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Cutting Edge: Episode 8

Dec 17 | 3:30 PM

Watch Dr. Desai discusses the study led by UCL and Great Ormond Street Hospital researchers who were able to identify for the first time how to pre-empt drug resistance in TB before they have occurred, and its implications. He goes on to discuss the use of gene therapy for Thalassemia, the study concludes that therapy was safe and well-tolerated by its participants. Lastly, a major feat for India, to be one of the 4 countries in the world to have performed a breathing lung transplant. Watch Dr. Apar Jindal, Director- Advanced Lung Transplant, Yashoda Hospital, give his views on this story and the future possibilities it holds for transplant patients.

[Music] good evening everyone and welcome back to cutting edge uh i'm dr naveda and on behalf of team netflix i welcome you all uh we have with us our host tonight is dr madison he's a senior consultant physician from amdapad without any further ado so i'll start with your presentation sure good morning everyone and welcome to the eighth consecutive episode of cutting edge this week in medicine and we have been doing stories after stories and let me admit we have our bias and that's because being a practicing physicians i think that this particular story would be more useful or that you can start using from same day or it can make a better understanding of the particular topic or there is something new technology that has come that we should know or what is coming in the future or what is the current pandemic status of the covido micron or vaccines so we keep trying including all this but we need your feedback we need your stories right for us to develop and tell you all so with this background we'll say that again many times our stories look absolutely dry and there is hardly any lighter moments so let me i thought that let me start something today differently right and we have been using the idioms uh involving many specialists for any small or the other reasons right we'll say it's not a rocket science or we say that it's not a brain surgery or don't invent reveal don't reinvent the wheel or once in a blue moon so these are the idioms that we use and there has really been no actual validation of this usage of these terms do we really feel that these particular professionals are really better off than the others or the others are less better than the others so very interesting story that has sergeant himself and what the cartoon says that what is the difference between a neurosurgeon and god well god doesn't think that he's a neurosurgeon so that's what the story title is who is more intelligent a neurosurgeon or a rocket scientist to be honest when i search for the nasa catalogues and they said there is no term like rocket science scientists what they mean prohibition aeroscience aerospace engineers so here the story appeared on the in the bmc on 13th of december and this was carried out by one resident doctors in the neurosurgery himself and he put out the notice in the emails and the platforms or various platforms and invited the aerospace engineers as well as the neurosurgeons of all different strata males females across the usa europe france and they could get almost around 600 response 700 responses out of 2 600 were the aerospace engineers and around 148 were the neurosurgeons but the total completion of the task that was supposed to be done to get the validation of the title was possible only in around four 400 rp persons so out of these there are 329 aerospace engineers and 72 other neurosurgeons they were asked to do an online test which completes 12 tasks which are known to have six different distinct aspects of human intelligence whether it is a memory recall speed spatial recognition and all types of such complex days but which can be finished in 30 minutes time and just to have the idea of what how do they differ these two super specialists or the super humans or the superintendent people differ from the general populations they ask the general populations also to go for this test and they're almost almost around 18 000 respondents who completed this general participated for this test so let's see what is the test they perform they did different tasks which are given as a 12 different task in which they test for the memory they test for the special spatial problem solving then semantic problem solving the mental manipulation and attention then problem solving speed and the memory recall seed and they compared the response of the neurosurgeons as well as the rocket scientists or aerospace engineers to be precise against the general population's answers which are considered as the unity so what they found was very interesting that they found that there are definitely few part of the human brain or cognitions which are better off in the neurosurgeons and some are better off in the rocket scientist so the mental manipulation attention was better with the aerospace engineers while the semantic problem solving was better with the neurosurgeons but overall the overall what they found that most of the domains were almost equal with the general populations and only two domain there were either group has differed significantly and that is the neurosurgeons did better on problem solving speed but this was again balanced by fairly bit worse on the memory recoil speed and the rocket scientists are better at this patient manipulations so perhaps the debate still remains unsettled and we should not put too much emphasis in someone else's professions and while we say somebody else's intelligence that is the idea so next time when we use the term whether it's not a brain surgery probably they say that this should be used only when it requires a speed for doing out that work otherwise better say that walk in the park or just a piece of the cake or something like that and we will not use this term to heroify any particular problem or maybe that all specialities are equal we want to the next story that is about daytime meeting in night safe workers now with the all different kinds of services available and the most of the call services and call operators and we see so many persons