Thread: The Shelf Life of Expired Medicines 🧵

1/ The U.S. Department of Defense and FDA ran a study called the Shelf Life Extension Program (SLEP) to check how long medications stay effective past their expiration dates.

https://twitter.com/maulikdr/status/1809776417049022764

2/ What They Found:

•Many drugs stay potent well beyond their labeled expiration dates.
•Some can last 5 to 10 years longer!

A common query posed by my pregnant patients: What is cord blood banking and should we go for it?
A thread 🧵: 1/13 Cord blood is the blood remaining in the umbilical cord and placenta after childbirth. It's rich in stem cells that can develop into various blood cells and help treat diseases. #CordBloodBanking #StemCells

As a clinician I come across scores of patients everyday struggling with weight control, poor lifestyle choices and the resultant undesirable effects. So I thought to write this.

A simple primer for layman on the role of two very important hormones : Insulin and Leptin.

Insulin: The Key to the Door

Imagine your body’s cells are houses, and glucose (sugar) in your bloodstream is like the energy delivery truck. Insulin is the key that unlocks the doors to these houses, allowing glucose to enter and be used as energy. Without insulin, glucose can’t get into the cells, so it stays in the bloodstream, which is not where you want it to pile up.

When Insulin Resistance Develops: It’s as if the locks on the doors start to rust. Even with the key, it’s harder to open the doors. Your body(pancreas) has to produce more keys (insulin) to try and unlock the doors, but it’s a struggle, leading to higher levels of glucose in the blood.

Leptin: The Fullness Signal

Now, think of leptin (produced by your fart cells) as your body’s fuel gauge, letting your brain know how much energy is stored as fat. When the tank is full (you have enough fat stored), leptin tells your brain, “We have enough fuel; let’s burn off some of this energy!” This reduces hunger and encourages your body to use up some stored fuel.

When Leptin Resistance Happens: It’s like the fuel gauge is broken. Your brain thinks the tank is empty and keeps signaling, “We need more fuel!” even though there’s plenty. This makes you feel hungry and less inclined to burn energy, even though you have enough stored, leading to further weight gain.

The Interconnected Pathway:

Imagine a busy city where both the fuel gauge system and the lock-and-key system are starting to fail. The energy delivery trucks (glucose) can’t unload their energy efficiently, causing traffic jams in the bloodstream. Meanwhile, the fuel stations (your brain) keep displaying the “more fuel needed” sign because the fuel gauges (leptin) are malfunctioning, leading to more energy intake than necessary.

Managing the City’s Traffic and Fuel:

To fix the city’s problems, you would need to oil the locks (improve insulin sensitivity) so keys can easily open doors again, allowing energy delivery trucks to unload efficiently. You’d also need to repair the fuel gauges (improve leptin sensitivity) so the fuel stations accurately reflect how much fuel is really needed, preventing unnecessary intake.

By improving the function of both systems, the city becomes more efficient: energy is properly distributed where it’s needed, and the fuel supply matches actual demand, leading to a healthier, more balanced system.... Let’s juxtapose these concepts directly with how the body functions and the diseases that can arise when these systems malfunction.

Insulin Resistance: The Lock and Key Issue

In our body, when insulin resistance occurs—akin to the rusted locks scenario—our cells don’t respond well to insulin, making it difficult for glucose to enter cells and be used for energy. This condition forces the pancreas to produce more insulin (more keys) in an attempt to overcome the resistance.

Diseases and Conditions:

•Type 2 Diabetes: Eventually, the pancreas can’t keep up, leading to high blood sugar levels. Persistent high blood sugar can damage organs and lead to complications like heart disease, kidney failure, and neuropathy.
•Cardiovascular Diseases: Insulin resistance can also contribute to atherosclerosis (hardening of the arteries) due to the associated high levels of insulin and glucose, leading to heart attacks and strokes.
•Polycystic Ovary Syndrome (PCOS): This condition is often associated with insulin resistance and can affect women’s menstrual cycles and fertility, along with increasing the risk of developing type 2 diabetes.

Leptin Resistance: The Faulty Fuel Gauge

With leptin resistance, the body’s “fuel gauge” system malfunctions. Even when energy stores (fat) are ample, the brain perceives them as insufficient and signals hunger, reducing energy expenditure.

Diseases and Conditions:

•Obesity: The primary issue with leptin resistance. Despite having enough or even excessive energy stored as fat, the brain’s continuous “hungry” signal leads to overeating and reduced calorie burning, promoting further weight gain.
•Metabolic Syndrome: A cluster of conditions including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, which occur together, increasing the risk of heart disease, stroke, and diabetes.
•Non-Alcoholic Fatty Liver Disease (NAFLD): Excess fat storage, partly due to leptin resistance, can lead to fat accumulation in the liver, causing NAFLD, which can progress to liver inflammation and scarring.

