

@rkalyes1 @lubulwaabdu @DrOribaDan @dr_evenakato @HilderKoriang @Asadthegeek @Beingmediccoo @DrOlweny @DrSerunjogiEmma @Dreadful45 @DrOtileUg @ddunguh @ps_lukwago @aruaclinic @27Jipman Btw if you are like me looking at the different rbc morphologies. This picture is for you. Interesting to see how they differ.

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Nirav Valand

@NiravValand30

3 months

@rkalyes1 @DrOribaDan @brucekirenga @Asadthegeek @DrMutungaEA @NewtonAllan6 @27Jipman @DoctorShagiy @kkananura @Katendefredi @DrEtolu @ps_lukwago @dr_evenakato @AineShaKa Has a bilateral pleural effusion with chest drain on the right pleural cavity. Could be secondary to heart failure, pneumonia, CKD. Rx would be to continue the drainage until<100mls/24h, Rx of underlying cause- antibx if pneumonia, diuresis if due to HF, or CKD.

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Nirav Valand

@NiravValand30

3 months

@rkalyes1 @lubulwaabdu @DrOribaDan @TSM_Humanist @Asadthegeek @DrAkhilRaghavan @DMavine @ddunguh @drkakamekeith @drkeithsiau @DrMutungaEA @DrOlweny @dr_evenakato @AineShaKa Dx hypertriglyceridemia history - family hx, if there’s a recent lipid emulsion infusion, DM Rx- statins if hypertriglyceridemia. He’s at a risk of CVA, Cardiovascular events, pancreatitis and many others

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Nirav Valand

@NiravValand30

1 year

@OGdukeneurosurg Could be a ?meningioma, secondary Mets from follicular thyroid cancer

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Nirav Valand

@NiravValand30

2 years

This is interesting 🧐

Avraham Z. Cooper, MD

@AvrahamCooperMD

2 years

This person’s aortic arch extended into THEIR NECK 🤯 #MedTwitter

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Nirav Valand

@NiravValand30

1 year

This is a message to everyone (especially the African and Asian societies since they are very similar) whenever you see signs and symptoms of something abnormal happening please see a doctor, it can be very much a life saver. Don’t wait for too long, it only makes it worse.

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Nirav Valand

@NiravValand30

3 months

This is an essential image regarding antibiotic stewardship, especially in this era of ceftriaxone syndrome in every health center and hospital. This is also the case of using the big "guns" available, please let us not just use them like giving panadol. Hospitals need guidelines

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Nirav Valand

@NiravValand30

1 year

Great mnemonic for canon balls on C ray. Check it out. (For the general public- canon balls is an appearance on the chest x ray we see like in this thread if you check usually seen when some cancers like in this mnemonic spread(metastasize) to other organs this case lung. )

Dr. Oriba Dan Langoya

@DrOribaDan

1 year

You can also summarise the differential through the CRESP mnemonic

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Nirav Valand

@NiravValand30

1 year

@Dreadful45 In addition to hygiene, men tend to share clothings more often.

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Nirav Valand

@NiravValand30

9 months

Came across this interesting quote, what’s your view about it. (From Think like a Monk) {The Bhagavad Gita is one of the religious texts of Hinduism, literally meaning song of God}

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Nirav Valand

@NiravValand30

8 months

@rkalyes1 @DrOribaDan @aruaclinic @Asadthegeek @dr_evenakato @DMavine @HilderKoriang @DrAkhilRaghavan @faith_nabushawo @MakSurgResident @InternalmedMak @Makerere_Medics @TheMakCCR @DrEtolu @Katendefredi @27Jipman @DennisPhd1 @ChefKarim02 @DrOlweny Diabetic ulcer and cataract secondary to poor glycemic control.

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @DrOribaDan @DrOtileUg @SemitalaFred @27Jipman @DennisPhd1 @dr_evenakato @DrEtolu @faith_nabushawo @AsasiraIgnatiu2 @NSengoobaa @DrOlweny @ChefKarim02 @conradlubwama Dermatomal rash of herpes zoster (Shingles ) with complication of Neuralgia. Rx- Gabapentin If not on aciclovir then would give 800mg five times a day for 10 days.