even the younger ones are involved in the night shifts so this study was funded by national staff of health and it was published on 14th of december and this is a truly randomized controlled trial having 19 healthy individuals out of which seven were women and 12 are men and first they were tested for their baseline circuit and rhythm using the extended periods of wakefulness and beam light and what are their effects on their body parts and their levels blood levels and then they were randomly assigned into two groups one group was even a typical daytime meals and no food at night and the other group was given daytime as well as the nighttime feeding and they were also subjected to specific type of activities right and the other group that ate only as i said during the daytime this was all for 14 days and they underwent the simulated night work conditions for 14 days that means they had to have as if they are working in a night shift that kind of activities was planned and both the grips were assessed and what they found is very interesting that the effects of mills definitely has effect on the circadian rhythm and the metabolism and the nighttime eating definitely had boasted the glucose levels to as much as 6.4 percent while distincting a meals to only daytime prevented this effect honest no significant increase in the glucose levels that means it arrows at par with the expected glucose levels but no increase in the glucose level if you avoid eating at the night even if you are working for the night shifts and this is probably the first study that gives the benefit of the exclusive data meeting for the night staff workers and maybe when somebody post these questions to us on our next visit we should say that you stick to the daytime feed only and because the effect was explained on the basis of circadian misalignment we know that our biological clock has a definite surgeries of the hormones released between insulin or glucagon or growth hormone and the moment the second rhythm is misaligned we are going to get lot of hormonal imbalance and that one of them the most important probably is the glucose and they have shown that the glucose intolerance insulin resistant diabetes and other factors are definitely more the persons who are nightshift workers and having the meals at night this is another interesting story that we found that we know that ideally the colonoscopy should be performed in all the persons after the age of 50 at least once in 10 years that's a routine right in usa but in india we hardly undergo for the seer reason that in the most tedious part of the colonoscopy is the vowel preparations the person has to clean his bowel and that requires a regulated the enema and that drains you person practically and that is why most of the people avoid colonoscopy to see whether we can do away without the preparations of the bowels the this particular study appeared in the gastroenterology on 12th of december and it was a prospective single arm study all the 40 patients who were otherwise scheduled for the colonoscopy were convinced to go for the colon scan capsule there was a capsule which has to be swallowed and it will do just like a capsule endoscopy that we do for the routine investigation of any part of tenderness investigations a colon scan capsule was made to swallow by these 40 participants and this does not require any oil preparations and this was basically a pilot study just to see the acceptance part the satisfaction part and there was no at particular time of this study there was no specific reference for whether it could detect more polyp than the conventional colonoscopy and that study is going to be undertaken now on a larger scale but this was a study for mainly see whether the colon scan capsule is better accepted and whether there is any complaints after this or side effects what they found that there is no serious side effects about 12.5 percent of the patients had abdominal cramping but it result without any specific medicines and now the researchers are going to take a larger multi-center study just to validate the performance not only the safety and but the also accuracy part that how many who are detected by the colon scan capsules as well as how many of the conventional colonoscopy and if this is proved equivalent i am sure it's going to be a game changer and we are going to use this more often so that we are going to detect more colon cancers much before up almost a decade before the actual uh is detected because colon cancers otherwise are very difficult to detect unless one goes for the every annual the stool for a cold blood test and every decade colonoscopy another interesting story that is our story number seven here we know now that there is a new exam or new dictate in the field of the diabetology also that sitting is new smoking that means if a person remains seated right is having as many health hazard problems of course that's more on the light but that's not correctly said but here they try to see whether the person who remains seated person who remains not seated but doing some activity and persons who remain standing all the time whether there is any difference in the insulin sensitivity this particular paper appeared in the journal of cardiometabolic disease and diabetes on 8th of december and again the this particular study was done in the obese 12 menopause remain right and they were given both the types of tasks they were given that they were given one group of people were given sitting regimen that is they have to sit for 14 hours the another was given the exercise regimen that is safety for 13 hours and exercise for one hour and the third group had sitting glaze regimen that means they had to sit only for nine hours and remain standing for four hours and may be walking for three hours so they were compared right and this activity was to be done for four days right they our the all metabolic parameters were studied including the insulin sensitivity and they did the two-step hyperinsulinemic new glycemic clamp studies also and what they found is very interesting that there was significant improvement in the peripheral insulin sensitivity in sitting less there was almost a