Save The Doctors

13/09/2025

New CDC guidelines for TB, potential Inicet question

12/09/2025

05/09/2025

🖐️ Rheumatoid Arthritis and Hand Deformities: What Everyone Should Know

🌿 What is Rheumatoid Arthritis (RA)?

Rheumatoid Arthritis is a chronic autoimmune disease. This means the body’s immune system, instead of protecting you, starts attacking the joints.
• It commonly affects small joints of the hands and feet.
• Over time, it leads to swelling, stiffness, pain, and deformities.
• Unlike normal wear-and-tear arthritis (osteoarthritis), RA can happen even in younger adults, especially women.

⸻

🔎 How Does RA Affect the Hands?

In the hands, RA causes:
1. Joint Swelling and Pain – especially in the knuckles and finger joints.
2. Stiffness – often worse in the morning (“morning stiffness”).
3. Deformities (if untreated for years):
• Ulnar Deviation: Fingers drift sideways towards the little finger.
• Swan-Neck Deformity: Finger bends in an “S-shape” (tip bent, middle joint over-extended).
• Boutonnière Deformity: Finger bends like a “buttonhole” (middle joint bent, tip pointing upwards).
• Weak grip and difficulty holding objects.

⸻

⚠️ Why Does This Happen?
• In RA, lining of the joints (synovium) becomes inflamed.
• This inflammation gradually damages cartilage, ligaments, and bones.
• Muscles and tendons become weak and imbalanced → leading to bent fingers and deformities.
• Without treatment, disability and loss of independence can occur.

⸻

👩‍⚕️ Who is at Risk?
• More common in women (3 times more than men).
• Can start between 30–50 years, but older people may also develop it.
• Family history increases risk.
• Smoking and poor lifestyle may worsen it.

⸻

🛑 Common Myths
• ❌ “It’s just old-age arthritis” → Wrong. RA can affect even young people.
• ❌ “Pain will go away on its own” → Wrong. It needs treatment.
• ❌ “Home remedies or oil massage can cure RA” → Wrong. These may reduce pain temporarily but do not stop joint damage.

⸻

✅ How Can We Prevent Severe Deformities?
1. Early Diagnosis is Key
• If you have persistent joint pain and stiffness (especially morning stiffness >30 min) → consult a doctor (orthopaedic surgeon or rheumatologist).
2. Proper Medicines
• Use DMARDs (Disease-Modifying Anti-Rheumatic Drugs) prescribed by doctors.
• They reduce inflammation and prevent joint damage.
3. Regular Check-ups
• Monitoring blood tests and X-rays is important.
4. Healthy Lifestyle
• Balanced diet with calcium, vitamin D, and anti-inflammatory foods.
• Quit smoking and avoid excess alcohol.
• Gentle exercise and hand physiotherapy to keep joints mobile.
5. Protect Your Joints
• Use assistive devices (special spoons, jar openers, splints) to reduce strain.
• Avoid lifting heavy objects with weak joints.

⸻

🌟 Key Message

Rheumatoid Arthritis is not just joint pain – it is a serious disease that can deform hands and disable people if untreated.
• With early treatment, regular medicines, exercise, and awareness, people can live a normal and independent life.
• Never ignore persistent joint pain and swelling – early action saves your joints!

⸻

05/09/2025

“Next-Gen GST Reform: A Historic Diwali Gift for India”

The Government of India has announced a landmark GST reform, being termed as a Historic Diwali Gift for the Nation. The objective is to make everyday living affordable, boost entrepreneurship, and strengthen the vision of Aatmanirbhar Bharat.

✅ Key Highlights:
1. Daily Essentials at Cheaper Prices
• Hair oil, shampoo, toothpaste, toilet soap, shaving cream, etc. – reduced from 18% to 5% GST.
• Dairy products like butter, ghee, cheese, spreads, and packaged snacks – down from 12% to 5%.
• Baby products (feeding bottles, napkins, diapers) and sewing machines – 12% to 5%.
2. Relief in Healthcare Sector
• Health & Life Insurance – 18% to Nil.
• Diagnostic kits, oxygen, glucometers, spectacles – now at 5% or Nil GST.
3. Affordable Education
• Maps, charts, globes, exercise books, notebooks, pencils, crayons – now Nil GST.
• Erasers reduced from 5% to Nil.
4. Uplifting Farmers & Agriculture
• Tractor tyres, parts – 18% to 5%.
• Tractors, bio-pesticides, irrigation systems – 12% to 5%.
• Agricultural machinery – 12% to 5%.
5. Automobiles Made Affordable
• Petrol/diesel hybrid, LPG, CNG cars (up to 1200cc petrol/1500cc diesel) – 28% to 18%.
• 3-wheelers, motorcycles, goods vehicles – 28% to 18%.
6. Electronic Appliances
• ACs, TVs (above 32”), monitors, projectors, washing machines – 28% to 18%.

