Praneel M

[Praneel M @maarikkal]

@nahidulislam404 skills

[TheLiverDoc™ @theliverdoc]

THE RIGHT SIDE UP:

We often hear: "Government meds are weak" or "Cheap meds don't work."

This is false.
Our lab data proves that Indian generics match the quality of premium brands. Don't let marketing fool you. The molecule doesn't care about the brand name on the box.

Your health deserves quality.
Your wallet deserves fairness.

This large scale study proves that in general:
Generics ≠ Inferior

We tested. We verified. The results are undeniable.

EVERY. SINGLE. PILL. PASSED.

Whether it was a ₹61 liver tablet from a big brand or a ₹16 one from Jan Aushadhi - they ALL met the strict Indian Pharmacopoeia standards.

Zero failures. The cheap meds worked just as well in the lab.

Please share and RT to help your family & friends save tens of thousands on medicines!
11/11

[SpaceX @SpaceX]

The final phase of Super Heavy's landing burn used the three center Raptor engines to precisely steer into catch position

[Praneel M @maarikkal]

@ivanvuko19 you are special in our heart. Hope you are doing well.

[iiam_yellow_ @iiam_yellow_]

Happy teachers day♥️ #kbfc

[Praneel M @maarikkal]

@abdulrahmanmash Where are their parents!!... It's so sad to see those kids scared hell out of it. No wonder we are proud 103th ranked.

[Praneel M @maarikkal]

@theliverdoc @DNovicetrader For some reason I was ignoring all previous ones but recently watched all of them. Big fan!! Caesor is how a leader must be- calm, smart, protective, vision, critical thinking and aggressive only when needed and as a last resort. It is nicely portraited as well.

[Praneel M @maarikkal]

@theliverdoc But I miss Aura of caesor. He was different and special.

[Praneel M @maarikkal]

@Varunmo80059385 @NikhilB1818 Yep

[Praneel M @maarikkal]

@NikhilB1818 Your 2nd point have lots of stake especially on providing the resources. Hope you do all u can to keep up with the needs of the coach.Though I don't agree of the decision on Ivan,we back you for the good.Btw,we alrdy have lost one valuable resource.Why can't we retain him ya?

[SpaceX @SpaceX]

Watch Starship’s third flight test → https://t.co/bJFjLCiTbK https://t.co/1u46r769Vp

[TheLiverDoc™ @theliverdoc]

How much alcohol is allowed?
Are there recommended limits?

via, @TRSOriginals feat. @theliverdoc

Full video: https://t.co/smGfT0y420

[TheLiverDoc™ @theliverdoc]

The 4th Laddu.

These 3 laddus were given to me by the wife of my patient on his birthday, a few weeks before.

She was now happy and the family was doing good for themselves.

My patient Paul, suffered from alcohol use disorder. He had been drinking for more than 15y. Three months back, he developed severe alcohol-related hepatitis. Jaundiced, with abdominal fluid, blood infection and disoriented, he was transferred to our Unit for expert management & liver transplant.

Liver transplant was not an option from the outset. Paul owned a small provisions and bakery shop, had two girls, aged 5y and 9y and his wife worked part time errands, but quit after the girls were born. They did not have enough money to evaluate Paul for the transplant.

So we put him on antibiotics, cleared the infection and put him on a salvage stool transplant to increase his life. You can read more on it here: https://t.co/kAWFmEJJZ7

He responded to it. Alcohol-related hepatitis resolved and he went back to being a stable cirrhosis patient. We put him on a psychiatry program to prevent relapse. He did well. For 3 months. Then stopped coming to my OPD and started drinking again. Initially 300ml/d and then almost a liter/d.

Paul's cousins dragged him to my outpatient department one day and I got to know his relapse was bad. He had stopped meds and was back with his "good friends." He paid for everyone's drinks. I spoke to Paul and told him that it was a disease, he needed help, his friends were not real and his daughters needed a father. He cried a lot and told me alcohol was more an attractive option than anything else. He agreed for deaddiction again and went back in the protocol and also went back to drinking.

Hospital visits and medicines and expenses for buying alcohol for himself and friends were getting a big deal. One day his wife comes in alone and tells me not to get him better again. He gets better, he goes back to drinking and we lose a lot of money. Let him remain little sick, so that we will somehow earn enough from the store to get through. He will be home and I can work at the shop and provide for all.

