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On a journey, the destination of which I know not; but the road, the menagerie of travellers, the pitstops, the potholes, the experiences are what make me, Me.
N.V.Ramanan Profile picture 1 added to My Authors
Mar 7 26 tweets 8 min read
Allow me to introduce you to the two Poisons of our time, with which are poisoning ourselves and also our children on a daily basis -

Uncontrolled

Salt/Sodium
Sugar

In our daily diet which we consume without any mindfulness. This thread began cuz last week I diagnosed a 20 yr old with Hypertension.

On evaluation we could not find any of the routine organic culprit for hypertension in such a young person. Patient was a non-smoker, slightly overweight but not obese.

I found the culprit in their Diet.
Mar 4 13 tweets 3 min read
Why do students leave India for #MedEd is not a simple answer - Seat mismatch to lay persons seems like the most plausible issue which can be addressed by increasing number of hospitals or seats.
IMHO this won’t change the scenario The reason being - Cost of education in private med schools is elitist & is unaffordable by commoners, so unless seats in public institutions increase students will prefer affordability.
Feb 10 4 tweets 1 min read
It doesn’t matter - Whether or not viruses mutate to become less pathogenic over time is correct or incorrect (A lot of people are referring to this hypothesis in context of Omicron & to push through that this means end of the pandemic) - because as I see it Omicron is able to infect despite boosters or natural infection+ full vaccination dose and is highly infectious, which means now it has the advantage to reach hosts (immunocompromised or non-vaccinated) that can aid further mutations faster than its predecessors.
Feb 8 5 tweets 1 min read
Gupta ji, there are many sides to this debate and there are too many associated takes, however justifying it by nullifying the right of choice of women by garbing it under modernity or liberalism is the worst of all. Your take especially in the backdrop of surrounding circumstances, involvement of rogue elements and the constitutionality involved demonstrates your lack of understanding of both modernism & liberalism apart from displaying how little you understand feminism.
Feb 8 4 tweets 1 min read
I used to commute for work, every single day during the peak of heat I would see young children, old men & women walking under the scorching sun many a times without even a slipper, when we would stop the car. I would carry juice & water bottles & food & hand them out Never once did I have anyone of these migrants stop to beg or even ask for money when we stopped, they would keep walking, because that walk was their only chance at surviving.
Jan 24 7 tweets 2 min read
It urgent and imperative that Indian medical community from top to bottom & bottom to top realise that they are in the process of creating a monster called “Anti-microbial resistance” with their irrational antibiotics prescription approach. And, Even Now is pretty late.

But seriously if we are going to use antibiotics Which should be last in the line of defence like Tazobactum, Levoflox, Meropenem as first line then we are inviting bugs that we have no ammunition against.
Jan 9 20 tweets 4 min read
Just thinking this out aloud & I will delete it later, I have been following Omicron growth very closely since SA & now having experienced patients in India I know that it is extremely transmissible & it infects rapidly, 24-48 hrs if exposed, extrapolating this To my observations in India, our infection control practices in India are really pathetic across all healthcare set ups, equally pathetic is personal protection by HCWs & in hospital patients & attendants & so is our in-hospital air ventilation.
Jan 7 5 tweets 1 min read
Govt’s & policy makers - Omicron is mild because our deaths are low & ventilators needs are low.

Chickengunya is a disease with high grade fever, debilitating body ache. However debilitating pain requires hospitalisation.

It is mild but in season it overruns hospital capacity Common Symptoms so far in present wave are - Highgrade fever that many times is not breaking with oral antipyretic even for 2 days, severe fatigue, headache, severe vomitting & diarrhoea, cough & breathing difficulty.

These may seem mild to read but most of my patients are
Jan 7 6 tweets 1 min read
In hospitals in Delhi HCWs are getting infected like wildfire. 😐 Can’t understand why hospitals donot have provisions for random RAT sampling of doctors.

If you are HCW & have symptoms please get a RAT done before starting duties.

And employers (public & pvt) both need to enable infected HCWs to take their due rest & recovery if infected
Jan 7 5 tweets 2 min read
Those who live in Delhi are familiar with concept of “route” on a daily basis for VIP movement (number increases during election season so does our inconvenience)
Armed forces corridor is put in place atleast 2 hrs before movement & during movement entire route is cordoned off Delhites endure traffic jams routinely thanks to this movement.

