Dr Gauthamkilaru

Medicine Doc

[Dr Jason Philip. M.S., MCh @Jasonphilip8]

"Doctor, I think my testosterone is low." Prakash, a male nurse (name changed) was 32. His marriage was falling apart.

Fatigue. Low libido. Erectile Difficulties. Brain fog.Weight gain around the waist.He had all the symptoms that social media associates with "Low T." Prakash was convinced testosterone was the culprit.

The problem? His testosterone was normal. Not once.Thrice. He arrived carrying 3 lab reports like evidence in a courtroom.

"Everyone keeps telling me I'm normal," he said."But I don't feel normal." I believed him.Many patients assume testosterone is a simple number.Low number = symptoms. Normal number = no problem. Medicine is rarely that straightforward.

Prakash's total testosterone was around 450 ng/dL, comfortably within the normal range. Most doctors would have stopped there. But something didn't fit. So we dug deeper. We checked two tests that are often overlooked: SHBG (sex hormone-binding globulin),& free testosterone. The results changed the entire story. His SHBG was nearly twice the usual range.

And his free testosterone, the small fraction actually available for the body's tissues to use, was scraping the bottom of normal. In other words, his body was producing enough testosterone.

But much of it was locked away. Unavailable. Like money sitting in a bank account you can't access. The next question was why. The answer turned out to be surprisingly mundane. A recent switch to a very low-fat "healthy" diet. And thyroid hormone levels running slightly high.

Both are known to increase SHBG. Both are potentially correctable. This wasn't classic testosterone deficiency. It was a transport problem.

Had we simply prescribed testosterone, we might have missed the real issue entirely. Instead, we addressed the thyroid problem with his endocrinologist and modified his diet. Three months later, his SHBG had fallen. His free testosterone had risen.His energy returned.His sex drive improved. Better erections. The brain fog lifted. Without a single testosterone injection.

The lesson?

A normal lab value doesn't always mean a normal physiology. Sometimes the answer isn't hidden in the number everyone looks at. It's hidden in the number nobody ordered.

Medicine rewards curiosity, humility, & calm analysis/pattern recognition. 3 drs had looked at lab numbers. I looked beyond it.

[برهان الدین ‏| Burhan uddin @burhan_uddin_0]

🚨 Baloch armed groups once again set fire to large cargo trucks that were transporting valuable stones from Balochistan to Punjab.

[Rishi Bagree @rishibagree]

Children are children. They will make mistakes, they will be mischievous, that’s part of growing up.

But no teacher has the right to hit them. Suspending this teacher is not just important, it is necessary

[Scott C. Howard @schowardjd]

Necrobiotic xanthogranuloma (NXG)

NXG is a rare non-Langerhans cell histiocytosis strongly associated with IgG monoclonal gammopathies, including MGUS & plasma cell dyscrasias. The combination of recurrent periocular yellow-brown papules & plaques disseminated xanthomatous lesions with ulceration, IgG-λ MGUS, pancytopenia, & characteristic histopath showing palisading granulomatous inflammation with necrobiosis and cholesterol clefts is highly diagnostic.

In this patient, prior therapies w/ prednisone & IVIG were ineffective or poorly tolerated. Initiation of lenalidomide 5 mg daily resulted in marked improvement within 4 months, including complete healing of the knee ulcer (see infra), regression of periocular and cutaneous plaques, and normalization of a previously severe anemia (hemoglobin increased from 7.4 to 14 g/dL). When the dose was reduced because of leukopenia, new ulcers developed, suggesting a dose-dependent treatment effect.

NXG most commonly presents w/ slowly progressive periocular xanthomatous plaques but may become disseminated & ulcerative. Ocular involvement is common but not universal. Given its strong association w/ monoclonal gammopathies, evaluation for underlying plasma cell disorders is essential.

Although no standard therapy exists, reported treatments include corticosteroids, IVIG, alkylating agents, interferon-α, & immunomodulatory agents.

[Shika Reddy 🚩 @Shika_Reddy]

chinna papa intha kashtamtho maatladutundi 😢😢😢

No government is helping these families from years..

@TelanganaCMO @revanth_anumula

[Dr Gauthamkilaru @Gautham9999]

C) Von Zumbusch Psoriasis

[C.Alberto Ortega @albertoortegana]

🚨 MEDICAL CASE CHALLENGE 🚨
Calling all medical students, residents, and doctors! 🩺🧠 Can you identify this definitive dermatological condition?
Case Details:
A young adult male presents with a chronic, severe, and painful inflammatory eruption localized primarily to his hands, distal phalanges, and periungual regions. The examination reveals confluent, pustular lakes, scaly plaques, and significant subungual involvement leading to nail dystrophy. The condition is characteristically resistant to standard topical therapies and slowly progressive, localized to the extremities.
What is the most definitive clinical diagnosis? 👇

A) Acrodermatitis Continua of Hallopeau
B) Impetigo Herpetiformis
C) Von Zumbusch Pustular Psoriasis
D) Palmo-plantar Pustular Psoriasis

Drop your answer and your clinical reasoning in the comments below!

#MedicalCase #Dermatology #MedEd

[हिन्दुस्तानी🇮🇳 समोसा ∆ @Indiansamosaa]

These cartoons were not drawn by the British. They were drawn by members of the Communist Party of India and published in the party's official newspaper, People's War.