difference of 13 percent and exercise regimen 20 percent compared with setting regimen alone so they also perform the metabolomics right on the muscle biopsies taken before the clamp to identify changes in the molecular levels and they found that the shifting less itself in as short as four days of time shifting sitting less shifted the underlying muscle metabolome towards the activity is as good as moderate to vigorous exercise compared to the sitting person so next time if a person claims that he cannot walk or he cannot jog at least tell them to avoid sitting for a longer time and let them remain standing or moving around if they can't do the physical activities so that's a message then this is the story about the neurology and we know that we have been treating the acute episodes of migraine with our conventional medicines as well as kryptons there are new medicines have come up in the form of the they are called the turns and gap and i don't think they are available or at least we are physicians or general physicians don't use these drugs but this appeared on the 15th of december there the pain relief in the acute episodes of migraine were compared between the conventional tryptons right against the newer molecules like less mediterranean and remarkable and herbo capant so all these different kinds of molecules which are supposed to be the first line of treatment for the acute attack of migraine were tested and there were 64 randomized control study meta-analysis was done and over enough essence of around 46 000 pistons and what they found that the tripton's returns and keplans they all were definitely having a significant reduced pain into our time which is the gold standard for the efficacy of any drug and but of all these three groups of drugs tryptons were definitely the most effective and detains were associated with the highest risk of adverse events among all treatments and certain treatments were associated with a higher risk of adverse events compared to the gay parts however the lack of cardiovascular risk for the newer classes of migraine specific treatments definitely offer an alternative to tiptons my our point of taking this study was that we generally do not use this newer class of drugs but we do use our conventional drugs that is most of us would try to abort an attack of migraine with the conventional nsaids drugs and will focus more on the non-pharmacological treatment when it comes to the chronic management so we have doctor pranav carol with us and we would like to have his opinion about the managing and acute migraine patients and what is the role of tryptons and other molecules if they have been using it and uh what is the role of our conventional medicines and what is the best treatment for acute episode of migraine so yeah welcome doctor to our platform and thanks for inviting me today i think this is a very important uh discussion because migraine is one of the biggest medical nuisance where you know there is no consequences as such you know but it is definitely a disruptive when it comes to an acute episodes of headaches now you know the important part is there are two two parts of migraine management one is the chronic and the acute we are going to talk only about the acute part you know and not talk about the prophylaxis in migraine yeah with the time limitations so the acute part you know is a it it requires a really a very tailor-made treatment to patient to patient rather than and if you look at the all the rcts which have been published and especially mentioned in this study also are basically matched with the placebos you know they have not done a lot of comparison with and the kryptons and tryptons in japans in japans and the the titans you know so these are not the comparison the ideal comparison if at all we want to do we should have done that that's number one the number two is the individualized means what i mean is that you need to think about the individual patient's preference the social recovery status the need of the drug to uh you know prevent the disruption of the work and of course the the cost of the treatment because the migraine is is minimum 10 years uh self-limiting condition you know so that also part the cost part also one has to look at so the in in in the experience of our past with the acute treatment of migraine you know these new drugs the knowledge of these new drugs is good for us but still i think it has to be tailor-made and the more important will be to prevention of acute attacks you know the more important is instead of drugs you know the more important should be i think we should be talking about to prevent the provocative agents the triggers you know and the non-pharmacological measures to prevent it you know so that otherwise i think it's it's difference between these new drugs and tryptons and the old drugs that we used to use i think the there are no major uh i think uh there are no major differences uh if you look in the overall way of course the the these new drugs are limited data we have limited experience of using them so i think we need to watch you know for the next but still i think it has to be a really individually uh tailor-made rather than you know so knowledge of these new molecules is good but still i think it needs to be tailor-made according to the need of the patient so that's uh that's the yeah one more point do we still use our goat preparations no i think we don't use that you know because uh now we say i think we have a better drugs you know so at least you know the people who don't who do not do well with nseids i think reptons works very well you know so we don't have amongst tryptophan do you have a specific preference for a particular tripton i think sumatriptan is good dessert is good you know i think it's it's some people will do well with one and some people will do well with others you know so i think there is uh there are minor differences amongst the kryptonites so right so the message is that you have to abort the attack with the best knock that is possible in a given situations patient by patient and but still most of us still use the nsaids as the first line of treatment and what we need to advise them is that you