Cutting Edge: Episode 10

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Cutting Edge: Episode 10

7 Jan, 3:30 PM

[Music] good evening everyone i'm doctor and this is the 10th episode of cutting it we're so happy to have you all if like you all know we have dr madhusai with the senior consulting physician uh who will be hosting the session hello good evening welcome i'm dr madhu visa and team netflix uh we are meeting for the first time in the year 2022. we have been waiting for a golden day but unfortunately that is not to be the case and we only wish that the omicron or any new ireland that comes doesn't do us more than the simple breweries doesn't lead to many lives or the economical losses and with this very high hope we begin our session we have many stories today with every new year there are new molecules which are coming up and there is an era of the novel markers they are also called the molecules or the signature molecules and we'll be seeing many of them but first story has to be with the ah koid pandemic so last week only there was a furrow and we all thought that every beginning of the new year we have some bad news and this was one of the news that we thought would be spelled doom because this came from a very prestigious institute from the france that is from the marseilles is called university hospital institute ihu and the this particular article appear in mid-rx which is has appeared as a pre-print article and not peer review and the researchers claim that they have found out a new variant and they call according to their university they give the name as ihu and this particular variant was first detected in a cameroon a person who visited cameroon cameroon is a west african province and he was already vaccinated and he contracted these infections and the genomic consequences sequences have found out that there were almost 46 mutations and 37 deletions and important part was that the mutations were also involving the spike protein domains that is the ns 501 y and e484k these are the dominant mutations and that could lead to the spell of some severe infections in the severity to comfort and the immune escape and what they found out that the subsequently they identified another 14 such 12 such cases and this came from a researchers scientist who is the head of the institute is d route incidentally dr rault also went into some controversy when he uh suggested hcqs treatment for the covet pandemic in the earlier part thankfully the who immediately sent a rejoinder and said that that this virus has been going on ever since the omicron virus surfaced and it is under their radar but really it's just a virus variant under investigation and as of now it is not a variant of concern and we did not give too much we need not fear about this particular virus and in fact had it been there for last one month and we have not are many such cases that is probably a very localized pocket of and mutant virus which we keep on getting for innumerable cases so let us not worry about the new variant and focus on how to deal with the omicron but we move on to the next story that is about an snake bite what is new in snake bite a very beautiful lengthy article appeared in england of medicine yesterday which is a review article of about 20 pages and the article begins with the statement that in 2009 who recognized nick white as a tropical disease but in 2017 only it just elevated its to a category a of the neglected tropical disease along with many other disease and the incidence of snakebites are no less than the cases of the resistant tuberculosis or many other infectious diseases we know snakes generally avoid human contact by returning retreating or hiding snakes know that humans are not their food but they can be the food for the human so that is why they avoid humans as far as possible it's only an accidental or a provoke bite that we will get and most of the time the bite is on the legs extremities and we have to remember very important part is that not that every bite has to have a venom and every snake bite need not be a poisonous neck by ah there can be as many as two to fifty percent of the bites could be dry that means without venom but when this neck has beaten with its venom that venom contains many of the protein toxins enzymes whether it's a hyaluronidase collagenase or protein is phospholipase especially for phospholipids a2 is very very important because they have got now drugs to counteract that kind of phospholipase as a synthetic peptides and metalloproteinases metalloproteinases are new for us but they can be responsible for many of the microvascular damage leading to hemorrhage skeletal muscle necrosis rhabdomyolysis and even thermal necrosis what is new in this particular article is that the lymphatic injury is one of the important part and it can lead to edema not only that but the lymphatics that is involved in the systemic absorption of the venous toxin so at least when it comes to management we have to keep this in mind that the lymphatic drainage hemorrhages is always obviously by the clinical syndrome by inspecting at the site of the bite and the different symptoms that the patient might have and whether it could be neurologic by way of the ptosis or breathlessness or respiratory depressants or cytotoxic or the coagulopathy by the intense bleeding or thrombotic complications what is more important the management in this three article is mentioned is that as early as possible one should get away from the snake that we know it but we if it is possible we should identify the snake and second part very important we must get the loosely splinting of the beaten body part we should not tightly put it because there could be an edema in the answering covers and it's keeping that in mind anticipating that any jewelries or any rings that person has been putting also should