A young patient with a relapsed, refractory haematological malignancy was advised review with palliative care. He was having severe pain and weakness in both the legs, which had been attributed to disease progression. He was subsequently started on symptom directed treatment. While his pain improved, his disease seemed to have worsened and it was time… — read more

“Did we require a more contemporary approach towards training that took on board the importance of self-critique and reflection?” I got to know that my musings will be published on a blog, just after I joined my current position. However, there was also the question of the excruciating wait time, which was spent understanding this… — read more

The BREEZE 2 trial is a multi-centre, waitlist randomised controlled trial evaluating a non-pharmacological breathlessness management complex intervention for patients with pulmonary fibrosis and other fibrotic Interstitial Lung Diseases and chronic breathlessness. The BREEZE 2 trial follows the feasibility trial labelled BREEZE-IPF, which was found to improve outcomes across a range of indicators of the… — read more

Review was sought in the Intensive Care Unit for an 87-year-old female with a history of aplastic anaemia, a recent diagnosis of acute leukaemia, pneumonia and desaturation, who had been started on non- invasive ventilation with Fi02 of 0.5 and PEEP of 5. Investigations were suggestive of pancytopenia, though parameters of renal function appeared to… — read more

An elderly obese female patient with advanced cancer was admitted with altered sensorium and fever. Lab reports were suggestive of an elevated serum creatinine. Empirical antibiotics were uptitrated and dose modified as per creatinine clearance.Adequate duration of antibiotics was completed with no appreciable response in the patient’s condition.The family also noticed the absence of appreciable… — read more

A middle aged male with a diagnosis of advanced adenocarcinoma of the pancreaticobiliary tree with malignancy related high SAAG ascites who had undergone therapautic paracentesis five days ago presented with complaints of abdominal distension and functional deterioration. He was a known case of Diabetes mellitus (previously on corrective doses of insulin discontinued due to advanced… — read more

This post re-evaluates the positioning of High Flow Nasal Oxygen as a comfort-care measure in the background of gross, unaddressed and festering systemic deficits in recruitment related policies. It also asks whether we are we in imminent danger of perpetuating a system that supports unquestioned transmission and risks certifying it as expertise. Only a minority… — read more

A cursory reading of my motivations to write this blog, which may be found hidden across numerous blog posts and most prominently in the About the Author section, will provide some perfunctory evidence for an ideology that advocates for responsible prescribing and warns against oversimplification of an ideology. In my experience, it is seldom that… — read more

A middle-aged patient with metastatic pancreaticobiliary primary with liver involvement and Chronic Hepatitis B with malignancy-related ascites with high SAAG (portal hypertension dependent) was started on diuretics (Spironolactone 100 mg once daily and Furosemide 40 mg once daily). A trend towards hypokalemia was noted, following which he was advised dose reduction in Furosemide to 20… — read more

A review was obtained for an elderly female with metastatic cervical cancer who had not been on any anticancer treatment and was admitted with dry gangrene, for which regular dressing was being performed. She was on regular antibiotics, despite which she had developed hypoactive delirium. No other underlying reversible causes of deterioration were identified. A… — read more