have to take as early as possible with the very onset of the episode of migraine because that's none of the drugs were going to work once the time is lapsed yes because once there is a edema in the vessel wall you know because of the inflammation then the drugs does not work as good as using it early you know so that's that's the the message you know you're right right so thank you very much dr caro to be with us and we have one more story where we need your inputs so stay with us yeah thank you by the way thank you thank you right so we want to know our story number five which is about the use of beta blockers in hypertrophic obstructing cardiomyopathy we know that hypertrophic obstacle cardiomyopathy also called asymmetrical cardiac hypertrophy has been in the means that beta blockers have been the treatment without the actual evidence and they have been used more without the randomized control trials but this is the first trial which appeared in journal of a clinical cardiology academy cardiology in 13th december and where this trial is called tempo trial where the metropolis beta blocker was used in 29 patients who are symptomatic of hypertrophic obstacle cardiomyopathy and this was again a two weeks trial where metropolis was given in the people and the same 29 peoples after two weeks were not given the metaprolol so it's a double-blind crossover randomized controlled trial operate metropolis versus placebo and what they studied was the different parameters of the hypertrophic obstacle cardiomyopathy what they studied was the left ventricular output gradient at rest with valsalla maneuver with exercise and the post exercise post exercise time and they found that there is a significant difference or reductions in all those who had received metabolism those two weeks where they received metoprolol and even their symptoms were also definitely less but and their symptomatology as far as the quality or experience was concerned was marginalically better but not clinically significant as far as their original change is concerned and when they studied the different parameters for the long-term effect of the meteor parallel on the cardiac musculature where it's a regression of the left ventricle hypertrophy uh at least there was a negative report in the sense that there was no improvement in the duration of the exercise or the peak oxygen consumption or the biomarkers like the anti-probenp or the measure of the diastolic functions were not altered the explanation given probably was that it's a two short study two weeks of trial cannot give you the change in the life particular myocardial architecture and that was the study but overall the beta blockers are good why this study is that there is another study in the same journal has appeared that there is a new molecule called mevacatin and this is a molecule which is a selective cardiac myosin inhibitor and this particular molecule is studied on the background of people who will be receiving beta blockers or calcium walkers and they are the ones which are studied for a much longer period almost around six to eight weeks they studied and they found that that particular drug called merocation has definitely a good improvement as far as the anti-pro and bnp levels are concerned or diastolic function concern or the peak oxygen consequences so maybe in the time to come we don't have only beta blockers but we also another drug which is a selective cardiac myosin inhibitor as the one of the drugs for the treatment of hypertrophic osteocardiomyopathy and this is how this study has given how much is the change in the left ventricular output gradient the symptoms and the there is no change in the exercise time all these factors then this another neurology story where we would definitely want dr caro to find this is about last time we talk about the stroke after epilepsy now we are talking about the epilepsy after stroke and this particular we know that we when a patient suffers from stroke it could be hemorrhagic stroke that is intracellular hemorrhage or there could be an acute ischemic stroke or that may be just transient ischemic attack so this particular data was presented in the america meeting of the american epilepsy society annual general meeting in the december and what they did was they enrolled 88 119 patients from the dennis stroke registry this is a denmark study and what they did they collected all the patients informations from all the data about those who had suffered from stroke but who did not have history of epilepsy and the first episode of epilepsy which is uh which has occurred after 14 days of the acute stock event were considered as the new epilepsy and what the the number of patients who had the enroll were the obviously the far number of patients were belonging to acute ischemic stroke that is almost close to 80 thousands while intracerebral hemorrhagic patients were about 761 and the transient ischemic attacks around 1300 and what they found that out of the 88 000 in odds numbers there was 3483 patients were diagnosed to epilepsy as i said after 14 days of the acute stroke because anything that occurs in the first week of the second week could be attributed to the stroke and the underlying pathophysiological mechanisms that might produce an epilepsy but those who had epilepsy after 14 days and that remained up to the four years of the time were analyzed and what they found was that the highest absolute risk of epilepsy was found in the group who had interceding hemorrhage and the risk in the first year also was more with the persons who had severe intracellular hemorrhage almost to 10 percent while those who had mild international hemorrhage and around 5 percent while persons with acute ischemic stroke were around 7.8 percent with a mile acute ischemic stroke had around 1.3 percent and those who had ti still had some risk but less than one percent of this and what they found was that this risk did decrease in the subsequent years after the stroke but it did not disappear up till now we are under the impression that the persons having the strokes will be followed up for one year if they don't develop epilepsy in the first year but they are not likely to get but