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Prof (Dr) Sunil Raina

@sunilraina15.bsky.social
196 followers 12 following 485 posts

Epidemiology, Covid-19, Climate Crisis, Public health, migration, tribal health, complexity Science, Kashmir, world health network, #SuperDemic, Himachal Pradesh

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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 12/06/2026
Planning an intervention without thinking of Contextualisation is meaningless link.springer.com/article/10.1...
link.springer.com
Active tuberculosis case finding using portable radiography reveals high undetected burden in rural Himachal Pradesh - Discover Public Health
Background Active Case Finding (ACF) in tuberculosis (TB) is a provider-initiated, systematic, community-based screening process that targets high-risk populations and is deployed across India, includ...
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 03/06/2026
LONG TB Why name: Between 30% & 80% of pulmonary TB survivors experience persistent symptoms, organ damage or functional impairment after treatment completion; a burden that existing outcome metrics fail to capture. @organicbotanic.bsky.social @elhopkins.bsky.social journals.lww.com/jfmpc/fullte...
journals.lww.com
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 02/06/2026
Hi, everyone My Twitter account had to deleted after it got hacked. After much thought & waiting I have opened a new account @SunilRaina65375 to stay connected & keep posting on health & disease primarily because bsky has not much members over here in India. @organicbotanic.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/04/2026
www.bmj.com/content/393/...
bmj.com
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 04/04/2026
#TB #AntibioticResistance #Covid TB may not be a unique historical accident- but a preview TB: Maybe the first pathogen to stumble on a winning long-term strategy, which other bacteria are now being inadvertently pushed toward by the very tools we created to fight them @organicbotanic.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 25/03/2026
TB's greatest evolutionary strength: phenotypic dormancy under hostile pressure Our policy- mass antibiotic exposure, incomplete t/t, no reactivation biomarker, ongoing transmission. We r designing the exact selective environment TB needed R we selecting for a better TB? #EndTB
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
10/10 "Relapse"—burden of explanation on the patient — their bacteria, adherence, immunity. "Recurrent TB in an unchanged environment" puts it where it also belongs — on poverty, housing, ventilation & public health systems. Words shape what we see & what we choose to fix #TB
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
9/10 What honest program design is ? → Active follow-up of cured patients, not just discharge → Aggressive household & community contact management → Treat the household as the unit of intervention, not just the individual → Measure transmission interruption, not just cure
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
8/10 This matters at scale. A program can have high cure rates AND stable or rising incidence at the same time. Because curing individuals doesn't interrupt transmission if they return to the same exposure conditions. We're measuring the wrong thing and calling it success.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
7/10 And here's the uncomfortable part. When that patient returns with TB again, the program records it as "relapse." Which looks like a patient failure. Or a treatment failure. Not a systemic failure to address the environment that generates cases in the first place.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
6/10 In high-transmission settings, the prior probability of re-infection is actually quite high. Studies have found that re-infection accounts for a large, sometimes majority, of recurrent TB cases . So our default assumption may be epidemiologically backwards
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
5/10 Think about what happens after a TB patient is declared cured. They go home. The same home. The same neighborhood. The same overcrowded, poorly ventilated spaces that gave them TB in the first place. The cure was biological. The risk environment? Completely unchanged.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
4/10 Here's what troubled me most. We say "relapse" implies the immune system or treatment failed. We say "re-infection" implies the patient just got unlucky with a new exposure. But isn't THAT also an assumption? Both labels carry hidden claims we haven't actually verified.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
3/10 To tell them apart, you need molecular strain typing — whole genome sequencing or similar. Most TB programs in high-burden countries don't routinely do this. So we just… call it relapse. By default. Without proof. That's assumption dressed up as diagnosis.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
2/10 First, the official distinction: "Relapse" = same bacterial strain comes back. Treatment didn't fully clear it. "Re-infection" = patient picks up a new strain. Fresh exposure. Sounds clean on paper. In practice? We almost never know which one it actually is.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/03/2026
1/10Something about TB terminology has been bothering me for a while. We call it "relapse" when a cured TB patient gets TB again. But what if that word is quietly misleading us — and hiding a much bigger problem? Let me explain. 👇
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 19/03/2026
Matters most in high-burden settings — South Asia, sub-Saharan Africa, Eastern Europe — where TB survivors have been recovering in silence for generations. Microbiological cure is not the finish line. Let's talk. 👇 #Tuberculosis #LongTB #PASTTB #GlobalHealth #LongCOVID #EndTB
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 19/03/2026
The parallel with PASC isn't rhetorical — it's mechanistic: ✅ Post-infectious inflammation persisting beyond pathogen clearance ✅ Multi-organ injury progressing independently ✅ Microbiome disruption (6–24 month of antibiotics) ✅ Amplified by pre-existing vulnerabilities
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 19/03/2026
The numbers are stark: 📊 ~47% of TB's total DALY burden falls AFTER treatment ends 📊 Abnormal spirometry in ~60% of survivors 📊 Up to 3× excess mortality in year one post-cure And most national programmes offer zero structured follow-up after sputum conversion.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 19/03/2026
So I'm proposing we call it: 🫁 Long TB (formally: Post-Acute Sequelae of Tuberculosis — PAST-TB) Multi-system. Post-cure. Under-recognised. Under-funded. Sound familiar
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 19/03/2026
Want the community's input — especially on naming. "Long TB" — accessible, mirrors Long COVID "PAST-TB" — formal, academic "Post-TB Syndrome" — neutral, clinical What resonates with you? What would patients, advocates, and policymakers actually use?