be removed and the lymphatic flow as i talked earlier the lymphatic flow should be obstructed by way of a good bandage or at least keep a blood pressure cuff tight and inflate it to 50 millimeters of mercury if it is an upper limb or 70 millimeters of mercury in the lower lip so that's a very very important take away from this review article that there is no advice for any of the articular venous tourniquet or any incisions or any suctions or sucking the poison or any application of heat cold or any electricity but what is important is try to obstruct the lymphatic flow so that the neurotoxins especially do not travel to the venous systems and thereby to the central nervous system so that's very important take away the another important part is that even if the snakebite appears to be non-venomous because there is no local bite many of the neurotoxins there may not be any local sites and the symptoms may not appear for a few hours so it is better that observe all snake white patients for at least minimum 6 to 24 hours and treatment wise you know the only treatment that is is antivenom antivenom is a definite treatment if you come talk to india india has got four poisonous snakes so we have got a polyvalent anti-venom serum and that is to be used the important takeaway again in this is that the children should receive the as large those as adults because the venom load in children is also going to be as large as the adult so in children need not be having a loss or lose those depends on the type of bite if it is neurotoxic you try to do enemy up to 20 amples initially if it is hematotoxic again high dose even if it is non-toxic give at least 10 amples of the anti-snake venom which is available in differentialized form and it has to be reconstituted to the liquid form and we have to have an anti uh testing for the hypersensitive reactions because all these antivenoms are prepared in the horse or the ship serum the antivenom also has to be given even later on initially with you to neutralize all that is not absorbed but unneutralized venom can also produce the delayed side effects and that is where the new uh this article suggests that antenna may have to be given for a prolonged period for its systemic effect for the unneutralized venom and as i said the phosphorylase a2 is one of the important protein which brings about the devastating effects and now the scientists are able to create or produce the synthetic peptides up till now all the anti-snake venoms represents are also either prepared in the horse or serum or serum or they use another types of venom but here the synthetic peptides are are made and they can be used one of them is various blade whereas planet is one which is it can be a broad spectrum anti-snake venom that means it can be used for any type of economy because it works at the molecular level the another one is against the matrix metalloproteinases which are another important mediators for the destruction so there are two drugs like betty mestart and mary may start they are right now in the trials and they can inhibit some of the cogullopathies caused by the hemorrhagic venom so important takeaways lymphatics should be obstructed by way of the loose planting and you increase your inflate your blood pressure cuff to 50 millimeters in the upper limit 70 millimeters the lower limb but do not go for the arterial venous tourniquet or any of the incisions use anti-venom use anything more frequently and in children also we should go for the same dose and as and when these newer synthetic peptides are available we should be using it without waiting for the anti-snake venom because anti-snake venoms are not easily available there is only central supply as when you come to india so new move on to the next story and that is about coronary angiography in cardiac arrest survivors when we know that most of the cardiac arrest that occurs outside the hospitals underlying cause is usually ischemic but there could be many other causes and this article particularly appeared in germa cardiology and where it is very difficult to get this kind of studies approved but these are the patients who have survived the cardiac arrest out of the hospital these are the very patients who did not have hd elevated marker infections on the ecg after the survival and these were the patients who were enrolled and they were divided into two categories they were all dutch patients uh across 19 such centers and all these patients who survived the cardiac arrest out of the hospital and not having st elevated medical infarctions were divided into two categories one category one group uh went for the immediate angiography and the second group the angiography was deferred till the patient all those patients who had recovered from the neurological complications so there are two groups and they were all followed for one year and every any time the patient any patients who had survival from the cardiac arrest had shock or kidney failure or medical infections were excluded from the study then all these surveillance side are divided into two categories and what they found was that the after one year the survival rate was practically no different in all those group who underwent immediate angiography and all those where the angiography was delayed but their primary target was the 90-day mortality out of in the first time and there was also no difference between the two groups as far as the 90 day mortality is concerned so the conclusion of the study was that coronary angiography can be delayed if the patient till the time of neurological recovery delay does not mean that the patients have to wait for days or weeks together but till the patient recovers from the neurological insult that may occur because of the hypoxia that follows the cardiac arrest arrays and if you just defer the angiography because the patient did not