Collateral Medical

Today -A proud moment n opportunity for our #medicaldevices sector as 1 major ask over a decade from @MiIAiMeD comes into creation 😄 Many thanks 2 Honble CIM Shri @PiyushGoyal , @DoC_GoI Dept of Commerce,@eepcindia ,#YEIDA @CMOfficeUP & @Pharmadept for supporting our request 🙏🏻

People with persistent irreversible brain disorders come to us as a last resort. And we re-diagnose them. We turn their original diagnosis upside down and treat them. The brain disorder reverses. Patients get their lives back. New episode #MustWatch youtu.be/NJWos8prZhI?si…

@theliverdoc Congratulations on the well deserved award

Dear friends, some good news! I won the 2024 ISG-IJG National Prize - Best Paper Award from the Indian Society of Gastroenterology (ISG) and Indian Journal of Gastroenterology (IJG) for our basic science paper published in 2022, on the gut microbiome and its association with clinical events in patients with severe alcohol-associated hepatitis. This is the second time my group has won this award. The first one, given in 2020, was given for our seminal and pathbreaking, foremost work done in 2018, on Ayurvedic medicines and liver injury. Our DrNB Gastroenterology and Hepatology fellows received the award on my behalf at the 2024 ISG Annual Meeting at Varanasi this week. I am glad to see our hardwork bear fruit and be recognized, and for the fantastic clinical and research team that I have the pleasure to work with.

I just f**king love how the @BBCOne destroyed the "social drinking is pretty much ok" myth with this fantastic narrative which is only a bit over 60 seconds. We need more of this. Much more. Featuring marvellous Hepatologists from across the UK including Prof. @DebbieShawcros1 Remember. A woman can get severe liver disease with lower limits of alcohol use than men. It's not the liver disease I'm worried about, it's the terrifying breast cancer. And 20 other types of cancers including the most hellish of them all, pancreatic cancer (the pain cannot be described). Alcohol is not beneficial in any dose, or form. Prof. Debbie Shawcross mentioned liver failure in 20 year olds due to alcohol use. My youngest patient that fell victim to alcohol was only 19. He vomited nearly half his total blood volume...collapsed at home...hit his head on the floor...bled into his brain...went into a coma...died on the ventilator, all in 2 days time. Just 19 years old. Read more on this here: #mustread ‘I had no idea being a social drinker would damage my liver by 31’ by @hazelreporting for @BBCPanorama bbc.com/news/articles/…

instagram.com/reel/C_QI6GEhr… Tried a new form of editing, and kinda proud of this outcome! 💕🎀🌸🧿 People in healthcare/content creators do watch and share your review! ⚕️💊#MedTwitter #MedX #ConteStrategy @CollateralMed @MDFinstruments

@RamjiFire @MoHFW_INDIA apologies for the delay in transit. It was delivered on the 22nd. Could you please confirm if this is resolved? Thanks.

I am very sad from your service. I ordered a standard rechargeable battery of cochlear cp802 on 16th July 2024 but today is 21st July yet battery is not provided by the company called ‘Colmed’ I have paid RS 12,095 @CollateralMed @MoHFW_INDIA

@RamjiFire @MoHFW_INDIA We apologise for the delay in transit. It was delivered on 22nd as per our records. Please do contact our helpline if you need any further assistance. Thanks.

@theliverdoc So sorry to hear this

Upset and miserable to know this patient died last week.

@theliverdoc Brilliant! Nothing like active prevention. I am sure this will also reduce their chance of getting HE.