After a couple months, after a severe binge, he developed severe alcohol-related hepatitis again. This time, it was worse. His kidneys were injured. The family denied admission. They had no money to spare. It would have to come from the daughters education, the mother had kept aside. They lived very far. Almost 400km from where I worked.

For the next 2 weeks, I regularly prescribed medicines, made suggestions to reduce symptoms and comforted the family over phone, while Paul was treated at home. A good physician nearby their home would administer antibiotics and fluids to Paul as he got sicker.

Paul died at home on the 18th day after I diagnosed him with recurrent alcohol-related hepatitis.

Three months after his death, his wife came all the way to visit me, on Paul's birthday, to give me sweets. Three Laddus. One from her and two from the daughters. Because I never stigmatized her or Paul. I did not make her look like a failure. I never blamed her or Paul for his disease. I never shouted at Paul for his behaviour. They were free now. The girls went to school and the wife was now running the shop well.

But all I could think about, was that fourth Laddu. The one I never received from Paul, because he died. A woman lost her husband, two bright young children lost their father. All three lives broken and a void that can never be filled.

I never advise anyone to even consume alcohol occasionally even if they are in the pink of their health. I don't advise alcohol in moderation. I don't, because I have post traumatic stress disorder from seeing families get shattered into a million little pieces due to alcohol.

[TheLiverDoc™ @theliverdoc]

Tips for liver health in six minutes

Full video link:
The Liver Doc x BeerBiceps on The Ranveer Show: Episode 1
https://t.co/LFGlHHHJPw

[Elon Musk @elonmusk]

Starship will make life as we know it multiplanetary for the first time in Earth’s ~4.5 billion year existence

[TheLiverDoc™ @theliverdoc]

Dr. Pal gets it wrong again and in the process, disparages mothers who opt for C-section instead of normal vaginal delivery

I am a gut microbiome clinical researcher.
https://t.co/sDs0dwkLzG
And it is my duty to correct health misinformation especially if it falls in my domain

Claims:
1. Vaginal delivery improves gut bacteria in babies rather than C-section delivery
2. Babies born through normal vaginal delivery have better future health (as in less obese) than those born through C-section

Does that mean moms opting for C-section are to be demonized for their kids poor health in the future?

Absolutely not.

This is misinformation.

Response:
1. Two new findings:
(a) Older studies mention that babies born through vaginal delivery have different bacterial profile when born through C-section. That is the microbiomes of C-section babies look a lot different from those of babies born vaginally. But the impact of this on future health of babies remain unclear - meaning there is no signficant impact on babies health in this context. But new studies have shown that whether born naturally or via Cesarean section, babies receive essential microbes from their mothers. So dont worry about the type of delivery.
"While cesarean-born babies do receive less of their mother's gut microbiome during birth, they make up for this by drinking their mother's microbes in breastmilk."
https://t.co/4rxddTdV6l
The study found that about 80 per cent of C-section-born babies had hospital-acquired bacteria in their guts when they were born, compared with 50 per cent of vaginally born babies. But by the time the babies were weaned at the age of around 6 to 9 months, these differences had largely disappeared. And all the babies were healthy, so the researchers can’t tell if there are any implications for health.
https://t.co/plm1hywdSF

(b) But hear this out - New research suggests that exposure to the vaginal microbiome during birth may not influence babies' gut microbiome as has long been assumed. A new study conducted by a team of Canadian scientists has revealed that the composition of the mother's vaginal bacteria has no significant influence on the bacteria composition found in infant stool during early life.
https://t.co/btbEAbZIFv
"It does not appear that exposure to maternal vaginal microbiota at the time of vaginal birth establishes the infant stool microbiome", - Dr. Deborah Money, Professor of Obstetrics, University of British Colombia
https://t.co/PYY93UVsaH

2. There is ABSOLUTELY NO link between C-section deliveries causing obesity later on in life. This has been debunked by well-designed studies recently. And there is no proof that the changes associated with gut bacteria due to C-section vs vaginal delivery promotes obesity in kids in the future. Absolutely none.
https://t.co/dmY0fByn2Q and https://t.co/S0DLMrCb9r and https://t.co/OC6Af5q0gU

A woman wants C-section vs normal vaginal delivery? It is her choice. And then there are medical reasons to opt for C-section too. C-sections is all fine. So my dear ladies, please dont get gas lighted into feeling sorry for yourself. You take care.

