Deepak Kumar

abracadabra gili gili chchoo

[Deepak Kumar @meDKumar]

@b50 @NetflixIndia I saw glimpses of Roshesh too, from Sarabhai vs Sarabhai

[Deepak Kumar @meDKumar]

@grok @GoodRecom Sorry but even this is not the one. Try again

[Deepak Kumar @meDKumar]

@grok @GoodRecom No grok, it's not. Please try again

[TheLiverDoc™ @theliverdoc]

STAY WITH ME.

A few years ago, a patient was referred to me because he was diagnosed with complicated cirrhosis. He had an infection which led to a condition called hepatic encephalopathy (brain failure due to high ammonia levels). The treatment largely involved ammonia reducing therapies. One drug was central to this - Rifaximin - a non-absorbable antibiotic that reduced ammonia in the body. I prescribed him Rifaximin for 6 weeks and advised him follow-up.

He came back to me, not after six weeks, but in 4 weeks, this time, in liver coma (worst stage of brain failure - due to very high ammonia). He spent two days in the ICU and six days in total in the hospital. His hospital bill was close to INR 80,000. He had no insurance and his wife borrowed the money from neighbors and friends to clear hospital dues.

Upon questioning, I found that he was not taking the Rifaximin drug I had prescribed. He was only on the other two drugs (one, a syrup called lactulose for improving ammonia clearance in gut). I was furious, because the patient spent a whole week unecessarily in the ICU and wasted so much money that he never had - just because he was "not compliant" to my orders. I decided it was time for me to school him a bit.

But I was wrong. He was compliant. He had purchased Rifaximin and was on it. For 15 days. Thereafter, he could not afford it. He was an autorickshaw driver who shuttled school children every morning and evening. He could hardly make ends meet. He had two children of his own. The Rifaximin brand I prescribed him was 42 rupees per tablet. He had to consume two a day - which would mean 2520 rupees a month. He just did not have that money - so he skipped it - to not compromise on other important matters - childrens education and food.

He was confused and scared about opting for a cheaper version of Rifaximin because one, he was unsure about the quality of Rifaximin that was not prescribed by me and two, he was "scared" that I would scold him for buying a cheaper Rifaximin and if that got him into trouble.

I was confused and scared about prescribing a cheaper version of Rifaximin because one, I was unsure about the quality of Rifaximin that was not "a good promoted brand" and two, I was "scared" that his family would scold me for prescribing a cheaper Rifaximin and if that got him into trouble.

It is heartbreaking that many doctors still simply don’t trust generic medicines. Too often, they worry that these cheaper options are lower quality or might cause more problems than the big, famous brands. This fear leads them to prescribe expensive drugs instead, and the real tragedy is that it pushes vital healthcare out of reach for the ordinary people who need it most - like my patient.

This narrative, that generic drugs 'are never good' and that only big pharmaceutical marketed drugs are what works has been deeply ingrained into doctors and patients alike - I do not know by whom and since when. Looking back, these strong emotions were based on either opinions, testimonials or second- and third-hand information. Not evidence.

Like I said. Stay with me. This is life changing and will disrupt the drug market in India. Here are the results of The Citizens Generic vs. Brand Drugs Quality Project.
1/11

[Deepak Kumar @meDKumar]

@AnupamPKher Anupam "Khet" 😀

[Deepak Kumar @meDKumar]

@thesatbir khichdi ke yaar kidhar gaye! chokha papad ghee aur achhaar.
kisi shanivar ka nyota sweekar kijiye humara, swad khichdi banti hai.

[Deepak Kumar @meDKumar]

@Sony @sony_india deeply disappointed with your service.
taking this up on SM after having spent almost a month for resolution.
#customercare #sad and #Sony #degrading
Time to move to a new brand.

[Deepak Kumar @meDKumar]

@Saurabh_MLAgk bhai Saab. Urgent and emergency situation in Vasundhara enclave. ek week se sewage overflow ho chuka hai aur DJB kuchh Hal nahi nikal paa rahi. Kuchh kijiye. Drinking water is also contaminated. Entire society is flooded with filth. @DelhiJalBoard

[Akshat Shrivastava @Akshat_World]

On 4th June the markets had fallen. Many Retail Investors placed orders for their Mutual Funds before 3pm.

The NAV allotted to them should have been for 4th.
But, they got their Mutual Funds allotted based on NAV on 5th.

This robbed them of their rightful gains.

I thought this is some kind of anomaly. And, maybe it happened with a handful of people.

But, when I checked within my investment community: I was surprised to see the extent of this problem.

Just bringing to everyone's notice.
But, no one literally stands up for small guys.

[Deepak Kumar @meDKumar]

@SiddharthKG7 pehle jahan lage huye hain unko to chalyein. aksar band hee rehte hain. even on the Capital's stations.

[TheLiverDoc™ @theliverdoc]

🚨Breaking🚨

We have a new paper published on something very important and I would like to simplify it for you. But before that, you have to understand something bittersweet about this strange but devastating, not so uncommon disease.

A few years ago, two young women came to my OPD and told me that their father was not "a mad person" like everyone else was claiming. Over the course of few months, he was home-bound, then bed-bound and people around him finally realized that he had gone "full cuckoo" and let him be. Except his daughters. They knew their father so well, to understand that there was no way he could behave like a bipolar-maniac like the psychiatrists they were showing him to claimed. According to them, he was a sweet, brilliant man, and he could not have a psychiatric disorder in a years time that incapaciated him. I believed them, and took his case up.

