Dicky Yulianda

[Mikael Dewabrata 📊 @MikaelDewabrata]

Sekalian aja lah kalkulatornya, terserah.

Nih: https://t.co/jw7kk3J9i9

[André Martin Mansoor @AndreMansoor]

1/14
I just finished 2 weeks of work in the hospital.

Here’s a glimpse of what I saw.

The kind of things that remind you why medicine is so good.

First up:
An S4 gallop you could not only hear… but see.

[DocXus @docxusofficial]

A 2 year old in the US was diagnosed with a disease from the 1700s

He was brought to the ER because he stopped walking.

No trauma. No fall. He just slowly stopped bearing weight on his legs over 6 weeks until he was crawling instead of walking.

His gums were swollen and bleeding. He had a rash. Pinpoint bleeding under his skin. Pain in both legs. Decreased muscle tone.

He kept his legs in a frog leg position and screamed when anyone touched them.

The doctors suspected everything.

First visit: possible fracture. Orthopedics recommended repeat imaging. Four weeks later he was worse.

Second visit: concern for leukemia. Then concern for nonaccidental trauma. Child protective services was called.

Then the workup began

> CT scan of both legs. No fracture.
> MRI of head and spine. Normal.
> lumbar puncture to rule out Guillain Barre. Normal.
> inflammatory markers. Normal.
> muscle enzymes. Normal.
> heavy metal screening. Negative.
> vitamin D and B12. Normal.
> bone marrow biopsy to rule out cancer. Normal.
> electromyography. Normal.
> muscle biopsy. Normal.

Weeks of testing. Multiple hospital transfers. Invasive procedures on a toddler. His parents watched their child get poked and scanned and biopsied while nobody could tell them what was wrong.

Then someone asked the right question.

What does he eat?

Chocolate milk and graham crackers. That was his entire diet. His mother had mentioned he was a picky eater at the very first visit. Nobody followed up on it.

His vitamin C level came back at less than 0.1 mg per deciliter.

He had scurvy.

The same disease that wiped out entire ship crews during the Age of Exploration. The same disease the British Navy solved in 1795 by issuing lemon juice to sailors.

Scurvy impairs collagen production and compromises blood vessel integrity. That explains the bleeding gums. The rash. The periosteal elevation on MRI. The bone pain. The inability to walk.

Every single symptom pointed to one thing and it took months to get there.

He was started on vitamin C supplements. Within a week he was moving his legs again. At 4 months he was walking and his hemoglobin was normal.

The entire workup could have been avoided with one detailed dietary history at the first visit.

We have MRIs and bone marrow biopsies and genetic panels. But the most powerful diagnostic tool in medicine is still asking a parent what their child eats for dinner.

All that extensive workup could’ve been replaced by a 5 minute conversation about food.

[DocXus @docxusofficial]

Dengue is DONE

Singapore just released a study that might end mosquito-borne disease as we know it. No drugs. No vaccines. Just mosquitoes fighting mosquitoes.

> infected male Aedes aegypti with Wolbachia bacteria
> released them into the wild to mate with normal females
> every single offspring from those matings was dead on arrival
> wild mosquito population practically vanished in treated areas

This isn’t some lab experiment btw.

24 month randomized trial. 15 geographic clusters. Nearly 400,000 residents. Published in the New England Journal of Medicine.

The results are insane:

> mosquito abundance in treated areas dropped from 0.18 to 0.041
> control areas went the other direction to 0.277
> 6% dengue positivity in treated zones vs 21% in control zones
> protective efficacy of 72%

No drug. No vaccine. No chemical spray. Just evolutionary biology weaponized against the most dangerous mosquito species on earth.

For context we’ve been fighting Aedes aegypti the same way for decades. Fogging. Larviciding. Nets. Awareness campaigns. And dengue kept spreading. More cities. More countries. More deaths. 400 million infections a year.

The problem was never effort. We were trying to kill mosquitoes after they already existed. Singapore said what if we just make sure they’re never born.

Cytoplasmic incompatibility. That’s the mechanism. Wolbachia infected males mate with wild type females and the eggs never develop. Do it at scale and the entire population collapses from the inside. Generation after generation.

They didn’t fight the mosquito. They turned reproduction into a weapon against it.

No pharmaceutical intervention for dengue has ever come close to 72% efficacy at this scale in a real world setting.

And this is just Singapore. Imagine this deployed across Southeast Asia. South Asia. Sub Saharan Africa. Latin America

If you’re still thinking about dengue control as fogging trucks and awareness posters you’re looking at the wrong decade.