have marker infarction the outcome would be same we asked dr jaisa who is a critical care clinical cardiologist and intervention cardiologist and a group friend of ours and let's see what he has to say about the angiography in the survivors of the cardiac arrest hello friends thank you very much for the opportunity given to me last week as you have already aware that there was an article regarding the rule of angiography out of hospital character is patient and whether is it justifiable to it immediately or it can be delayed or deferred why is it important because we all know that the ischemic heart disease is the root cause of certain correct death and whenever the patient is being resuscitated after a cardiac arrest out of hospital the first thing which we must rule out is to rule out the ischemic part which is a correctable cause and once the neurological status is being established then i would say i think the role of angiography does require and in a case of st elevation mi it is the important parameter which we must encounter and those patients who are not having non uh est elevation mri in those category of patient i think it can be deferred till the patient is having a good recovery and the rest of the hemodynamic parameters are in favor of the patient to undergo any of the coronary intervention thank you very much thank you dr jay for the inputs and in the same study it was all those patients who developed some complications were allowed to undergo the immediate angiography also luckily that number was not big then another interesting study from the new england journal of medicine this is about the chlorothalidone or the treatment of hypertension in chronic kidney disease you know that in chronic kidney disease the mortality is always very high what we did not know before this study was that the mortality is mainly because of the hypertension which was not adequately controlled so in this randomized controlled trial of 160 patients uh all who had the stage four chronic kidney disease and who had poorly controlled hypertensions out of which there were 76 percent of the patients also have diabetes and they were 60 persons were receiving loop diuretics numbers do not match because they are going to have overlap of the disease and all these patients they were randomly assigned to in the one to one ratio of either receiving chlorothalidone to begin with in a 12.5 milligram and gradually increase every four weeks to a maximum dose of 50 milligram or another group which was placebo receiving the other anti-hyperc treatment at the beginning of the study the systolic blood pressure and the 24-hour ability blood pressure range for the chlorothalidone group as well as pressure growth was almost around 142 to 140 millimeters and the diastolic blood pressure was also around 74 to 72 millimeters of mercury and what the study found out after 12 weeks of the chronium therapy was that the systolic blood pressure reduction in the cloth solution was as much as 11 millimeters in the closed helicopter and only 0.5 millimeters in the placebo group and this has resulted into a significant reduction in the albumin to create in ratio from the baseline put in there within 12 weeks itself for the ctd that is the close halidon compared to the placebo to the tune of 50 percent so a clear clear-cut immediate reductions in the album creating uh ratio in the patients who received chloroside down and thereby control their blood pressure to a desired level and although patients with advanced secret disease and poor control hypertension chlorthalidone improve the blood pressure at 12 weeks which is a very significant uh gesture so that is what the only side effect was the hypokalemia that is to be kept in mind but again that can be managed not without any difficulty so that brings to the end of our first round and over to nivida thank you sir so before we go to our second uh section of the stories um we have a quick poll for all of y'all um just give me a minute uh so we had a few uh or in people in the audience who said that they would like um cutting edge at a different time so we have two options uh y'all can tell us if you all prefer the same 9 p.m slot or if y'all would rather have it at 10 p.m so y'all can put in your work and submit it and we will then take a call [Music] okay so 78 says 9 pm all right uh so we shall stick to our 9 pm slot and we continue with the second half of of the story now okay so this is a very very interesting story from again cardiology that is from the journal of clinic american journal of cardiology and this is up disappeared in the 22nd of december in the clinical electoral physiology section of general of american college of cardiology and here the patients who had one of the cardiac device whether it's a defibrillator or the loop recorder or a pacemaker alone all those who died these patients that cardiac device was recovered from the dead bodies and then it was subjected to the interrogations or the further analysis so we can say that this cardiac device was almost seen like a black box to see what happened and what were the terminal events at the time of death and out of the total patience means total subjects were the 260 diseased individuals out of which 162 had medical legal cases because there was a certain date and they could not have the immediate cause given and there were 998 unexpected so total of 260 cases where the pacemaker or any of the device was implanted was explanted and subjected to the interrogations and they could do it in 98.5 so practically most of the defibrillators or the devices could be subjected to interrogations and they could find the cause of death in almost 64 percent of the patients uh in the subco sudden cardiac death and 28.6 percent of the non-sudden deaths what is important interesting thing is that what they could find is a definitely