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Vincent Rajkumar Profile picture
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25 May, 5 tweets, 4 min read
Over 500 doctors have reportedly died of COVID in India in the second wave. Can someone confirm report here that >95% were not yet vaccinated? @DailyhuntApp @IMAIndiaOrg @Milan_reports @soutikBBC @PSampathkumarMD

H/T @amitsurg
m.dailyhunt.in/news/india/eng…
In my discussions with leaders of 3 large hospitals, fully vaccinated healthcare workers got COVID but didn't get serious illness. @spkalantri

There are some deaths despite full vaccination. But my sense so far is fully vaccinated are highly protected from severe disease.
Besides vaccination status, the other consideration is viral dose. Healthcare workers are at risk of high viral dose exposures and multiple repeated exposures which puts them at higher risk. The loss of life described below is tragic. Some are very young doctors.
See moving thread below of some doctors who have lost their lives. @AnantBhan @QuintFit
More details.

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Vincent Rajkumar Profile picture
26 May
How and why I treat high risk smoldering multiple myeloma (SMM). Thread.

1/ Based on the progression risk curve over time, and genomic analysis, SMM is now considered a heterogenous clinical entity in which 50% of patients have premalignancy and 50% asymptomatic malignancy. ImageImage
2/ These two groups can be considered as high risk SMM (asymptomatic malignancy) and intermediate/low risk SMM (premalignancy).

We are specifically concerned about high risk SMM, defined as 50% risk of progression to myeloma over 2 years. Image
3/ Patients with high risk SMM can be identified by the Mayo 2018 criteria: Also called the 20-2-20 criteria.

BMPC >20%
M spike >2
FLC Ratio >20

Any 2 of the 3 risk factors is considered high risk SMM. @MayoMyeloma @MayoCancerCare @myelomaMD Image
Read 12 tweets
Vincent Rajkumar Profile picture
24 May
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.
Read 5 tweets
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

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