💡 Why This Matters?
• Direct savings for common households.
• Boost for MSMEs, farmers, and students.
• Healthcare, education, and agriculture become more accessible.
• Strengthens India’s move towards Ease of Living.

⸻

📌 Suggested Hashtags:

05/09/2025

“Next-Gen GST Reform: A Historic Diwali Gift for India”

The Government of India has announced a landmark GST reform, being termed as a Historic Diwali Gift for the Nation. The objective is to make everyday living affordable, boost entrepreneurship, and strengthen the vision of Aatmanirbhar Bharat.

✅ Key Highlights:
1. Daily Essentials at Cheaper Prices
• Hair oil, shampoo, toothpaste, toilet soap, shaving cream, etc. – reduced from 18% to 5% GST.
• Dairy products like butter, ghee, cheese, spreads, and packaged snacks – down from 12% to 5%.
• Baby products (feeding bottles, napkins, diapers) and sewing machines – 12% to 5%.
2. Relief in Healthcare Sector
• Health & Life Insurance – 18% to Nil.
• Diagnostic kits, oxygen, glucometers, spectacles – now at 5% or Nil GST.
3. Affordable Education
• Maps, charts, globes, exercise books, notebooks, pencils, crayons – now Nil GST.
• Erasers reduced from 5% to Nil.
4. Uplifting Farmers & Agriculture
• Tractor tyres, parts – 18% to 5%.
• Tractors, bio-pesticides, irrigation systems – 12% to 5%.
• Agricultural machinery – 12% to 5%.
5. Automobiles Made Affordable
• Petrol/diesel hybrid, LPG, CNG cars (up to 1200cc petrol/1500cc diesel) – 28% to 18%.
• 3-wheelers, motorcycles, goods vehicles – 28% to 18%.
6. Electronic Appliances
• ACs, TVs (above 32”), monitors, projectors, washing machines – 28% to 18%.

💡 Why This Matters?
• Direct savings for common households.
• Boost for MSMEs, farmers, and students.
• Healthcare, education, and agriculture become more accessible.
• Strengthens India’s move towards Ease of Living.

⸻

03/09/2025

Here are the details—duration, format, and fee—of several notable Diabetic Foot Care (DFFC) programs available in India:

⸻

1. Certificate Course in Diabetic Footcare (Medvarsity / Apollo AHERF) – Fully Online
• Duration: 3 months (course validity approximately 4 months)  
• Fee: Approximately USD 115 (plus applicable taxes) 
• Accreditation: Apollo Hospitals Education & Research Foundation in collaboration with the British Accreditation Council (BAC)  

⸻

2. Podiatry and Diabetic Foot: A Certificate Course (Max Healthcare) – Online
• Duration: 3 months 
• Fee:
• Indian nationals: ₹14,500
• International participants: US$246.88 
• Format: Fully online, comprising 12 modules covering anatomy, diabetic foot pathophysiology, wound care, Charcot foot, footwear, and prevention.

⸻

3. Diabetes Foot Care & Footwear Training Programme (CMC Vellore) – Hybrid/In-person
• Duration: Not explicitly stated; typically a short hands-on program (often a few days to a week) 
• Fee: ₹12,550 (including 18% GST; covers materials, and in-person sessions) 
• Format: A hybrid course combining both distance learning and practical, in-person training.

⸻

4. Certificate Course in Diabetic Foot Management (CCDFM) – Chellaram Diabetes Institute / PHFI
• Duration: Not clearly specified in the brochure (likely self-paced online) 
• Fee: ₹7,000 (all-inclusive) 
• Notes: Endorsed by Public Health Foundation of India (PHFI) and Leicester Diabetes Centre, UK, but not a formally recognized medical qualification—it’s a certificate course, not a degree or diploma .