important learning lessons but that there are many events which were there 30 days before the death so it could have been avoided had there been the uh like non-sustained ventricular tachycardia repetitive fibrillations or defective replacement indicator or end of the life of the battery status all these things are then so what we learn from this is that patients who undergo all these kind of cardiac device placements should be regularly followed for their the working of their devices so that we can prevent some of the complications which can lead to death and second important part was the medical legal implications that there were eight fatal motor vehicle accidents uh the persons who had these cardiac placements device placements and they died in a motor vehicle but out of these are only one head ventricular arrhythmias generally it is filled that he might had some microlil infarctions or them that could have led to the accidents but no only one of them had the ventricular arrhythmias the other dates were not because of the alkaline functions or the pacemaker or the device failures and the unfortunate part is that even in country like usa that only four percent of the morticians that is the people where these dead bodies are finally take for the disposal they return the device to the manufacturer if we have more such devices here or anywhere as a part of policy if we just return this device to the manufacturer right we may know many more things and can improve the manufacturing process as well as the learning or advising to our patients undergo cardiac device placements we again have dr jay shah who will help us in suggesting something more about this study over to dr jaish ah hello friends as we all know that aicd there is automated implantable defibrillator it is being kept mainly in patients to prevent them for developing foreign correctness due to ventricular engineers but what if a patient is dead and then you wanted to find out the reason why it is you know the event has occurred and for that i think this article has given us a new importance that what is the importance of doing an interrogation of an aacd device after death and that is mainly which will help in giving us the idea about the critical device malfunction timing of death what will be the pre-mortem abnormality as far as the ventricular arrhythmia is concerned this is a ventricular fibrillation or atrial fibrillation whether the device was having end of life and what was the reason or for the development of sudden cardiac death whether it was an inability to deliver the shock appropriately so i am sure that this particular article is racially informative and information after death in a patient already having an aicd is going to be very very fruitful thank you very much thank you dr jay it was really very very useful to know that we need to put this as part of our regular feature in all pieces of underground now we come to the novel markers as we suggested that this time we are going to a few new novel markers or the signature molecules which might help us in detecting the diseases well before it full-blown disease appears and this particular study appeared two days back in the journal of nature and here the rna profile acting that is a specific type of rna molecule called the cell free rna or cfrna this was identified from a single blood sample from the prospective mothers or the female and this particular the cohort of this study was the eight independent different types of the groups of women right and there were different radically basically different racially different pregnancy ladies having the pregnancy and the different types of gestations of about 1840 numbers and they also had the collected the samples the plasma banks where the samples of the women with the different stages of gestations are collected the 24 539 such samples were also analyzed for the cell free rna that is one of the important marker for detecting the complications of pregnancy at different stages of gestations and what they found that this particular cf rna from a single sample of the mother can track the pregnancy progressions at the placental level at the paternal level and the fetal levels what could go wrong and at what stage the different stages of cfrna would be different and this particular novel method of detection has a sensitivity of 75 percent which is quite good and the procedure positive predictive value of 32 percent again a very very important because the present method of detecting the pregnancy complications are as i understand is mainly ultrasonography at the different stages of the pregnancy the first second trimesters the sonograph synthology is the one prolly that will help our obstetrician experts will be giving us more about this but this particular method of novel marker has definitely a better sensitivity and the positive predictive value and maybe in the future this will become the standard investigation at different stages of the gestations the cf rna is a signature molecule as i said and it can give us the idea irrespective of the maternal age body mass index and the rays which are known to have a different effect on the pregnancy outcome so we have dr munjal pandiya he is an obstetrician's and the assistant professor at the medical college and also the uh vice president of the uh and the secretary of the associations of obstetrics and gynecologists of so let's hear from dr munjal pandya what he has to say about this cell free plasma rna with respect to this particular study of cell free rna profile in predicting the pregnancy or gestational age or progression of pregnancy and uh predicting preeclampsia once before its development is really fascinating uh now this particular study has been published and uh on 5th of january 2022 it says that uh the females who were studied they took the blood sample at least 14 