Mathew John

Caring for a person with type 2 diabetes is quite stressful. As the duration of diabetes increases and comorbid conditions like kidney, eye and heart disease set in, it becomes tougher. (1/5)

Hyderabad-based paediatrician Dr. Sivaranjani Santosh on Wednesday (April 1, 2026) defended her campaign against certain electrolyte drinks, alleging that misleading branding and high sugar content in products such as ORSL and its rebranded version ERZL pose a risk to children’s health, reports @The_SidSingh thehindu.com/news/cities/Hy…

Flu vaccine: Who needs it, how often, and is it worth it? 1. Who should take it? Annual influenza vaccination is recommended for: 🔸Elderly (≥60 years) 🔸Children (6 months–5 years) 🔸Pregnant women 🔸People with diabetes, asthma and heart Disease 🔸Healthcare workers Ideally, everyone benefits, but these groups benefit the most 2. How often is flu vaccine needed? It is recommended to be taken once every year. This is because: 🔸Flu viruses keep changing 🔸Immunity wanes over time ✅In India, the best time to take is April–May (before monsoon peak) 3. Which flu vaccine is the best? There are two options: 🔸Trivalent (protects against 3 strains of flu viruses) 🔸Quadrivalent (protects against 4 strains) ✅Quadrivalent vaccine is preferred because of broader protection. ✅All approved vaccines are effective and safe. Brand matters less than getting vaccinated on time. 4. What are the side effects of this vaccine? 🔸Side effects are usually mild, which include injection site pain, low-grade fever and body ache. 🔸Serious reactions such as immune-mediated complications are very rare. 🔸Vaccine does NOT cause flu 5. Who should avoid or delay? 🔸Severe allergy to previous flu vaccine 🔸History of severe allergic reaction to components 🔸Moderate–severe acute illness → delay, not avoid Flu vaccine is safe in pregnancy and most chronic diseases. 6. Why should one take flu vaccine? 🔸Flu is often a mild illness, but it is NOT always “mild”. 🔴Severe flu can result in hospitalization including mechanical ventilation and ICU care, worsening of chronic diseases, and can even result in myocardial Infarction (heart attack) in high-risk individuals. Bottom line: 🔸Annual flu vaccine is a simple, safe, underused protection. 🔸Flu shot is not just about flu, it is about preventing complications. Dr Sudhir Kumar @hyderabaddoctor

Indian Consensus Guidelines on Adult Immunization 2026 Update 🔹 Adult vaccination in India remains a major missed opportunity, despite excellent gains in pediatric immunization. Adult coverage for influenza, pneumococcal and hepatitis B remains alarmingly low. 🔹 This 2026 update simplifies adult vaccine practice by grouping patients into 12–18 years, 18–49 years, and ≥50 years, with added focus on at-risk, high-risk, immunocompromised, lifestyle-related, pregnancy, and special situations. 🔹 Every adult visit should become a vaccine review visit. Prevention should no longer be restricted to childhood schedules alone. High-impact practice takeaways 🔹 Influenza vaccine should be annual for all adults, especially older adults, pregnancy, diabetes, CKD, chronic heart/lung/liver disease, and immunocompromised states. 🔹 Pneumococcal vaccination is now much simpler: Use single-dose PCV20 for all adults ≥50 years and for 18–49 years with risk factors/comorbidities. 🔹 Tdap/Td remains underused in adults. Give one Tdap in adulthood, then Td/Tdap every 10 years, and one Tdap in every pregnancy (27–36 weeks). 🔹 Hepatitis B vaccination should be strongly considered routine adult preventive care, particularly in diabetes, CKD, dialysis, liver disease, HCPs, and high-risk adults. 🔹 Shingles vaccine is no longer optional thinking in older adults. Recombinant zoster vaccine is recommended for all ≥50 years, and earlier in selected high-risk individuals. 🔹 COVID-19 vaccination remains relevant in adults, particularly during pandemic/local epidemic settings, and should continue to be prioritized in older adults, obesity, and comorbidity clusters. Special populations matter 🔹 Diabetes is now clearly recognized as a vaccine-relevant condition. Core adult vaccine basket in diabetes includes: Influenza, Pneumococcal, Tdap/Td, Hepatitis B, COVID-19, Shingles, and selected MMR/Varicella/HPV where indicated. 🔹 CKD, dialysis, transplant, malignancy, HIV, rheumatologic disease and immunosuppression need structured vaccine planning, not opportunistic prescribing. 🔹 Pregnancy is a key window for prevention. Routine focus should include Influenza, Tdap, COVID-19, and Hepatitis B when indicated. 🔹 Healthcare professionals must be fully vaccinated, not only for self-protection but for patient safety and institutional infection control. Practical India-focused message 🔹 Adult immunization should now be treated like BP, HbA1c, and lipid review—a standard part of chronic disease management. 🔹 If the patient has diabetes, CKD, CVD, CLD, COPD, cancer, transplant, or age >50 years, think vaccines proactively—not reactively. 🔹 In Indian OPD practice, the “Big 6” to routinely think of are: Influenza, Pneumococcal, Tdap/Td, Hepatitis B, COVID-19, and Shingles. Bottom line Adult vaccination is no longer preventive luxury — it is standard chronic care. Source: Indian Consensus Guidelines on Adult Immunization 2026 Update

