DrSalunkhe Shivaji Profile picture
Aug 29, 2020 26 tweets 10 min read Read on X
W Maharashtra
#covid19 has reached hinterland in tier 2 /3 cities & beyond becoming uncontrollable as all beds in different designated centers are occupied full with covid19 person
Admitted either due to breathlessness requiring oxygen or comorbidities abound requiring vigilance
Pandemic Decipher
1/25
covid19 is an attack on our distorted might In our #Variedresponse most will overcome, some would suffer protracted misery & sadly unlucky few, FEW won't survive

We must empathize, urgently mitigate & strive best to protect humanity as we face this menace
2
Pertinently this virus is a #Stresstest to physiological, psychological & immunological competency, challenging each individual until present time
Testing our multisystemic resilience, developmental journey, comorbidities, immune memory & subjecting us to scrutiny of viability
3
#Comorbidities are myriad inflictions that one carries or develops & affects ones competency to any insult outside our comfort zone, those inflictons burden our survival mechanisms as we fight to withstand, endure & cope while facing impending threat challenging life to hilt
4
Evolutionary Renin Angiotensin Aldosterone System is the prime component to HPA axis handles #Stressresponse RAAS sustains our agility to survive, regulates normal vessel tone HTN reflects chronic derangement, puzzle to peripheral vascular resistance inflicting end organ damage
5
#Paradigmshift
There's obvious indifference, massive social derangement, to any discerned mind How eager, prepared we are & intend to act counts

Skepticism derails scientific wisdom vital to potential sway each wield & collectively we must usher prevention control to survive
6
This pandemic attacks vulnerable Reality haunts to once Ambitious, Elite, Type A High Achiever but now consumed #domiciled to multiple comorbidities being burdened jeopardizing own physiology, yearning relief & now plans to amend health as clock is ticking away
7
Food abundance is an evolutionary journey from hunter gatherers until our #Spoiltchoices patronize processed food
We delegate physical tasks to prefer sedentary life comforts Our food habit patterns & vices initiate pathological derangement & cause moribund systemic changes
8
Virus binds ACE2 Receptor & cofactors @ progenitor cells Clara-club, Pneumoctye2 & endothelial cell at lungs, myriad vessels to initiate inflammatory response, hijack #RAASSCoV2Axis system on cells, down regulate on purpose to replicate & spread by droplet from one host to next
9
Evolutionary drive to succeed engenders purpose to strive more Our ambition perpetuates #Stress as we get consumed inflicting collateral damage while achieving fleeting success Our relevance is linked to eminent status, enduring goals to achieve hierarchy in race against time
10
Choices cities offer attract all, spares none, to sustainence first, burdens many with preclinical health implications & comorbidities segregates vulnerable from resilient Thriving cities are epicenter to globalization some among the presymptomatic cases become #superspreaders
11
#Reiterate
Simple task to #Containment is challenged due to conditioning, dereliction of duty, trust deficit by overconfident, rebellious, wilfully ignorant & polarized as they avoid wearing a mask, hand washing or follow social distancing thus viral contagion causing mayhem
12
Many nation states are unprepared unable to comprehend the consequences as we move along new learning curve facing overwhelmed medical systems with glaring inadequacies while chaos derails efforts As new information collates to existing guidelines causing #Confusion to masses
13
Nation states vigilant with cohesive, cooperative population, proactive approach & prudent economic sense will prevail in #Crisis
While ones with unfair economic burden, social divide, vulnerable system, huge underprivileged & dependent VICTIM population might face long wrath
14
Virus spares none from childhood to infirm attacks #faultlines VICTIMS of circumstances affecting individual, family & economy Society's VICTIMS of unfairness suffer the most
Virus finds even match in resilient subject those having reserves to overcome crisis without turmoil
15
Fast pace indulgence erodes functional might to organ systems with added #liabilities as lifestyle stress, chronic oxidative damage, proinflammatory states, ⬇️lung Compliance, COPD, CKD, CAD, CVD, metabolic endocrine syndromes accelerates aging Obesity HTN DM are most targeted
16
covid19 patient faces #ostracisation
irrespective of status, risk suffering emotional neglect, isolation & oblivion Barrier disease creates can shatter personal moral Avoidance & shunning is a sad reality to patient care reflecting infectivity & prevailing fear to the disease
17
Viral pathophysiology in lungs is a spectrum➡️ alveolo-capillary membrane targeted, alveolar damage, surfactant loss, capillary stasis precipitating thrombosis
Varied lung dysfunction decompensatation progresses to system dysfunction, systemic shock #MODS thus risk to life
18
#Supportivetreatment is mainstay assisting & fine tuning respiratory efficiency with NFO2 & steroids Not a single drug really has passed double blind #RCT against covid & approved Comorbidity & system reserves of individual person ultimately decide disease course & prognosis
19
Hope our effort works with #vaccination same as those who recovered from natural infection Post vaccination ones exposed to virus might respond as per innate & acquired immune memory Very fact those prone with disregulated immune might & sensitized system will remain at risk
20
covid19 is a puzzle yet to decipher, medical scientists are focusing on #Missinglinks trying their best with objective findings as a team work to defend vulnerable & fight covid head on as moral duty beyond responsibility by offering most relevant care to the present context
21
Health fraternity is overwhelmed with burnout trying best to save lives, virus attacks healthcare staff, doctors & enforcers #Highriskproviders loose life in the line of duty, despite this frontline workers put collaborative effort to manage patients with evolving consensus
22
#Leaders are expected to focus, empower & act in this carnage with earnest priority to save lives over economy A TASK to unprepared system as social divide, moral decline & trust deficit foster anarchy which ails society, brunt is being faced by commoner VICTIMS of situation
23
Contextually there are too many social variables introcept, amend mistakes, prioritize family, contribute as citizen, restrict casual movement, control lifestyle needs, shun desires inciting stress #Moralobligation to citizens is to be vigilant & protect SELF first
24
Viral inflicton is beyond social construct, overcome ignorance, have gratitude to where we are, prioritize life pursuits #Responsibility is to respect health Contentment is to recognize freedom #Focus on compassionate relationship, emulate moral values to instill upbringing
25
As citizen now is time to rise, forget differences, work unitedly in the hour of crisis to protect vulnerable, alleviate their suffering, be supportive & SEEK EARLY HELP This challenge expects us to amicably mould & entrust faith on able #MEDICALLEADERS to control pandemic

