Victory of Truth-सच्चाई की जीत

दुर्दांत अपराधी, कितने ही नेताओं और अफसरों का चहेता विकास दुबे मारा गया. खबर है कि शहीद हुए SO देवेंद्र मिश्रा ने विकास दुबे और बड़े-बड़े लोगों की सांठ गाँठ के बारे में ऊपर तक आठ पत्र लिखे थे पर सुनवाई नहीं हुई, बल्कि खुद ही शहीद हो गए, क्यों? क्योंकि मामले में बड़े-बड़े लोग लिप्त थे/ हैं. मैंने भी २०१४ में ईमानदार सरकार और रामराज्य वाले प्रधानमंत्री के आने में विश्वास करके पशुओं के वैक्सीनेशन में दशकों से चल रहे हजारों करोड़ प्रतिवर्ष के घोटालों का कच्चा चिट्ठा मंत्रियों और प्रधानमंत्री जी के सामने रखने पर क्या पाया था? निदेशक के पद से मुक्ति, १२२ करोड़ का डीफेमेशन केस (लड़ता रहूंगा जब तक जीऊंगा), नौकरी से मुक्ति की सिफारिश (जो अंतर्राष्ट्रीय दबाव और जरूरत के हिसाब से बेहिसाब लिखापढ़ी के चलते टली हुई है). मैंने भी ऊपर तक अनगिनत खत लिखे, अभी भी लिखता हूँ और जीते जी लिखता रहूंगा, ब्लॉग भी लिखता हूँ, कितने ही मंत्रियों संतरियों से मिल चुका हूँ, पर जवाब क्या मिलता है? तुम्हारे सच के पागलपन के लिए क्या ३५ सेक्रेटरी, सैंकड़ो डाइरेक्टरों और दर्जनों मंत्रियों को बर्खास्त करके झोला डंडा लेकर सरकार से संन्यास ले लें. और भी बहुत कुछ मिलता है जैसे चुप रहने के आदेश, मारने कि धमकी, नौकरी छीनने के मेमो, और जाता क्या है?  पूंजी, चैन, और भी जाने क्या क्या, जिस पर बीते वही जाने. पर इसमें आश्चर्य करने जैसा कुछ नहीं है यह देश ऐसा ही था, ऐसा ही है, ऐसा ही रहेगा. ये रामराज्य और ईमानदार नेता, सब ढकोसले हैं. यदि सच के लिए लड़ना है तो ये सोच के लड़ो कि सच्चाई को जीत मिली भी तो आपके बाद मिलेगी, ये सोच कर लड़ो कि आपको लगी हुई इस बीमारी का कोई इलाज नहीं है, इलाज है तो मौत है, और मौत सबको आनी ही आनी है तो क्यों ना ऐसी बीमारी पालो जिसका इलाज ही मौत है. सच्चाई की जीत हो ना हो, आपकी जीत अवश्य होगी.

COVID-19 Presentations and Environmental Safety Concerns

COVID19 presentations

Courtesy from: https://app.hedgeye.com/insights/81268-the-coronavirus-outlook-worse-than-expected

Courtesy from: https://innovationorigins.com/how-colossal-is-the-corona-iceberg-in-the-netherlands/

Courtesy from: https://www.researchgate.net/publication/340183646_COVID-19_MORTALITY_ICEBERG

The disease caused by a Corona Virus named SARS CoV-2, a positive sense RNA virus. The virus infection has different presentations in different patients.

o It is a viral disorder and is self-limiting in 90% of patients. If antivirals should be given are effective when administered within 48 hours.

o The virus behaves like HIV in some patients; if lymphopenia or reduced CD4 cell count, then give anti-HIV drugs.

o It produces hyperimmune inflammation, so if there are signs of hyper inflammation such as high ESR, CRP and ferritin, anti-inflammatory drugs such as HCQ, indomethacin, and steroids become important.

o It behaves like bacteria, so azithromycin can be given; azithromycin may cause cardiotoxicity, so doxycycline may be given. Actually in most cases of viral infections bacteria are secondary invaders but become the primary cause of death.

o It produces thrombo-inflammation; fibrinogen and d-dimer levels are raised then give anticoagulant – heparin, nafamostat, and steroids.

