Neurophilia

Neurointervention, Neurointensivist, Autodidact, technophile, Sempiternal scholar, Teacher,

[Neurophilia @bobvarkey]

@drmohansai Is a recording available? I could not manage to join yesterday

[Neurophilia @bobvarkey]

@Kinza1278 Her life

[Neurophilia @bobvarkey]

@drmohansai @aartisarwal @Yasaman_Neuro @ManniWaraich @RMJCashmore @startrek30 @codebrainNCC @KalagaraHari @deepak_neuro @nirmalregency Thank you

[Neurophilia @bobvarkey]

I use it for remote coding with Hermes/Ollama pro cloud /Telegram.
Unlike Claude CLI or Claude pro, it never hits a limit and I can run it as long as I want without any worries about cost or limits . Ollama pro is very generous with its limits . I use Claude only to plan my app and clean up the code
Hermes also supports multiple telegram bots and accounts with Ollama pro, so that all members of my family have a bot each. The total cost is only $20 a month

[Neurophilia @bobvarkey]

@ChessbaseIndia Way to go Praggs!

[Neurophilia @bobvarkey]

This is the bot that has hacked my account. Even X is unable to get it back.

[XRP Ledger Announces @XRPL__A]

Came in with complaints of feeling of weakness of left index tip. Flummoxed me a bit till the full exam

[Neurophilia @bobvarkey]

@pocusmeded Do cardiologists still auscultate patients?

[Neurophilia @bobvarkey]

Just came across a nerve conduction study in this format. Very interesting to see the potentials displayed on the side. The raw data seems to make more sense

[Neurophilia @bobvarkey]

A B12 bombshell

🧠 "Normal" B12 ≠ Optimal B12
500 maybe the new norm !

A UCSF study in Annals of Neurology looked at healthy older adults (avg age 71) with B12 levels well within the normal range (average 414.8 pmol/L vs the US cutoff of 148).
Those with lower-normal B12 showed:

• Slower thinking and visual processing
• More white matter injury on brain scans
Is it time for updated guidelines that use functional biomarkers instead of just the minimum cutoff.

“ Revisiting the definition of B12 deficiency could lead to earlier intervention and prevention of cognitive decline."

🔬 B12's Role Goes Beyond Blood (Cornell, Jan 2026)

B12 deficiency affects muscle mitochondrial energy production (muscles have high energy demands)

• B12 supplementation in aged mice improves mitochondrial function
• B12 interacts with lipid metabolism, organelle stress, and epigenetic regulation ,acting as a "gatekeeper" of multiple hub pathways
• Low B12 is linked to lower muscle mass and strength
• An estimated 25% of elderly in developed countries have suboptimal B12

Bottom line: The old way of thinking “B12 > 148 pmol/L is fine" is being challenged.
Higher levels (closer to 500+) appear protective for brain and muscle health, especially as you age.

[Neurophilia @bobvarkey]

From zero to hero.
Started of spending 2-3 hours a day fixing OpenClaw crashes. After 6 months, I have hit a record of 8 days straight without gateway or agent errors. Thanks to OpenClaw, Hermes agent and Macky
The 1st remote crash occurred on day 9

[Neurophilia @bobvarkey]

A lady with generalised tremulousness sent to us for evaluation. Her knee jerks are ↘️. She appears anxious, fidgety and has generalised tremors. She has been referred by Psychiatry for ‘tremors’
What could she have?

[Neurophilia @bobvarkey]

CM Vijay has come out with a fantastic proposal. Government officials should only go to Government hospitals for treatment. Why should taxpayers find their treatment in private hospitals?
If they want to avail of such facilities let them fund their own expenses

This is a great model that should be rolled out across India

[Neurophilia @bobvarkey]

How I remember the constantly evolving classification of idiopathic inflammatory myopathies

With the mnemonic SOUND
which stands for

anti-Synthetase syndrome
Overlap Myositis
inclUsion body Myositis
Necrotising myositis
Dermatomyositis

[Neurophilia @bobvarkey]

A lady with generalised tremulousness sent to us for evaluation. Her knee jerks are ↘️. She appears anxious, fidgety and has generalised tremors. She has been referred by Psychiatry for ‘tremors’
What could she have?

[Neurophilia @bobvarkey]

What could this young man possibly suffer from?

[Neurophilia @bobvarkey]

Newtons 1st law (Inertia) applies to our thought processes also. We prescribe the same medications and brands until there is a sufficiently strong effort to switch medications or brands
This maybe an internal (knowledge update) or an external (update from colleagues, industry) stimulus.

[Neurophilia @bobvarkey]

Ever wondered how iron metabolism works
Iron is fast becoming part of our therapeutic armamentarium in Neurology
Here’s an easy guide.
Let's break it down using an ice cream analogy! 🍦😋
The body needs iron for many things,
However"free iron" can be harmful

[Neurophilia @bobvarkey]

Hepcidin is the body’s main switch for iron, deciding whether iron stays stored or goes into the blood.

[Neurophilia @bobvarkey]

Why is Ferritin high in inflammatory disorders and there is still a relative iron deficiency??
The answer lies in Hepcidin

Hepcidin is a small hormone made in the liver that controls how much iron your body puts into the blood.

[Neurophilia @bobvarkey]

The great debate of whether the medical training is better in the US or India? After working in both environments…