Hear me out. Cirrhosis group of patients are among the highest to have repeated hospital visits including outpatient, inpatient emergency care. One of the most common reasons? Repeated infections. Even though bacterial infections predominantly lead to increased hospitalization, outpatient and emergency visits are mostly due to seasonal viral infections. Management of the latter to simply put, is symptomatic care with anti fever medications. Cirrhosis patients can consume paracetamol up to 2-3g per day for 2-3 days for fever relief. Yes it is safe, but get a prescription. But, in the last 6 months, the footfall of patients in my outpatient and emergency, asking for management of seasonal infections reduced manifold. This translates to lesser financial burden, travel and hospitalization and tests for the patient and more space to include new patients, those requiring acute care and those needing reasonable hospitalization for the doctor. What did I do? I started aggressively vaccinating my cirrhosis patients for three major preventable infections: Pneumococcal vaccine (bacterial) Influenza vaccine (viral) Hepatitis A vaccine (viral) The number of patients coming to the outpatient and emergency with avoidable infections from the above three causes reduced drastically after this. Doctors, vaccinate your cirrhosis patients. Patients, if you have cirrhosis, ask your doctor for your vaccine schedules. It's life changing. Reduces travel burden. Reduces hospital visits. Reduces treatment costs. Reduces work-related absence.

@theliverdoc @HepCommJournal @ebtapper Amazing. Brilliant. Thanks for persisting and publishing this despite all the pressure.

Breaking: Our magnum opus, the most exhasutive review on complementary and alternative medicine (CAM) and the liver is out now in @HepCommJournal journals.lww.com/hepcomm/fullte… We thank @ebtapper for inviting us on behalf of The American Association of the Study of Liver Diseases (AASLD) and helping us prepare the content topics/outline to write on, with full freedom and beyond the word limits, to make this paper a powerhouse in educational value. Not many chief journal editors would want this topic to be written upon, fearing backlash from the alternative medicine community. This paper is like a breath of fresh air among hepatology publications. Our paper is unique because it is black and white, avoids ambiguity and contains sections on understanding various types of CAM and its definitions, its use across the world, global level of regulations and pharmacovigilance networks that are in place to check for adverse events (you'll be surprised at what is happening in Asian continent). We discuss impact of CAM causing liver injury and clinical outcomes including death or liver transplantation, describe the pattern/severity of liver injury, the toxicology and chemical analysis of retreived traditional and propreitary herbal products (including Homeopathy). Toxicology analysis of CAM products in India was a brainchild of our unit and the core of my work which helped us unlock a lot of facts about potentially dangerous Ayush medications. At the projects peak, we analysed over 350 formulations paying from our own salary for the education of patients and community. We recently sunset this project due to extreme costs and lack of self funding. But our selfless work was paid back in the form of authoritative and disruptive pro-public peer-reviewed publications on alternative medicine (especially Ayurveda and liver injury) from our group, which over the years, have helped us get invitations from influential academic groups to teach about and write educationally of this topic, that other doctors in India would fear to write on or Indian journals would dread to publish. A special section is dedicated to discussing emerging herbal threats to the liver and also a cool discussion on the "myths on herbals beneficial for the liver." This work is a culmination of everything we have been doing since more than half a decade on the topic of CAM and the liver. My co-authors are Homeopathy and Ayurveda practitioners who are now deep into clinical research, leaving behind their pseudoscience practice lives. @arifhussaintm leads the team. Their work shines through in this paper. Please read and share this paper widely. It will mean a lot to us who spend weeks and months researching, preparing and writing it, and also deservingly values scientific astuteness of influential journals like @HepCommJournal who remain unbiased and visceral in publishing topics that were once considered controversial, but are extremely important, for not only the physicians, but also the public. Free to read in full and download: journals.lww.com/hepcomm/fullte…

@biztradegovukIN @MyWayDigital @accoson @gminstruments Thanks for all the support

Congratulations to Mumbai-based @CollateralMed for signing partnerships with three Scotland-based companies @MyWayDigital, @accoson and @gminstruments in the areas of diabetes, blood pressure and respiratory disorders. Great to see these 🇬🇧 health innovations now coming to 🇮🇳 🤝

Tips for liver health in six minutes Full video link: The Liver Doc x BeerBiceps on The Ranveer Show: Episode 1 youtu.be/Rg5lbQj62Og?fe…

@theliverdoc Loved the first point :)