o It produces silent hypoxia; the oxygen level is very low, but the carbon dioxide level is normal; the person is conscious. The lung is compliant. In such patients, oxygen supplementation with high flow nasal cannula, BiPAP (if required), and ventilator (only 1%) can be of help.

o Cytokine storm and ARDS: this is a terminal illness and managed as per protocol for ARDS. Non-compliant lung and sudden death is the major outcome. Levilimab from Russia is a new drug that can be administered not only to patients already in a serious condition but used as a prophylactic to prevent the "cytokine storm" from occurring and allowing the patient to avoid intensive care and lung ventilation. It will go into the market under the brand LSIRA.https://www.eurekalert.org/pub_releases/2020-06/b-adf060920.php https://theprint.in/health/russia-approves-levilimab-for-treating-severe-covid-19-patients-says-it-reduces-death-risk/439094/ http://outbreaknewstoday.com/russia-covid-19-cases-top-500k-levilimab-approved-for-treatment-78666/

The SARS CoV-2 Coronavirus has a very wide spectrum of illness ranging from asymptomatic to cytokine storm. It has wide presentations, though the target organ is the lung.

The immunoinflammatory reaction primarily occurs in the lungs, but the manifestations of the thromboembolic phenomena have a very wide presentation.

In the initial stages, the patients have marked leukopenia; lymphopenia, in particular, is a predominant feature. The platelet count may be normal or slightly low, d-dimer and ferritin (acute phase reactants) levels are very high, parallel to high CRP and procalcitonin levels. The smear shows no evidence of DIC, the fibrinogen level is normal, PT and aPTT are either normal or slightly prolonged, but d-dimer is very high, LDH is very high.

Lung pathology and pathology in other organs show a hypercoagulable state with a thromboembolic phenomenon taking place. Microthrombi are being formed, like Thrombotic thrombocytopenic purpura (TTP) but it is not TTP as there is no evidence of purpura or thrombocytopenia.

As the disease advances, d-dimer and ferritin levels keep on increasing → multiorgan failure, then the platelet count falls very rapidly → PT and aPTT are prolonged. In the later stage, it is somewhat similar to DIC.

In the initial stage of the illness, the patient has a predominantly thromboembolic phenomenon, a hypercoagulable state due to immuno-inflammation. It mainly affects the lungs but can affect other organs also. Most patients do not have DIC like pictures in the initial stage of the illness (In DIC, fibrinogen levels should be low, PT and aPTT should be prolonged, peripheral smear should show microangiopathy). But when a patient develops multiorgan failure, a DIC-like picture is seen.

Monitoring: oxygen saturation, CO2; repeat CBC, platelets, d-dimer, ferritin, IL-6 every day or alternate days. Rapidly increasing levels are indicative of the worsening of patient condition. Act fast. A 3- to 4-fold rise in d-dimer means a critically ill patient, who may not survive.

Patients aged 60 years or above, or those who have comorbidities, are already decompensated to some extent. Survival is better in patients with no comorbidities.

Severe and persistent lymphopenia means that the virus is acting on the bone marrow and hematopoietic system. If neutropenia also occurs, this results in secondary infections. The virus has a more fulminant course in immunocompromised patients compared to those in whom the immune system is normal.

Cytokine levels are increased in these patients (TNF or IL-1, IL-6), the cytokines act on monocyte tissue factor expression, if they're acted upon by IL-1 and IL-6, they stimulate the coagulation pathway → prothrombin generation → thromboembolic phenomenon.

Multiple mechanisms are in play in the pathogenesis of a thromboembolic phenomenon.

Hypoxia is one of the factors stimulating hypercoagulation.

Nafamostat is an oral anticoagulant with antiviral activity. Maximum data available is on heparin and LMWH rather than nafamostat.

Kawasaki-like syndrome in children in the UK; similar data in India not available or published.

COVID toes and fingers are not an acute manifestation, they occur after the patient has recovered. Probably it is due to vasculitis persisting for some time after the disease has been taken care of.

Do tests: baseline, the next day, and then alternate days. If d-dimer is not increasing, then once every 3 days.