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I am Dr. Sivaranjani, a pediatrician , raising concerns about how ERZL is being marketed and positioned in pharmacies, and the risk it creates for consumers making critical decisions during dehydration. This issue is not about whether ERZL is safe in isolation.
It is about how it is presented, perceived, and potentially misunderstood in real-world settings. ERZL is a commercially marketed electrolyte drink. However, its branding and advertising raise serious concerns. *It should not be using ORSL in its communication.* Why? Because: * ORSL itself is not the original medically recommended ORS * Referencing ORSL in any form creates brand recall in the minds of consumers * Instead of reducing confusion, it continues and reinforces it When ERZL is positioned as a continuation or replacement of ORSL, it keeps that same association alive — especially among parents who may already believe ORSL was equivalent to ORS. 👉 This defeats the very purpose of regulatory action. In pharmacy settings: * People are often making quick decisions under stress * They rely on familiar names and visual cues * Branding can directly influence what they choose If ERZL continues to build on ORSL recall, it risks being perceived as a medical solution for dehydration, even when it is not the same as ORS (the medically recommended solution). There are also concerns around ingredients like sucralose, especially in children and with prolonged use, based on global health guidance. This makes clear communication even more important. After raising these concerns, I have received a legal notice from Johnson & Johnson and Kenvue. This petition is not about conflict. It is about: * Clarity in healthcare communication * Preventing consumer confusion * Ensuring responsible branding and advertising * Allowing doctors to raise public health concerns without hesitation We urge the Food Safety and Standards Authority of India and the Ministry of Health and Family Welfare to: 1 *. Ensure that, since ERZL closely resembles ORSL, Kenvue is directed to rebrand it in a way that does not create recall or association with ORSL.* 2. Prevent misleading positioning that may confuse consumers 3. Strengthen enforcement at the pharmacy level 4. Ensure clear differentiation from medically recommended ORS 5. Protect healthcare professionals raising genuine concerns In healthcare, even small confusion can have big consequences. Clear choices save lives. @fssai @JPNadda @MoHFW_INDIA @narendramodi Stand for public health. Sign and share this petition to help protect every family from confusion in critical moments. c.org/4wzT58q4wN

What happens when a patient on semaglutide progresses to dialysis — do you stop it? 📢New pooled RCT analysis (SUSTAIN-6, SELECT, FLOW, SOUL; n=34,064) finally addresses this clinical gap. 📈307 patients initiated dialysis 🟢165 stayed on treatment 🔴SAEs: 45% (sema) vs 57% (placebo) 🫀MACE rate: 9.7 vs 16.1 per 100 PY ☠️All-cause mortality: 13.8 vs 18.1 per 100 PY ✅ Numerically favourable across the board. Continuation appears safe — not powered for efficacy, but reassuring for a question we face regularly. 🏁A dedicated trial is still needed. doi.org/10.2337/dc26-0…

Presented at #ACC26: Among patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level below 55 mg per deciliter led to a lower 3-year risk of cardiovascular events than targeting a level below 70 mg per deciliter. Full Ez-PAVE trial results: nejm.org/doi/full/10.10… Editorial: Paving the Road toward Targeted Lipid Lowering nejm.org/doi/full/10.10… @ACCinTouch

Pls, your lives are so precious! You are your parents life line! Pls do not throw away your lives! Yes. Being a medical student is very tough, and it gets tougher when there is this toxic culture of humiliating students/residents. Pls, FAIMA is working towards making it better for you! Pls reach out to the 24×7 helpline if you are feeling low or if you are being harassed! Do not throw away your precious lives! Hang in there! We are all there for you. Please! #harassment #medicalcolleges #suicides #FAIMAhelpline #parents

Dr. Sivaranjani got a court case! For 8 years, Dr Sivaranjani has been raising concerns about fake ORS! Last week she got a court case from one such company. Companies in India spend crores on lawyers and Bollywood celebrities. Imagine if they instead spent on good quality ingredients as well? This is not just a court case on Dr. Sivaranjani, this is also an attack on freedom of speech. Companies should remember that Freedom of Speech allows Freedom to Criticize. Share this video to support @dr_sivaranjani and help this reach more Indians.