weeks prior to the full time or the expected date of delivery and that particular sample was analyzed for cell free rna the conclusion they made was it was they were able to diagnose the exit or accurate age of gestational age in comparison to sonography we all know that the first trimester sonography has variation of approximately plus or minus three days the second trimester one does a variation of plus or minus one week now both those uh parameters were equal to the cell free rna which was achieved and gestational age was uh you know achieved with same accuracy but with regards to third trimester when sonography variation is around more than or equal to three weeks uh this particular cell free rna analysis was found to be superior so that is one thing which would uh help in analyzing the gestational age of that particular pregnancy specifically so when the patient comes later in the pregnancy or when the patient does not is not sure of the last semester period date the second one which was very much impressive was they tried to get the issue of origin of that particular rna so with regards to maternal placental and fetal tissues they had a little success to find out uh or to channelize or to uh you know connect the links of biological changes that happens in preeclampsia that made them able to diagnose that particular preeclampsia at least months before it gets developed so that particular modality if achieved in a you know if studied in a larger bulk and approved would be of great help the further future as the study mentions holds in with regards to accurately studying the maternal and the fetal tissue health along with the development of disease as and when it starts developing so we had this nipt for example to compare a study cell free dna was studied from maternal circulation now the conclusion was it is a screening test and even if positive it needs to be supported by some invasive testing so with regards to this particular study we hope that if we achieve uh the accuracy and level it they say that i had a sensitivity level of 75 and positive predictive value of around 35 percent so very very important inputs and i think cell free rna would be one of the important investigation we would be looking for in the future we move on to our story number three again a novel biomarker as i said in the beginning that we are going to have many new markers in the time to come and this one is also very very important it appeared in the molecular psychiatric journal and we know that depression is one of the very important cause of mortality and these figures say that wha says that almost 20 percent of the people who have depression and the lifelong prevalence and after point pandemic the number has definitely increased and the depression patients and the families have to suffer a lot if we have some marker which can predict and we have some marker which can predict the effect of the anti-depressant drug definitely it is welcome so this is another biomarker which is called gs alpha which is a very small protein which is normally been present in the cholesterol raft in the blood and from there it can be present this gsf gs alpha protein can be present in the wbc's it can be platelets everywhere it is present and a person who has got the depression this particular jsf alpha is pulled into the cholesterol draft into the blood and that is why it could the good more more relating like serotonin neurotransmitters are not available and that is why the person lashes into depression so this particular study was a six weeks open level study and the emory university school of medicine and 49 subjects had major depressive disorders and there are 59 healthy controls and what they did was they collected the blood at the visit born in visit 2 they separated the platelets and they could get these particular gs alpha levels as well as they subjected them to the release of cyclinine adrenal cyclase activities which is the final pathway for this mood elevation so what they studied was that in the patients who had major depressive diseases and patients were normal they studied the levels of the gs alpha proteins as well as the activity of the pg e1 activated adele cyclist activities which will be increased if the drug is working or if the patient has depression this particular activity will be very low and once the person receives the drugs the activity will go up and they studied the levels the third visit was after six weeks of the nd represent treatment and they could find that this particular novel marker could help us not only in diagnosing the depression but will also help in the predicting of the efficacy otherwise the conventional anti-depressant drugs we know we have to wait for weeks together for its if efficacy so this particular study is very useful and suggests again a new marker coming off for the depressions and we ask our good friend psychiatrist and who is very much into the management of the depressions and different kinds of mental disorders dr himanshu what has he to say about the depression how they manage how they diagnose and what is the place of this particular novel marker in their practice good evening i am dr himan look for depression we cycled is feel that there is only one diagnostic method is taking clinical interview we don't have any other tests to diagnose depression we talk to the patient and we feel that the patient is fulfilling all the criterias of depression like sadness of decreased intestinal activities sleep disturbance decrease appetite and many mores and we diagnose depression like this only and we were having really lately of any other instrument but look now the science is going towards as as neuro cycle is going towards more towards uh neurological part like so new new methods are coming up so bio markers are new things which is coming up and this will really help us to