Hope for a Good Vaccine

Although many pharma companies are coming with claims of success of their vaccine and Italy (who believe that it is a non-viral disease) has claimed a few days back development of an effective SARSCoV-2 virus vaccine for COVID-19, the future of any vaccine as protector of humanity from COVID-19 is bleak. Covid19 antibody mapping in Wuhan (where disease precipitated in its worst form) indicated that vaccines may not be effective to protect you for long or at all and can not save you from 2nd or 3rd waves of COVID19. Only 4% of people had COVID19 antibodies after such a widespread occurrence of COVID in Wuhan. Similarly, in California, less than 20% of people could develop a protective immune response. In viral infections, the post-cure immune response is always better than afforded by any of the good vaccines. Thus you may imagine how good may be the eagerly awaited vaccines. Suppose you get an effective vaccine, how many doses will be required each year, it is a pertinent question in light of the reversal of illness in recovered patients reported first in South Korea and then almost from everywhere indicating a poor protective immune response. In India, we are not able to vaccinate about 20 crores of kids against polio, how will it be possible to vaccinate 138 crores with COVID-19 vaccine? Will the Indian economy can afford vaccination and treatment?

Besides, effective treatment of COVID-19 maybe with antiviral drugs. How many of Indians and people in the less developed world can afford that treatment?

Thus, if you want to fight with COVID19 than Be self-reliant. कोविड-19 से लड़ना है तो आत्मनिर्भर बनो

कोविड-19 से बचने के लिए यह सोच कर बैठना कि अगले 1 साल में अच्छी वैक्सीन और कोई दवा आ जाएगी बड़ी भारी भूल होगी क्योंकि बुहान में जहां यह बीमारी काफी विकराल रूप में फैली थी वहां भी इसके एंटीबॉडी चार परसेंट लोगों में भी नहीं मिले अर्थात दूसरी और तीसरी लहर आने से कोई रोक नहीं सकता वैसे भी कोविड-19 जाने के लिए आने वाली बीमारी नहीं है जिस बीमारी के लिए एंटीबॉडी बनने की दर इतनी कम हो और मृत्यु दर भी नाममात्र की वह बीमारी कभी जाती नहीं है

https://www.nature.com/articles/s41591-020-0949-6

Don't wait for any good vaccine (it maybe by year-end) or any treatment as the majority of Indians fighting for food and treatment for minor ailments may not afford the luxury of using repeated shots of costly vaccines and treatments. Don't rely on that government to arrange for you all such vaccines and treatments as the government is already reached bankruptcy evident by the facts

1. Already cut the salaries and jobs in the public sector.

2. Already froze all community and public development programs.

3. Despite cheaper and cheaper petroleum all over the globe, we are burdened with ever-increasing diesel and petrol prices, etc.

4. Despite the fear of the spread of COVID19 through huddling, bars and liquor shops were the first to be opened.

5. In the country where half of the people are half fed the Mantra of Atmnirbhar is given i.e., you have to live and die at your own expense.

6. In the country where building mandir, masjid, statues, and monuments and advertisements of fake achievements are a priority and more important than the creation of jobs, hospitals, and education you need to be really Atmnirbhar.

7. The country which fights wars and enemies on social media and through bogus boycott appeals you really need to be Atmnirbhar.

Therefore, keep yourself educated, alert, and ready to fight COVID19 with the faith in your win.

अगर कोई वैक्सीन या दवा आ भी गई तो भारत के 90 परसेंट लोगों को उपलब्ध नहीं हो पाएगी वजह होगी उसकी कीमत और हमारी सरकार जो पहले से ही लगभग दिवालिया हो चुकी है आपकी कोई सहायता नहीं कर पाएगी. सरकार के दिवालियापन के लक्षण सर्वविदित है.

1. नौकरियां और नौकरी पहले ही बहुत कम हो चुकी है

2. सारे विकास कार्यों पर रोक लगा दी गई है सिवाय चुनाव के.

