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Cutting Edge: Episode 2

Oct 29 | 3:30 PM

In episode 2, watch Dr. Mahadev Desai discuss how antibiotics are now accepted as the first line for most appendicitis cases. Another COVID-19 related article studying the long term effects of COVID found high rates of cognitive dysfunction, which was more likely to be seen in hospitalized patients. Another news article on COVID-19 found an association between corticosteroid use during COVID-19 infection and mucormycosis. Watch the whole episode to know more about such stories.

[Music] hi everyone a very good evening i welcome you all i'm dr samadhya from netflix i welcome you all on behalf of team netflix we have with us dr madev desai sir who is a senior consultant physician at hcg hospital ahmedabad a quick replay of our first episode of cutting come to very edge molecule which made headlines as if uh something new drug it is the practically cure as people perceive for the fight against 19. newly assigned uh 2019 by the manufacturers and it is probably going to receive an emergency authorization in the usa soon japanese were initially created [Music] again initially created to find influenza in that sense both have been repurposed both drugs have a similar mechanical action to is [Music] [Music] [Music] hormones in use and it suggests [Music] [Music] good evening everyone and i see so many similar consultants also in the audience thank you very much for being with us and last week our story number one was the coveted vaccination 100 crore mark that we india crossed and we were very happy about it uh we begin in the continuation with the covet stories and today's story number nine is the vaccination whether it is coveted vaccination is linked to pregnancy outcomes and this is basically a novice norwegian registry where there was a case control study where all the ongoing pregnancy women as well as the women who had miscarriages in the first trimester were compared and there were two arms again in the we know that vaccine is not given even in the pregnancy in the first trimester but vaccine is offered to the people who are at high risk and especially the healthcare workers so amongst the 14 000 and nearly 14 000 women who are having an ongoing pregnancy norway norway norway there were about 530 female head workers who are pregnant so we have both the arms on one side there was a on largely unvaccinated ongoing pregnancy and part of it about five percent had the vaccines given to them and we are studying they are studying there as well as on the other side there were about four thousand five hundred miscarriages instance of miscarriages in which also there were about five percent of the women were vaccinated and this appeared in the 20th october of new england journal of medicine the major outcome is that the kovid19 vaccine is not linked to pregnancy loss and there was no correlation between the covenant vaccination and the risk of first prime minister miscarriage and vaccination during pregnancy in fact is likely to give protection to the newborn infant after birth and now that it's already in that pregnancy the women should be vaccinated as they were very high risk of hospitalization and covenant complications initially naturally when the vaccines are out because of the clinical trials they do not include the pregnant women they are also not offering but later on even the indian the obstetrics and gynecology foxes also now said that we can give access to the pragma in fact we should offer them the vaccines so this study proves conclusively that the vaccine is not responsible for any pregnancy outlaw pregnancy loss in the first trimester so that's about our story number nine we move on to story number eight which is related to one of the anti-depressant drugs that we often use that is multazepine metrozapine uh is also used when there is a patient of dementia was very aggressive in his behavior and this is a study called simbad study in which which published in the 23rd october in the landsat and there are about 200 participants who are recruited from 26 uk centers and they are probable of possible alzheimer's disease and they have agitations and that was not responding to the other treatment and they were given the metaspins and the outcome is that the metazapine did not help in resolution of the regression in fact it led to higher mortality amongst the treated patients so the beta zippin is not to be prescribed in a patients who are having dementia and who are aggressive that was the story number eight move on to story number seven we know that during covet time we have so many drugs which have come which have been used as a repurposed drugs and amongst them we know that the fate of icqs or our methane but this is another drug called fluoxamine phloxamine is basically an ssri that is selective serotonin reuptake inhibitor which is used more for ocd obsessive compulsion disorders but in one of the very small study they could find that it also has got an anti-inflammatory and antiviral property and that is why a bigger trial was conducted and this was published on 27th october in the landscape and this was done in the brazil around 11 clinical centers and they recruited 740 on the patient's arm and 756 on the placebo arm the patients who receive fluoxamine they were given 100 milligram bid for tenders and all the inclusion criteria exclusion contained obviously for the same in brazil they have got what they call it emergency setting or the kovid entry registration centers what they studied was that how many of the patients in who received fluoxamine and how many of the patients who did not receive uh fluoxamine of course the standard can remain allowed in both the arms and what they studied was how many patients need to be