⸻

Summary Table

Course & Provider Mode Duration Fee Key Highlights
Medvarsity / Apollo (Online) Online 3 months ~$115 Apollo + BAC accredited, flexible, evidence-based
Max Healthcare (Online) Online 3 months ₹14,500 Structured modules, recognized certificate
CMC Vellore (Hybrid) Hybrid Short (days) ₹12,550 Practical exposure, in-person training
Chellaram / PHFI (Online) Online Self-paced ₹7,000 Affordable, recognized by PHFI, not a degree

⸻

Choosing the Right Fit
• If you need flexibility and accreditation at a modest cost:
Medvarsity/Apollo’s online course (~USD 115) is a solid choice.
• If you value a structured online experience with formal recognition and are okay with a slightly higher fee:
Max Healthcare’s 12-module online certificate (₹14,500) might be best.
• If hands-on learning is your priority and you’re comfortable investing in a short in-person segment:
CMC Vellore’s hybrid training offers practical immersion for ₹12,550.
• If you’re looking for the least expensive option and are fine with a non-degree certificate:
Chellaram/PHFI’s programme (~₹7,000) offers good foundational knowledge, though it’s not a formal qualification.

⸻

26/08/2025

With OrthoCare Clinx – I just got recognised as one of their top fans! 🎉

26/08/2025

Osgood–Schlatter disease (OSD) is a common cause of knee pain in growing children and adolescents, especially those who are physically active.

⸻

🔹 Definition

Osgood–Schlatter disease is an overuse injury of the knee, characterized by painful inflammation of the tibial tuberosity (just below the kneecap) where the patellar tendon attaches.

⸻

🔹 Causes / Risk Factors
• Repetitive stress from activities like running, jumping, or sports (football, basketball, volleyball).
• Growth spurt – bones grow faster than muscles/tendons, increasing traction forces.
• More common in boys aged 10–15 years (but also occurs in girls, usually a bit earlier).
• Sports participation with high knee load.

⸻

🔹 Symptoms
• Pain, swelling, or tenderness at the tibial tuberosity (bony bump below kneecap).
• Pain worsens with running, jumping, kneeling, or climbing stairs.
• Visible or palpable bony prominence at the tibial tubercle.
• Usually affects one knee, but may be bilateral.

⸻

🔹 Diagnosis
• Clinical diagnosis based on history and exam.
• X-ray: may show fragmentation or irregularity of tibial tuberosity.
• Important to rule out other knee pathologies.

⸻

🔹 Management

Osgood–Schlatter is self-limiting and usually resolves when growth plates close (late teens). Treatment is conservative:
• Activity modification – avoid overloading sports until pain improves.
• Ice packs after activity.
• NSAIDs (e.g., ibuprofen) for pain relief.
• Stretching (quadriceps, hamstrings) and strengthening exercises.
• Knee padding/strap to reduce stress on tibial tubercle.
• Rest during flare-ups.

Surgery is very rare, considered only in severe persistent cases after skeletal maturity.

⸻

🔹 Prognosis
• Symptoms typically last months to 1–2 years, but improve as growth finishes.
• Some may be left with a permanent bony bump at tibial tuberosity, but usually not painful.
• Excellent long-term outlook, with return to full sports participation.

⸻

14/08/2025

Neuropathic Pain Diagnosis
│
▼
┌──────────────────────────────────┐
│ Any RED FLAGS? (Acute neuro loss, │
│ cauda equina, infection, fracture)│
└──────────────────────────────────┘
│
Yes ───► Urgent referral/surgery
No
▼
┌──────────────────────────────────┐
│ Comorbid Depression / Anxiety? │
└──────────────────────────────────┘
│
Yes ───────────────────┐
▼ No
**Duloxetine** ┌────────────────────┐
(Start 30mg/day → │ Prominent Insomnia /│
titrate to 60mg) │ Sleep disturbance? │
└────────────────────┘
│
Yes ────────────────────────┐
▼ No
**Pregabalin** ┌────────────────────────┐
(Start 75mg night, │ Cardiac disease / │
titrate up) │ Elderly / Fall risk? │
└────────────────────────┘
│
Yes ──────────────────────┐
▼ No
**Gabapentin** **Nortriptyline**
(Start 300mg night, (Start 10–25mg night,
titrate as tolerated) ECG if cardiac risk)

Combination Strategy
• If monotherapy inadequate after 6–8 weeks:
• Duloxetine + Pregabalin (low dose each)
• Nortriptyline + Gabapentin
• Avoid Duloxetine + Nortriptyline (same pathway → ↑ side effects)