Dr.Divya Sai

PG JR Family medicine

[THE SKIN DOCTOR @theskindoctor13]

This is Keratosis pilaris. A common, harmless skin condition that causes tiny rough bumps, mostly on the arms and thighs. Also called chicken skin or strawberry skin. Here's how to handle it:

1. Moisturise: Apply a thick, oil-free, fragrance-free cream at least 2-3 times a day. One application should be within five minutes after bathing on damp skin, and another after exfoliation (point 2). Prefer creams over lotions. Look for ingredients such as urea, lactic acid, shea butter, glycerin, or ceramides.

2. Gentle Exfoliation: Start with two to three times a week to remove dead skin and smoothen the bumps. Use mild chemical exfoliants like urea* 10–20%, lactic acid* 10–12%, ammonium lactate 12%, salicylic acid 2-3%, or retinoid creams (if prescribed). Apply them as directed and then apply moisturiser immediately after or within a few minutes.

3. Shaving or waxing can worsen keratosis pilaris. If hair removal is done, apply a cool compress for a few minutes to soothe the skin, then moisturise.

4. To avoid dryness, keep baths short, around five to ten minutes, use warm rather than hot water, and avoid over-washing as once daily is usually enough.

5. Avoid bar soaps because they dry the skin. Use a mild, fragrance-free cleanser instead.

6. Do not scratch, pick, or attempt to remove the bumps manually. Avoid harsh scrubbing. Do not use harsh loofahs, rough exfoliating gloves, or scrub the skin hard, as it irritates and worsens keratosis pilaris.

7. Wear soft, breathable clothing. Choose loose, comfortable cotton fabrics. Tight or synthetic clothing causes friction and can worsen the bumps.

8. Still not helping, visit a dermatologist.

*Urea and lactic acid can function as both moisturisers and exfoliants, depending on their concentration. At lower concentrations, they primarily act as moisturisers, while at higher concentrations, as exfoliants.

[ILLIASUL IBAD @IlliasulK]

I was on duty that day, a final-year medicine trainee.
A call came from orthopedics.

“45-year-old man, fall from bike — fracture left distal radius, rib fracture on right side. Now complaining of left-sided chest pain.”

They’d given him diclofenac for pain.
Pain had improved… but 30 minutes later, he started clutching his chest.

“Probably rib pain,” they thought.
But the rib fracture was on the right side.
He kept insisting —

“Doctor, this pain is on the left… and it’s getting worse.”

So they called me.

When I reached, he was in visible distress — sweating, anxious, restless.
No addictions. No comorbidities. No prior drug allergy.

He said, “Initially my pain was in the right chest and left forearm… now it’s heaviness on the left side of my chest.”
The X-ray had ruled out any left rib fracture.
No local tenderness.

Something didn’t add up.

I asked him to describe the pain.
He said quietly,

“Feels like someone’s sitting on my chest.”
He was nauseated, sweating more.

While talking, I noticed something else — red rashes scattered across his abdomen and thighs.
They looked fresh.

“When did this start?”
He thought for a second.

“About 45 minutes ago.”

I checked his drug chart — IM diclofenac for pain.
I looked at the rash again, then at his face turning pale.
The timing fit perfectly.

My orthopedic colleague asked,

“What are you thinking?”

I said, “Let’s get an ECG — now.”
He replied, “We already have one, it was normal for pre-op.”

Still, we repeated it.
And that changed everything.

ST elevation — V1 to V4.
Troponin and CK-MB both high.
Acute coronary syndrome.

We gave a loading dose, sublingual nitrate.
His BP was 150/80.
I added verapamil.

He started feeling better.
We repeated the ECG after an hour —
the ST elevation had vanished.

My colleague asked, “Why verapamil?”
I just smiled.

Because this wasn’t atherosclerosis.
This was an allergy of the heart.

That night, I met Kounis Syndrome —
an allergic storm that spasms the coronaries.
Triggered by a painkiller.

A paradox —
the drug meant to relieve pain had almost broken a heart.

In the following months, I saw two more.
One after penicillin.
One after a bee sting.

Each time, I remembered that man.
And his quiet, unforgettable line —

“Doctor… the pain has shifted to the wrong side.”

Medicine teaches you to treat what you see.
Experience teaches you to question what you don’t.

Sometimes, the clue isn’t in the test —
it’s hidden in the timeline.
In a rash. A word. A hesitation.

