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Cutting Edge Ep 4: The top 10 stories this week

Nov 19 | 3:30 PM

Watch the episode to see how some blood pressure-lowering drugs are benefitting in preventing diabetes. Published in Medscape on the 16th of November, Europe has given a green light to the use of once a week ‘Semaglutide’ for weight loss. Stuck between unfair beauty standards and culture, the misuse of corticosteroids is now being studied, Dr. Desai talks about the silent epidemic that has gripped the country.

[Music] very good evening to everyone i am dr niveda and on behalf of team netflix i welcome you all to our fourth episode of cutting edge um we have with us our speaker for the show uh dr madev desai he's a senior consultant physician at hcg hospital good morning everyone and first of all let me thank you all for joining for the fourth consecutive friday episode of cutting edge and today we are coming out with another 10 interesting stories with few experts comment as we go ahead the first story obviously about the kovit we know that the europe has become the epicenter for the third stage and third phase and as we see that the number of cases are increasing in europe the austria has come out with a novel way of curbing the spread of the kovid 19 and their first time come out with a lockdown for the unvaccinated people and as it is 65 of the austrian public population is covered with the vaccines one which is the lowest rate in the western europe and the seven day infection rate is more than 800 cases or 100 million people a hundred thousand people and as you can see in this graph the graph is showing the increased rates of copy 19 infections and particularly the austria has a rapid surge and that is why they have to come out with the stringent actions and this is for the first time that some ever country has come out with the lockdown for the unvaccinated people all unvaccinated people are allowed to get out of the house only for either working purpose or for buying the food and about 2 million people are yet not vaccinated and that is why they have to cut down and come out with the strict actions and not only that but they also made a provision of 500 euros for the as a penalty and if somebody doesn't allow the officers to look into it and they may be further analyzed with a 1450 euro as a penalty so maybe we hope that we don't have to come out with this kind of actions and this is one thing that prompt us to go for more and more vaccinations to our people who are still not vaccinating and good part is that government is making all the efforts and not only that they are giving the penalty for not allowing but they are also giving the instant vaccinations at the every spot where they are checking for the vaccinations and now they are also going to start with the every house-to-house vaccination so that's a welcome step and let's hope that we don't have to go for this kind of stringent actions we move on to story number nine uh that's very interesting story up till now we know that we have only heard about the sniffer dogs but near they have never heard differ forms this particular is a very small tiny one millimeter warm which is called c elegans the name is also something unique c elegans and this c elegans has been used for many medicinal purposes earlier but this town japanese biotech company has come out with a use of these nematodes for the pancreatic cancers the urine of the pancreatic cancer patients have been kept in a dish and the worms are put into it and they smell it and they give the different colors to this urine and that is how the pancreatic cancers can be diagnosed with the help of this form and it has been proved that they have later on confirmed with the other methods of pancreatic camel for pancreatic malignancy and all the 22 samples that have been tested with this nematode has been found to be correct and many of them have been early stages the company does not say that it is for the diagnosis but it is for the screening for the screening test there has to be something which can easily be done and can be done in a mass levels and without a prick or without any extra cost so let's hope that this kind of novel investigations may help us in early diagnosis of many cancers we move on to the story number eight we know that when the sars cover vaccination started there are many apprehensions about whether it can be given to the immuno compromised patients patients with having cancers or patients on immunosuppression therapy and pregnancy and children of course pregnancy and children early were not allowed because they were not tested in the clinical trials but this particular story appeared in the clinical oncology journal of november 10th issue and here for the first time thousand and one patients of different cancer types have been uh tested for the safety and immunogenicity of the sarcoid vaccines they have either received the one of the mrna vaccines of physical or moderna or jnj vaccines and what they found that first dose at least has to be received by the and all the participants and 32 people also had received the booster dosages and what they found as a good news for all the patients who i've received either for the cancer treatment including the chemotherapy radiotherapy is that the immune response is good it may not be as good as non-cancer patients but good enough to save them from severe complications of covid and jnj vaccine was less immunogenic than the