probably what we learned from this is that all patient with stroke should be followed up or so at the relative should be advised about the occurrence of epilepsy if it occurs it has to be brought to the notice of the for the further investigations we have dr caro we want his expert opinion and his experience about the incidence of different types of strokes and the epilepsy yes dr carol welcome back yes so this is a very again a very interesting topic this the epilepsy after the stroke uh the the data which they suggest the incidents and the percentages i think uh it is a large study but this is a study which has been only the same data which was available in the previous papers also is the same so the ischemic stroke has a lesser uh epilepsy than the hemorrhage you know that's a standard thing which was available before also there are studies which talks about that this is even still an under diagnosed condition because if you do electro encephalograph in first 72 hours of ischemic stroke actual incidence of electro encephalographic seizures are actually almost at 20 percent you know uh so it's even higher you know actually what this this study is only the clinically epileptic patients you know but if you do an electro encephalogram then the incidence is much higher now the important uh the message everybody must understand is that this is a very important to diagnose in early early epilepsy which is first 14 hours 14 days and then the remote epilepsy in the post stroke situation the first 14 days epilepsy or i will say for 7 days epilepsy is a very very important to identify the reason is that in an ischemic stroke the epileptic seizure starts in a penumbra zone which is surrounding your infarct which is a salvageable area of the brain now when there is an epilepsy it it converts a lot of penumbra into an impact you know because there is a excitatory neurotransmitters are influxed and it produces neurotoxicity the neuronal toxicity because of that and therefore many times and the second thing is in intracellular hemorrhage there is a higher risk of uh hematoma expansion as well as peri hematoma in facts you know because of these so so it's important that we identify this and the mechanism here is basically an imbalance of the neurotransmitter million between the excitatory and the inhibitory neurotransmitters so this is a situation related like suppose there is an acute ischemia you will have for seven ten days seizures higher chance because of there is a change in neurotransmitters but but when it talks about remote then then you have to treat it like any other epilepsy where there is a structural change in the neuro synapse so you know when you are talking about a remote epilepsy you have to consider it as like a gliac is related or structure related your neurotrans neuro neuronal synaptic uh structural changes rated epilepsy so that's that that is to be followed not for four years but it is you have to follow it as if you are following any other epileptic chronic epileptic patients for a secondary prophylaxis but as as far as the early epilepsy is concerned for seven to ten days you don't need to treat them because that situation closes down the moment that acuteness is over so the neurotransmitter milieu part is over the in in seven to ten days of due course and therefore it need not be the anti-epileptic drug need not be given for a prolonged period of time so i think that's a very important uh message that the the first is it has to be diagnosed as early as possible and especially you know you don't do eeg for all patients in first 72 hours so there are certain uh things that you should suspect if there is a fluctuating sensorium or if there is a disproportionate dis worsening despite normal metabolics and there is no major expansion in the deficit and still patient gets little drowsy then you must suspect that there is a ongoing non-conversative status or non-convulsive seizures are going on and encephalograms should be done and then it should be treated but otherwise for all patients to give a prophylactic anti-epileptic is not a correct strategy and it is not recommended also so we have to treat the the patients who get a clinical seizures but not to all patients because there is a higher risk because the risk is four percent uh in ischemia and may be eight to nine percent so you can't treat hundred patients if there is a risk to ten people or four people you know so i think that's the thing that's the message i would like to give you yeah you already answered our questions about the prophylactic anti-epileptic but there might be some set of base patients whom you would like to give anti-epileptic because one caesar also might prove to use more intelligence where where will i continue the anti-drug is i'll continue with the anti-flip drugs anybody who got a second or third episode after 14 days because then you know you must suspect that that ischemic stroke or hemorrhagic stroke has done some structural changes into the neuronal synapses which is going to be there otherwise you know because now that's a structure related the first seven days or ten days is more of a neuronal neuronal transmitter neurotransmitter related you know so that situation is going to get settled but the structure related issues we will like to give a profile axis for a long time you know uh because now after 14 days there is a change in the structure so which is going to remain there you know it's like a scar epilepsy you know like you have a scar epilepsy you know so that is where i like to the other place where i like to give a benefit of doubt is when there are silent infarcts you know like the you know people who have diabetes hypertension who develop a symptomatic stroke but if you do mri there are many times small vessel disease related changes there are silent small infarcts you know which has not actually led to a eloquent stroke you know but i would like to give a benefit of doubt to them because they have got a structural changes already in the uh the mri so if they develop seizures after two weeks or maybe one seizure in early part and then they develop again after two weeks of the acute early phase then i will definitely