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Nirav Valand

@NiravValand30

9 months

@kkananura @DrOribaDan @rkalyes1 @damshae87 @AttoGladys @graekan @DrOtileUg @dr_evenakato @conradlubwama @27Jipman @ChefKarim02 @MarkariusK @DrOlweny @DMavine @DrEtolu @SharifMutabazi The blurred vision is due to optic neuritis. Some images here. Check ‘em out.

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Nirav Valand

@NiravValand30

6 months

I have understood one thing from practicing medicine so far and this is my principle “Treat the patient and not the stature of the patient” What is your say about this?

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Nirav Valand

@NiravValand30

7 months

You don’t want to miss this! Attend it while you can!

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London)

@rkalyes1

7 months

📚 📖 I have put in a lot of effort preparing this talk. It will be worth your time! 👇 Join me online tomorrow as we learn about SGL2 Inhibitors 🔥 🔥 @NakaseroHosp @InternalmedMak @UgandaPhysician @UScientists

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Nirav Valand

@NiravValand30

9 months

@rkalyes1 @DrOribaDan @mbiineron @Asadthegeek @DrOtileUg @damshae87 @AbelKennedyO1 @ErasmusMD @ChefKarim02 @27Jipman @DrOlweny @faith_nabushawo @dr_evenakato @DrEtolu @DrSerunjogiEmma @JosephOgavu @DennisPhd1 @ACCESS_UG Abdominal X ray- bowel obstruction although not so typical x ray ECG - ?second degree Mobitz type 2 heart block with ectopic ventricular beats Histology- ? Increased Inflammatory cells Dx- 1. 2nd heart block 2. Bowel obs- ? Malignancy Rx -NPO, IV fluids, NG tube DRE findings?

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @DrOribaDan @UgandaPhysician @ASOU_Official Although didn’t have any particular focal symptoms but hydatid cysts could present in that manner. Others could be a cystic tumor or arachnoid cyst

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Nirav Valand

@NiravValand30

3 months

A man with h/o pain and limited movement in his right hand after punching a wall. On physical examination, the ulnar side of the right hand was swollen and tender and the patient had a limited range of motion in the wrist joint. What do you see?

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @rwotmix @Asadthegeek @DrOribaDan @damshae87 @DrOlweny @27Jipman @DrSerunjogiEmma @conradlubwama @DrEtolu @dr_evenakato @JosephOgavu @JuliusTusingwi1 @KamaraDaniel3 @faith_nabushawo @DennisPhd1 @DrOtileUg After this I had done some reading, if there’s a rapid tamponade formation then you would see a classic Becks compared to those who have had chronically, and also those with pre-existing hypertension. This is an interesting study

Elevated Arterial Blood Pressure in Cardiac Tamponade | NEJM

In cardiac tamponade cardiac output falls, but peripheral vascular resistance increases, so that systemic blood pressure may be maintained at normal or near-normal levels. We recently observed a pa...

www.nejm.org

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Nirav Valand

@NiravValand30

1 year

This goes to all the doctors(actually to everyone). Watch this short clip, and get your enthusiasm in medicine back if it had gone away 😊. Have a great day!

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Nirav Valand

@NiravValand30

8 months

@rkalyes1 @nirav @Oriba @Asadthegeek @DMavine @dr_evenakato @DrOlweny @DrEtolu @faith_nabushawo @SharifMutabazi @27Jipman @conradlubwama @ChefKarim02 @DennisPhd1 Seems like grade 1 finger clubbing mixed with peripheral edema with leukonychia Ddx - Cor pulmonale 2 to primary lung d’s - r/o GI malignancy, liver cirrhosis, -> hypoalbuminemia - ?CKD (not necessarily cause the clubbing though)

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Nirav Valand

@NiravValand30

6 months

@aruaclinic @Arnold_Khaukha @BrownJHM @ChefKarim02 @DrMutungaEA @DrOribaDan @rkalyes1 @imedverse @dermatology Herpes zoster aka shingles.

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Nirav Valand

@NiravValand30

4 months

Many incidents happen in diabetes management, whereby they come as complications, and one of the reasons why they reached that stage was because they did not know how to use their insulin pen/syringe. Below is a link to understand how to inject yourself.