mrna vaccine unlike pfizer or moderna but still it provides enough immunity to prevent from the severe infections and what the study suggests that patients with cancer should receive mrna vaccine if it is possible it's available and as far as jng vaccine is concerned a booster dose should be given so that's our story number eight we move on to story number seven and this is something uh more often physiological changes and this i like the most and it appeared only yesterday in the new england journal of medicine as a review article about how salt affects the blood pressure and new understanding up till now all of our understanding about the role of sodium in the maintenance of the intra extracellular fluid volume and the blood pressure and we know that sodium levels are maintained right irrespective of how much salt we take by exactly excreting the amount of extra salt by the kidneys so sodium has been and the kidney has been the mainstay of maintaining the extracellular fluid volume as well as the blood pressure this particular article a review article goes in detail it's almost about 10 pages but gives some novel ideas about how the other factors also contribute to our understanding we know that sodium balance is maintained with minimum fluctuation and health despite flexing the intake and we know that there is a complex interplay of renal tubules renin-angiotensin system anti-diuretic hormone atrial network peptide as well as the other factors aldosterone all and what it has been studied that if you try to give the potassium chloride in addition to sodium chloride for containing the total amount of salt a person takes in a day as against the 100 sodium chloride then the number of patients having lower blood pressure rates of stroke as well as the major cardiovascular events and even death have been reduced remarkably and we all know as a physicians at least that there was a landmark trial called bash dietary adjustment to salt to stop hypertension this was a trial where the main focus was on main diet of fruits vegetables and low dairy fats and sodium was reduced to 3 grams and the results were very impressive the patients who had hypertense and had blood pressure dropped by at least 11 millimeters systolic and five liters diastolic which was equivalent to one anti-hypertension medicine so since then people have been using this but little bit people have realized that it is not only the sodium that was low but probably the fruits and vegetables and the fiber that was going on along with it has also contributed to this reduce in the blood pressure and now that this particular research article suggests review article suggests that there are another novel quotation switch which are operating on the renal tubules which also reduce the soil sensitivity and again another novel factor is that the dietary fibers when we take fibers in the diet they lower the blood pressure by altering the salt sensitivity and gut microbiomes if you take fiber the fiber is acted upon by the common cell bacteria and they generate sort chain fatty acids which activate the receptors in the kidney artery heart immune cells and they stimulate the anti-inflammatory regulated t-cells which are called t-rex cells and that is why the blood pressure is lowered down with the help of the fibers and contrary to that if a person takes too much of salt sodium salt then it will change the compost in such a way that the lactobacilli which has one of the most important gut microwave goes do not work and that is why the blood pressure goes elevated so something that probably we saw for the first time a potassium switch as well as the role of fiber in maintaining the blood pressure in the sodium balance we move on to the sixth story this story was contributed by one of our viewers dr santos doggery from chik manglor and we are thankful to him for the same and this was a story about the government notification about an important permission to carry out the post-mortems in the covet era beyond sunset generally the postmoderns are not carried out after sunset unless it is a mediocre postmortem but here the postmoderns are allowed with the notification by the government of india ministry of health and family welfare department on 15th of november that host modems can be carried out as long as the infrastructures are good there is a good light there is a facility for the video recording and as long as the evidentiary value is not disturbed by doing the post-mortem at all hours the exceptions are if there are cases of suspected homicide suicide rape or the body is decomposed or there is a suspicion of foul play then it is better that the postmoderns are not at done after sunset and again if the postmoderns are done for the organ donations then it should be done without any of these formalities and as early as possible because we are going to save many lives with that organs and it is also important that all these facilities have to be maintained for the good uh light as well as the other infrastructures and video recording of the post modern also has to be done and whatever is required to be done so that it can be maintained for the legal purposes so these are our stories for the right and over to yes so it's time uh for our favorite story of the week to go on so the five stories that y'all just heard about um yeah here please put in your words to tell us what was your favorite story so far so we have the salt the blood pressure and the salt uh the diet story