Adenovirus causes mild infections mostly in children
Outbreaks of ‘Madras eye/pink eye’, clusters of seasonal respiratory illness are not unusual
Severe illness with adenovirus has been rare
After a build up over 3mo we now see a surge
Parents should look out for:
Sudden onset high fever with chills
Headache and throat pain
Nausea and vomiting
Red eyes and red throat
Poor response to fever medications
Excessive tiredness
Burning sensation during urination
As a neonatologist I shall delve into short & long term effects on the child a bit later on.
For today, the question I am looking into is ‘will > C section = < maternal and neonatal mortality’ adjusted and not adjusted to Human developmental Index (HDI)
#Csection and #MMR and #NMR 2/n
WHO recommends an ideal rate of 15% at a population level. Less than this, mums and babies are at risk, more it will veer towards unnecessary sections.
Does this hold good when we look into pooled country wise data?
Aug 13, 2021 • 7 tweets • 2 min read
I am further convinced that Twitter at least is not the place where we can further the cause of general welfare. Some of us will note the blind spot we have to numerous privileges we have. But, we still have to give the best for ourselves and our kids. We have no choice.
So we make points that clearly lay out - we can’t escape the race, we work hard. We find lateral entry points for others a great disadvantage.The label of our own privileges: class, caste, IQ, merit is a burden if anything.I don’t see why anyone should have a problem with that.
Aug 12, 2021 • 7 tweets • 2 min read
Finally read Prashanth’s editorial. Not easy or comfortable read. Not easy also because we all have inherent biases. The flow of thoughts are complex and the sentences are long. One drifts to one’s own life events rather than read author’s reflections, hence maybe a bit lost 1/n
Basic premise is to question the merit of meritocracy. But meritocracy exists very patchily in our society. The ladder to climb to a better social standing, affluence, influence if only was professional college, degrees, high paying jobs the equation would have been simpler.
Jun 4, 2021 • 17 tweets • 8 min read
#violenceagainstdoctors
Doesn't make sense at all, but somehow feel compelled to.
What could it be due to? 1. It is Ok to hit someone:
Physical retribution for perceived wrong has been acceptable in our society (thrashing in schools/police with lathi/spanking kids for eg)
1/n2. Bipolar perception of the profession:
Noble profession - not a job that should pay the bills (expecting anything in return for job well done makes it less noble)
Doctors deified (can perform miracles, bring back from dead) + vilified (fleece patients, take cuts, looters)
May 22, 2021 • 10 tweets • 3 min read
Assuming #Children will be affected more in #COVIDThirdWave. We need to prepare
Uniform Rx approach
Upskilling providers
Better networking of pediatric beds
Capacity building
Leveraging telemedicine
Prioritising more vulnerable
Registry of pediatric covid
Taskforce
Uniform treatment approach: @iapindia and @nnfindia already have good protocols in place. We need all practicing pediatricians sign up to it. Any deviation has to be made consciously, discussed with family and peers. Exceptions should be the exception not the rule
Apr 18, 2021 • 12 tweets • 5 min read
Some of us are back. Although we are doing good work by individual patients we look after building a healthcare system fir the nation is a different ball game.
Few points 1. Healthcare is not an election issue, politicians will not prioritise it, budget allocation v low
2. Our govt run places are free at point of use, but inadequate, incompetent, poorly manned, not networked - patient is not the focus, bad outcomes are norm and accepted
Jan 22, 2021 • 5 tweets • 2 min read
#medtwittter apparently #doctorbashing happening on twitter too!
My thoughts 1/n 1. Refuse exalted ‘you are demigod elevation’ 2. If it’s a time critical/life death situation do not hesitate for a second (if can make a difference)
2/n
3. Do not ‘undersell’ by ‘discounting’ / free follow up /packages 4. Respect your time and space - late evenings and Sundays are for rounding and emergencies
Sep 24, 2020 • 9 tweets • 4 min read
Dr Barrington draws attention to this well written open access commentary #MedTwitter#Neonatology#Disability#QoL A good life cannot be predicted from a brain scan!
Neonatologists often stare at seeming disasters early in the life of a newborn. Parents are distraught and ask how the road ahead would be? We are tempted to carry out tests and scans, lean on our personal experience and give our opinion: This itself has consequences 2/n
Jul 26, 2020 • 17 tweets • 4 min read
#ChildHealthMatters #DevelopingBrain from 18 days post conception to early childhood is surreal #First1000Days = critical for a lifespan of health + wealth of society
Let us marvel at some key facts on Developing Brain (Source: @UNICEF 'Building Better Brains: @TheLancet ) 1/n
The blueprint of the human brain includes 86 billion neurons and around one quadrillion synapses (which enable neural connections), coded in only 10,000 genes (Herculano–Houzel, 2009)
Jul 24, 2020 • 6 tweets • 2 min read
#MedTwitter
I had a joke about proctologist, but then thought why go there?