clinically diagnose and see the effect of antidepressant to treat the patients and this will be really miracle because by by by giving a prescription of getting this market done and which will give us idea about how these identities work so uh dr motherboard is talking about this this newer biomarkers for depression and it is thank you yeah thank you dr desai uh we move on to our next story and that is another interesting breakthrough in the management of diabetes that here we know that conventionally diabetes the main or the only hormone which works for the diabetes with certainties insulin and insulin is considered the main hormone controlling the blood glucose levels and this study appeared in the cell metabolism on the 4th of january and this is carried out by a prestigious salk institute in the california and they identified they could recover another hormone called fibroblast growth factor 1 fgf1 and it works exactly like insulin the only thing that the pathway is different insulin also produces lipolysis this fgf1 also produces the lipolysis and thereby reducing the hepatic glucose productions of the glucose and thereby reducing the glucose in the blood and this particular activity is carried out they have injected this fgf1 in the periphery and they could find that it gets attached to the fjf receptors and they bring about its effect and the activity pathways of the insulin and the fgf1 is almost same except the last part as it is shown in this cartoon that both try to bring down the blood glucose you can zoom out and see how it works the insulin works at the pathway of what is called pde3b while the fgf1 pathway uh works at the different mole pathway and that is pde 4 pathway it's too much greek and latin for all of us but only thing that suffers to say that there is an another way which is a non-insulin way of controlling the blood glucose and the scientists tried to match whether it's really a different pathway or it's just an increases the endogenous produce production of insulin but no it is definitely something that is non-insulin hormone and which works like insulin and this is very very important because now we'll have probably many drugs which will work through this pathway either injectable ones and oral ones and we know our one of the main important problem in the type 2 diabetes is insulin resistance so this particular pathway probably would make our insulin resistance management much easier so let's hope for the fgf1 or its containers or its the analogues come in the market sooner the better so we have left-hand column doctor asu oja he is a senior consultant physicians and attest to the samaya medical college mumbai what has he to say about the different mechanism of action of fgf1 and its effect on the live policies oh dr asudos ojax hello everyone i am dr ashwija i teach medicine in a respectable medical college i am professor of medicine we i want to share a recent advance published in the cell metabolism it is a new molecule called fgf3 fgf1 fabric factors one what is this this is a inhibitor of an enzyme called lipolysis please understand the basic pathophysiology in diabetes what is happening that there is relative insulin deficiency or there is lot of insulin resistance when there is relatively insulin deficiency the sugar keeps rising when there is lot of resistance in spite of insulin is there there is less uptake of sugars in the liver and other departments what they do they try to compensate it how do you do it they use the lipid to produce sugar what is happening here there is a lot of sugar but there is no insulin which should put inside the cell and make the cell comfortable what is happening there is lot of sugar outside but within the cell there is deficiency when there is deficiency they feel that their cells are feeling as if there is a total glucose decreased and they try to make glucose and one of the pathway is lipolysis in which they break down the lipids into smaller fatty acids and these fatty acids are metabolized to prevent sugars and this sugar further rises the sugar level so what this promising molecule fdf one is offering it is inhibiting the enzyme called lipolysis with lipolysis what is happening that because liquids are not broken into a smaller factor of fatty acids and again these fatty acids which tend to have been used to increase the gluconeogenesis new sugar formation they are unable to produce more sugars and that is how the sugar is reduced in the cases which have got very high insulin resistance and so that is the promise and i am happy to share that this is can be used for treatment of diabetes thank you thank you dr asatos you have given good insight about how fgf would be working we are waiting for the different uh clinical trials that will undergo henceforth about the utility of this particular way of working and now we come to the top story we started our new year with the invariant which is probably not in a variant of concern but what is new in this corona pandemic is the cdc has the central of disease control usa has cut down the isolation time to fighters or americans with coed 19 positive infections and this appeared in on the 27th of december not at everybody accelerated with wholehearted enthusiasm but what the argument put forward by the cdc is that the current pandemic is in usa at least 73 percent are because of the omicron infections and as we know that omicron infections as a very rapid concept of symptoms as well as the resolution of the symptoms in most of the patients and they become non-pre-sex by day five so the guidelines suggest that the persons who had the covered infection should isolate themselves for the next five days and the u.s authorities had said that that previously they used to have the isolation for 10 days but now they should have isolation for five days and the repeat test is not required