A person asks Sadhguru, “How much weight training exercise do you recommend?” And Sadhguru answers, “Weight training is not useful, but do 25-50 Surya-Namaskars, it is complete exercise.” First of all, I am not sure why anyone would ask someone like Sadhguru, who is most of the time, in another dimension, a question on exercise and weight training. And secondly, Sadhguru is just plain wrong. Weight (or strength) training is one of the most important aspects of exercise regimen you can include in your daily or 3-4 times a week physical activity because there is great science behind its benefits. I advise my obese or sarcopenic (very poor muscle mass in advanced liver disease) patients to include weight training to improve clinical outcomes. The highest level of scientific evidence showed that standard muscle-strengthening activities were associated with lower risk of death in patients with non-communicable diseases – including cardiovascular disease, diabetes and lung cancer. Another metanalysis showed strong evidence for a considerable risk reduction of strength training for 60 minutes a week, on all-cause death (−15%), cardiovascular disease death (−19%), and cancer death (−14%). See here: bjsm.bmj.com/content/56/13/… here ajpmonline.org/article/S0749-… Sadhguru says the older we get, the better we do not weight train. He is again absolutely wrong. The findings of another systematic review/metanalysis support power (strength) training as an effective therapeutic intervention for improving physical function in adults diagnosed with frailty (poor physical function in old age) and patients with chronic medical conditions. See here: physoc.onlinelibrary.wiley.com/doi/full/10.14… In fact, another study on strength training, this one again a metanalysis, concluded that strength training interventions can be used as a non-drug treatment for hypertension (!), as they promote significant decreases in blood pressure. See here: nature.com/articles/s4159… Strength training also reduces significantly, chronic inflammation as shown in another high quality systematic review and meta-analysis. See here: onlinelibrary.wiley.com/doi/abs/10.100… Resistance/Strength training improved muscle mass and muscle strength, thereby improving performance status. Improved performance status is a wonderful benchmark for an active and healthy life. See here: bjsm.bmj.com/content/57/18/… Even in fatty liver disease, independent of weight loss, exercise training was associated with 3 and a half times more meaningful treatment response towards lowering liver fat. Strength training is a powerful tool to maintain liver health. See here: journals.lww.com/ajg/abstract/2… and here bjsm.bmj.com/content/52/13/… Now Surya Namaskar. Surya Namaskar or Sun Salutation is a sequence of around twelve yoga poses connected by jumping or stretching movements, varying somewhat between various Yoga schools – which means, it has no regulation or standardization unlike weight training. In Iyengar Yoga there is a way, in Ashtanga Vinayasa Yoga there is Type A and B and there are other types followed by other schools or Yoga teachers. Along with the stretching and jumping, which is done is a slow and steady manner, the practice includes chanting a “mantra” calling out twelve names of the Sun God. In its classical form, Surya Namaskar is not an exercise, and is not aerobic. The energy cost of exercise is measured in units of metabolic equivalent of task (MET). Less than 3 METs counts as light exercise; 3 to 6 METs is moderate; 6 or over is vigorous. American College of Sports Medicine and American Heart Association guidelines count periods of at least 10 minutes of moderate MET level activity towards their recommended daily amounts of exercise. For healthy adults aged 18 to 65, the guidelines recommend moderate exercise for 30 minutes five days a week, or vigorous aerobic exercise for 20 minutes three days a week. Surya Namaskar in its classical form has a measly 2.9 METs and in its rigorous form (some people perform mutated highly active forms of Surya Namaskar to make it feel like an exercise) can go up to 7.4 METs – which requires a lot of jumping and little stretching and no time to chant the Sun God names - does not even come close to strength training by any margin. Those who are part of the Surya Namaskar and Yoga cult would provide anecdotal experiences on its benefits (please see comment section) through non-classical forms and would call it an “exhilarating experience.” Experiences are not scientific, evidence are. Many Yoga journals and some dubious and third rate Ayurveda journals have also have published on such experiences in small group of patients, which are not validated or published in better journals [like this junk here: ncbi.nlm.nih.gov/pmc/articles/P…] There are no metanalysis level data to prove effectiveness of Surya Namaskar as beneficial as aerobic exercise or better than strength training as Sadhguru claims. Do Surya namaskar if you are doing nothing. But upgrade to strength training if you want something. And stop listening to pseudoscience peddlers who speak religion and culture for your healthcare needs. Sadhguru suffers seriously from Dunning Kruger fallacy: a type of cognitive bias, where people with little expertise or ability assume they have superior expertise or ability. This overestimation occurs because of the fact that they don’t have enough knowledge to know they don’t have enough knowledge.