The Interconnected Impact on Health

When the “city’s” systems (the body’s insulin and leptin signaling pathways) malfunction, traffic jams (high blood sugar) and incorrect fuel station signs (constant hunger signals) lead to widespread issues. The body’s inability to properly use glucose for energy and accurately regulate hunger and energy storage can cause a cascade of health problems, from obesity to type 2 diabetes to cardiovascular diseases.

Managing Health: Just as managing a city’s traffic and fuel requires fixing the locks and fuel gauges, managing the body’s health involves improving insulin and leptin sensitivity. This can be achieved through lifestyle changes such as diet modifications, regular physical activity, weight management, and, in some cases, medication. By restoring proper signaling and function in these hormone pathways, we can reduce the risk of associated diseases and improve overall health.

Understanding the roles of insulin and leptin and the consequences of their resistance is very important for maintaining a healthy lifestyle for disease prevention and management.
Thanks for reading.

#InsulinSensitivity
#LeptinResistance
#HealthyLiving

A concise guide on pregnancy
After a long career as an obstetrician, I shall try and make pregnancy and its experience a bit simple to understand.
This article is primarily intended for those experiencing pregnancy for the first time.
Pregnancy can be both exhilarating and exhausting, a wonderful journey or a challenging ordeal.
Pregnancy is an exciting and transformative time in a woman's life. It is a time of joy, anticipation, and wonder as you prepare to bring a new life into the world. However, pregnancy can also be a challenging and overwhelming experience, particularly for first-time mothers who may not know what to expect.
Throughout my career, I have cared for women who faced a range of complications during their nine months of pregnancy, as well as those who experienced no problems at all.
No two pregnancies are same. Not even in the same woman. So never ever compare your pregnancy with your friend’s or relative’s. Pregnancy typically lasts 280 days from the start of your last menstrual period (LMP).
You can track this in terms of weeks (40 weeks), days (280 days), or months (approximately 9 months and 10 days).
Your obstetrician will always talk in weeks since that is the precise way of monitoring your baby and you. I will advise you to get used to the week’s measurement.
Therefore, pregnancy is typically divided into three trimesters, each spanning roughly three months. Each trimester- 1,2 and 3 will have different experiences for the pregnant woman.
All non-IVF (natural) pregnancies begin in fallopian tubes. Your ovum will get fertilized in the tube and get into your uterus where it is welcomed to stay for 9 months.
Your body will undergo 100’s of physiological and anatomical transitions to accommodate your baby. So naturally you will feel lot of changes. In first 16 weeks, those changes are in form of nausea, vomiting, weakness, fatigue, aversion to food, nausea especially after tempering food, pain in tummy (lower abdomen), Chakkar ana, overall feeling of “maza nahin aa raha hai” type. The scale will vary between 0-10.
You will have checked your urine for pregnancy before you contact your obgyn for your 1st visit.
The general schedule of visits is: every 4 weeks till 32 weeks, every 2 weeks till 36 weeks and every week in the last month of pregnancy. Special and high-risk cases might need more frequent visits.

As a doctor, my primary field may be healthcare, but my curiosity led me to explore the financial world. The learning has been profoundly enlightening. From running a private practice to understanding the economics of healthcare, investing, personal finance,financial literacy has… twitter.com/i/web/status/1… Decoding Balance Sheets and Income Statements(Profit and Loss account )isn't just for accountants or investors. These financial documents are the pulse and blood pressure of any organization. Whether you're in healthcare, technology, education, or even non-profits, understanding… twitter.com/i/web/status/1…

Parenting in an uncertain world requires a delicate balance of guidance and empowerment. Here are 7 principles to help children born today navigate the future with resilience and relevance. .. 1. Foster adaptability: Teach your children the importance of being flexible and adaptable. Encourage them to embrace change, learn new skills, and cultivate a growth mindset. Adaptability will be their superpower in an ever-changing world. #AdaptabilityMatters"..

Sperm counts around the world have halved over the past 50 years, with the pace of decline more than doubling since 2000, according to recent research on male fertility...
. The biggest causes of deterioration of sperm cells are pollution, smoking, age, and certain health conditions.
DNA fragmentation of sperms can be of outstanding importance, and the test was officially included in the international guidelines in 2021...

Waist/height ratio above 0.5 is a better predictor of health than BMI.
The problem with BMI is that it does not differentiate between weight contributed by fat, muscle and bone. A very muscular individual may have a BMI over 30, inviting the label of being obese, even if the body fat content is not high. Similarly, a person with low muscle mass or low bone weight may have a BMI of 22 but still be at a high risk of diabetes, hypertension and heart attacks. While BMI broadly correlates with the prevalence of cardio-metabolic diseases..

Pregnant women are advised not to clean their cat litter tray and to wear gloves while gardening.
Avoid eating raw meat or from eating unwashed fruit and vegetables.
This is to prevent the infection of Toxoplasmosis which is deleterious to the baby inside.. Toxoplasma Gondii is a parasite which can infect many mammals and birds, but can only sexually reproduce inside cats. Its normal lifecycle is to be shed into the environment in cat faeces, from where it may be picked up by rodents and birds, which are then eaten by cats..

