He is just 48 years of age; father of two boys aged 12 and 16 respectively ; the only breadwinner of the middle class family. His entire family of four tested positive around 10 days ago.
He and his wife had to get admitted as their spo2 dropped to 90 suddenly on day 3. 1/n
The hospital stay was uneventful for him except that he got to know he was suffering from an undiagnosed Diabetes. They received the necessary doses of steroids and Remdesivir which definitely saved their life.
2/n
Gradually he got better and was discharged after 5 days. His wife though experienced severe weakness and couldn't get up from the bed. Her spo2 remained around 92 at best. She is still in the hospital.
3/n
He returned home 2 days ago. Hoping everything would be fine with his wife too and she too would be home soon. Suddenly on that night he started having difficulty in vision in his left eye. He thought it would be due to fatigue and just slept off. 4/n
The panic set in next morning when he just couldn't see anything through his left eye. He called up his physician who asked him to immediately see him. He got MRI done and these were the findings.
5/n
His is not a one off story. While we are all talking about COVID19 pandemic there is something else unfolding which is even more dangerous- Mucormycosis.
6/n
As the writers of this article write in the title, this is indeed like limping from frying pan(COVID19) into the fire (mucormycosis) 7/n
japi.org/x27464c4/post-…
What is mucormycosis?
It is a serious but rare fungal infection caused by group of molds called mucormycetes which live throughout the environment and mainly affects people who have health problems or take medicines that lower the body's ability to fight germs and sickness. 8/n
The hallmark is tissue necrosis manifested as eschar or black discharge in the nasal or oral cavity. Orbital, ocular and cranial nerve involvement are ominous signs that must be taken seriously. If not removed at the earliest, it quickly spreads to brain and can be fatal. 9/n
The landmark RECOVERY trial published in June 2020 has served as a ‘license’ to use steroids in patients with COVID-19 and there has been no bigger life saving drug apart from steroids. Sorry, Remdesivir and Tocilizumab! 10/n
Here's the link to the RECOVERY trial. 11/n
nejm.org/doi/full/10.10…
But the downside of steroids is that coupled with newly diagnosed Diabetes and COVID19 here it led to proliferation of mucormycosis. He was operated yesterday and lost his left eye. The surgeons had no other option but debride all the necrotic area it spread to brain. 12/n
“It’s raining mucor. It’s really painful to see young and elderly suffering. People are losing their battle to mucor post Covid,” Dr. Ashwini Tayade writes here. 13/n m.timesofindia.com/city/nagpur/8-…
The even more unfortunate part is that there are very few signs and symptoms by which you can diagnose mucormycosis and the infection spreads like a wildfire. Even sadder is the fact that it has higher mortality rate than the COVID19 itself. 14/n m-timesofindia-com.cdn.ampproject.org/v/s/m.timesofi…
So how can we minimize the risk of mucormycosis?
1. Don't get infected by COVID19.
For that - Wear masks, practice social distancing and take vaccines whenever available.

2. If you are above 40 and have never got your routine blood investigations done because.. 15/n
.."Apun to ekdum fit hai" then sorry but you are living in denial. Get your blood sugar and lipid profile tested. India is the diabetes capital of the world. The good thing about Diabetes is that it can be managed. But the later you diagnose it, the worse are the outcomes. 16/n
3. Doctors should exercise caution while writing prescription for steroids after weighing the risk:benefit ratio adequately. I'm sorry to say this but I have seen doctors precribing steroids to even people isolating at home with spo2 levels above 97 and no other symptoms. 17/n
The fine print of the RECOVERY trial clearly revealed some important messages that we seem to have overlooked. Benefit was specifically shown with low dose, short duration dexamethasone in moderate to severe illness. Doctors need to know when not to precribe steroids. 18/18
Patients discharged after COVID-19 should be taught to seek immediate medical attention, should they notice any symptoms such as: facial swelling, pain, numbness, eye swelling, bloody or black- brown discharge from the nose. Though sometimes the symptoms can be silent.
Just to mention the most important point of the thread -
STEROIDS AND ANTICOAGULANTS ARE THE MOST LIFE SAVING DRUGS IN COVID19.
We need to have ways to quickly identify and treat Mucormycosis, manage blood sugar levels and do not take steroids without consulting physician!
As more and more people suffer and recover from COVID19, let's not forget another important disease that can be equally dangerous - Mucormycosis.
Read this story to find out more and please share it amongst the medical fraternity.
psychidiaries.wordpress.com/2021/05/02/let…