give in the give them benefit and i will follow them as if any other anti-any any other epileptic patients you know and will continue anti-epileptic drugs yeah but in an acute stroke suppose there is a massive hematoma international hemorrhage would you not keep it so that i will i will in fact see that's a that's a very special situation i will consider like if somebody has a large supra supratantorial intracerebral hematoma in that situation i will like to give the patient anti-epileptic drugs even though he has no symptomatic seizures because one seizure will lead to edema which can calm the patient that can lead to a temporary herniation so that is where the other other indication is subarachnoid hemorrhage which where i will always like to give anti-epileptic whether there is a seizure or not because the seizure can lead to a rupture of the aneurysm re-rupture of the aneurysm so that is where i will definitely see to it that the patient receives the anterior despite there is no seizures clinically you know so that's where right excellent excellent thank you so much for your inputs and we would love to have you again on our platform thank you it was pleasure having you with us thank you thanks thanks yeah so this is another interesting new development in the treatment of the antimicrobial resistance so this particular study appeared in the nature on 15th of december december this study was carried out where the researchers tried to find they collected the specimens of over 3000 patients who had suffered from tuberculosis and they deal the detail genomic analysis of all the samples of the persons who had tuberculosis and what they tried to see is whether the persons who develop subsequently the multi-drug resistant tuberculosis or mono-drug resistant tuberculosis is there any difference in the genomic picture or the map of from the persons who had infection with the drug sensitive tuberculosis so that is why they gave the name pre-resistance as if if you can pick up a particular type of genomic tuberculosis strain infections maybe you presume that this person is going to have pre-resistance and that you be very aggressive on the treatment of those kind of things so the full genomic sequence of as i said three one three five samples of the tuberculosis were studied right for creating a tree family tree of tuberculosis that they give the name fire it's called phylogeny this was done in the lima suburbs of the peru and this study was spun over 17 years and they identified and separated different genomic differences of all cases were mono and multiple drug resistant cases and they coined the term pre-resistance for the those kind of particular type of tuberculosis genomes which subsequently develop the drug resistant tuberculosis and now they have already applied this particular studies results into the worldwide available independent global tuberculosis data set and they could validate that this particular type of different types of genomic related tuberculos trains are definitely going to cause the multi drug resistance or mono drug resistant tuberculosis something that may be applied to other bacteria in the time to come so if we have the genomic diagnosis or the differentiation of a different type of bacterial infections we can as well say that probably this person is going to have this particular type of drug resistance or maybe the drug sensitive type of infections so something new for us to know and one more interesting story now this is a story about the gene therapy for thalassemia and it is actually available also elsewhere the this particular we know that for thalassemia measure where the transfusion is the only treatment the survival depends on the multiple blood transfusions or maybe they have to go for the hematopoietic stem cell transplant for the cure of the disease but that's not easy to get a hematosomatic stem cell transplant you need the hlms donor large amount of money and facilities at the center and you have to pray that there is no graph versus horse reactions and they should be on drug for a long time so that's not easy well what they did was very interesting they just found out the all the persons who have the beta thalassemia we know that beta thalassemia particle is alpha thalassaemia and beta thalassaemia the beta thalassaemia also are of two different types of the genotypes one is b0 b0 where there is the just reducing the number of the tibetan globulin chains while beta-1 thalassaemia beta-1 genotype is one where there is an abroad arrogant or abregant type of gene so it's not that easy to treat that so what they did was they introduced one particular type of gene which is called the amino acid globin which is called the ba d87q this particular type of amino acid sequence containing globin was first injected into a viral vector and this viral vector was subsequently put mixed with the person's cd 34 cells so this was all harvested afterwards first the patient's blood was collected who are ready for the study the blood was collected the stem cells were separated out and if there was not enough they were given the granulosa and stimulating factors and this was done and once the blood is collected that person undergoes myeloid ablation so he has to have all the cells of all different types of the components whether it's rbcw or platelets have to be able to by the typical drugs that we use and then this particular represents of the gene that is called betty cell gene or it's known as beverly it's very difficult to pronounce betty baglogen automatically that is called shortly known as batty cell so that battery cell therapy is given to all persons who are having a transfusion dependent thalassemia there are 23 patients and they were injected it has to be injected only once once it is injected and they have followed up these all patients for a median time of 29.5 months it ranged from anything from 20 to 40 months and what was their primary endpoint whether the transfusion independence life is sustained with the hemoglobin of more than nine percent and not requiring any blood uh transfusions for next 12 months or more and what they found is very very reassuring that almost 20 of the 22 patients