#MedTwitter
Then there was one about the surgeon, it simply did not cut
Jul 21, 2020 • 6 tweets • 2 min read
1/n @BBMPCOMM with area wise hospital co-ordination committees one hopes both public and hospitals will have a seamless admission and discharge process.
suggestions for safe/panic free #bedmanagement 1. SPOC of each hospital + Arogya mithra update bed status every 4 hours
2/n 2. Each and every CCC should have a Covid Hospital overseeing. (govt/pvt) Hub and spoke each big hospital with several CCC in catchment area: Designated hotels, hostels, schools, function halls ( Current BEIC out of city is isolated and treatment escalation hard).
Jul 12, 2020 • 6 tweets • 3 min read
#COVID__19#BengaluruLockdown should open the window of opportunity to ensure 1. We can save more lives 2. We can fight the panic, both interlinked.
If neither nor, then we would have done nothing but harm. @epigiri writes what precisely @BBMPCOMM can do to augment PH measures
2/n @BBMPCOMM@DHFWKA 1. Need experts + feet on ground who can contact trace, crunch data and use it for capacity building 2. Stop spending energy on spraying, sanitising = 100Mi viral particles can fit in on a pin head! 3. Focus on people - triage - get beds
Jul 8, 2020 • 6 tweets • 5 min read
1/n #COVIDBangalore#BedCrisis @mla_sudhakar says over 70% beds not utilised yet @Sowmyareddyr relates a bed hunt that went for hours
We read about HCW shortage/morale down
We hear doctors in line of duty struggling to find beds for themselves
There are 2 ways to go about this:
2/n 1. Say all is well and the problem 'goes away' 2. Accept there is a problem - first step towards solving one
Shall we for a moment set the first one aside?
Jul 3, 2020 • 7 tweets • 5 min read
#ChildHealthMatters#COVID19#ChildrenWithCovid
With the coming together of many factors
Children who are naturally resilient need focus 1. No socialisation with peers/school settings 2. COVID news 24/7 3. Financial, Psychological stress in families
4.COVID illness itself
Children are extremely perceptive , but form impressions that adults may not recognise easily @UNICEF has some useful stuff unicef.org/coronavirus/6-…
The most crucial thing in this 'Monitor your Own Behaviour'
Jul 2, 2020 • 7 tweets • 3 min read
#Immunity in simple terms: 1. Innate immunity
Physical barriers = shuts door on intruder
Non specific defences =kills any intruder soon after entry 2. Acquired immunity
Learn to kill a specific foe = system has to learn to identify and tailor make antibodies, needs time
Physical barriers = stickiness of nasal passage, the slime, intactness of skin etc : Tries to see if the doors can remain shut
(Now if you are clever you erect further barriers you #MaskUp)
Jun 28, 2020 • 8 tweets • 3 min read
1/n Few Suggestions #Covid19Karnataka#BedManagement @DHFWKA@BBMPCOMM must have everything set. Yet, 1. Triage Task force - risk stratification - assign home/centre/hospital for initial care. Patients enter triage in two streams: New and already known(Home etc).
2/n 2. Bed management task force: Single decision maker, but have reps of all med colleges and large pvt hosp - avoids refusal from any such centre
Pledge not to come close to anyone and anyone without a mask!
Jun 24, 2020 • 5 tweets • 3 min read
@DHFWKA should look into a tiered response 1. Pool 150 -200 beds each from all medical colleges Gov and Pvt: These have huge campuses, separate buildings, manpower. Equipment can be leased/sourced = will easily give about 3000 beds
1/N#CovidBangalore 2. Have a bed management war room - should have admin reps from each of these medical colleges + BBMP+DHFWKA 3. Network all other hospitals and fever clinics to this war room - real time, this also serves as transport hub
2/N
Jun 13, 2020 • 4 tweets • 2 min read
1/n #HospitalBills
Hospitals hire doctors for their expertise and sometimes star value, managers for efficiency, financial returns
Nurses and support staff to keep things running (most essential)
Each of the above have their tasks cut out.
2/n
India has allowed pvt enterprise in #Healthcare to be free market driven, regulation for safety is becoming norm (NABH) but price regulation has never been addressed. So any corporate body focus will be on brand value, results, returns and growth.
Jun 7, 2020 • 6 tweets • 3 min read
#Delhi#COVID19 situation: We need to watch and learn and fast. @DHFWKA@BSYBJP@epigiri@BBMPCOMM 1. Bed Manangement 2. Testing 3. Home care 4. Co-ordination committee BBMP and Pvt
1/n2/n Bed Management:
Ring fencing: COVID +non COVID beds ICU +ward
Real time app: useful only if mechanism of updating is in place (else panicm/misinformation)
Admission and discharge criteria: Clinical parameters (not epidemiological)
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