3. जब सारी दुनिया में तेल की कीमतें घट रही है हमारे यहां लगातार बढ़ रही है

4. यह जानते हुए भी की भीड़ बढ़ना और कोविड-19 बढ़ना साथ-साथ होगा सबसे पहले शराब खाने और ठेके खोल दिए गए हैं जिससे कि सरकार का खर्च चल सके

5. जहां पहले से ही लगभग आधी जनता भूखी है उस जनता को आत्मनिर्भर होने का मंत्र दे दिया गया है

6. जिस देश में मंदिर, मस्जिद, गुरुद्वारे, मूर्तियों का निर्माण और प्रचार विकास कार्यों और स्वास्थ्य एवं शिक्षा सुविधाओं से पहले आता हो उसके मानसिक दिवालियापन में कोई शक नहीं रहता

7. जिस देश में दुश्मनों से लड़ाई सोशल मीडिया पर प्रचार और बॉयकॉट की अपील से लड़ी जाए वहां ईश्वर भी कोई सहायता नहीं करते और आपको आत्मनिर्भर बनना ही पड़ता है. बाकी आपको कोविड-19 से 2020 के अंत तक (उसके बाद तो आपको इसके साथ रहने की आदत ही पड़ जाएगी) लड़ना है तो आत्मनिर्भर बनना है अपना ध्यान खुद रखना है आप को बचाने कोई नहीं आने वाला.

बाकी तो,

होई है वही जो राम रचि राखा

क्योंकि हम कुछ करने के लायक बचे ही नहीं हैं

भक्ति रस में डूबे हुए राष्ट्र को ईश्वर भी बचाने नहीं आएगा क्योंकि उसने इंसान को कर्म करने के लिए बनाया है भक्ति करने के लिए नहीं

Still, the more serious matter of concern is Environmental Health

Matter of concern for environmentalists and so-called sensible about COVID, a sociopolitical disorder caused by excessive diagnosis with ulterior motives is-

Who will estimate how much non-biodegradable and biologically hazardous waste had been generated worldwide out of testing, treatment (PPE, syringes, tubings, etc) and prevention measures (masks, PPE kits, gloves, disinfectants, sanitizers, automatic and semiautomatic dispensers, bottles, fruit and vegetable disinfecting/ decontaminating chemicals and many more to come) for COVID 19. It would also be interesting to hear from all the so-called experts, environmentalists, epidemiologists, and empathetic/self-declared sensible people on their somewhat educated estimates and somewhat fancy perspectives on the degradable/ nondegradable biologically hazardous and less hazardous and non-hazardous wastes ( eg., 0.1% of a or 500% of b and 1000% of c and so on and so forth). Who will account for???

About Vizag Gas leak Tragedy: Everything is possible to save rich and mighty in India at the cost of poor people of India

About Vizag Gas leak Tragedy

Everything is possible to save rich and mighty in India at the cost of poor people of India

I doubt that the cause of the Vizag tragedy was due to styrene gas leak. Most probably it is a planted idea to save the responsible company in future when the case will go to the court. My assumptions are based on the following facts.

1. People were falling unconscious without smelling any odour while the normal human nose can smell this gas at 50ppm level in the air but none of the reports said that it was smelled by anyone. The gas causes even mild toxicity on long term exposure of >300ppm in air. To cause such severe toxicity that is death on exposure the gas concentration is required to be 10000 ppm, and at 60 degrees C even under saturation level gas can reach only about 8000 ppm (that is in the closed chamber). That lethal concentration is almost impossible to reach in an open-air environment.

2. Styrene is neither gas nor volatile because its boiling temperature is 145 degrees centigrade. The styrene gives out irritating or toxic fumes (or gases) in a fire only. It is reported as a gas leak, not fire blast, that means it was not the cause.

3. Styrene is 3.6 times heavier than air and rapidly settle down, not spread at height more than 3 ft, but in nearby village and area, people fell which walking, animals died when standing.

4. As you can smell styrene as irritating toxic fumes and get suffocated you will struggle before you succumb to the styrene poisoning but in none of the cases shown on TV or in media, any struggle was evident even in animals.

This all shreds of evidence create doubt about the investigation and the case is made weak to be fought in the Court.

Everything is possible to save rich and mighty in India.

