Pranjal Agrawal, MD, MPH

@hyderabaddoctor The nails were response to an acute illness, and will recover on their own in typically about 3 to 6 months. The cycle for nail and hair growth is delayed by 3 to 6 months

When a Little Toe Moved Menaka was 25. She had just started her dream job at a leading technology company. A bright B. Tech graduate from a reputed college. Her parents were proud. She was excited. Life had just begun to unfold beautifully. Two weeks before everything changed, she had a mild fever. It lasted three days. It was labeled a “viral fever.” She recovered and moved on. Then, suddenly, over just two days, she became weak. First her legs. Then her hands. Then she could barely move. By the time she reached a nearby hospital, her condition worsened dramatically. She became unresponsive. Her breathing failed. She was intubated and placed on a ventilator. That was when she was referred to us. MRI brain, MRI spine, and cerebrospinal fluid analysis pointed to Acute Disseminated Encephalomyelitis (ADEM), a rare, immune-mediated inflammatory condition of the brain and spinal cord. It often follows a viral infection. The body’s immune system, instead of settling down, mistakenly attacks the brain. And in Menaka’s case, it was fulminant. We had very little time. We explained everything to her family; the diagnosis, the uncertainty, the risks. She was deeply comatose. We started high-dose intravenous steroids, the standard first-line treatment for ADEM. Five days passed. There was no improvement. In fact, she worsened. Her parents sat outside the ICU, waiting for hope in every footstep that came toward them. We decided to escalate treatment. Plasma exchange (plasmapheresis), a procedure that removes harmful antibodies from the blood, is recommended in severe, steroid-refractory ADEM. After the first session, something extraordinary happened. Her little toe moved. It was subtle. Almost invisible. But we saw it. Her eyes opened briefly. She was not following commands. She was not making eye contact. But we knew, something had shifted. With each plasma exchange session, there were small, fragile signs of improvement. Every morning during rounds, we spoke to her. “Menaka, open your eyes.” Silence. “Menaka, move your hand.” Nothing. After rounds, the hardest part was facing her family. Telling them, again and again, that she was still deeply unconscious. Watching hope struggle against fear in their eyes. Two weeks passed in the ICU. She was still on the ventilator. And then, one morning, during rounds, I said, “Menaka, open your eyes.” She opened them. “Raise your hand.” Her fingers trembled. Just slightly. But they moved. That was enough. I walked out of the ICU faster than usual that day. Her parents were standing there. I said only one sentence: “She responded.” The relief on their faces, that mixture of disbelief and gratitude, is something no textbook can teach. Over the next two weeks, she gradually improved. She was weaned off the ventilator. She was discharged with significant limb weakness, but alive, conscious and recovering. We advised intensive physiotherapy and rehabilitation. One month later, she walked into my OPD. Not in a wheelchair. Not on a stretcher. Walking. I asked, “What problems are you facing now?” She looked thoughtful and said, “Doctor, my nails are dark. They don’t look nice.” “Anything else?” “No, Doctor. I am absolutely fine. I want to rejoin office, but I feel awkward with dark nails. Can you give me medicine for that?” In that moment, I realized something profound. A month ago, we were fighting for her life. Now, she was worried about how her nails looked at work. I smiled and said, “There is a simple solution. Apply nail polish. Any color you like. You can even change it every month.” She smiled widely and freely, the kind of smile that belongs to someone who has unknowingly crossed the edge of life and come back. And I felt something every doctor knows but rarely speaks about: There is no greater reward than seeing a patient and family smile after surviving what once felt impossible. Sometimes recovery announces itself loudly. Sometimes it begins with a little toe. Dr Sudhir Kumar @hyderabaddoctor (Note: The name has been changed to protect privacy. Image is AI-generated)

Science just got sidelined. This isn’t about vaccine safety or restoring confidence —it’s about political agendas endangering public health. We should all be alarmed.

In India, doctor bashing is a political sport because doctors are considered "rich looters" since the public feel that increasing general consultation fees by 100 rupees is catastrophic... ...when this so-called health minister arrived in a ₹10000000 Range Rover along with the media to fire the CMO of a public hospital... ...all because the senior doctor who I was told is a gentleman and highly efficient, asked a patient to get a vitamin B12 injection from the outpatient day care service and not emergency services because a vitamin B12 injection was never an emergency. If there is a species that can be considered scum of the universe, it's politicians of India who dehumanise doctors in front of the public for optics. And the joke is on us because we elect these buffoons to serve us.

@DGlaucomflecken You do real Ophthalmology too!! I thought you were just a comedian. J/k, I love your personality

Pterygium

Eye diseases caused by sunglasses: None, obviously Eye diseases caused by the sun: 🧵

ABIM must wake up to the realization that doctors carry a smart phone computer with them. We work in teams. We have colleagues who we can consult for rare disorders and when doubts arise End MOC. It’s useless. CME, maintenance of licensure & credentialing is enough.

