SHAMSUL H

MBBS,MD.
Life long learner of Medicine.
#FOAMed.#MedTwitter.

[SHAMSUL H @Shamsul_Hi]

JAK inhibitors and the story behind its nomenclature.
#MedTwitter

[SHAMSUL H @Shamsul_Hi]

📌Knuckle Hyperpigmentation -
Causes -
Frictional.
B12 deficiency.
Insulin resistance.(e.g. PMOS, Obesity).
#Medtwitter

[SHAMSUL H @Shamsul_Hi]

Significant Mid cavitary gradient in LVH, Hypovolemic State, severe tachycardia produced in CW has a late systolic peaking.
Don't confuse with LVOT gradient in HOCM.
1st pic - mid cavitary gradient of 51 mmHg in a patient with concentric LVH.
2nd pic - 🗡️ shaped CW,in HOCM.

[SHAMSUL H @Shamsul_Hi]

IAS aneurysm in subcostal view.
#echofirst

[SHAMSUL H @Shamsul_Hi]

Using PR jet velocity for estimating mean Pulmonary artery pressure (meanPAP).
Here RAP = 15 .
mPAP= 4(3)² + 15 = 51 mmHg.
Can be used for estimating mPAP when TR velocity is less.
Here PR is Severe - Dense jet,steep deceleration & early termination of diastolic flow.
#echofirst

[SHAMSUL H @Shamsul_Hi]

@drahmedmohsen85 Sir,this one from my gallery....
A case of RCMP with ascites & pericardial effusion..... floating falciform ligament s/o Ascites.

[SHAMSUL H @Shamsul_Hi]

🟣 Purple urine bag syndrome - PUBS is the result of UTIs with certain bacteria which produce sulphatases and phosphatases -> tryptophan metabolism to produce indigo (blue colour) and indirubin (red colour).
Can be seen in patients with long standing urinary catheter.
#MedTwitter

[SHAMSUL H @Shamsul_Hi]

Another LA Myxoma...
#echofirst
#POCUS
#MedTwitter

[SHAMSUL H @Shamsul_Hi]

Male,35 Y, having fever,jaundice,prerenal AKI,farmer by profession.
Now c/o B/L subconjunctival hemorrhage.
Lepto IgM (+).
Classical Weil's Disease.
#MedTwitter

[SHAMSUL H @Shamsul_Hi]

Methotrexate (MTX)-cornerstone in treatment of RA,to be taken once weekly with Folic acid supplementation.But unfortunately few patients take it on regular basis leading to MTX toxicity.
MTX mucositis is the presentation.
T/t:1.) Stop MTX.
2.)Inj. Leucovorin.
3.) Hydration.

[SHAMSUL H @Shamsul_Hi]

👇 is from Dr Ahmed Mohsen's book.

[SHAMSUL H @Shamsul_Hi]

RAC sign.
Retro aortic anomalous coronary sign - anomalous left coronary artery traveling posterior to aortic root.
#POCUS
#echofirst

[SHAMSUL H @Shamsul_Hi]

Case of massive Pericardial effusion with impending cardiac tamponade.....see the swinging heart inside Pericardial effusion...this is k/c/o - Double output Right ventricle (DORV).
#POCUS
#echofirst

[SHAMSUL H @Shamsul_Hi]

Left Atrial Appendage clot can be missed in routine 2D ECHO....TEE is the investigation of choice to rule out LAA clot.
Here a patient with Post partum cardiomyopathy,EF ≈20%,LAA clot can be seen in 2D ECHO...echogenic pedunculated mass attached with LA Appendage.
#POCUS
#ECHO

[SHAMSUL H @Shamsul_Hi]

Vaccines recommend in COPD;
PCV 21 newly recommend.
PCV 15,20 & PPSV 23 are there.
RSV ≥60 Years.
Zoster >50 Years.
Yearly influenza vaccine.

[SHAMSUL H @Shamsul_Hi]

GOLD COPD 2025 updates compared to GOLD COPD 2024.
#Medtwitter
#COPD

[SHAMSUL H @Shamsul_Hi]

Ensifentrine & Dupulimab added in management of COPD.

[SHAMSUL H @Shamsul_Hi]

This is similar to Smoky apperance/spontaneous echo contrast in vessels/heart chamber.

[SHAMSUL H @Shamsul_Hi]

Look at the IVC....
The echogenic things floating within the IVC. It’s called particulate matter and is often observed in patients with no known cardiac pathology.
This is a normal finding.
#echofirst
#POCUS

[SHAMSUL H @Shamsul_Hi]

Bicuspid Aortic Valve.
28 Y/Male patient.
PXAS view showing RCC & LCC fused with raphe.
Valve opening and closing properly.
There was no COA.
No AR ,No AS.
Ascending aorta was not dilated.
#POCUS
#echofirst

[SHAMSUL H @Shamsul_Hi]

https://t.co/sUfRVXtvfU

[SHAMSUL H @Shamsul_Hi]

Classical windsock deformity of ruptured sinus of Valsalva.
This patient had H/O previous intracardiac repair of VSD with Aortic Valve replacement.
#MedX
#ECHO
#POCUS
#RSOV