News about Styrene gas leak tragedy

1. https://www.downtoearth.org.in/news/health/vizag-gas-leak-styrene-levels-2-500-times-more-on-may-8-cse-analysis-71020

2. https://www.hindustantimes.com/india-news/styrene-gas-leak-survivors-will-have-to-wait-some-more-days-to-return-home/story-gehQWN1jGe1JUyC1ajrxVO.html

3. https://indianexpress.com/article/india/vizag-gas-leak-andhra-govt-to-send-back-styrene-stock-to-s-korea-6405294/

4. https://indianexpress.com/article/explained/vizag-gas-leak-what-styrene-is-for-and-how-it-behaves-6399198/

https://www.downtoearth.org.in/news/health/vizag-gas-leak-styrene-levels-2-500-times-more-on-may-8-cse-analysis-71020
5. https://economictimes.indiatimes.com/news/politics-and-nation/all-you-need-to-know-about-styrene-the-gas-that-leaked-in-vizag/gas-leak/slideshow/75622534.cms
6. https://www.hindustantimes.com/india-news/vizag-gas-leak-what-is-styrene-and-how-it-can-kill-if-inhaled/story-6BiXy6jk6y2q3h7eddZKlO.html
7. https://www.livemint.com/news/india/lg-polymers-admits-leaking-vapor-from-gas-storage-tank-caused-vizag-tragedy-11589009346537.html

सुना है अगले वर्ष पैदा हो जाएंगे दो करोड़ और हिन्दुस्तानी; Protagoras Paradox and COVID-19

सुना है अगले वर्ष पैदा हो जाएंगे दो करोड़ और हिन्दुस्तानी

कोरोनाकाल में कितने काल के गाल में समा जाएंगे ये तो पता नहीं, पर, 

देश के अमीरों तुम्हे बचाने के लिए इस वर्ष भी ख़ाख़ हो जाएंगे करोड़ों हिन्दुस्तानी,

यूँ तो सरकार ने खैरात बांटी है बहुत, फिर भी भूख से मर जाएंगे करोड़ों हिन्दुस्तानी,

हमारी औकात ही क्या है, कभी रेल पथ पर सोते हुए, कभी राजपथ पर रोते हुए

तो कभी किसी अमीर की फैक्ट्री के धुंए से मर जाएंगे करोड़ों हिन्दुस्तानी,

मेरे भारत, तेरी नदी का पानी जहर हो गया है, जिसे पीके परलोक चले जाएंगे करोड़ों हिन्दुस्तानी,

मेरे भारत तेरी ज़मीन में उगते नहीं अब दरख्त गरीबो को छाँव देने के लिए,

 धूप में जल कर मर जाएंगे करोड़ों हिन्दुस्तानी,

मेरे देश के अमीर पीते हैं खून गरीब का या फिर किसी विदेशी झरने का पानी,

अक्सर होती हैं उनकी ख्वाबगाहों में रंगो-नूर की महफ़िलें, उन रंगो की धुलाई में बह जाएंगे करोड़ों हिन्दुस्तानी,

देश के नायकों खुशियां मनाओ आ रही है नई खेप मजूरों की,

सुना है अगले वर्ष पैदा हो जाएंगे दो करोड़ और हिन्दुस्तानी।

आका हमारे कहते हैं, ज़िंदा रहे तो मिल जाएगा दाना -पानी,

खाने को कुछ नहीं है, पीने को कुछ नहीं है, कोई बात नहीं, यह तो वर्षों का है सलीका हमारे जीने का,

तकरीरें सुन कर अच्छा लगता है, पर फिर सोचता हूँ,

भूख से बिलखकर मर गए जो, अब तक क्या कभी ज़िंदा नहीं थे वो?

ये देश भी अजीब है मेरे दोस्त जहाँ मरे हुए भी मर जाते हैं दुबारा और बार बार, जीने की आस में,

घर में रहो बंद वरना मर जाएंगे करोड़ों हिन्दुस्तानी,

हम मर गए तो ठीक, ज़िंदा रहे तो मिल जाएगा दाना -पानी।

सुना है इशू अपनी सलीब को ले कर गए थे प्रभु के पास और अमर हो गए,

हम तो पुश्तों से ढो रहे हैं अपनी सलीबें, पर अपना तो खून अभी भी साफ़ ना हुआ  बन कर रह गया गटर का कीच

  पैदा हुए थे जैसे, वैसे ही रह गए बनके गंदे, मजूर, मजबूर और नीच के नीच करोड़ों हिन्दुस्तानी।

सुना है अगले वर्ष पैदा हो जाएंगे दो करोड़ और हिन्दुस्तानी।

From Wall of my Daughter

Today many countries have an interesting paradox. Do we continue lockdown for a very long time and wipe out our economies or let a few 100 million die and keep the economies going.