😠 😡

[Dr Gauthamkilaru @Gautham9999]

SAPHO

[C.Alberto Ortega @albertoortegana]

What's the diagnosis? Patient with a history of severe acne vulgaris treated remotely with isotretinoin presented with acute pain of the neck and lower back and associated radicular symptoms. Physical examination found tenderness over the sternoclavicular joints bilaterally along with occasional scattered pustules on the left palm (Fig 1, A) and nontender grouped, deep-seated vesicles with crust on the right palm (Fig 1, B). Magnetic resonance imaging of the spine found multiple foci of abnormal bone marrow signaling in multiple vertebral levels and the left iliac bone (Fig 2). Core biopsy of the left iliac bone found normal bone negative for cytokeratin AE1/AE3, and cytology was negative for malignant cells (Fig 3).
Diagnosis?

[C.Alberto Ortega @albertoortegana]

What's the diagnosis? Patient with a history of severe acne vulgaris treated remotely with isotretinoin presented with acute pain of the neck and lower back and associated radicular symptoms. Physical examination found tenderness over the sternoclavicular joints bilaterally along with occasional scattered pustules on the left palm (Fig 1, A) and nontender grouped, deep-seated vesicles with crust on the right palm (Fig 1, B). Magnetic resonance imaging of the spine found multiple foci of abnormal bone marrow signaling in multiple vertebral levels and the left iliac bone (Fig 2). Core biopsy of the left iliac bone found normal bone negative for cytokeratin AE1/AE3, and cytology was negative for malignant cells (Fig 3).
Diagnosis?

[NewsMeter @NewsMeter_In]

#TelanganaMedicalCouncil raids #skin & #hairclinics in #Kondapur, #Hyderabad.

�� #NeoskinClinic: Treatments offered without a qualified dermatologist or required permissions.

🔹 ORA Aesthetics: Dental practitioners performing skin & hair aesthetic procedures.

🔹 #TrayaHairLossSolutions: Online consultations without proper clinical registration or qualified #dermatologists.

TGMC says action will be initiated under Sections 34 & 54 of the NMC Act, 2019.

It will also recommend sealing unauthorized establishments and warned that registered doctors aiding such practices could face disciplinary action, including suspension of licence.

#Hyderabad #Telangana

[Dr sthanu subramanian @drsthanus]

Radiation Recall and Woody Fibrosis.

This finding is consistent with radiation recall, in which patients undergoing chemotherapy have sequelae of radiation therapy months to years after the original treatment.

The mechanism of radiation recall is unknown but may result from changes in vascularization, impaired epithelial stem cells, or impaired DNA repair.

Chronic woody fibrosis sets the stage for an impaired microenvironment.

If a trigger drug is introduced, the tissue is far more vulnerable, often leading to a more intense or prolonged radiation recall reaction.

*Treatment focuses on improving quality of life, using physical therapy, massage techniques, hyperbaric oxygen therapy, and sometimes pentoxifylline or vitamin E to improve tissue health.

●This infographic breaks down the clinical distribution and therapeutic triggers of Radiation Recall Dermatitis (RRD)

Sources:

https://t.co/Rnk9w03VWC

https://t.co/a10EnEBeXG

[Shukri Hamk 🇦🇺 @Yazidisto]

Never forget the 80 Yazidi grandmothers who were buried alive by Islamists for being considered too old to be sex slaves.

[Śrīrām 🇮🇳 (Modi's Family) @Vadicwarrior]

Muruga 🙏

[Comman Man @CommanMan777589]

A Hindu girl was allegedly abducted by Muslim boys with the help of the police seen in video !

She belongs to the Rajasthan Pandit community. Let @PoliceRajasthan confirm the truth of the video

[The Analyzer (News Updates🗞️) @Indian_Analyzer]

Rahul Gandhi in April:
- Mamata protected RG Kar rape accused.
- Mamata did Corruption.
- Mamata didn't work for Bengal
- Mamata is opening way for BJP.

Rahul Gandhi in June:
"Come merge with us. We will make you National Vice President."🤡

[News Algebra @NewsAlgebraIND]

BIG UPDATE 🚨 Auto driver arrested by Police.

Shiv Sena workers tracked down the auto driver who beat a senior citizen in Thane for simply asking him not to spit & gargle on road 😳

The senior citizen is currently hospitalized with a fractured leg.

[Team Hindu United @TeamHinduUnited]

Arbaz Khan and his gang abducted a married 18-year-old Hindu woman in Karauli, Rajasthan.

The family says, “We are Gadia Lohar — descendants of those who stood by Maharana Pratap — but now our daughter is being fed Gau-man's.”

It is further alleged that the police took a bribe of ₹5 lakh and tried to clear the case.

[Scott C. Howard @schowardjd]

A man in his 30s (FST IV) w/ primary sclerosing cholangitis underwent liver transplantation in 2012. Multiple episodes of allograft rejection necessitated quadruple immunosuppression w/ prednisone, tacrolimus, mycophenolate mofetil, & everolimus.

Approximately 10 yrs post-transplant, he presented w/ a 4-mo hx of a progressively spreading hyperpigmented eruption, initially involving the abdomen & subsequently extending to the trunk and upper extremities, w/ axillary predominance & intermittent pruritus.

O/E: numerous scaly violaceous-brown macules & thin velvety plaques involving the chest, abdomen, back, flanks, & B/L axillae.

What’s your DDx❔

[Krishanu Singha @KrishanuOnline]

This is TMC leader and Lok Sabha MP June Malia; a video featuring her is currently going viral.
The video appears to predate the West Bengal Assembly election results.
In it, TMC leader June Malia is seen instructing other TMC workers and miscreants to assault BJP workers—essentially inciting post-poll violence—while also warning them not to record the conversation.
We urge the West Bengal Police, the Kolkata Police, and the Honorable Chief Minister to take appropriate action against her.

[Prem @itsurprem]

Reason why my respect to doctors are always 💯

Life has been changed for this little boy👏