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More from @DevPalkar

29 Apr
Long thread alert.
When it comes to Modi ji, because of his strong narcissism, he tries to steal credit for things which are not his creation.
For eg, initial part of vaccine hesitancy was because BJP tried to portray COVAXIN and COVISHIELD as if they were its own creation 1/n
It should have brought the scientists more to the limelight instead of posting photos of Modi over anything related to vaccines.
Many people who don't like him were obviously going to refuse the "vaccines made by BJP".
2/n
Our health minister kept promoting Baba Ramdev's jadibutti and keeps neglecting plight of resident doctors and doesn't take any strict action against people who inflict violence on doctors.
3/n
Read 15 tweets
28 Apr
Was in the middle of a webinar with @ProfSomashekhar @HaryaxPathak @AlishaAkhani @pankti4299 @iamcrazybunny when I had to urgently go and attend a psychiatry reference in emergency. 1/n
A young female in her 30s had ingested mosquito kill poison and was rushed to emergency. She was not feeling well since last 3 weeks with complaints of crying spells, sleep disturbance and sadness of mood. This was also corroborated by the husband. 2/n
Upon taking the history I found the major stressor to be the fact that the couple were not able to repay Rs 30,000 they had taken on loan from Mr X. Now this Mr X was regularly harassing them over phone and demanding his money. 3/n
Read 6 tweets
25 Apr
My 3rd night duty of the week and my 7th after the start of 2nd wave. On night duties I double up as doctor and a watchman constantly keeping an eye on the patients who negligently remove their NRBM masks. 1/n
Sometimes I can imagine how Yamraj must be taking a walk around the hospital too at night finding his next prey. I try to be as vigilant as possible, trying desperately hard to let him go empty at least from my ward. 2/n
But despite trying my best there will be one or two who will remove their masks and deteriorate and Yamraj will have the last laugh. These kind of deaths are the ones most difficult to accept. 3/n
Read 11 tweets
24 Apr
*NOT A COVID RELATED THREAD*
It's the birthday of the best batsman ever @sachin.
I don't know how dull my life would be without sports. @bhogleharsha had once said sports is different from other forms of entertainment because it's not an escape from reality but into reality. 1/n
Many people are questioning about the luxury filled, bubbled up lives of cricketers playing IPL at a time when India is going through the most terrible crisis. It does feel IPL today is cut off from the reality around us. 2/n
But I firmly believe we need the IPL. It provides livelihood to many many people right from groundsmen to advertising guys to physios to sports writers, etc. It's one of India's biggest original brand and we should be proud of it. 3/n
Read 10 tweets
23 Apr
The enthusiasm of Dr. Maitry Talavia (intern, of the left in the pic) and Jay Rana(final year MBBS student, on the right) who were posted with me in one of the COVID wards today deserves a thread. 1/n
At a time when the healthcare system is facing a severe shortage of staff, interns and even final year MBBS students are being pushed into battlefield and rather than being afraid of the task they are excited. 2/n
Their levels of empathy, curiosity and compassion made me recall my days as a medical undergraduate student. Today, while I was managing the more serious patients, these two wonderful people ensured that none of the patients were left hungry. 3/n
Read 11 tweets
20 Apr
He was maintaining spo2 of 95 percent on 12 litre NRBM so I was quite shocked when sister suddenly came running to inform me that the patient is having severe coughing. I was on the other side of the ward trying to explain another old man to wear his O2 masks snugly 1/n
I immediately rushed to the scene and checked his spo2. It was 65 percent. He had removed his mask and was snorting on some pudiyas which strongly smelt of camphor and cinnamon. They were sent to him by his family in the Tiffin box. 2/n
And our hero was snorting these pudiyas with much glee, keeping his NRBM mask comfortably on the bed till he started to cough loudly and helplessly. After 15 minutes, helped settle the patient in prone position and now on 15 liters NRBM he is maintaining 85-86 per cent spo2. 3/n
Read 6 tweets

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