The tradition of practical medical exams in India, especially bedside exams for final-year MBBS students, is centuries old. Bedside teaching is crucial, but it faces new-age challenges. Let me describe the issues shaping the landscape of medical education and exams in India. 1/n India boasts an impressive 703 medical colleges, and these institutions collectively admit over 100,000 MBBS students annually. However, this sheer volume poses an immediate predicament: where will the patients for these university examinations come from?
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The NMC's @NMC_IND bid to cut links between medical professionals and the pharma industry is sending shockwaves through India's healthcare. But is this strict approach the solution? 1/n Is the NMC's proposal too ambitious? Is it feasible to untangle deep-rooted ties between doctors and the drug world? Let me rewind to a case that could hold some answers. 2/n

𝗦𝗰𝗿𝘂𝗯 𝘁𝘆𝗽𝗵𝘂𝘀 is a devastating disease. At Sevagram, our healthcare providers regularly care for hundreds of patients with severe scrub typhus in the ICU. Unfortunately, around 15% of these patients do not survive. 1/n A study from India published in the 𝗡𝗲𝘄 𝗘𝗻𝗴𝗹𝗮𝗻𝗱 𝗝 𝗠𝗲𝗱𝗶𝗰𝗶𝗻𝗲 a day before—caught my attention. CMC Vellore, PGI Chandigarh and JIPMER, Puducherry were some of the institutes that participated in the study. 2/n

1.Covid19 has taught us an important lesson. Uncommon or previously unheard diseases—𝗠𝗼𝗻𝗸𝗲𝘆𝗽𝗼𝘅, as an example— can suddenly arrive, when least expected. They trigger uncertainty, fear & irrationality. As in Covid19, only science can help us move from darkness to light. 2.The @NEJM on July 22 reported 528 𝗠𝗼𝗻𝗸𝗲𝘆𝗽𝗼𝘅
infections diagnosed between April 27 and June 24, 2022, in 16 countries —from Europe, Americas, Western Pacific, and Eastern Mediterranean region. Here are study findings:

What's in a name? That which we call an oath by any other name would turn out just as ineffective.”

Hippocrates or Charaka— their sayings lose relevance when medical professionals pay only lip service to the oath and fail to follow its spirit when they practice medicine. 1/13 "I swear by Apollo, the physician, by Asclepius, Hygeia, and Panacea and I take to witness all the Gods and Goddess." So goes the Hippocratic oath taken by medical graduates during their rite of passage.

How many medical graduates are familiar with the Greek Gods? 2/13

A long thread on snakebite- a neglected public health problem in India.

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India has the highest number of deaths due to #snakebites in the world. Snakes bite, injure, or disable hundreds of thousands of people and kill close to 58 000 Indians each year. 2/N
Victims of snakebite often need ICU admission and access to ventilators and dialysis. Venomous snakebite is more expensive to treat than treating a heart attack or a stroke.

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My 7-slide summary of the @NEJM 7 July study on safety and effectivity of #COVID19Vaccination in adolescents

Q What was the research question?

Is Covid vaccine safe and effective in adolescents aged 12-15 years of age? 2/n
What did the researchers do?

In an ongoing multinational, placebo-controlled, observer-blinded trial, researchers randomly assigned 2260 adolescents to receive two injections, 21 days apart, of BNT162b2 vaccine or placebo.

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#COVAXIN trial preprint was published few hours ago. Here is my summary of the trial- over 7 slides.

How was the trial designed? 2/n
What was the primary and secondary outcome?

I couldn't believe my eyes. So I asked my colleague to read to me the recent Covid19 guidelines by DGHS @MoHFW_INDIA. I couldn't believe my ears too.

The 9-page-PDF guides how to treat, investigate and monitor patients with Covid19 infection.

What is the first surprise? 1/N Surprise 1.

Asymptomatic patients: "No investigation at this stage. And “No medications are required.”

No blood tests or fancy drugs for early Covid! 2/N

1/n
The COLCORONA clinical trial (Lancet 27 May 2021) concludes that if we treat 70 Covid positive people with colchicine for a month, we prevent 1 hospital admission or death.

How did the researchers estimate the sample size of their study? 2/n
Assumptions. They assumed that 7% of those on placebo shall either die or need hospital admission. Oral colchicine shall reduce this number to 5.25.

To detect a difference between the 2 arms of the study, they needed to enrol about 6000 people in the study. Which they did.

I cringe when Times of India reports results from a COVID19 case-series from Maharashtra- drugs are doing great. Not a word on control arm or standard of care. They should ask—and tell us—who did they compare the drug with. These numbers are confusing and distort science. 1/4 First, #Favipiravir. Maharashtra reports that 5.5% (27/495) mildly sick COVID patients on Favipiravir died. Normally, about 98% of such patients recover. Are these results “encouraging”? Or should we be worried about the association of increased mortality with Favipiravir? 2/4

My quick comments on the #Favipiravir study results released by #GLENMARK in a press release.

Did Favipiravir succeed in achieving faster viral clearance? No. The difference between the two arms of the study lacks statistical significance. The 95% CIs cross 1. N/1 What about secondary endpoints? Would you pay Rs 12500 for a drug that promises to make you fever-free a day earlier?

Look at the 95% CIs again- they barely float above 1! Not impressive! And were these patients hypoxic? The data does not tell us. 2/2