Anirban Bhattacharjee MBBS MD DM IDCCM EDIC

Intensivist. A learner. #AIIMSonian.

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

@praffulgarg97 @DrDhruvchauhan @gupta_rekha Only the civilised will understand that this is not the way a head of the state should behave. Even if there has been an interruption, there is a civilised manner in which he could have been asked to not interfere. But madam needed to show her arrogance for popularity..

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

@sumit_DL @DrDhruvchauhan @gupta_rekha There is a basic professional courtesy. She is talking to a senior doctor, not a college student. But understanding this requires education and intelligence that not every one has.

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

@NewIndianXpress When a clown becomes a ruler, the court becomes a circus! #rekhagupta

[Anish Gawande @anishgawande]

As expected, a case has been filed against the brave woman who stood up to the BJP in Mumbai by Zen Sadavarte, the daughter of Gunaratna Sadavarte - a BJP-affiliated lawyer who is the poster child for “fake citizen concerns.”

The sheer arrogance and entitlement of the party in power should disgust you and me. “Disrespect” to a minister warrants an FIR, disrespect to the people of Mumbai is totally acceptable 🤡

[Suraj G Naik @yoursurajnaik]

This was totally expected. Shame on BJP and those who are supporting BJP for this incident.

A complaint has been filed against the woman who stood up against the BJP's morcha that blocked the roads in Worli.

It's not just her voice it's the voice of millions who suffer from authority and I Stand with that Woman who stood up against BJP's Morcha

#MIvsCSK

[AIIMS Guwahati @AIIMS_Guwahati]

The Department of Anaesthesiology, Critical Care & Pain Medicine, AIIMS Guwahati, under TRACE-ICU, conducted a 2-day mechanical ventilation workshop featuring hands-on training in AI-based ventilation, NAVA, and esophageal pressure monitoring. The event was inaugurated by Col. Prof. (Dr) Ashok Puranik, who emphasized the importance of such initiatives in advancing ICU care. A total of 22 national and 1 international faculty delivered the sessions.

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

Becoming anti-fragile

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

By all means, follow Iran-US-Israel war. But do not forget Epstein files. Do not let the war take your attention away from Epstein files. #Epstein_file #epsteinfiles #Epstein

[Dr. Med @DrNikhilMD]

HYDROXYCHLOROQUINE

Hydroxychloroquine is one of the most important long-term drugs in autoimmune medicine. Originally developed as an anti-malarial, it is now a cornerstone DMARD, especially in lupus. It is preferred over chloroquine because of a better safety profile. It is not a strong immunosuppressant. It is an immunomodulator that works gradually but significantly alters long-term disease outcomes.

Mechanism of Action

Hydroxychloroquine is a weak base that accumulates inside lysosomes and increases their pH. This interferes with antigen processing and MHC class II presentation, leading to reduced T-cell activation. It decreases pro-inflammatory cytokines such as IL-1, IL-6 and IFN-γ. Most importantly in lupus, it blocks endosomal Toll-like receptors that sense nucleic acids, thereby reducing type 1 interferon signaling. This targeted dampening of immune activation explains its central role in SLE.

Clinical Uses

In systemic lupus erythematosus, hydroxychloroquine reduces disease flares, improves rash, arthritis and fatigue, and improves long-term outcomes. Stopping the drug increases flare risk. It is also photoprotective and highly effective in discoid lupus.

In rheumatoid arthritis, it is useful in mild early disease and as part of combination therapy, although it does not strongly prevent erosions.

It also has benefit in antiphospholipid antibody syndrome due to anti-thrombotic effects and improves symptoms in Sjögren syndrome.

Metabolic and Vascular Benefits

Hydroxychloroquine has important additional advantages. It improves lipid profile by lowering LDL and triglycerides. It reduces plasma glucose by decreasing insulin degradation. It also has anti-thrombotic properties. In lupus patients, this translates into reduced inflammation along with potential reduction in cardiovascular risk.

