1) This is Kaiser Wilhelm II of Germany (1859-1941).

He strengthened the German Empire but his erratic personality and tactless behaviour antagonized the international community.

It is believed that his unstable foreign policy was one of the major reasons behind World War I.
2) He was born on the midnight of 26th Jan, 1859 and had an extremely traumatic birth.

You can read an extensive account through this link.

3) Long story short, his attending doctors were forced to operate within the confines of royal etiquette --> while dealing with a breech delivery --> with the patient under chloroform --> a relatively unknown substance.
4) Understandably, outcomes were far from perfect.

1. He had a level of birth asphyxia --> this left him with hyperactive and aberrant behaviour, limited social skills and poor decision making.

2. Erb's palsy of his L arm --> it was about 6 inches shorter than his R!
5) Various cruel and unusual (by modern standards) treatments were tried for his withered L arm. But none worked.

His behaviour worsened progressively, as he aged.

The end result --> a world war which destroyed the German empire and produced nearly 40 million deaths!
6) As an unofficial student of history, I can also say that the roots of the 2nd world war lay in the termination of the first.

The signficance of this birth injury may thus be appreciated.

It changed the world as his contemporaries knew it.
7) I am not an Obgyn specialist and I have never conduced an LSCS in my life. But I have great respect for those who do.

I consider obgyn to be harder than medicine for we are dealing with two lives here --> at the razor's edge of safety with no margin for error.
8) It is easy to criticize those who operate on this razor's edge but please don't forget that any mistake here can have certain ramifications.

Ramifications that can, potentially change the world.
9) My post is not in favour of or against LSCS which many external observers think the medical profession, is engaging in wantonly.

I simply don't know enough to comment.
10) But before we start forming opinions, it is essential to know the importance of proper obstetric care and everything it entails.

Mistakes here can last a lifetime and, change the world.
Please retweet if you fijd this helpful and informative!

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More from @AdiG1993

Jul 11
1) Unpopular opinion here --> but something you should check out.

If you are planning on doing MD gen med residency, it might be worthwhile to do it somewhere with a relatively smaller subspecialty/gen med ratio.
2) A large and very well equipped subspecialty dept will usually directly admit all the unusual/teaching cases. Gen med can't do much here.

A smaller dept usually does not have enough staff to cover 24×7 on call and is less enthusiastic about situations like this.
3) So you get all the input that you need while managing to take care of patients directly.

This is very important --> you can't fire a rifle after placing it on someone else's shoulder.
Read 4 tweets
Jul 9
1) I was reading a bit of neurology today, for exams and general knowledge.

I have always maintained a lively interest in medical history and the development of this great profession of ours.
2) I was also influenced by the fact that we have a patient admitted at present, with generalized chorea under evaluation.

Common differentials have been ruled out but we haven't made the elusive diagnosis yet.

So a bit of reading was in order.
3) Neurogenetics is one such topic which has grown by leaps and bounds within the last few decades.

Clinical diagnoses of yesteryears can now be confirmed by genetic tests --> thanks to the work of certain stalwarts like Prof. Anita Harding.
Read 10 tweets
Jul 8
Since there are lots of MBBS students are asking me how to approach Harrison in UG,

Here is my approach -->


Etc etc
The latest Harrison is a giant encyclopedia of molecular data. Clinical medicine has been reduced to a bare minimum. I am talking about the 20th ed.
In fact, the Oxford Textbook of Med 6th ed is relatively better clinically but it comes in 4 giant volumes.
Read 4 tweets
Jul 5
1) It must be hard being an MBBS student nowadays with everybody criticizing you for not having enough clinical knowledge/not going to the wards etc etc.

I don't think we should blame them for circumstances beyond their control.
2) Medical science has expanded so rapidly that you must now run, just to stay in the same place. Basic knowledge has also changed with along with our ideas of complications. Its no longer 'a simple case of anything'.
3) You will need an MBBS course lasting at least a decade if you need people to master all the skills that MBBS students of decades earlier could master. Medical science has far outpaced our capacity to learn.
Read 9 tweets
Jul 3
1) A terrible crash at the Grand Prix today, but thankfully no lives were lost --> and it is all thanks to this man.
2) Who was he?

Dr Eric Sidney Watkins |(1928-2012) , commonly known in Formula 1 (F1) as Professor or Prof Watkins was an English neurosurgeon.

He was the FIA F1 Safety and Medical delegate, head of the F1 medical on track team and first responder for a period nearly 26 years.
3) He is most famous for treating Ayrton Senna, the Brazilian three-time F1 champion who died in 1994 in a crash at the San Marino Grand Prix in Italy. He was only 34 at that time.

Here is a pic of the two together!
Read 9 tweets
Jul 3
1) Gen med residents are taught to think of secondary hypertension, especially primary hyperaldosteronism, if the following conditions are met.

- young onset HTN (age < 40)
- family history
- resistant HTN
- hypokalemia
2) First of all, young onset HTN is a controversial term nowadays --> with the rise of fast food and sedentary lifestyles with pediatric obesity and metabolic syndrome --> it is entirely possible that the age may need to be shifted even lower!
3) This study, done in AIIMS with @DrSarahAlam as the lead author looked at PA epidemiologically.

202 patients with young onset HTN (YH) were evaluated.

Surprisingly the mean age was 43.9+/- 10.9 years!
Read 12 tweets

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