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 19/03/2026
A thought I can't shake: We declare TB "cured" when the sputum turns negative. But up to 80% of survivors go on to have bronchiectasis, fibrosis, cognitive damage, depression, pericarditis... We've been calling this a cure. It isn't.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 12/03/2026
#Tuberculosis #Covid Expect this to happen across geographies & remember for every detected/symptomatic case, there are minimum of 15% infected, though not symptomatic ones already roaming around u @organicbotanic.bsky.social @microlabdoc.bsky.social www.bmj.com/content/392/...
bmj.com
TB surge: Is England about to lose its low incidence status?
Once considered a disease consigned to the past, tuberculosis is making a resurgence in the UK. Emma Wilkinson examines why and asks experts what could help turn the tide In 2024 England saw its larg...
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 07/03/2026
#AI “The Architecture of unfreedom"
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 07/03/2026
#AI #Unfreedom Where is my Privacy? This is about viewing tools, what about the listening tools? www.thehindu.com/sci-tech/tec...
thehindu.com
Meta AI glasses showed bank info, naked people, and porn to overseas workers: Report
Swedish investigation reveals Meta AI glasses exposed contract workers to sensitive content, raising serious privacy concerns and regulatory scrutiny.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 05/03/2026
#TB As I keep saying- we r not far away from the day when TB will lose it’s status of being the disease of socioeconomic vulnerable alone It is airborne & all of us share that space @organicbotanic.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 04/03/2026
rimum non nocere. First, do no harm. Are we applying this principle to TB preventive therapy in the era of primary drug resistance? A question the global TB community can no longer defer. #TB #GlobalHealth #MedEthics @organicbotanic.bsky.social @microlabdoc.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 27/02/2026
So much for the hype www.theguardian.com/technology/2...
theguardian.com
‘Unbelievably dangerous’: experts sound alarm after ChatGPT Health fails to recognise medical emergencies
Study finds ChatGPT Health did not recommend a hospital visit when medically necessary in more than half of cases
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 27/02/2026
#AI What worries me most is that the whole of us living through current times are actually unaware of its large scale impact What I ask- Is the human good actually irrevocably linked to development of AI OR Is AI, the new nuclear-An elitist choice @organicbotanic.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 21/02/2026
#TB Current TB control programs, particularly in high-burden regions like India, often rely on risk-based screening that may overlook a significant number of cases outside defined high-risk categories, potentially hindering elimination efforts link.springer.com/article/10.1...
link.springer.com
Diminishing returns of risk-based tuberculosis control in Kangra district and the case for comprehensive strategies for elimination - Discover Public Health
Background Current tuberculosis (TB) control programs, including India's National TB Elimination Programme (NTEP), heavily rely on risk-based screening that prioritizes high-risk individuals. Evidence...
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 02/02/2026
Most corrosive is the normalization: Victims treated as collateral Truth delayed until it’s politically or reputationally safe Outrage that flares briefly, then fades It isn’t just committing harm—it’s looking away, explaining it away, or waiting for someone else to act @organicbotanic.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 02/02/2026
It isn’t just criminality at the margins—it’s how power, money & prestige can hollow out moral guardrails When abuse is hidden in plain sight, enabled by silence, NDAs, institutions & social clubs, it tells us something uncomfortable: accountability weakens as influence grows @elhopkins.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 01/02/2026
#Rabies #NeglectedTropicalDisease youtu.be/Sadmx_nTVY8
youtu.be
Suspected Rabies Case In Gujarat: Man Hospitalised After Disturbing Behaviour
YouTube video by NDTV
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 25/01/2026
The honest takeaway: Historically, "reactivation" was assumed without proof. Molecular tools revealed this was often wrong. The deeper insight? For patients: treat early. For populations: tailor strategy to local transmission dynamics. One size fits all = ineffective TB control.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 25/01/2026
Drug resistance changes everything: Old view: Resistance = poor adherence New evidence: Drug-resistant strains are TRANSMITTED In some settings, 78% of drug-resistant TB comes from transmission of already-resistant strains. Recent transmission drives the MDR-TB epidemic.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 25/01/2026
For TB control, timing is CRITICAL: Recent transmission (0-2 yrs) Active transmission chains to interrupt High immediate risk to contacts 44-78% of drug-resistant TB is transmitted, not acquired Reactivation (>2 yrs): Isolated events from latent reservoir No active chain to trace
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 25/01/2026
For individual patients, timing is irrelevant: Same clinical presentation Same treatment outcomes Same treatment duration Host immunity (not timing) determines disease severity What matters? Early diagnosis. 16.8 weeks to treatment = transmission. 8.5 weeks = no transmission.