Pharmacokinetics

It is well absorbed orally and reaches peak levels within hours. It accumulates in melanin-containing tissues such as the retina and skin. The half-life is long, around 40 to 50 days, and steady state takes several months to achieve. This explains its slow onset of action and why toxicity can persist even after stopping the drug.

Dosing

Current recommendations advise not exceeding 5 mg/kg of actual body weight per day. Most patients are maintained on 200 to 400 mg daily. Dose reduction is necessary in chronic kidney disease, particularly when GFR falls below 60 mL/min. Correct weight-based dosing significantly reduces the risk of retinal toxicity.

Adverse Effects

The most important adverse effect is retinal toxicity. Risk increases with higher daily doses, long duration of therapy, kidney disease and concomitant tamoxifen use. The classic presentation is bilateral bull’s-eye maculopathy, and damage may be irreversible.

Other adverse effects include mild gastrointestinal symptoms, proximal myopathy with normal CPK, rare cardiomyopathy and conduction disturbances, and hypoglycemia in diabetic patients. It can increase digoxin levels and requires caution when used with hypoglycemic agents.

Monitoring

Baseline evaluation should include CBC, liver transaminases and creatinine. Routine laboratory monitoring is not required after baseline in stable patients. Ophthalmologic screening with a baseline retinal examination and periodic follow-up is essential for early detection of toxicity.

Pregnancy and Lactation

Hydroxychloroquine crosses the placenta but has not shown teratogenic effects and is recommended to continue in lupus pregnancies because disease flare poses greater risk than drug exposure. It is considered compatible with breastfeeding.

Clinical Takeaway

Hydroxychloroquine is a long-acting immunomodulator that stabilizes autoimmune activity, reduces lupus flares, improves metabolic and thrombotic risk, and requires careful weight-based dosing and regular retinal screening for safe long-term use.

[The Bottom Line @WICSBottomLine]

#TBL 490: VENT-AVOID - Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During COPD Exacerbations https://t.co/u1XvTRfyME

Article by @AbhiDuggalMD
Review by Chung
#FOAMed

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

@IRCTCofficial I have received no reply to my emails yet. It has been 4 days since I raised the cancellation request..

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

UPDATE: Finally reached through to the helpline. They said to cancel with the airlines (that I already did) and contact IRCTC via mail (done that too already). Kindly process refund. @IRCTCofficial

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

💡 Clinical takeaway: Early addition of vasopressin to norepinephrine may improve outcomes in septic shock—but larger, well-designed trials are needed to confirm these findings.

📖 Read the full article: https://t.co/HaFL9V5Krh

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

Our latest study, published in IJCCM (Oct 2025) explores how the timing of vasopressin initiation impacts outcomes in septic shock.

🧠 Key Findings:

Early AVP initiation (within 6 h of shock onset) was linked to a 16% RRR in short-term mortality compared to delayed use.

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

Early use also reduced hospital and ICU mortality, shortened hospital stay by nearly 2 days, and decreased the need for renal replacement therapy.

The analysis included 7 studies with nearly 4,000 patients and employed trial sequential analysis for stronger evidence appraisal.

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

@canva Get well soon..

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

@DrAnkurKhandel1 Himalaya kab jaa rahe hai?

[Dr. AK 🇮🇳 @docakx]

🌟 IRON DEFICIENCY - Evaluation and treatment

Iron Deficiency in Adults - A Review, JAMA March 2025

[Aravind Palraj @Rheumat_Aravind]

🧵 Urea vs Creatinine in Rheumatology – Read Between the Lines

In lupus, vasculitis, RA—we check kidney function daily.
But urea and creatinine don’t always rise together.
Let’s decode what they mean—and when they mislead—in rheumatology. 👇
@IhabFathiSulima @CelestinoGutirr @ASNKidney @arvindcanchi @JasmineNephro #MedTwitter

[Anirban Bhattacharjee MBBS MD DM IDCCM EDIC @icu_bug]

@drkeithsiau Pseudomembranous colitis due to C. difficile.