That’s where the diagnosis lives.

🩺 #MedTwitter #KounisSyndrome #StorytellingInMedicine #Allergy #Cardiology #Rheumatology #Immunology
#Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History
@DrAkhilX @IhabFathiSulima @Janetbirdope #MedTwitter #RheumTwitter
@CelestinoGutirr @aditya_gan3500 @nileshnolkha @nirmalregency

[Mind Muscle Project @mindmusclepro]

What are the Best Protein sources for Fat loss & improving Metabolic health?

🟢 Prawns - 4.1
🟢 Whey Isolate - 4.2
🟢 Tuna - 4.6
🟢 Aquatein Protein Water - 4.8
🟢 Tilapia - 4.8
🟢 Katla Fish - 5
🟢 Pea Protein - 5
🟢 Tofu - 5
🟢 Epigamia Turbo Greek Yoghurt - 5.3
🟢 Epigamia Turbo Protein Shake - 5.4
🟢 Whey Concentrate - 5.4
🟢 Egg Whites - 5.6
🟢 Rohu - 5.7
🟢 ID High Protein Paneer - 5.8
🟢 Greek Yoghurt - 5.9
🟢 Provilac Milk - 6
🟢 Organic Mandya HP Paneer - 6.2
🟢 Soy Chunks - 6.6
🟢 Amul High Protein Paneer - 6.8
🟢 Rawas - 7
🟢 Amul Protein Lassi - 7.1
🟢 Pomfret - 7.3
🟢 Akshayakalpa HP Paneer - 7.6
🟢 Chicken Breast - 7.8
🟢 Raw Protein Shake - 7.7
🟢 Mackerel - 8.2
🟢 Milky Mist High Protein Paneer - 8.1
🟢 Skyr - 8.6
🟢 Nuvie Protein Milkshake - 8.9
🟢 Hung Curd- 9.5
🟢 Edamame - 9.5
🟡 Sprouted Moong - 10
🟡 Amul Slim n Trim Milk - 10
🟡 Tempeh - 10.1
🟡 Amul High Protein Dahi - 10.7
🟡 Quail Egg - 11
🟡 Parmesan - 11.3
🟡 Eggs - 11.6
🟡 Mutton - 11.7
🟡 Chicken with Bone - 11.9
🟡 Fuelled Bar - 12
🟡 Pro. Fitness Bar - 12
🟡 Mozzarella - 12.7
🟡 Duck Egg - 13
🟡 Bacon - 14
🟡 Rajma - 14.6
🟠 Paneer - 15
🟠 Whole Truth Bar - 15.1
🟠 Nuvie Protein Bar - 15.1
🟠 Cheese Cubes/Slices - 15.5
🟠 Yoga Bar - 15.6
🟠 Toor Dal - 16
🟠 Max Protein / MuscleBlaze Bar - 17.3
🟠 Chickpea - 18.2
🟠 Pumpkin Seeds - 18.5
🟠 Curd - 18.5
🟠 Feta Cheese - 18.8
🟠 Amul Taaza - 19.2
🔴 Egg Yolk - 20
🔴 Quinoa - 20
🔴 Peanuts - 21.5
🔴 MyFitness Peanut Butter - 25.7
🔴 Whole Truth Peanut Butter - 25.9
🔴 Almonds - 27.3
🔴 Amul Gold Milk - 27.8

When it comes to fat loss & Metabolic health, protein is your best friend.

The goal is simple, obtain the maximum amount of protein for the least amount of calories.

This ensures your body preserves muscle, keeps you fuller for longer & gets you into a Calorie deficit.

> Items with Calorie to Protein ratio below 10 are the best.

> Items with Calorie to Protein ratio in between 10-15 are good, but shouldn’t be the main protein sources.

> Items with Calorie to Protein ratio in between 15-20 are not good choices, mostly avoid (as protein sources), better to have in small quantities for other nutrients if needed.

> Items with Calorie to Protein ratio above 20 should be totally avoided, unless one is physically super active & trying to gain weight.