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 25/01/2026
#TB #PostAcute #Reactivation The TB paradigm was wrong in 2 ways We overestimated reactivation (molecular tools showed 30-80% is recent transmission in endemic areas) We assumed the distinction mattered clinically (it doesn't) But timing DOES matter epidemiologically. Here's ?
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/01/2026
#Nipah The condition of two nurses, who tested positive for the Nipah virus in Kolkata, remain critical The confirmed cases of Nipah virus include two nurses, a doctor, & a health staff member. 100 quarantined @organicbotanic.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/01/2026
#TBRiskFraming How it is said matters “Given current 2nd-line drug availability & costs, expected MDR-TB mortality is 40% " Reality: 2nd-line drug cost $1,000-5,000 for 18 month t/t while generic would cost $100-500 40% mortality is pharmaceutical profit prioritization, not biological inevitability
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/01/2026
#Nipah History of NVD in West Bengal Siliguri in 2001 with reports of person-to-person transmission in hospital settings (nosocomial transmission) Nadia in 2007, reporting five cases & five deaths; 100% mortality @organicbotanic.bsky.social @elhopkins.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 23/01/2026
#Nipah India rushes to contain deadly Nipah virus outbreak after five cases confirmed West Bengal & Kerala in India have had a history with Nipah Virus Disease as cases have been found in past as well @organicbotanic.bsky.social @brownecfm.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 28/12/2025
www.linkedin.com/posts/sunil-...
linkedin.com
#epistemology #systemsthinking #wisdom #science | Sunil Raina
On Epistemological Humility and the Future of Knowledge: We're optimizing for the wrong patterns. Falsifiability—science's gold standard—privileges what can be quickly tested in labs. Short timescales...
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 12/09/2025
The study claims that “findings highlight the need for further research to identify potential protective factors that may have promoted resilience among children exposed to the COVID-19 pandemic” Is this biologically plausible @njbbari3.bsky.social @drinfosec.bsky.social @microlabdoc.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 12/09/2025
#CovidInKids Covid as Protective factor? Resilience? I thought resilience was a socio-cultural construct Precisely why I have reservations with evidence alone science, evidence constructed through statistical power @organicbotanic.bsky.social @elhopkins.bsky.social jamanetwork.com/journals/jam...
jamanetwork.com
COVID-19 Pandemic Exposure and Toddler Behavioral Health in the ECHO Program
This cohort study evaluates whether the COVID-19 pandemic was associated with parent-reported internalizing and externalizing problems among US toddlers who participated in the Environmental Influence...
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 08/09/2025
#Tuberculosis Malnutrition-known to be a risk factor for making TB symptomatic. But our recent experience using a case-control design saw that this & other known risk factors may actually be over exaggerated @organicbotanic.bsky.social @elhopkins.bsky.social @microlabdoc.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 07/09/2025
#CovidInKid #CleanAirInSchools The mis-information that it doesn’t impact kids has been busted many times over, yet our effort to correct that is very limited or restricted @organicbotanic.bsky.social @elhopkins.bsky.social @drinfosec.bsky.social www.dimsumdaily.hk/hong-kong-re...
dimsumdaily.hk
Hong Kong reports dual cases of severe paediatric influenza, one co-infected with COVID-19
The Centre for Health Protection (CHP) of the Department of Health disclosed today that there are two instances of severe paediatric influenza A infection, with one of the cases also infected with COV...
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 06/09/2025
#CARCON #NeglectedTropicalDiseases #DogBite #OtherAnimalBite Come & join us as we explore the socio-cultural contextualisation of animal bite & the solutions there to @organicbotanic.bsky.social @elhopkins.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 06/09/2025
#ClimateChange Is India witnessing it’s worst floods in the current century If we go by the situation in North & Northeast India, it may well be @organicbotanic.bsky.social
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Prof (Dr) Sunil Raina @sunilraina15.bsky.social · 02/09/2025
#Floods While climate science is the earliest to recognise “Outliers/extreme weather conditions” as critical, is it too late to prevent the impact of these? Have we moved so far ahead that preventing devastation is impossible? @elhopkins.bsky.social @organicbotanic.bsky.social
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