which got the highest words uh right shall we move on to the story number five okay so this is another interesting development that the europe has given the green signal for the uh weekly semaglutide or the weight loss if you remember before two weeks we have also done the story of tetsapatite for the weight loss and this is another glp one molecules which is already approved in usa in before few months but now that europe has also given the consent and why it is important we've mentioned is because we there are facts in the means there are some undercurrents showing us that probably in january february we might get the oral sima glutathione in indian market also so this hemaggluti is studied as a once a week 2.4 milligram intramuscular injection right in the european union for the wage management chronic weight management and the results are as impressive as the bariatric surgery that is an important take out and the patients who had the body mass index of more than 27 gram kilogram per meter square with one of the comorbidities like hypertension cardiovascular disease or type 2 diabetes or patients who already are obese with a vmi of more than 30 were enrolled and what they found that there is an impressive 17 to 18 percent weight reductions and which was sustained beyond 68 weeks that's a very very impressive and it the results have already been out about the main study called the step study which was hemoglobin treatment effect in people with obesity where more than four 4500 people were in involved and these were the patients who did not have to have it so it was purely for the weight management study and with an impressive results probably the jury is out that the semiglutid is going to be one of the important treatment as it is we don't have much many drugs for the weight reductions whatever drugs came earlier whether it was fenforming or without us the other drugs like lowercase serine they all had some of the side effects and rimanna bond they were all withdrawn later so hopefully this is the drug which is going to be step because we already use other drugs like lyra glutide that is also approved for the weight reductions but once a week and with impressive results and probably the oral molecule likely to be in the market soon it becomes the news for us we have dr om lakhani one of our consultant endocrinologist from ahmedabad let us hear what he has to say about this new molecule hello everyone i'm dr um working at zadis hospital so the news of one sweetly injectable sibo protein receiving approval in europe for weight loss is not at all surprising the same formulation is already approved for weight loss in the united states and this comes after the convincing step trial which was published in the new england journal of medicine which clearly showed the benefits of using one sweetly similar protein in the dose of 2.4 milligram for weight loss even in patients not having type 2 diabetes now lyrathropy which is also a glp one receptor agonist and also from no one artist right so once daily injectable drug has already been approved for weight loss and has been used in clinical practice since many years in the dose of three milligrams once a day so what is the significance of this news now the first important thing is that we are now comfortable in the space in which we are using effective medical therapy for weight loss which is as effective as bariatric surgery now the weight loss which was achieved with the injectable sigma protein in the clinical trial was as close as one would expect from a sleep gastrectomy secondly the oral version of this chemoglobulin which is called probilsis is soon going to be launched in india now we have heard that it will launch as early as january or february of 2022 so the drug would be primarily approved for use in type 2 diabetes patients the off-label use of the same for weight loss can be expected this is actually good news because after a long time we are having a safe and effective oral drug in india which can cause significant weight loss so for those who are looking for medical options for weight loss this would be a fantastic bit of news and please talk to your endocrinologist's opposition for this option in future thank you one of the readers wanted to know about the duration of lyrical semi-gluted injections and the trial was for 68 weeks but i'm sure it can be given for a much longer period because for diabetes all these glp one agonist can be used for a very long period and now we already have that for years we can use it so shouldn't be a problem now there is another story about the fda approving treatment for polycythemia vera we know polycythera is not a very common disease but it's one of the milo proliferative disease where mainly the rbc's proliterators are increasing there is an increase in the hemoglobin and the rbc mass when the hemoglobin is more than 18 grams or the pcv is more than 50 then it's considered as polycythemia it's not only the increase in the rbc but there is also increase in the wbc as with the platelets and that leads to the hyper viscosity syndrome and incidence of arterial venous thrombosis so all that we had right now up till now was the plebitomes frequently as well as the aspirin and maybe the drugs which are called cytoreductive drugs like the hydria hydroxyurea and muscle fun but this is for the first time and one of the interferon that specific for the polycythemia has been approved by the fda and this is called the rope