Internal medicine

  Unmasking the Masquerader: A Clinician's Guide to Recognising and Working Up Autoinflammatory Syndromes Dr Neeraj Manikath , claude.ai Corresponding Author: Department of Internal Medicine | Postgraduate Medical Education Conflicts of interest: None declared | Funding: None Abstract Autoinflammatory syndromes (AIS) represent a rapidly evolving frontier in internal medicine — a group of disorders defined by dysregulated innate immunity, episodic or chronic systemic inflammation, and a diagnostic odyssey that can span years. Unlike autoimmune diseases driven by adaptive immunity and autoantibodies, AIS arise from intrinsic defects in inflammasome signalling, cytokine regulation, or pattern recognition pathways. Clinicians who do not think of AIS will not diagnose AIS — and their patients pay the price in organ damage, unnecessary immunosuppression, and diminished quality of life. This review equips the postgraduate trainee and practising consultant with a structured, bedside...

  The Sit-to-Stand Test in Pulmonology: Dr Neeraj Manikath , claude.ai   1. Clinical Introduction: A Walk You Didn't Have to Take A 64-year-old former teacher with COPD (GOLD Stage II) attends her quarterly outpatient review. Her spirometry is unchanged, her inhaler technique is exemplary, and her exacerbation diary is reassuringly blank. Yet she tells you quietly that she can no longer climb a flight of stairs without stopping. Her resting SpO₂ is 96%. You note the observation — and move on. Three months later, she is admitted in acute-on-chronic respiratory failure.   This scenario replays daily across respiratory clinics worldwide. Resting spirometry captures static lung mechanics — but it tells you almost nothing about how a patient's cardiorespiratory system behaves under physiological stress. The Sit-to-Stand Test (STS) fills exactly this gap: a deceptively simple, equipment-light exercise challenge that translates seconds of effort into clinic...

  Recurrent Thrombosis While on a NOAC: A Systematic Approach to Evaluation and Management Dr Neeraj Manikath , claude.ai Abstract Recurrent venous or arterial thromboembolism occurring in a patient already receiving a non-vitamin K oral anticoagulant (NOAC) represents one of the most clinically disquieting scenarios in internal medicine. While true NOAC failure is uncommon, the differential is broad — spanning non-adherence, under-dosing, pharmacokinetic interactions, and unmasked thrombophilia, to malignancy and catastrophic antiphospholipid syndrome. This review provides a structured, evidence-based framework for evaluating and managing recurrent thrombosis on NOACs, intended for postgraduate trainees and practicing consultants who encounter this scenario at the bedside. 1. The Clinical Hook: A Case That Should Haunt You A 54-year-old woman presents to the emergency department with acute right leg swelling. Six months earlier, she was diagnosed with an unprovoked proxim...