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Vincent Rajkumar Profile picture
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24 May, 5 tweets, 2 min read
Worth remembering that people who have raised alarm and advocated caution have been more right on COVID.
It has been a hard year trying to project appropriate level of caution and worry, when faced with some who didn't like masks, some who felt it's just the flu, and some who felt we can just let people get herd immunity by natural infection. @dwallacewells nymag.com/intelligencer/…
I keep thinking of the times I have been wrong. Where I tried to project optimism: cross reactive immunity protecting India, variants unlikely to be more transmissible & lethal, dismissal of importance of neutralizing antibody levels, potential severity of reinfections.
The times I have been right are far more when I advocated caution and sounded warnings.
Eric was among the first to sound the alarm last year. And again this year with the variants. He guessed how serious they can be much better than me. I wish I had seen the crisis in India coming. @DrEricDing

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Vincent Rajkumar Profile picture
23 May
Mucormycosis with COVID in India:
#BlackFungus

Many theories on why incidence is high.

Fix what's in your control:
1) Avoid steroids unless there is hypoxia
2) When indicated, use steroids at right dose and right duration.
3) Check & control blood sugars
4) Avoid antibiotics
There will be hardly anyone who gets mucor without at least one of these 4 factors.

Sure there may be something else going on in addition because we do have a lot people taking steroids and antibiotics for other reasons, and people who have diabetes who hardly ever get mucor.
But it will take time to investigate these additional factors and see if they can be fixed.

If someone is urgently in need of oxygen now, you have to give whatever oxygen is available. No choice. But you could control sugars, and use steroids at right dose for right duration.
Read 4 tweets
Vincent Rajkumar Profile picture
23 May
Just heard from @spkalantri that fully vaccinated healthcare workers are getting COVID in their institution @_mgims in India, but cases have all been mild. #VaccinesWork @paimadhu @soutikBBC

India needs a lot of help with vaccines to get over this crisis.
I am aware of anecdotes of fully vaccinated people get seriously ill and even die in India. But these are exceptions. Anecdotes don't give you a sense of the denominator. Exceptions will occur based on level of neutralizing antibody response & the vaccine used. See thread.
There is more on the protective effect of full vaccination against even the B1.617.2 variant in this thread by @jburnmurdoch
Read 4 tweets
Vincent Rajkumar Profile picture
22 May
I am attending the Kyle Symposium on Myeloma & Plasma Cell Disorders @MayoClinic

Inspired by the expertise & dedication of my colleagues. @Rfonsi1 @MorieGertz @moricemdphd @myelomaMD @ADispenzieri @MyelomaDrKapoor @RahmaWarsameMD @Leif_Bergsagel & many more

Pre-pandemic pics
Our full team and our guidelines are at msmart.org
@MayoMyeloma

@Taxkourel @moricemdphd
The annual symposium honors Bob Kyle. A legend in American Medicine. mayoclinicproceedings.org/article/S0025-…
Read 5 tweets
Vincent Rajkumar Profile picture
22 May
Why are prescription drug prices so high in the US?

Let us start with insulin as an example. Insulin is the Achilles heel. If we understand insulin, we understand why it's so hard to fix our broken system.

1/ Existence of a vulnerable population needing a lifesaving medicine
2/ Monopoly

3 companies control the market for insulin. In a monopoly with significant regulatory and legal barriers to entry of competing products, the seller can set the price however high they want.

Here, the monopoly is not over a luxury item, but a lifesaving medicine.
3/ Patent Evergreening:
Making patent life extremely long & preventing competition.

Covert: By making newer version of a drug and patenting it (see insulin below)

Overt: Filing multiple new patents on same drug to stretch patent life, pay for delay schemes, lawsuits.
Read 19 tweets
Vincent Rajkumar Profile picture
21 May
Finally we have important data that shows that neutralizing antibody levels are highly predictive of protection from symptomatic COVID. @NatureMedicine @Nature nature.com/articles/s4159…
20% of convalescent titer gave 50% protection from symptomatic disease.

Just 3% of convalescent titer was able to give 50% protection from severe disease.

mRNA vaccines and Sputnik V look really good. Blue is proportion protected from symptomatic COVID.
The observed efficacy with the various vaccines aligns very well with the predicted efficacy from neutralizing antibody titers.

Pfizer/BioNTech, Moderna, Novavax, Sputnik V looking very good.
Read 5 tweets
Vincent Rajkumar Profile picture
20 May
Monoclonal Gammopathy of Undetermined Significance (MGUS) is present in ~5% of the population age >50. MGUS carries a lifelong risk of the cancer multiple myeloma at a rate of 1% per year.

Should we screen for MGUS? iSTOPMM trial will answer this question nature.com/articles/s4140…
iSTOPMM has enrolled more than 80,000 people living in Iceland, 40 years of age and older. The trial asks 2 questions: Does screening provide benefit? Does intensive follow up of MGUS provide benefit. @SaemundurMD @sykristinsson
Here is an excellent thread by the first author @SaemundurMD on the iSTOPMM trial.

@IMFmyeloma @BindingSiteHaem @BrianDurieMD @sykristinsson
Read 6 tweets

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