interferon alpha to be njft this is an injection which can be taken intramuscularly uh subcutaneously every two weeks and if the response is good it can be delayed later so something which is uh welcome in the treatment of polycythera of course we do this is approved for all types of polycythera and really all types means the part which is of course not secondary pulsation of era and also probably the patients who have received any kind of treatment we can give the because it's worked at a totally different point that is it is working at the receptor level so it can be used in patients who have received other treatment for polycythemia we want to the third story which is very interesting story it is called the story about the spontaneous clearance of the hiv virus we know that hiv virus is something which one gets into the dna of a person's t cells right it remains for the rest of the life and that is why the treatment is also lifelong but up till now only one patient had spontaneous clearance of hiv that patient name was lauren willenberg who had lived with hiv for 27 years and then suddenly she had no hiv in spite of all the investigation that are carried out for the viral load for the even everything and this is the second case which was just appeared in the analysis of internal medicine and both the cases who have reported have corroborated and they have gone for the extensive investigations whether there was any trace of any of the viral particles in the patient's blood as well as whether say that patient is receiving any drug for the antiretroviral therapy which was not there this particular patient is an 30 year old argentine woman who is coming from a village called espanza and she had contracted the disease from her husband who unfortunately died and she again had a second marriage and she also delivered a baby but she did not have the hiv infections at that time and this was the second case where the hiv clearance is there this without the use of stem cells stem cell transplantation has led to the clearance of the hiv infections in few patients but the hiv clearance without stem cell transplantations has been reported in very few patients the authors say that they want more patients to be reported so that they can do the studies and try to find out what is the particular factor in a particular patient who had why they are clearing the and maybe at some day will have a cure for this and very interestingly the village which is called espanza the meeting in spanish is home so let's hope that this particular case also opens our door for this and they have as i said found out that this particular lady had more than 1000 cd4 cells which itself is a sign of immune recovery and this is these are the type of people who are called allied controllers where they control the hiv replications on their own and they contain the infections without antiretroviral therapy so move on to the second story which is again very interesting and of practical importance disappeared in the landsat on 13th november this story is about the use of antihypertensive medicines and its effect on the new development of diabetes so we know we have been using many antihypertensive medicines whether it is thiazides or beta blockers calcium blockers ac inhibitors or angiotensin receptor blockers the meta-analysis which had 22 randomized control trials with more than one leg 45 000 patients they will come out that lowering the blood pressure by particularly as inhibitors and arvs have definitely much better effect as far as the new development of diabetes is concerned compared to the beta blockers and thiazides which on the contrary have more chances of getting the new onset diabetes so we have again our expert's opinion from dr sanjeev fattak who is a senior consultant diabetologist uh let's see what dr fatah has to say about dear friends from uh metrics it is indeed an honor to share my views about the article published in the landsat and it is there on the medscape also now demonstrating that both ac limiters and arvs combinedly called the rash blockers have been associated with preventive effects on type 2 diabetes we know that these drugs are very good for preventing the cardiovascular events and even for the renal endpoints but now this article has reinforced our belief that these are not only drugs for diabetes when kidney and heart but they are actually drugs for preventing diabetes this is a meta-analysis which has been recently published and if you can recall our article published about two years back in journal of diabetes about the sweetening 16 and the mechanism by which this ras system can be causative factor in diabetes and thus by blocking the ras the ace inhibitors as well as the er beast we had demonstrated that it can reduce type 2 diabetes new onset by about 23 to 27 collectively 25 and now this study has clearly shown that in comparison with beta blockers or thiazides which actually increase the risk of diabetes and ccbs which are neutral even compared to these drugs the incidence of new diabetes is much much lower in people who are prescribed either is inhibitors or air thank you very much thank you dr sanjeev we move on to our story number one of this week which is something really an eye-opener right in fact when i went for the story i didn't know some of the horrifying effects of this and this story is the name fairness mania which is run by the cnn in november 2021 cnn has started a crusade against the what they call it