How To Inject Insulin

When you are injecting insulin, you should aim to inject into the fatty tissue just underneath the skin. Watch our video guide.

www.diabetes.co.uk

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Nirav Valand

@NiravValand30

6 months

I wanted to put up this post to acknowledge mental health. I want to be discussing about depression with some of my senior colleagues/lecturer @EmmanuelMpamizo I have been seeing many people coming in with complaints which were being managed as something, but have depression

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Nirav Valand

@NiravValand30

8 months

@rkalyes1 @IDIMakerere @InternalmedMak @DrOribaDan @Asadthegeek @dr_evenakato @DrAkhilRaghavan @DrEtolu @DrOlweny @faith_nabushawo @ps_lukwago @ChefKarim02 @DrSerunjogiEmma My reasoning would be to reduce the sudden development of adverse events from heavy infestation of the worms in the eye. But this is my thinking.

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @DrOribaDan @damshae87 @ErasmusMD @DrOlweny @DrSerunjogiEmma @JosephOgavu @27Jipman @InternalmedMak @AnaesthesiaMak @NewmenPhiona @DrOtileUg @dr_evenakato @drkakamekeith Sorry I got a bit caught up with the unit Indeed there is a partial respiratory compensation It can get a bit tricky to understand sometimes so I wouldn’t blame them. But I am posting this maybe it can help out.

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @ACCESS_UG @balamu_NCD @27Jipman @DrOribaDan @lubulwaabdu @TPPerspectiv @thsseb @celeebu @ChefKarim02 @dr_evenakato @DrEtolu @DrSerunjogiEmma @damshae87 @KamaraDaniel3 @conradlubwama This is a good summary for that. Although we might not see some so commonly on wards. Although some tests might not be present

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Nirav Valand

@NiravValand30

11 months

@rkalyes1 @DrOribaDan @DrSerunjogiEmma @JosephOgavu @damshae87 @27Jipman @DrOtileUg @HilderKoriang @conradlubwama @graekan Bilateral renal calculi more prominent on the right, if more than 2cm, will require a percutaneous nephrolithotomy. Any evidence of sepsis, would require a percutaneous nephrostomy or DJ stent placement.

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Nirav Valand

@NiravValand30

7 months

This could be the future of kidney transplants. Very interesting where we are heading with technology. @rkalyes1 Prof what do you think about this? (Source @UCSF )

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Nirav Valand

@NiravValand30

7 months

@DrOribaDan @lacor_hospital @rkalyes1 @InternalmedMak @CelestinoGutirr @MakCHS_SOM @dr_evenakato @drkeithsiau @DrOtileUg @IAmTheOlum @faith_nabushawo @MinofHealthUG Hyperpigmentation of the palms with a smooth beefy tongue. (Subacute cord degen) DDx Vitamin B 12 deficiency secondary to ? Pernicious anemia from ?atrophic gastritis Ix- anti- intrinstic factor antibodies, anti-parietal cells antibodies. Rx - IM 1mg B12 every week for 6 weeks.

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Nirav Valand

@NiravValand30

2 months

I want to come up with a series of weekly podcasts/meetings about medical topics that are a bit difficult to understand especially for the medical students but also the doctors alike. What do you think about it? If yes then which ones?

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @ErasmusMD @DrOribaDan @DrOlweny @DrSerunjogiEmma @amutuhair @damshae87 @27Jipman Prof, would really like to thank you for these cases, they really help to think and make you read new concepts. Learnt a lot.

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Nirav Valand

@NiravValand30

6 months

@rkalyes1 @DrOribaDan @ddunguh @aruaclinic @Asadthegeek @DMavine @dr_evenakato @DrOlweny @DrMutungaEA @DRKEN100 @faith_nabushawo @ps_lukwago @InternalmedMak @27Jipman Multiple myeloma. As Seen by the investigations. Will require a hematologist for bone marrow. Also Need to do Ca, RFTs, Electrolytes. Rx - I rem Dr Ssali using immune therapy(Bortezumib), Thalidomide, Dexamethasone, IV fluids(if Ca is high), monitor RFT, Ca

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Nirav Valand

@NiravValand30

11 months

Attend it, so that you can get a better understanding of the pins and needles/ stinging feeling/burning sensation on the feet&hands like feeling you get, called Paresthesias medically a part of peripheral neuropathy.

Nakasero Hospital

@NakaseroHosp

11 months

Do you have a feeling of burning in your feet, skin or fingers? Join the us this Thursday as we discuss the peripherial Neuropathy presented by Dr Marvin Miiro (Head of Internal Medicine) at 7:00pm. Click to register in advance .

