Mother Kevin Internal Medicine Insights

Twitter Page of the Mother Kevin Postgraduate Medical School (MKPGMS), St Francis Hospital Nsambya, the Medical Postgraduate School of Uganda Martyrs University

[Association of Physicians of Uganda @UgandaPhysician]

As we get ready for the conference, let’s introduce you to some of our executive members.

🅾️Meet the regional representative East ern Uganda Dr Asad Muyinda.

[Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) @rkalyes1]

Happy to chair the launch of the 4th generation calcium channel blocker Cilninipine(Cinod)
1. Less oedema
2.Less reflex tachycardia
3. Less proteinuria better renal protection.
4. Renal protection in DM
@Ug_kidneyf
@DrOribaDan
@JosephOgavu
@BatteAnthony
@PeaceBagasha

[Dr. Oriba Dan Langoya @DrOribaDan]

Dear participant,
The Ministry of Health in collaboration with Cambridge University Hospitals invites you for the next SCALE Critical Care Grand Round to share knowledge on management of Acute Kidney Injury & Critical Illness.
Link: https://t.co/DZ9VnVdBjx
#MedTwitter #MedEd

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

To wrap this up, patient had a pericardial effusion.

We attributed it to dialysis inadequacy (was doing one to two times a week)

Was not in tamponade. No pericardioscentesis done

He received daily HD with a measured reduction in the effusion volume on follow up.

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

Bedside Cardiac ECHO showed this

@JosephRuberwa
@dr_bongomin
@IAmTheOlum
@HilderKoriang
@RoseMuhindo1
@drkeithsiau
@emmyrov
@HeartUganda
@Ug_kidneyf

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

45/M.

T1DM, HTN, ESRD.

Irregular on HD.

C/O Breathlessness.

130/65 mmHg

Desaturating on RA.

Description?

DDx?

Initial workup?

@JosephOgavu
@rkalyes1
@DrOribaDan
@dr_evenakato
@graekan
@DrOtileUg
@atuhairwe_irene
@NiravValand30
@RoseMuhindo1
@PeaceBagasha

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

45/M.

T1DM, HTN, ESRD.

Irregular on HD.

C/O Breathlessness.

130/65 mmHg

Desaturating on RA.

Description?

DDx?

Initial workup?

@JosephOgavu
@rkalyes1
@DrOribaDan
@dr_evenakato
@graekan
@DrOtileUg
@atuhairwe_irene
@NiravValand30
@RoseMuhindo1
@PeaceBagasha

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@NiravValand30 Two top differentials.

1. Pericardial Effusion

2. Dilated Cardiomyopathy.

The oligemic lung fields went against number 2

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

45/M.

T1DM, HTN, ESRD.

Irregular on HD.

C/O Breathlessness.

130/65 mmHg

Desaturating on RA.

Description?

DDx?

Initial workup?

@JosephOgavu
@rkalyes1
@DrOribaDan
@dr_evenakato
@graekan
@DrOtileUg
@atuhairwe_irene
@NiravValand30
@RoseMuhindo1
@PeaceBagasha

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@NiravValand30 It was actually that straight forward

[Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) @rkalyes1]

Join me to congratulate Dr Joseph Ruberwa who has finished his nephrology fellowship at UNC, USA.
@JosephRuberwa
@UNCMedCenter
He has always been very supportive of the work we do here in Uganda
@ISNkidneycare
@AfricanAFRAN
@MulagoReferral
@MinofHealthUG
#StopNCDs

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@JosephOgavu @DanSsekirembeka @rkalyes1 @DrOribaDan @dr_evenakato @graekan @DrOtileUg @atuhairwe_irene @NiravValand30 @RoseMuhindo1 @PeaceBagasha @KennedyNamara @27Jipman @Ug_kidneyf @damshae87 @NsambyaHospital @DrNdibarema @VKomuntale Good progress

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@DanSsekirembeka @JosephOgavu @rkalyes1 @DrOribaDan @dr_evenakato @graekan @DrOtileUg @atuhairwe_irene @NiravValand30 @RoseMuhindo1 @PeaceBagasha @KennedyNamara @27Jipman @Ug_kidneyf @damshae87 @NsambyaHospital @DrNdibarema @VKomuntale With what expectation in mind!

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

In our setting, we must optimize resources.

With the above history and imaging, what DDx are most relevant!

A big clue lies in revision of CXR interpretation.

👆🏿The above questions give a good guidance

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

What is the shape of the heart!

What is the CTR!

How are the lung fields!

How are the costophrenic angles!

Is there any device!

[Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) @rkalyes1]

Please be aware 😒! Covid-19 is back! It is an ID (Infectious disease) that devastates patients with NCDs (such as hypertension, kidney disease, diabetes and chronic lung diseases).

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@DrNdibarema @JosephOgavu @rkalyes1 @DrOribaDan @DrOtileUg @VKomuntale Case definition of UTI vs Pyuria vs Asymptomatic Bacteriuria?

Validity of HbA1c as a sugar-monitoring tool in stage 3b vs 4 CKD?

No related symptoms.

Patient being reviewed at a quarterly visit.

Stable for 4 years under care.

Baseline eGFR ~13 ml/min

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

70/F, 4 years in Nephro Care. DM/HTN, CKD4A2.

Taken off Soluble Insulin 3 months ago (desired reduction of 💉s). eGFR was 25
Switched to Dapagliflozin
R/V 3/12 later, eGFR 30

Comment on labs!
Next step?
@JosephOgavu
@rkalyes1
@DrOribaDan
@DrOtileUg
@VKomuntale
@DrNdibarema

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@rkalyes1 @DrOribaDan @DrOtileUg @graekan @27Jipman @NiravValand30 @damshae87 @conradlubwama @dr_evenakato @HilderKoriang @DrVeniceOmona In fact, practitioners should desist from the diagnosis of ulcers (alusa).

Be quick to look there.

Medicine of guesswork is out of vogue

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@Esmemaitea How was the respiration Prof!

Rate, rhythm...

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

@rkalyes1 @DrOribaDan @DrOtileUg @HilderKoriang @JosephOgavu @NiravValand30 @damshae87 @27Jipman @conradlubwama @DanielOlinga3 @DrSerunjogiEmma So, the bleed in this case is primarily due the Aneurysm.

The BP is more of a precipitator.

And the high BPs in this period may as well be autoregulatory

[Mother Kevin Internal Medicine Insights @IMInsightsMK]

Autosomal Dominant Polycystic Kidney Disease

[Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) @rkalyes1]

🏥 37 yrs previously healthy business man presents with thunder-clap head ache and failure to talk.
Can you link the scans?
What is your diagnosis?
What next?
#StopNCDs like hypertension, diabetes, chronic kidney disease, Chronic lung diseases, mental health, cancer & injuries