This is the craziest report you will read today. Last year, a professor and dean at a university in Spain suddenly began publishing papers with a multitude of far-flung researchers. His coauthors, until then exclusively national, now came from places like India, China, Nepal, South Korea, Georgia, Austria, and the United States. A company called iTrilon run by [Dr.] Sarath Ranganathan from Chennai, India created multiple research papers based on faked and plagiarized data and sold author positions to many senior clinicians and researchers across the globe. Based on these publications, many clinicians and researchers procured promotions in their respective universities and institutes. A 6 month investigation by @RetractionWatch has uncovered this large "Paper Mill" from India catering to struggling clinical researchers on a pay per article for author position basis. First and corresponding author positions were most expensive. Paper Mills also bribe editors of middle level and dubious journals to clear peer review without scrutiny. India is now becoming a shady place for the business of research and healthcare and it is just shameful that this is happening in a country which has a great good to contribute towards clinical research. retractionwatch.com/2024/01/18/exc… science.org/content/articl…

The Cabinet has approved the construction of a new 6-lane bridge across River Ganga, connecting Digha and Sonepur in Bihar. This project will boost connectivity, spur economic growth and benefit lakhs of people across Bihar. pib.gov.in/PressReleasePa…

US Covid hospitalizations are on the rise, now >20,000 new admits/week, and this wave is just getting started as the JN.1 variant becomes dominant and wastewater levels surging in the Midwest with other regions to follow. The booster protects vs JN.1!

Dear general physicians in India, If you really love your patients, please stop abusing antibiotics for every sore throat and cough you see in your outpatient department. Blanket use of antibiotics for every patient with respiratory symptoms will only create more challenges for our patients, especially those with high risk of multidrug resistance such as chronic liver disease as well as cancer patients. No patient has ever had a deficiency of Azithromycin and Amoxicillin + Clavulanic acid for you to prescribe them like candies. Every purposeless action will have grave reactions.

18-year-old Natalie Raanan from Chicago is one of the U.S. citizens taken to Gaza and held hostage by Hamas. She and her mother Judith were both kidnapped while visiting family members. 🇺🇸🇮🇱

We need to talk about this ☠️Azithromycin and Amoxyclav for every run-of-the-mill viral sore throat ☠️Cefuroxime for every viral cold and cough ☠️Upgrading to Meropenam from Ceftrixone when a single fever spike persists in the wards ☠️Upgrading to Colistin with a single fever spike on Meropenam in the ICU ☠️Starting Ceftazidime and avibactam when patient enters the ICU ☠️Not stopping previous antibiotics but adding on more antibiotics in the ward and ICUs like a domino effect ☠️Not de-esclating or stopping antibiotics on time when body fluid cultures come back sterile ☠️Over-the-counter antibiotic sales without prescriptions 💀Alternative medicine practitioners prescribing antibiotics and antifungals without a clue, when Ayurveda or Homeopathy never had a germ theory ☠️People taking antibiotics unnecessarily and for the wrong indications AND stopping after 2 or 3 pills, that too taken erratically ☠️Irrational and illogical antibiotic use domesticated/ farmed-for-food animals and in veterinary practice ☠️Medical representatives asking doctors to prescribe a new antibiotic because it is better than the rest and more "powerful" without knowing recommendations for use - and ill-informed doctors learning medicine from medical representatives on antibiotics use. 🚨This depressing list is endless🚨 This is a complete human-made disaster that needs reflection from every treating doctor to follow what is necessary to reverse the damage done and to prevent irreversible damage in patients who will one day require life-saving antibiotics. Patients with liver disease and cancer will be the worst hit because of this foolish and irrational antibiotic use. Brace yourselves.

@BijoyTelivala Januvia is the least useful of them all.... the weakest diabetic med!!

Glad to see Eliquis/Xarelto/Imbruvica in the list So many seniors pay ridiculous amount of money for these drugs #medicare #drugpricing #seniors

@VincentRK @ABIMcert @Rfonsi1 I’m increasingly frustrated with it. Last LKA block I wrote them about 3 questions one of which was obviously blatantly wrong and 2 others which were worded incorrectly. Time to just give up on the ABIM MOC sham, it is a relic of another era.

I’m at the point where I will rather quit than do @ABIMcert Longitudinal Knowledge Assessment (LKA) and try to keep ABIM certification active. It’s interfering with patient care and research for me. And I’m getting the myeloma questions wrong. Useless. @Rfonsi1 #MedTwitter

3 cases of Amoxycillin+Clavulanic acid antibiotic related severe drug induced liver injury the last week & all on plasma exchange therapy for severe jaundice All 3 had viral influenza fever & NONE needed antibiotics in the first place When will doctors stop creating patients?

Please stop prescribing Antibiotics for every fever Antibiotics for viral fever Azithromycin for every sore throat Ivermectin for viral infections, esp Covid* B-complex vitamins ALONG WITH antibiotics Probiotics with every antibiotic course** Zinc & Vit.C during flu season***

I think my lab partners may stop taking up my Ayush analysis projects Just received news that their ICP-MS machine's standard column got stressed, had to be sent for maintenance after analyzing Siddha meds Machine went bonkers with the amount of Lead detected in Siddha med 🫤

@BijoyTelivala Unfortunately, common sense has been wrong equally, if not more often than data as well. The best physicians are the ones who use both🙂

There are 2 kinds of #oncologist One who knows all the data The other one who uses what we call Oncology #CommonSense Personally I think the later one do a better job #MedTwitter Very rarely is data is black or white

It is impossible for any doctor to have all the right answers all of the time If you dont know the #answer just tell the patient so tell them that you will try and look it up or direct them to some one who you think might have the answer #MedTwitter

@BillFOXLA @FoxNews Seems bizarre that it’s so easy enter illegally, but so hard to get a legal work visa