The Protogoras Paradox succinctly captures the paradox of our times!

Protagoras Paradox

Over 2000 years ago, in Greece, there was a lawyer named Protagoras. A young student, Euthalos, requested to apprentice under him, but was unable to pay the fees. The student struck a deal saying, “I will pay your fee the day I win my first case in the court”. Teacher agreed. When the training was complete and a few years had elapsed without the student paying up, the teacher decided to sue the student in the court of law.

The teacher thought to himself: ‘If I win the case, as per the law, the student will have to pay me, as the case is about non-payment of dues. And if lose the case, the student will still have to pay me, because he would have won his first case. Either way I will get paid’.

The student’s view was, ‘If I win the case, I won’t have to pay the teacher, as the case is about my non-payment of fees. And if I lose the case, I don’t have to pay him since I wouldn’t have won my first case yet. Either way I will not pay the teacher.’

This is known as Protagoras Paradox, which ever way you look both have equally convincing arguments, one can go either way in supporting the teacher or the student and would not be wrong.

Those in medical practice often come across such situations, either in making a diagnostic or therapeutic decision. One physician can recommend a course of treatment based on scientific evidence and another can recommend a diametrically opposite course again based on medical evidence. Right or wrong, but some merit would exist on both sides. Often the physician himself is having an internal struggle to make a decision about the most appropriate course of action, Protagoras & Euthalos are arguing in his mind, to do this or to do that. The horns of dilemma are tearing him apart.

But what prompted this essay was a tweet by Donald Trump, ‘hope the cure is not worse than the disease’. I hate to say, but I find some merit in this tweet. In our global attempt to flatten the COVID curve, one hopes that we do not flatten the global economy curve. The question is what’s the best way forward. One group recommends ‘total lockdown’ to break the transmission chain, based on evidence from China, they managed to control the spread of the virus by ruthless lock down and 3 months later they are showing that disease is controlled in Wuhan. On the other hand, the other school of thought is graded isolation & protection of elderly and very young and those with co-morbidities, let it spread amongst the young and healthy, after all the disease ultimately will be controlled when we achieve ‘herd immunity’. The medical community is divided in these two groups. To enforce complete lockdown or Graded isolation?

To complicate the issue the epidemiologists have joined the bandwagon with cacophony of statistical analysis. From Rosy to Dooms day predictions. If we don’t do a complete lockdown then a million people will die in 1 year. No say some more like 90 million will die in 1 year. Whose data analysis is correct. Some suggest do nothing, nature will take over in a few months and all will be well, they quote historical data to justify their recommendations. On whose inputs should we base our disaster management strategy.

Then come the economists with their doomsday predictions. If this continues till May our medical resources will be overwhelmed, Agriculture will suffer, food shortages will occur, production will come to a standstill. There will be an economic crisis of the proportions that world has not seen ever. So, break this lockdown nonsense and let’s get back to work as usual.

What will our political masters do. My guess is they will listen to medical experts, epidemiologists & economists. Then they will decide what course of action will ensure their survival, what will get them people’s votes and they will run with that. At present ‘Lockdown” finds favour with them. Boris in UK had to abandon the recommendations of the medical community about graded response, because the people’s perception became that our Government is not doing enough to protect us citizens. That means revolt against him. So,screw it, lets go with total lockdown if that’s what the people want. Gradually people will get tired of lockdown and demand- let life go on. Then with equally convincing arguments the governments will say the time has now come to lift the blockade, we have controlled the contagion, we have won. Unfortunately, the costs in either case will be huge, both lives and money!

Incidentally the Protagoras Paradox has not been resolved till date. Students in Law school still hold mock trial and give arguments on both sides wthout any resolution of the dispute.

Really a perplexing situation.