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Nirav Valand

@NiravValand30

1 year

@nihar_nayak2 @OGdukeneurosurg @SolarSunil @flozinatorMD This is quite interesting. Did the CSF collection form a web ? It can be seen in some cases of TBM. the csf for TBM I have seen has usually been more clear or a bit turbid. Seems like the protein level in this patient was high.

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @DrOribaDan @DrOlweny @JosephOgavu @EnockArts @DrOtileUg @conradlubwama Could be a neurogenic bladder, overactive bladder. It seems like she has an accessory ureters on the right.

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Nirav Valand

@NiravValand30

1 year

@OGdukeneurosurg Manage the airway first - intubate. Seems like a prevertebral hematoma from one of the major blood vessels so page vascular surgeon.

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Nirav Valand

@NiravValand30

9 months

@rkalyes1 @DrOribaDan @SemitalaFred @brucekirenga @damshae87 @ChefKarim02 @conradlubwama @DrEtolu @DrOlweny @dr_evenakato @DrOtileUg @SharifMutabazi A bit more history to it but from this, a couple of DDx- PTB, PJP, malignancy as well although no clear features on Xray Ix- if coughing and has productive cough- TB GenXpert, baseline tests, would be good to do a HRCT chest, ABG. Rx- According to cause PJP - CTX Anti-Tb O2

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Nirav Valand

@NiravValand30

11 months

@DrOribaDan @AndreaLConroy @CelestinoGutirr @DrOtileUg @rkalyes1 @JosephOgavu @damshae87 @lacor_hospital @dr_evenakato @DrSerunjogiEmma @faith_nabushawo HIV associated peripheral artery disease. HIV patients have a high risk for PAD usually the risk factor being smoking, low CD4 count. Could also be cryoglobulinemia- is there any family hx or evidence of any other organ dysfunction?

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Nirav Valand

@NiravValand30

11 months

@rkalyes1 @DrOribaDan @damshae87 @27Jipman @dr_evenakato @AJOHNSON1219 @DrOtileUg @DrSerunjogiEmma @Katendefredi @DrStrange @faith_nabushawo @MirembeDr @JosephOgavu X-ray- degenerative changes in the spine with osteophytes and decreased bone density. I don’t see any fractures. Dx - bladder outlet obstruction complicated by acute kidney injury (AKI on CKD) secondary to prostate enlargement- Cancer vs BPH Ix - PSA, electrolytes, CBC, USS

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Nirav Valand

@NiravValand30

11 months

Sometimes I see these fact sheets and think we really read and retain a lot in Medicine. Btw this is a fantastic summary for everyone to keep in mind

Journal of Brown Hospital Medicine

@BrownJHM

11 months

Classification of antibiotics (Pharma guide pre work) #Medtwitter #medEd #TipsforNewInterns #FOAMed

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Nirav Valand

@NiravValand30

7 months

@rkalyes1 @DrOribaDan @damshae87 @Asadthegeek @DMavine @DrAkhilRaghavan @DrOlweny @DrSerunjogiEmma @DrOtileUg @DrEtolu @faith_nabushawo @ps_lukwago @27Jipman @InternalmedMak Interesting case, though a bit of more history Ix- RFT, Urinalysis, mRDT, RBS, CBC, peripheral smear, LFT Ddx- AKI sec ? Cause - malaria, ?GBS, PSGN, UACR

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Nirav Valand

@NiravValand30

5 months

Revamp your space effortlessly at our Shoppers Stop Plaza store! Explore quality paints and hardware for your projects. Transform your surroundings effortlessly with our range of options. Visit us for easy solutions and friendly support. (Your support means the world to me😊)

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @Asadthegeek @DrOribaDan @damshae87 @DrOlweny @27Jipman @DrSerunjogiEmma @conradlubwama @DrEtolu @dr_evenakato @JosephOgavu @JuliusTusingwi1 @KamaraDaniel3 @faith_nabushawo @DennisPhd1 @DrOtileUg Becks triad, seen with cardiac tamponade is a clinical finding of three signs; 1. Hypotension 2. Muffled heart sounds 3. Raised Jugular venous pressure. Also, interestingly, they have a phenomenon called pulsus paradoxus - a paradoxical drop in BP during inspiration.