[હની કુમાર/ਹਨੀ ਕੁਮਾਰ @hunnykumar1908]

Best resources for the USMLE STEP 1

•First Aid for the USMLE STEP 1

•Kaplan USMLE STEP 1 lecture notes (Set of 7 books)

•Pathoma: Fundamentals of Pathology

•BRS Physiology

•Rapid Review Pathology by Goljan

• Biochemistry by Lippincott

• Microbiology by Lippincott

[Dr.Divya Sai @DivyaSai17]

@OneLuckyGirl_28 Abundance in everything I desire

[Sandeep Mall @SandeepMall]

Five books and one podcast that has influenced my life and would strongly recommend everyone to read

[Dr. Apurv Khandelwal @Dr_ApurvK]

Juggling PG residency and a thesis is a nightmare. I was losing weeks on literature reviews and managing citations.

Then I found an AI research assistant that completely changed my workflow. It feels like having a superpower.

Here’s how it can save you 100+ hours:

#MedX

[The Wolf of College Street @aditya_gan3500]

20 years old lady presents with shaking of the hands for a few years.

She can't drink a cup of tea without spilling it, can't button her clothes properly and has writing difficulties.

Her father has the same problem.

She gets diagnosed as essential tremor by an outside neurologist.

Response to therapy is not that good and so she comes to us for a 2nd opinion.

Its not a tremor but a dystonia +/- dystonic tremor affecting her hands and some multifocal myoclonus.

No stigmata of Wilson disease.

Neuroimaging is clear.

We are suspecting SGCE associated myoclonus-dystonia because of the paternal inheritance (d/t maternal imprinting) --> genetic testing is awaited

My point is that apparently rare diagnoses may be rare because they are actually missed --> even by subspecialists

Rare diseases may not be truly rare --> just rarely diagnosed!

Keep an open mind at all times!

#MedTwitter
#NeuroTwitter
#MovementDisorders
#RareDisease

[Metabolic Mind @Metabolic_Mind]

Is high protein intake responsible for chronic kidney disease? Have you ever heard that ketogenic diets are harmful to your kidneys?

These are just a few of the common kidney health myths debunked in this interview with Dr. Thomas Weimbs, who says that traditional views on what causes chronic kidney disease are “definitely not founded in science.”

Dr. Thomas Weimbs (@weimbslab), professor and vice chair at UC Santa Barbara, has spent decades studying chronic kidney disease (CKD). His recent research explores the impact of ketogenic interventions on kidney function, and the findings may surprise you. Rather than harming the kidneys, Dr. Weimbs is finding that keto can actually improve kidney function in people living with CKD.

According to Dr. Weimbs, “Clearly, the number one cause of chronic kidney disease is not protein in excess—it’s, of course, carbohydrates in excess and type 2 diabetes. Insulin resistance is causing chronic kidney disease.”

In this episode, you’ll learn:

- Why longstanding myths about protein and kidney function need to be re-examined
- Why misconceptions around keto and kidney health exist
- How ketogenic diets are showing promise for chronic kidney disease (including PKD)
- About results from randomized controlled trials and the 2-year Virta Health study
- How ketones may directly benefit kidney health

Dr. Weimbs also shares insights from his lab’s ongoing research—findings that challenge conventional thinking and call for a re-examination of how we understand and treat chronic kidney disease.

Expert Featured:
Dr. Thomas Weimbs
@weimbslab
https://t.co/MA1fi5NOAt
https://t.co/nllUFQxAct

CMEs Mentioned:
Managing Major Mental Illness with Dietary Change: The New Science of Hope
https://t.co/Lu6vwHNOBy

Brain Energy: The Metabolic Theory of Mental Illness
https://t.co/C7e6w7Fh7x

Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.

Learn more about metabolic psychiatry and find helpful resources at https://t.co/o8ByM0LCAS

Timestamps:
0:07 - Introduction to Dr. Thomas Weimbs and his work in kidney disease.
3:03 - Why did Dr. Weimbs start studying ketogenic diets for kidney disease?
5:21 - Why do people think a ketogenic diet can be bad for kidneys?
10:19 - What evidence is there that ketogenic diets are good for kidney health?
16:57 - Why does a ketogenic diet improve kidney health and reverse kidney disease?
19:50 - Free CME lectures on metabolic psychiatry and metabolic health
20:19 - Pushback on if kidney disease can truly be put in remission.
22:42 - Are acidic diets like keto bad for kidneys?
27:13 - Are current kidney treatments all based on outdated biases?
29:00 - Where to hear more from Dr. Weimbs.