[TheLiverDoc™ @theliverdoc]

This absolutely dangerous idiotic reel has almost 100K likes on Instagram

Alcohol normalizing videos are a whole level of stupid, but this Amul man-baby and his video wins the Stupid Internet of the Year Award 2023

Please don't drink alcohol
There is no safe level of alcohol that benefits health

Most importantly, please don't mix alcohol with your pre-workout, it could give you a cardiac arrest

And more importantly, please don't make such stupid videos

Alcohol increases blood flow because your body is under stress to throw it out of your body

If this guy is your trainer, please dump him

If you are still following this guy, even after reading this post, then your are the idiot, not him.

[TheLiverDoc™ @theliverdoc]

This is a very important point.

As a physician caring for the sickest group - critically ill cirrhosis patients on a daily basis, this is a difficult but daily decision that I have to painfully take, mostly because the majority of my patients in the ICU are young males (25 to 40 years) with alcohol related liver disease, many of them requiring life support.

One, it is not easy to let go of a young patient, especially when they have a young wife and very small children and especially if they are the sole bread-winner. The family collapses. It is a descent into hell for them. You wont realize it because you are on a 9 to 5 job. But it does happen.

Two, it is not easy to lead the grief-stricken but financially burdened small family to make a decision of letting go. It is never easy. I have been doing this for decades, but trust me, it is always as difficult as it was the first time. In India, unfortunately, we have to choose between saving a patient's life and saving their money most of the time. And it is a harrowing and unfair comparison. Money matters. All the time. Because we do not have a system that rightfully promotes equality in healthcare.

Three, in India, most doctors, have not yet learned the art and care of "letting go." Empathetically letting go off a critically-ill patient is devastating, but also a rationally important aspect of clinical medicine.

Where medical science ends, wholesome empathy begins. There is a clinical medicine which does not feature any drugs or protocol. It features only care, love, empathy, concern, worry; and blood, sweat and tears. It is the most powerful aspect of clinical medicine and it is called "Palliative Care"
- people normally call it palliative "care" and not palliative "medicine" for a reason.

It is the branch of medicine that lets doctors know that we are humans first and everything else later. Every doctor, from the MBBS student to the superspecialist MUST learn the art of palliation.
It is mandatory. It is a worthy bittersweet symphony.

Because initiating palliation and discussing palliation options does not mean medical science lost, but humanism won.

A large number of hospitals make money by milking critically ill patients. This is blood money. If you cant save a life, move on to saving the rest of the family by engaing with them with empathy and helping them being financially stable, instead of leeching out their resources.

Lean to call the right shots for your patient and family and not for yourself or your hospital.

I wrote about palliation in cirrhosis with my senior Dr. Chandankumar recently. Young hepatologists and fellows in hepatology or critical care doctors may please read this if interested:
Palliative Care for Patients with End-Stage Liver Disease via @JCEH_Hepatology
https://t.co/rPfpaf931m

[TheLiverDoc™ @theliverdoc]

Things that your liver will love you to do*

1⃣Brisk walk at least 150 minutes a week
2⃣Run at least once a week
3⃣ Black coffee, no sugar, 3 cups a day
4⃣Avoid alcohol (including Homeopathy) & tobacco
5⃣Sleep for at least 7 hours in a day
6⃣Avoid herbal supplements
7⃣Get your hepatitis B vaccine shot/booster
8⃣Limit added sugars & ultraprocessed food
9⃣Avoid sugar sweetened beverages
1⃣0⃣Lose weight
1⃣1⃣Follow a Mediteranean diet (sans alcohol)
1⃣2⃣ Whole eggs - 5/wk in cardio-metabolic disease
1⃣3⃣Whole eggs - 7/wk if no cardio-metabolic disease
1⃣4⃣ Include fermented food portions in daily diet
1⃣5⃣Listen to real clinical doctors

*based on published scientific evidence

[SpaceX @SpaceX]

Starship’s hot-stage separation was the first time this technique has been done successfully with a vehicle of this size