This was not an isolated incident. A young graduate from Bangalore visited me because his father was unable to make calculations and kept forgetting things around the house and would burst into anger spells with the mother and son. Neurologists and psychiatrists diagnosed him with dementia disorder with psychotic symptoms. He worsened rapidly. He was a maths teacher at a prominent university and there was no way he could get his calculations wrong.
I believed the son and took his case up.

Another man, a son, rushed his father into the emergency one day. He was behaving strangely and he defecated in front of his family on the dinner table. He suddenly became abusive and then went into a state of confusion, progressing to coma. Elsewhere, they told him it was a stroke and he could not get better. But the son could not believe it. I believed him, and took his case up.

In 2020, a group of researchers across the world, saw many children with autistic symptoms, managed as autism, and various psychiatric illnesses - depression, anxiety, hyperactive disorders. But their parents believed that there was something more to it and the diagnosis of autism in their children was more than meets the eye. So they took them to various doctors, finally ending with liver specialists. The parents believed that their children were not autistic. The doctors believed them and took their cases up.

All these patients had one common disease. It was called portosystemic shunt syndrome or PSS - a condition that causes blood from the portal circulation (intestines, spleen and liver) to bypass the liver and flow directly into the systemic circulation, through a large, abnormally developed vein, called as shunt, leading to high ammonia levels in the body, that affects brain functions and lead to a host of neuro-psychiatric symptoms leading to various misdiagnoses.

It may or may not be associated with cirrhosis. In the group of children with "supposed" autistic disorder, there was no cirrhosis and it was a congential disease (from birth) - called Abernathy Malformation.
https://t.co/vNbZZ2fyqB

The treatment is simple. Close/block that damn shunt - through a simple, angiographic/radiological procedure called "shunt embolization". And we did.

The two daughters got their father back. He was not a "looney" anymore. They went for family trips together and attended weddings of their cousins. The father of the young man from Bangalore went back to getting his calculations correct. He was never angry. The man who defecated in front of his family and came in a coma to my ER, went back home walking after two weeks. He was never told what he went through, but his family is still trying to forget that which they witnessed [https://t.co/b6yUDPgE6x].

And all the kids, diagnosed with "autism" and "psychiatric diseases" woke up the next day as different little people, seeing the world differently. They were not autistic anymore. This is what timely diagnosis and shunt block does, in this dreadful disease...

- a reminder to doctors: "The good physician treats the disease; the great physician treats the patient who has the disease." - Sir William Osler.

Our unit, arguably performs the maximum number of shunt blocks in India, which is life changing for many patients. And @SRajesh_IR is the expert in it. We also have the largest number of publications on this from the country.

We did the largest series first [https://t.co/9xS6YOsMSY], followed by a larger series on early vs late shunt block [https://t.co/jS1IBV9qEw] and now we have this new paper that shows how to predict clinical outcomes in those undergoing shunt block in cirrhosis based on liver pressure variables - something very novel and new in medical literature.

Thank you for reading. Please share this so that other (especially doctors) will know about this disease entity that hides in plain sight.

Please read the new full paper here: https://t.co/CkuzagOv7P

#livertwitter #MedTwitter

[Deepak Kumar @meDKumar]

@ovshake42 you would see Wamiqa in The Jubilee on Prime. she is amazing

[Deepak Kumar @meDKumar]

@humansofny @ramkid we have always loved what you do Brandon.

[Mini Nair @minicnair]

South Delhi and Bangalore South are the most richest and educated constituencies of India.
They both elected Ramesh Bhiduri and Tejasvi Surya.

Education and Money cannot wash away bigotry.

[Deepak Shenoy @deepakshenoy]

This is HUGE! RBI says banks and NBFCs have to release documents of properties and collateral mandatorily within 30 days!
* Have to remove encumberance within 30 days, and return docs
* Docs can be returned from any branch, not just home branch of customer
* Loan docs must mention where the borrower can get them back once he repays
* If the bank/NBFC doesn't return docs or release the encumberance charge within 30 days - they pay 5000 rs. per day of delay
* If bank/NBFC loses the docs - they will pay and assist owner in getting docs back or attested copies (but they get another 30 days i.e 60 days before the 5K per day penalty, only if they lose the docs)
* If the loan taker dies, Banks/NBFCs need to have a detailed procedure on how heirs can get original docs.

Applies for even past loans where full repayment happens after December 1, 2023.

This is awesome for homeowners who borrow, but also for collateral based lending like for cars, securities and all the other stuff. And applies to NBFCs also, so housing finance companies can't escape.

[Cricket🏏Netherlands @KNCBcricket]

If you can bowl and want to be a part of the team's ICC Men's ODI World Cup 2023 preparations, then head over to the link below and upload your video

https://t.co/cQYjcW7bQq

[Deepak Kumar @meDKumar]

@iamsrk #jawan #AskSRK ek sawal tha, ye picture dekhte huye popcorn khane ka time milega kya?

[Nimish Dubey @nimishdubey]

Just a reminder of what the atom bomb did.
A boy wait for his turn at the crematorium at Nagasaki in September 1945.
The dead body of his baby brother strapped to his back.
The photographer's description of the scene will always haunt me...

[The Paperclip @Paperclip_In]

Take a close look at this photograph. A slice of colonial India where Indian servants used to diligently sway Punkhas for their British ‘masters’. But, why aren't they pulling the ropes with their hands? Sit back as we unravel some intriguing history. Thread. 1/15