Those who commute b/w Delhi Gurugram know that during election season like now, thanks to PM & others leaders flying for rallies we can be stuck up in a jam thanks to this route.
Jan 4 4 tweets 1 min read
About the Goa-Mumbai cruise cases (& other Covid related policy mistakes) It is seriously a pathetic understanding of Covid19 science when -1) Cruises are allowed to run despite knowing Omicron is spreading 2) it is epic stupidity then to keep passengers in that closed space. It is pathetic health policy failure when mass events like political rallies, religious meetings are conducted by leaders despite knowing that even last year this is how delta worsened.

That a political leader like AK who was having symptoms continued to do election rallies
Jan 3 5 tweets 1 min read
In the last 2 days, many non medics have told me that they are not worried about this wave because “they have read/heard that Omicron is mild & that the wave lasts only 10-14 days”

This is a such a disastrous understanding of Omicron. Some of my “mild Covid” patients from the current wave - A 23 yr old, exhausted and with severe headache since last 6 days, 45 yr old, body ache, cold, cough which is making sitting & sleeping difficult since 5 days & deranged sugar control
Mild is a misnomer.
Nov 23, 2021 12 tweets 2 min read
Came to know about 2 doctors who became Covid+ recently in a single hospital in Delhi.
And, the part which outrages me most is, that If, IF we had anything Ben remotely like Test, trace & Isolate - Their respective departments & staffs should have been monitored, But Instead, we have nothing - Zilch, Nada. One of the doctor it seems has the entire family infected.

The colleagues & the staff know & the departments are functioning routinely, single or part masking.

Can we expect anything better from common people on the streets?
Nov 23, 2021 4 tweets 1 min read
Flu/common cold is a respiratory viral illness, We need bi-annual vaccine shots among vulnerable (& in many countries where flu prevalence is low children & adults) to prevent severe pneumonia, hospitalisation & deaths. Most Flu vaccines have a far lower efficacy than many Covid vaccines and that efficacy varies from year to year.

We use flu shots for elderly, children, HCWs in India & across the globe & where mandated among young adults.
Sep 29, 2021 4 tweets 1 min read
For eg - Not everyone wants to or needs to share their mental health diagnosis or their reproduction related medical history or maybe a diagnosis of HIV with an employer - how will the Digital Health ID ensure this autonomy for people? You may says that govt will provide options but then an employer may add a clause that not sharing your Health ID will make you non-eligible for workplace insurance….

These are real time issues that happen & have happened in countries that use digital ID
Sep 28, 2021 35 tweets 6 min read
Majority of people (medics as well as non-medics) who are going ga ga about Single National health ID have got no clue about the issue, intricacies involved as well as fallouts (many of which can be extremely serious) & have done no background research on this. Just because it is digital and just because it is unitary DOES NOT (AND I REPEAT DOES NOT) make it - Correct or sensible or the perfect solution.
Before we even talk about a single National health ID or system we need a lot of transparency & data security discussions on table
Aug 27, 2021 15 tweets 3 min read
What is the point of announcing - “We anticipate so many lakh cases in the 3rd wave per day” when despite all of this, the entire country will behave complacently about - Precautions that can prevent such numbers??

And don’t kid yourself about not being complacent because… 1) Go to any market place/mall/shop (I have sample sizes Delhi-NCR) - 80-90% of people will be having a mask hanging in their neck or no mask but a cloth covering their mouths not noses, people will be interacting from close distances while their masks are hanging.
Aug 25, 2021 4 tweets 1 min read
Based on Phase 1 safety data of 82 patients 😶🙄😐 Matlab I would like to meet the biostatistician who came to the conclusion that an 82 subject study can provide statistical significance in this case. Has to be some really big shot genius & we should learn from the genius. Hats off to the dude.
Aug 25, 2021 4 tweets 1 min read
I kid you not.

This absurd pricing where 90% of Cost Price will simply go to Hospitals & Insurance companies as their profit is a situation which is already a reality in some private sector hospitals.

This translates into unaffordable or insanely expensive procedures. When Foreign Investors or funds make & are allowed healthcare acquisitions worth 1000’s of crores (90% of large scale private hospitals are now owned by these investors) how can we expect that the cost of healthcare will remain rational?