could be evaluated right and this is the first study where they involved not only the persons about the age of 50 but also there were seven patients who also seven patients who were younger than 12 years and the average hemoglobin during the transmission independence was 11.7 gram with a range of 9.5 to 12.8 grams 12 months after battery cell trans infusion the median level of gene therapy derived so they could find out that this particular rise in hemoglobin is because of the uh gene which was transfused and because it has a different hba so the hb87q was found out of say 9 to 12 grams was almost around 8 to eight point seven grams so the native hemoglobin was hardly around two to three gram and but for this they would have been on transmission dependent and we know the person receives multiple blood transfusion there are problem of iron overload and they have to be on the chelating therapy for the lifelong so this battery cell gene therapy was very well tolerated and except one person who developed significant thrombocytopenia but is he survived so this is about the story about the gene therapy and thalassemia and now we move on to our top story of the day which obviously is going to make every one of us proud and for that we have dr apar jindal who is the director of the in the transplant unit head and he himself is a pulmonologist by training and we are very lucky to have you sir welcome and before i begin i'll just make a very small lighter part as we started with that there was a one good friend of cardiothoracic surgeon's friend called he was a mechanic and one day he went to him for his problem and the cardiac surgeon cured his problem and said that uh lel you have to they said how much should i give doctor that he said give 5000 rupees then come on doctor what are you talking we charge hardly 100 rupees for this kind of just you just put a hammer what do you do then the card authors can say my dear next time when i come to with my car i'll continue my engine and then do it and that is how the our story also begins with a breathing lung transplant that is the first time it has been done in hyderabad in the krishna medical institute that's known as the kim's and this was done by the team of doctors headed by dr sandeep attawar and this is a very proud moment for all of us because after us and canada india has joined in the lung transplant which is the breathing lung transplant this particular technique is something which definitely helps us more in preserving the lung that is available as a donor we know there is always a scarcity of lung donor organs and there is a lot of wastage because of the transition and safety of the persons and most of the lungs that are donated are the patients have under i remain in the vent related so either there may be accumulation of the fluid or there may be the infections so this particular technique or they call it the breathing lung unit they have got a specific organ reconditioning box in which the explanted lung is kept for few hours and there there is a facility for weighing that lung so they would know how much is the weight because of the fluid accumulations and after that they attach the ventilator all the attachments to the they oxygenate it they give the nutrient solutions with antibiotics and then it's ready for the transplant so it's salvages a large amount of lung and that definitely helps a long way in the outcome of the lung transplant so this is something something phenomenal and we like to more from the persons who will be doing it and the pulmonologist himself so over to you dr jindal once again thank you very much for coming at a very short notice and we know this is a very short time development hardly two or three days time and you have been busy with a lot of invitations for giving the first hand stories so please enlighten us about this thank you so much for having me here so doctor as you've already rightly pointed out this is a special kind of preservation uh system in which we can not only enhance the utilization of organs but also improve the quality of foreign see what happens is typically once an organ donor is there and we have harvested the lung out of the donor body of the lung is kept in the preservation fluid which provides nutrients and oxygenation to the lung for a period of about six to eight hours during which time the lung has to be transplanted implanted into the recipient's body and this is called as the cold ischemic time many a times these lungs are suffered injury because of trauma because of adhesions there might be hemo pneumothorax and those sort of injuries which compromise the quality of the donor lungs now since lungs are a scarce resource out of every 10 donations only about 2 or 3 lungs are usable so this kind of a situation this kind of a you know methodology where we can get the lung we can mount it on a disposable unit and then we can help improve the quality of plunk by not only keeping it in a preservation solution but passing through different types of antibiotics different types of nutrient-rich solutions which is called as the steam solutions and maintaining the quality of the organ repeatedly checking the organ quality by estimating the ph the acidosis levels the lactate levels and of course we can even do a bronchoscopy while the lung is mounted on the system to clear off any clots or any secretions which may be present inside the airways so definitely this will add to another 30 percent of increase in the number of lungs which can be added to the pool of the recipients and in a resource-care country like ours where the number of donations is actually very low one of the lowest in the world uh this kind of system can definitely be a boon for many of the recipients who are on the waiting list and are dying on the waiting list because of the scarcity of organs the only drawback here is costing about cost but sir i was told yeah i was told that the hyderabad has the highest number of lung transplants in india and even the kovit time they they have done lung transplantations which match the numbers in the western countries so your experience about the kovid and the long term absolutely so i was in chennai at that point of time