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Nirav Valand

@NiravValand30

10 months

@rkalyes1 @Asadthegeek @DrOribaDan @damshae87 @DrEtolu @DrSerunjogiEmma @amutuhair @27Jipman @dr_evenakato @DrOtileUg @faith_nabushawo DDx - DM/CKD with severe symptomatic hyponatremia (? Drug induced) Rx- hypertonic saline 3% slowly not to raise the Na by more than 8mmol/L (to avoid central pontine demyelinosis)

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Nirav Valand

@NiravValand30

9 months

@rkalyes1 @Ziza00 @ChefKarim02 @conradlubwama @DrOribaDan @ACCESS_UG @Asadthegeek @dr_evenakato @DrOtileUg @DrEtolu 1. How wonderful you feel about the trust 2. Why she was ok that medicine and what medicine she was placed on. 3. Regular monitoring and symptoms of kidney disease 4. Family photo.

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Nirav Valand

@NiravValand30

9 months

@TheMakCCR Occupational lung disease - pneumoconiosis. Might require long term oxygen therapy and other supportive treatments. Ideal world- would ask for monetary compensation from the companies as it was occupation related.

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Nirav Valand

@NiravValand30

8 months

@DrOribaDan @Asadthegeek @ahoysvet @CelestinoGutirr @dr_evenakato @DrOtileUg @rkalyes1 @kkananura @InternalmedMak @MakCHS_SOM @VBKerry Came across this “the prevalence of PVCs in pregnancy is higher than that in the normal population. Frequent PVCs have adverse effects on pregnancy, and the PVC burden might be the main factor associated with adverse pregnancy outcomes.”

The burden of premature ventricular contractions predicts adverse fetal and neonatal outcomes among...

Premature ventricular contractions (PVCs) may increase during pregnancy, however, few studies have evaluated the relationship between PVCs and the pregnant outcomes.PVCs may increase the adverse...

www.ncbi.nlm.nih.gov

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Nirav Valand

@NiravValand30

11 months

@rkalyes1 @ACCESS_UG @Ug_kidneyf @JosephOgavu @DrOribaDan @DrOtileUg @DrSerunjogiEmma @graekan @27Jipman @HilderKoriang @dr_evenakato @conradlubwama @damshae87 20/F having proteiuria, with mild pleural effusion from hypoalbuminemia. Probable causes - PSGN, Membranous Nephropathy and still in the age of Minimal change. Would like to know her blood pressure, RFT, r/o autoimmune, has some few WBCs- any fevers? Rx- cause - steroids

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Nirav Valand

@NiravValand30

1 year

@rkalyes1 @ErasmusMD @DrOribaDan @DrOlweny @DrSerunjogiEmma @amutuhair @damshae87 @27Jipman I would say this is sepsis - hypotension, altered mentation supported by the elevated WBC, ESR. Would want to do her blood cultures, PBF, would want to know her fluid status, RFTs, electrolytes, ABG, PCT, serum lactate, CXR, urine analysis. Broad spectrum antibiotic.

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Nirav Valand

@NiravValand30

5 months

@rkalyes1 @DrOribaDan @Asadthegeek @damshel @ASOU_Official @Makerere_Medics @TSM_Humanist @ErasmusMD @aruaclinic @DrAkhilRaghavan @drkeithsiau @DMavine @ps_lukwago @DrEtolu @DrMutungaEA @DrOlweny @dr_evenakato @DrOtileUg Severe metabolic acidosis with paradoxical abdominal breathing with acute hepatic and kidney injury complicated by hyperkalemia, hypocalcemia and pneumoperitoneum. Any exam finding? 1. ABCDE 2. ICU for respiratory support 3. IV calcium gluconate 4. +/- Emegency dialysis

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Nirav Valand

@NiravValand30

6 months

@rkalyes1 @DrOribaDan @DrEtolu @damshae87 @InternalmedMak @Asadthegeek @dr_evenakato @DRKEN100 @ps_lukwago @faith_nabushawo @DrAkhilRaghavan @27Jipman @aruaclinic @Makerere_Medics @Nyakubaho_MD Sternotomy ?CABG with -right pleural effusion secondary- ?AKI on CKD; HF, pneumonia -widened mediastinum- ?pericardial effusion Rx -ABCDE -Oxygen therapy -Diuresis if not on dialysis -salbutamol for K+, potassium binders - since no changes in ECG. - thoracotomy

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