Competent Manpower shortage plague not only @CDSCO_INDIA_INF & SLA for Drugs but also internationally in EU & USA FDA .There is no need to have an army of inspectors for #MedicalDevices if task can bdelegated to 3rd Party CBs @mansukhmandviya thehindubusinessline.com/economy/faced-… @jo_da123

Irrespective of your ideology, @theliverdoc should be supported in this issue. What he stood for is science and EBM, this will set a bad precedent. Tomorrow any company selling harmful drugs will start suing doctors for merely stating things that benefits community at large. #india #medX #MedTwitter

@Madhusmita_k @BlueDart_ @BlueDartCares We are sorry for the gap. We will check and update you soon.

@CollateralMed @BlueDart_ @BlueDartCares iam not able to track my consignment shipped by colmed. Will I be getting it or should I ask for a refund?

@theliverdoc Found some... Thanks for highlighting the linkage

@theliverdoc Thanks for the wonderful post. Is there any specific study on Sleep and HE?

Hey do you want to hear something really cool about the liver? You know that we have a 'body clock,' right? This internal biological clock is responsible for the 'circadian rythmn' that drives various body processes in a 24 hour period. Circadian rhythms are physical, mental, and behavioral changes that follow a 24-hour cycle. One of the most important and well-known circadian rhythms is the sleep-wake cycle. Circadian rhythms are influenced by light and dark, as well as other factors. But what controls these biological clocks? A master clock - which resides in the brain. In humans, the master clock is a group of about 20,000 nerve cells (neurons) that form a structure called the suprachiasmatic nucleus, or SCN. The SCN is in a part of the brain called the hypothalamus and receives direct input from the eyes. But a group of researchers from the University of Queensland has found that it was not just the brain, but also the liver - that functions as the master clock! To figure this out, they turned to our best lab buddies - mice. Mice are nocturnal animals...meaning, they are very active at night and mostly finish off their napping sessions (a mouse sleeps for 12h a day) during the day and late evenings. But these researchers did something strangely cool. They transplanted human liver cells into mice, to replace their mousy-liver cells. And the mice started behaving weird. They ate and slept at different times compared to mice without transplanted human cells. The mice started to eat and be active before night-time began, which was very unusual for a nocturnal animal. Basically, their biological clock became more "human." What does this mean? The liver is a master organ. It has more secrets in it, than we can ever imagine, but will unlock in due time. And any disease affecting the liver, can disrupt your circadian rythmn/ biological clock... ...which is why in patients with cirrhosis - their sleep-wake cycle is disrupted - they tend to sleep more during day, and are more active at night (like an actual mouse) - a condition called minimal (covert) hepatic encephalopathy. This is also the reason why patients with diabetes, when they have fatty livers, they have disrupted sleep - many people with type 2 diabetes experience poor sleep quality or insomnia. If the liver is healthy, your normal functioning, especially sleep-wake cycles, become better. So remember, keep yourselves healthy so that your liver, the master clock remains healthy. Here are fews tips on keeping a healthy liver in case you missed it before. Here x.com/theliverdr/sta… and here x.com/theliverdr/sta… Source: Mice with humanized livers reveal the role of hepatocyte clocks in rhythmic behavior science.org/doi/10.1126/sc…

Many many Thanks 🙏🏻 to Dr @mansukhmandviya ji fr yr kind assurances to have the Bill of Drugs & Devices reviewed by an Appropriate Committee to ensure Modern Progressive laws so that @makeinindia of #medicaldevices is accelerated to achieve our Destiny of being a leading Mfg Hub