at mgm hospital where we did the first in asia transplant done for a covet patient that was the first transplant done for any kovet patient over here only about three other transplants had been done in u.s at that point of time following that uh between the three centers that yeshua hospital where i am at kim's hospital in hyderabad and at mgm hospital chennai we've done close to about 60 65 transplants for covert patients or although these are not uh you know very good indications these are very sick patients these are not real ideal candidates who should undergo transplants but still it is an option for many of those who were stuck on ventilators or who were stuck on ecmo and the lungs were failing to improve so we've got good numbers we've got good experience but then the long term survival and outcome of these patients is yet to be seen right thank you so much and what are the immediate complications that we expect after the transplantation lung transplantations so basically if you look at it from the timeline perspective the major complications that we see in uh post transplant are two one is the risk of infection since you're now on immunosuppressants and you'll be lifelong on immunosuppressants the risk of infections is always there so we keep you on prophylactive antibiotics so you'll be on a small dose of cotrimoxazole or molecular zone with or without balkan cyclovate but still they can be breakthrough infections and since you're getting a foreign object somebody else's lung the other major scare is rejection it can be acute cellular rejection acute um you know antibody mediated rejection or over a period of a couple of years one year or later it can also turn into a chronic rejection beyond this because of the immune suppression and because of the change in the you know immune surveillance that is being produced in the body we do see metabolic complications like diabetes hypertension hypercholesterolemia renal failure and even some malignancies liver proliferative malignancies to be more precise but even lung cancers have been seen in patients post transplant but then the incidence and prevalence of these diseases of these complications is pretty much low so if you look at the weight if you obey the risk versus benefit balance the benefit of transplant for these patients with end-stage lung disease really really outputs it beats the risk of complications by a huge margin right the survival rate otherwise but for the transplant would have been in a single digit so definitely thank you so much for having you and we will definitely have you for one full one hour session about the lung transplant and uh areas of your speciality thank you so much my pleasure thank you so much for having me thank you with this we complete our rounds of stories and we thank particularly dr apar for his presence and enlightening us so we move on to our quiz action the first quiz is the night time eating boost like risk of which disease is it peptic ulcer is it diabetes it's heart failure or it is carcinoma of the in the colon and uh we'll announce uh the winners uh for each question at the end of the third uh question we got our first winner uh so we can move on to the next yeah yeah that's correct the diabetes is the right answer now which truck effectively reduces the lvot gradient post exercise in hypertrophic obstructive cardiomyopathy patient is a decoction ac inhibitors metaprolol or the philippine so all entries are correct all that we have to see is which one it was the first first fastest finger first and now the our last questions in the first year of each of the following condition there is the highest risk of epilepsy or stroke we have heard dr carol in this on at length is it atrial fibrillation acute ischemic stroke transient ischemic attack or intracerebral hemorrhage again i think everybody got it right except probably one or two that it's an interceptable hemorrhage so till we get the results we once again request you to give your stories uh right to our editorial team and we'll process it and if it is good and again we'll also reward to the persons who gives the story which comes in our first 10. yes i think we have the winners uh here uh for the first question um we have dr aravind raju for the second question we have dr indira nayak and for the third question uh we have dr narayan um so congratulations everyone and uh we'll surely we shortly get in touch with you uh for your uh winner for your prices someone from netflix will give you a call and thank you so much for tuning in uh so if you would like to see thank you yes i think who is we always give a bidding advice that the host year end season is coming and we will be happy meeting people but always maintain the distance and wear the mask and we must as and when the booster dose is available we should take it so with that stay home stay safe and enjoy our program and keep give us your feedback comments criticisms thank you very much good night have a good time thank you

BEING ATTENDED BY

Dr. Murtuza Zozwala & 822 others

SPEAKERS

dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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dr. Roma Kumar

Dr. Roma Kumar

Senior Consultant, Max Super Specialty Hospital Gurgaon & Institute of Child Health at Sir Ganga Ram Hospital, New Delhi

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dr. Pranav Kharod

Dr. Pranav Kharod

Consultant Neurologist, HCG Hospital

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dr. Apar Jindal

Dr. Apar Jindal

Director - Advanced Lung Failure, Transplant Pulmonologist. Co-Director - Lung Failure Unit, Yashoda Hospital

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dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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dr. Roma Kumar

Dr. Roma Kumar

Senior Consultant, Max Super Specialty Hospit...

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dr. Pranav Kharod

Dr. Pranav Kharod

Consultant Neurologist, HCG Hospital

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dr. Apar Jindal

Dr. Apar Jindal

Director - Advanced Lung Failure, Transplant ...

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