[Suraj Kumar Talreja @suritalreja]

Yesterday I was at the Passport Office for renewal of my passport, I am sharing some important things I noticed that can help others too:

1️⃣ If you are submitting your Aadhaar card as a document, make sure it is digitally signed, you’ll see a green tick if it’s valid. If it's not, re-download it from the UIDAI website. Otherwise, it may be rejected.

2️⃣ If you're adding or changing your spouse's name, carry:

Your marriage certificate

Your spouse's passport

Photocopies of both

In case you don't have a marriage certificate, be ready with Annexure J, a self-declaration form available here:
🔗 https://t.co/cax4KLISs8

3️⃣ When providing address proof (like Aadhaar), make sure at least one parent’s name is mentioned on it. It’s a minor detail but often checked during verification.

4️⃣ I made the mistake of not updating my marital status from "Single" to "Married" during the online form submission. At the passport office, I requested the officer taking my photo to update it. He asked me to write a short application on the spot, and then updated the records manually. So better to update it online before your appointment to avoid delays.

5️⃣ If you’re going for passport renewal, know that they will cancel your old passport. However, any valid visa on the old passport remains valid. You just need to carry both passports while traveling.

6️⃣ Lastly, once everything is done at the passport office, wait for an SMS confirmation saying “Your application with File No. XXXX has been granted…”. This means your file has been accepted and is moving forward.

Hope this helps someone preparing for their passport appointment!

Let me know if you have any questions. ✅

[Lorwen Harris Nagle, PhD @LORWEN108]

He won the 2002 Nobel Prize for documenting these "cognitive biases" that hijack your judgment every single day.

But here's what most miss:

[Dr Neha Chawla || FreeGym @thestrongdoc]

Got a sweet tooth?
But you also wanna stay lean and healthy?

Regular desserts are fine once in a while.
But if you crave more, try these high protein desserts.

Protein increases thermic effect by 20-30% vs carbs/fats.

5 banger desserts, 25-35g protein each🧵

[Abhi Rajput @Abhirajputfit]

Can I hit 100g protein without eggs or meat?

Every vegetarian asks this.

And the answer is:
Yes but only if you do it right.

Here’s a no-BS guide to get 100g protein without meat or eggs:

[Dr.Divya Sai @DivyaSai17]

@thestrongdoc Thank u mam

[Dr.Divya Sai @DivyaSai17]

@thestrongdoc Can we mix unflavored whey mam?

[FittrwithKJ | Kapil Jadhav @Fittrwithkj]

Some of the pricier purchases which have paid off way more than my expectations :

1. MacBook Pro 16-inch 2019 model: Works like it's new, even in 2025

2. Timemore Chestnut C2 coffee grinder: Manually grinding beans and brewing coffee offers an unmatched coffee experience every single day

3. Aeropress: I've personally found this the best manual coffee brewing method

4. Louis Vuitton Marco wallet: Lasted well even after 12 years of rough usage and it looks like it might go well for the next 10-12 years

5. Under Armour Project Rock shoes: 6 years, survived multiple hikes, runs & workout sessions. Truly versatile and tough shoes. It appears that they might last another 3-4 years

6. Nike gym shorts: I think this one wins. 14 years and they somehow look like they're new?!!!

In many cases, items are priced exorbitantly and don't provide much value

In a few cases, they provide value for decades, so spend wisely

[Dr.Divya Sai @DivyaSai17]

@askdheeraj @rkrish_ Aiims started MD Family medicine courses since jan 2024 sir in aiims jodhpur, from july 2024 many other aiims started separate MD family medicine.

[Aanchal @AanchalXIV]

If your goal is strength, muscle tone, better posture, or longevity, the typical bodybuilding split may not be your best friend.

Most women in commercial gyms or even online programs unknowingly follow training plans modeled after competitive male bodybuilders:
•Chest day
•Back day
•Arms day
•Glutes-only day
•Or sometimes: glutes + abs, and little else.

While these routines are popular, they are often ineffective, unsustainable, and misaligned with what most women actually want from training.

Let’s explore why, and what the science suggests instead.

[Dan Go @CoachDanGo]

- Sleep at 9pm
- Wake up at 5am
- Walk 2-3 miles a day
- Have final meal by 5pm
- Sit on a porch & do nothing for hours

Your grandparents had it right all along.

[यमराज @autopsy_surgeon]

What is wrong with India’s medical education system? How can someone do this?