The concept of "opportunity cost" is extremely important in all aspects of our lives.
The real cost of any purchase isn't the actual dollar cost. Rather, it's the opportunity cost -- the value of the investment you didn't make because you used your funds to buy something else.. said Warren Buffett.

When we acquire something, we pay two costs: the price we pay for it and the cost of what we have given up to acquire it. With our money, if we choose to invest it, our opportunity cost will be not having saved it;

The owners of both Haldirams and Bikaji are four brothers who split the original Haldiram, founded in 1932 by their grandfather Ganga Bishan Agarwal. The oldest brother Shiv Kishan Agarwal runs the Nagpur entity with control over the west and south India market, while the second brother Shiv Ratan Agarwal runs Bikaji.
The youngest two brothers Manohar and Madhusudan Agarwal run the Delhi-based entity with control over the north India market. Together the family controls nearly 50 percent of India’s ethnic snacks market.
#funtrivia

A lay person sees only the subcutaneous fat.
A general surgeon/ obgyn sees visceral fat in the patients.
Visceral fat is the invisible enemy which is the root cause of many life style diseases.

Anyone can have visceral fat, no matter their body type and weight.. It's caused by several factors such as poor diet, lack of exercise, stress and lack of sleep. Unlike subcutaneous fat that you can see and touch, most people don't know they have visceral fat and therefore don't take steps to getting rid of it…

If you have a SIP of Rs. 10,000 for a period of 35 years, that amount growing at 12% p.a will grow to Rs. 5,17,99,620.
₹5 cr plus.
Now just increase the SIP amount by 10% a year. This grows to Rs. 14,81,83,096. Which is almost 3 times the amount, ₹14cr plus. This is the power of #compounding. Build the habit of regular early equity investing, first pay the SIP then spend. You do not need to know fancy technical or fundamental analysis, no need to time markets and get anxious. By the time you retire, your corpus will be ready.

If you were wondering the difference between shut down and restart in a pc:
A simple example of a chef working in a kitchen will suffice.

Shutting down completely would be like if the chef cleaned up and went home… Holding the power button down to shut down faster would be like if the chef didn't clean up and just left a mess and went home.
Restarting the computer is telling the chef to clean up everything and then set everything back up without him leaving the building…

#COVID19 is affecting fresh newborns. Delivered a healthy 3 kg full term baby uneventfully. Short labor, no PROM, no distress, clear liquor. Baby had persistent grunting. Shifted to nicu. Xray reveals totally white lungs bilaterally. Echo normal… Covid antibodies level is 1600 ( normal <1) and IgG is >200 ( normal <17).
Baby is on ventilator and prognosis is grim. Mother has absolutely no symptoms.
Please please, all pregnant ladies, mask up, especially in last trimester. ..

How I deal with #sextortion :
I received a Hello from an attractive girl dp on WhatsApp.
I was curious.and wanted to know why that young girl wanted to be my friend, but accepted it.
She started sending me private messages.
She called me handsome and asked my age… I told her I'm quite a bit senior to her.

We kept chatting for a few days, suddenly one day she asked if we could talk about adult things, I said OK.
Then she replied with a face like 🤪😉😜and said ok dude, you start."

A simple but fascinating explanation of a complicated concept of time-space.
#science The more you move in space, the less you move in time. And vice-versa.

Extremely important incometax law for self employed professionals:
Do not make payments in cash above ₹10,000 per day, if you are planning to claim expenses in your balance sheet.
For transporters it is 35k per day. If a person takes a cash loan from a financial institution or a friend, the total amount cannot exceed Rs 20,000.
The same regulation applies to debt repayment.
The repayment of a Rs 20,000 loan must be made through a financial channel.

One of the biggest characteristics that entitled people have is the "you owe me" mentality. It seems that they fundamentally believe in their superiority over others; they see themselves as more important, smarter, and overall better in life… So naturally, they expect bigger benefits from life which are often upsetting for those surrounding them. They are the people who think the rules don't apply to them and they should get what they want."
#entitlement

Do not miss the bus.
Retirement planning should begin as soon as you start earning. Strange but true.
The real power of compounding works so much better when you start so much early.
And in the equity markets, the law of averaging over a long periods like 15-20 yrs... works wonderfully well.
So if you start investing in a mutual fund SIP at the age of 25 with only Rs.5000pm, your corpus will be a staggering Rs.3.21Cr at the age of 60. ( Assumed 12% annualized return).
If you start at 30, that will be 1.75cr
At 35 = 94 lacs
At 40 = 49 lacs..

Angler fish:female is 40 times the size of the male. Her goals in life include not moving much, murder, and attempting to lure a male partner to procreate.
The males look almost nothing like the female Angler Fish. Not only are they much smaller, they sport huge eyes and nostrils that help in locating her through the darkness. Once the female has been found, the male will swim up to her and bite down on some part of her body. From this point forward he will never let go for the rest of his life..