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More from @YDrshivaji

Oct 2, 2020
#Cliniciansdilemma
When doctor faces trust deficit, a part of clinician within each doctor is undermined at times resulting in unnecessary & insane tests usually at the behest of patient who's anxious to rule out Diagnostic delusion
Clinical Dx is a challenge to any doctor
Inspite of informing to patient gravity of situation we risk everything esp when unexpected inevitable occurs
When we're prudent to patients impending situation at times patient disappears as they perceive exploitation/undue fear mongering
Patient expectations counseling dilemma for essential but costly test, prescribing specific drug but informing inbuilt risk, procedure advice and risk of comorbidities & anesthesia related complications, advising various Rx modalities admissions need & their cost implications
Read 10 tweets
Jul 30, 2020
Attack on doctor
Patients psyche ingrained by doctors
Favourable outcomes are easily attributable to care doctor provide some pride (variables forgotten) also sole reason why patient pay for results w'out realising input cost, efforts also expect compassion,kindness from doctor
Lead from front Asses setup capabilities, most important don't be adventurous have policy decision & stick to it
Evaluate patient, relatives & their depth of social delinquency use social worker
After clinical assessment weigh in their expectations & outcome failure & then decide
Unfavourable/grave outcome when occur, some relatives assume to believe it could have been averted with another or better care, here counselling failure is usually primary reason as an astute clinician empathise of doing our best keep them in loop don't predict outcome else refer
Read 4 tweets
Apr 2, 2020
Lets respect #COVIDー19 waging lone battle for own survival,while most of us are alive & contained in our secure abode to flatten the curve but in denial about action to other species pushing into oblivion~extinction exceptional species will rebel to thrive in survival battle1
viral phobia,madness leading to social & physical distancing is yet to set in, once this happens the actual & avoidance response will transform resulting in real impact that will be realised with lag effect, hygiene consciousness will set in as top priority2 #CORONADISTANCING
collectively we need to establish remedy to minimise human casualties putting aside our differences by pro nature policies, although authorities eager to unleash grandeur ambitions w'out any urgent & long-term precautions would be risking vulnerable as bait to this lethal virus3
Read 7 tweets
Mar 24, 2020
#lockdown
This pandemic is given us opportunity to care & tend to the aged in our homes
Start at home looking after the vulnerable especially those with whom we have lost touch, reconnect with them
This isn't time to dwell but protect & amend help the needy to keep them well
#keepelderlysafe Be watchful focus within family for any chronic ailments in geriatric populn with HTN, DM, CKD, tumour remission
Hx past operation, focus on dementia, mental health, single, bed ridden & neurovascular conditions,
chr respiratory ailments do medication top up
Consult your doctor for any doubts don't feel helpless spend quality time with them, once taken care look at your nearest neighbours needing help, form cohesive team especially during clampdown be vigilant & monitor new case addition important follow rule of law & @MoHFW_INDIA
Read 4 tweets
Mar 23, 2020
#motherhood is cradle to ontogeny,enduring nature's ingenuity to propagate evolving distinctive life form with universal precision to genetic hierarchical dominance
Her subtlety to creation,resilience,tenacity & evolution no modern innovation can match efficiently & benevolently
prior to embark'g on sacrosanct lifelong parenthood both must accept basic premise to embracing vow to respect, share-care & survive mutual harmony & hardships
Reciprocate with emotional maturity & integrity to family, making life pursuit meaningful & respect gender equality1/24
initiation is a surprising uncertainty to physical & psychological transform'n for the greater good,expecting to get over unscathed through whole process ASAP
Concerned partner need to support & empathise with her to endure & empower her during tiredness & morning sickness 2.
Read 25 tweets
Mar 23, 2020
#COVIDー19 is dominating everything today for obvious reasons we have to be responsible & will be subjected to
Flight and fight response
Remember first priority is to survive this crisis
Social construct like economy, enjoyment ..will be taken care of when we're out of wood
Be Responsible by
self control & be minimalist practice general activity inertia to reduce spread by hand washing when touch to every fomite & public surface No,no to spitting, cough with precautions, self segregate when ill & consult,self immobilise follow minimum touch policy
Survive infodemics and pandemic
Practice physical distancing try reducing your BMR, self restrict oneself to writing, reading books, gardening reduce clutter, meditate, hobbies
Pandemic survival; matter of luck is very important your immune response competency will be tested
Read 7 tweets

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