for these persons who had once they call it infections but there have been many definitely people feel that it is too early and it was the people have comment very harsh words also in the columns but the argument put followed by the main advisor of the u.s government there is anthony who is an authority on this infectious diseases that this would help the asymptomatic people to return to work or the school with proper precautions and as i said that they already said that no retest is required as against it what our government indian government has come out in the day before yesterday with the new guidelines for the isolation which clearly states that all persons who are having 19 infections should be isolated for seven days after the test has become positive and if they remain a febrile for consecutive three days and the maximum minimum of seven days isolation is required they have to continue wearing the mask that is obvious and the repeat rt pcr testing is not required what is added in this guideline today evening is that all those who come from the uh we buy the flight from the other countries they have to have a compulsory home quarantine for seven days and only after that is negative on the eighth day they can be allowed their current trend can be terminated so that is new and one more last talk about the uh new message from the icmr chief dr valdrampargava which also raised some controversies but what he has to say is absolutely based on the scientific evidence on the trials that people started asking that why malnu piraville is not included in the national guidelines even though it is there in the some of the guidelines of the states what dr bhargava has to say is that this particular drug molyneux is a repurposed drug than known antiviral drugs but has many known teredogenic mutagenic side effects as well as damage to the cartilages and damage to the muscles and all those young people who are likely to have the conceive might conceive definitely must use contraception for the three months period of time when they have to take these medicines otherwise the child to be born might have some problems in the territoric influences of this drug so malnu piravir is a drug which has to be taken with utmost care and only in the indicated persons what dr vardo's argument was that this is a drug which was approved by only in the trial of 1433 patients and that to be the reduction of only three persons in the moderate disease from the mild cases so at least we have to be very careful in using a drug which is a new drug so that we don't put that drug into this reputation our patients into some complications as it is we have got other drugs also available and as far as the omicron is concerned which is again replacing the delta virus and measuring the patients itself is a very mild illnesses and doesn't go to the lungs it just remains in the upper throat and that is why we hardly see any pneumonia cases or the hrcd showing any of the evidence of pneumonia or hypoxia or patients going to ventilations unless unless the patient had some comorbid conditions or respiratory diseases there we may are justified in using certain drugs otherwise we should put it on hold till we have more experience about this drugs so with this we stop our today's session and over to dr nevita for quiz and the further deliberation thank you sir the quiz section so this is your first question so what is the current level of hu variant of corona given by the whf is it a variant of no consequence variant of interest variant under investigations or variant of high consequence you can put in the abcd and after all the three questions we will announce the winners um so i think yeah most of them are now getting it right we can move on to the next question fibroblast growth factor lowers hepatic glucose production by which particular pathway is it activating pde3 pde1 e4 or suppressing lipolysis same thing abcd but on your put in the right answer and the first person uh to get the right answer we'll announce it at the end okay as per ministry of health and environment department revised guidelines for mild asymptomatics covered patients home isolation is recommended for how many days i'm sure everybody's right now we are talking of ministry of health and welfare for indian government of course there are a lot of answers coming in uh okay so we have the list of doctors here uh so for the first question uh we have a doctor nikita uh for the second question we have dr adityan bhaskaran and for the third question uh we have dr krishnan so congratulations and uh we'll meet you all next friday uh yeah thank you so much next friday is 14th of january and makar sankranti new sunday but i'm sure by nine everybody will be free and relax and we'll have few more stories till then we know the best vaccine is the mask so we keep a triple layer mask or an n95 mask avoid the social distancing and governments also increasing their curves on the by imposing the curfews and the restrictions on the crowd gathering so let us stay safe and have the mask on and with that we say goodbye to all of you and have a good uh festive season and especially the kite flying for all those who are enjoying the kite flying but stay safe thank you good night thank you so much everyone


Here is your dose of a few interesting cutting edge news from the medical world. Watch Dr. Himanshu Desai give his views on the article published in Molecular Psychiatry in January 2022, on biomarkers for depression. Nature on the 5th of January, 2022 published a study that studied RNA profiling to predict pregnancy-related heath, catch Dr. Desai as he discusses this study in-depth. A promising therapeutic route for diabetic patients especially with insulin resistance was published in Cell Metabolism on the 4th of January, 2022.


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