the white lies that the whitening agents or the fairness agents or fairness creams which have been used indiscriminately and some of these so-called the whitening beauty creams are having the low dose of steroids called beta methyl zones and we know that when the steroids are being used for a long time they definitely have a bleaching effect they reduce the pigmentations because they work on the melatonin and they do reduce the pigmentations but the moment the steroids are removed from applications they start getting the side effects in the form of acne hirsutism or the sun exposures leading to the rashes and the burning sensations so this is about they all started with the story of a lady who at the age of 14 was told by the neighbors that she had gone and got a cream which is going to make her skin she incidentally has a darker skin so her parents thought that this is something that is going to help her because we know in india we all love the fair skin and the fairness and that we definitely believe in colorism or the discriminations we can say so this particular lady unfortunately she applied at the age of 14 she continued to apply force and her skin becomes better so all her friends are all were very happy she was also very happy but as it happens after few years right suddenly she could not apply because of one of the other reasons and she started getting intense burning sensations and rashes and her skin becomes darker than the earlier and then she realized that something is not correct and she started a blog and she had more than six lakhs followers and one of the lady from the usa or the other country countries ask her that she also running from the same problem what should she do then she said stop right away and be prepared for whatever consequences that you might get for these particular problems because of the steroid role so we know that this in our country also the people are using we use beta methazone for the skin conditions like eczema or psoriasis but it is a singular etch drug it should be prescribed and should be made available only on the prescripts of a registered medical practitioners but there are so many spurious or duplicate screen ointments and even the so many cosmetic these kind of ointments are available even the grocery store so the problem is enormous and in the right earnest the cnn started a crusade and we thought that we should also join to this crusade for making the awareness that all that appears white need not be good and we should read and we should read the labels of any cream that we are going to apply and see whether it contains the beta method even if it is in a small dose when it is applied for a long period it is going to have its deleterious effects and something that may not probably be covered later on by doing are spending a lot of money and this is our story and i think we must educate all our patients and the relatives that don't go by the appearance or just use something which is going to do more harm in the time to come so that's all about our stories thank you and let's go to the quiz yeah uh it's time for the second poll um so in the next five uh stories that we ran uh tell us what your favorite story was so far there are five options and you all can scroll on the screen uh to see the story that you all like the most okay so we had um the hypertensive uh the medicine that was used to control uh prevents early onset of diabetes was the favorite uh story so far uh so if we could move to the quiz uh part of it thank you so much so here's the first uh session of a question for the quiz uh you all know what to do so uh put in your answers uh the first person to get the right answer uh netflix will get in touch with you uh and we'll give give you a prize guessing the right answer all right uh can we go to the next slide yeah so so this is the second question uh the same thing uh put in your answers a b c or d which option is right and the first one to get the correct answer we get in touch with you for a price all right and moving to the last uh question okay uh so give me a minute and i will check who the winners are meanwhile i can appeal to the readers that please look if you come across interesting stories do let us know because that will help us in reaching out to the masses with the interesting stories and also will reward as a token of appreciation through the stories which make it in the first 10 of our next episode and as we have talked about in our first story about the austria about the lockdown we wish that we don't have to get into that so let us spread again the message of kovid appropriate behavior and vaccinations and the masks of cell distancing etc so over to you thank you sir uh we still tried there were many right answers so um okay uh so we have the final list here uh y'all can also see it in the comment section but i'll read it out to you all uh for the first question we have dr janani for the second question we have dr ravi khan smile and for the third question we have dr hsr arora um here's a list of the winners and netflix will get in touch one of us from metrics will get in touch with y'all uh to take it forward and we'll meet you all next friday same time with the same two people and hope to see all them thank you so much and enjoy your weekend thank you good night thank you

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dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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