Tired, but not giving up! Pls download and share before there is a gag order on me. Thanks to @IndiaESI (who also impleaded in my PIL against misleading branding of sugary drinks as ORS), @FAIMA_INDIA_ , HRDA Andhrapradesh, HRDA Telangana, MARD Thane, MARD Nagpur, Junior Doctor's Association Ahmedabad, Telangana Junior Doctor's Association, Junior Doctor's Association Ranchi, T-SRDA, GARD, Telangana Doctor's Forum, RDA Aligarh, RDWS UP, IMA Telangana State, IMA Hyderabad Airport, Endocrine Society of Telangana, Indian Doctor's and Dermatologists against quackery, for condemning the notice of Johnson&Johnson and Kenvue in which they accused me of disparaging them for my commercial benefits and views! Thank you for staying by my side! Grateful!

Recently my son asked me why he needs to do mental math when calculators exist. I told him if he doesn't, he will make irrational decisions throughout his life. Let me explain. Say you see two packs of snacks. A 500g pack for ₹100, and a 200g pack for ₹45. Which one should you buy? The math is not at all hard, but people who are scared of mental math will not do it. This is not such an important decision that you pull out a calculator for it. So you make the decision on vibes - say ₹100 "looks too high", or that the smaller pack costs "less than half of the biggest one" or some such. The problem isn't that you made a poor decision on snacks. It is that if you do this repeatedly, you train your mind to make decisions on vibes. Over time your reasoning muscle atrophies - so you start relying even more on vibes. Before you know it, you are taking even big decisions on vibes. Should I rent or buy a house? Let's decide based on "EMI affordability", not rental yield. Should I invest in this IPO? I have heard of the company's brand so I'm all in. It isn't only financial or quantitative decisions either - in my mind the math muscle and the logic muscle are closely correlated, so a decline in one certainly affects the other. Like the Arab who let the camel's nose inside the tent, fear of math is the first step towards thoughtlessness, and needs to be nipped in the bud. Intellectual laziness starts with snack prices.

Some Good News.. Glad to be elected as the Chair, Education Working Group of the International Society of Endocrinology. Its an Honor and a Responsibility, looking forward to contributing together as a working group to the broader goal of advancing endocrine education globally :) @IndiaESI @EndoBrigade @Rssdi_official @IMPA_12 @SAFES_endocrine @IdecPune @SAobesityforum

The critics of GLP-1 and next-generation obesity therapies have a data problem. Semaglutide and tirzepatide didn't earn their place in the NEJM and Lancet through anecdote—they did it through rigorous RCTs with hard endpoints. Tolerability concerns and discontinuation narratives are worth examining, but that scrutiny should be applied evenly—including to the financial relationships of those doing the examining. Meanwhile, patients are losing weight, reversing comorbidities, and coming back to the clinic asking for more. That's not marketing. That's medicine. The debate about whether these therapies matter is over. The only question left is whether you're going to be part of delivering them well—or watching from the outside while others do.

Retraction—Today, we retract an unsigned 1977 commentary suggesting talc powder containing asbestos was not harmful. The Lancet was informed that the author had undisclosed competing interests and breached publication ethics. /4

@karthik2k2 I have tried to practice this gradually. I decide at the start of consultation 1 vs 2. Thank you for putting it in words.

Just like your X feed it’s not hard to curate your clinical practice. You just need two steps 1. Go the extra mile for the good patient 2. Do the standard of care for the problem patient Make sure you keep conversation sterile, and absolutely robotic. The problematic ones thrive on drama and chaos. Fight the urge to entertain that. Once they realize drama is not on offer, they will find a new doctor. You may see fewer patients, but you will find peace ✌️

It is preferable not to do tests which you cannot interpret.

9/ The most important shift? Prescribers must move from a glucose-centric mindset to a complication-centric one — treating cardiovascular, renal, and hepatic risk, not just HbA1c. Affordable price is the headline. Safe, consistent, educated delivery is the real story. 🎯 Thank U

8/ Semaglutide is not a "prescribe and forget" drug. It demands structured patient counselling, side-effect management education, and dietary guidance — at every initiation.

3/ Generic doesn't mean unregulated. Mandatory batch-to-batch testing for impurities, stability, and temperature excursions must be enforced — not assumed. Regulators, welcome.