This is the most important vector control breakthrough in years and nothing else we have even competes.

[André Martin Mansoor @AndreMansoor]

Only 4 mechanisms cause hypotension — and you can often tell which one it is at the bedside.

A practical framework for shock.

Watch full video here: https://t.co/R3h7lhtKXd

[Dr. AK 🇮🇳 @docakx]

🚨Chronic Fatigue Syndrome - New Study

91.5% had a pathogen visible on blood smear.

One woman labeled with Chronic Fatigue Syndrome for 40 years was finally found to have Bartonella on a blood smear. 4 decades of suffering solved by a simple peripheral blood smear examination.

Many “CFS/ME” cases are actually missed zoonotic infections—Babesia, Bartonella, Borrelia (BBB).

Maybe CFS isn’t “medically unexplained”—maybe we just didn’t look hard enough. BBB matters.

As per the article co authored by @Aguirre1Gustavo

Aguirre Chang, Gustavo & Tarello, Walter & Trujillo Figueredo, Aurora. (2026). ZOONOSES ARE THE LEADING CAUSE OF MYALGIC ENCEPHALOMYELITIS/CHRONIC FATIGUE SYNDROME (ME/CFS). BASED ON THE RESULTS OF 322 BLOOD SMEARS MICROSCOPIES AND THE THERAPEUTIC RESPONSE TO ANTIMICROBIALS AGAINST THE IDENTIFIED PATHOGENS.

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕🔥 Review article
Filling the Gaps: A Review and Update on Beta-Lactamase Inhibitor Combinations #IDXposts
https://t.co/Zgv16Bba2Z

[HHS @HHSGov]

Introducing: The New Pyramid

[13🍜 @yearendsale_]

If you’re on holiday in JOGJA but not going to Malioboro, try these places:

[Prof. Nick Talley @Prof_NickTalley]

I'm thrilled to announce the 10th edition of Talley & O'Connor's CLINICAL EXAMINATION: A systematic guide to physical diagnosis has just been published (Dec 1st, 2025). It is humbling medical students in Australia, New Zealand, UK, Ireland, South Africa, Pakistan, Malaysia, Singapore, Canada and around the world have used and liked the book. We hope the new edition will prove just as useful to all aspiring clinicians.

[Wataru Hayashi / 林 航 @DraWataru]

The pathobiology of human fungal infections | Nature Reviews Microbiology

(https://t.co/Av4qN3Eg7M)

[JAMA @JAMA_current]

📢 ICYMI: This Review summarizes the diagnosis and management of adult #KneePain—with a focus on #osteoarthritis, patellofemoral pain, and meniscal tears. Globally, osteoarthritis impacts over 650 million adults.

Add this to your reference manager: https://t.co/lfs2Rnnuzc

[JAMA @JAMA_current]

Peripheral neuropathy, defined as damage to the peripheral nerves, affects approximately 1% of adults worldwide.

This Review summarizes the pathophysiology, clinical presentation, diagnosis, and treatment of length-dependent peripheral neuropathy. 🧵

https://t.co/tgk8h7SdEL

[Dr sthanu subramanian @drsthanus]

A one-page guide on in-flight medical emergencies, created by Nick Mark, MD, for https://t.co/ZJITBlo4DU.

@nickmmark

[Dr sthanu subramanian @drsthanus]

Head-to-toe assessment .

https://t.co/FCgPYqJZpT

[Netflix Indonesia @NetflixID]

Terpukau banget sama pesona Desa Wanirejo + Eva Celia 😍 Pemandangannya indah, warganya pun keliatan ramah-ramah. Jadi pengen ke sana nggak sih? Kamu bisa liat lebih banyak tentang Desa Wanirejo di film Abadi Nan Jaya yang udah tayang di Netflix!

[MEDCRUX @medcrux]

🙍‍♂️ A man presents with the following lesion after traumatic inoculation. Identify the causative organism❓

A) Mycobacterium scrofulaceum
B) Sporothrix schenckii
C) Madurella mycetomatis
D) Phialophora verrucosa

👨‍⚕️ Drop your Answers below 👇

[WatchmenID @WatchmenID]

Abadi Nan Jaya Spoiler Without Context

[Dr sthanu subramanian @drsthanus]

Snake bite management.

https://t.co/NaaruhPn0D

[Alí Sebastian Meza @AliSMV7]

Invasive candidiasis in intensive care
medicine: shaping the future of diagnosis and therapy

https://t.co/wR3cRkO7Ah