hospitalized or how many patients need to be shifted to the tertiary care and what was found that the even the flow examine had an absolute risk reduction which is something really very important that absolute risk was five percent and the relative risk reductions of the primary outcome that is shifting to the hospital hospitalizations or tertiary care was to the tune of 32 percent so fluoxamine maybe right now it's not of course still remains a drug on uh investigational drug and repurposed drugs but maybe this is a drug which has we looked for because it has produced the reductions in the implemented cytokines and maybe that is the drug we might use in the future then there is another interesting stories we all know that now that there are so many patients who are coming after they recall from the covet kovid it was once thought it's like an and any other viral illnesses and it has only the short-term complications but now we know that that's not the case we know that we had many comp complications after the patient results and this has happened even in the patients who are asymptomatic mildly symptomatic or patients would hospitalize and discharge so so many studies are coming out where we find long-term complications in the covid this one is one which is was presented or published in jama on 22nd october this is about the neurological symptoms what the the name given is a brain fog when the patients of long covet when they resume their work and they do find many of their cognitive functions are impaired so in this particular study this was done in a mountainous health system so 740 participants were studied and they were evaluated about their higher functions and especially the cognitive functions we know that patients who have got difficulty in concentration difficulty carry of the calculations or the language difficulties or attention difficulties there were a part of cognitive functions and there are established taste for doing the cognitive functions and what they found that persons who had covet before even eight months they still have the many of the cognitive dysfunctions and particularly the patients were hospitalized have more executive functioning that is the decision making or the comprehension these are all affected and what they did was they studied so many things including the memory recall they give they asked the participants to name the animals in one minute and they could see how many they can recall that is called the memories different kinds of category fluency that is the animal counting in one minute then they also ask for many of the tasks within they did for the attention span and all that they found that the great fog can persist even after eight months of the covet so this has a bearing in as far as the persons who are having an important functions so we also need to look out for these normally we ask only symptoms like breathlessness or fatigue or myalgia but we also need to ask about their memory and about their other difficulties in concentrations or sleep and if we find that there are some disturbances better that we refer them to the psychiatrist in time so that they can be treated that's about story number six and these are the different levels of abnormalities they could find they could find that anything from 15 percent to 25 percent of the people have all different kinds of memory on processing speed or executive functioning or the phonetic fluency or category fluency as i said or memory executive these are all different kinds of abnormalities they could find in the large number of persons whom they studied the only limitation that was quoted by the authors were that may be that because the patient all of this patient had some difficulty in concentration or memory so there can be an inclusion bias in this but even then so this is about the story number five so yeah there's a very interesting story it's not a medical story it's about the medical officers the doctor story this is the story regarding one of the private hospitals in kochi it's a very big chain of hospitals called previous memory hospitals and it has a centers multi-speciality hospitals but one of the hospitals in kochi went into bankruptcy and there was an insolvency cases against the hospital so what hospital did that hospital differentiated or discriminated between the full-time uh attached to the hospitals and the consultants the all the proceedings all the money there they had they said that only the consultant would go only about 2.3 percent of the their dues while the full-timers will get about 90 percent of the dues so the consultants doctors went into the court but in the first court that is the nclt uh they rejected consultants appeal and then they went to the state government a state court and they also refused to entertain the consultant's applications but supreme court recently only admitted at least in the court will now hear in the next three weeks time about whether the consultants can be discriminated the consultant's argument was that the consultant spend the same time in fact who becomes the consultant the senior doctor so a consultant brings the patients operate the patients strain spends as much time at the junior or the full-time doctors so why should they they be discriminated so it's a very interesting story and we need to see because again if you take the run run the pole probably if those who are the full-timers although anywhere or those who are the consultants will have their different opinion but it's very interesting to see the outcome of this story yes the full-time employed model is safer than the consulting model that is what the outcome of these theory if you go by the verdict so far and the appeal is that even as the consultant doctors perform the same duties and spend almost equal amount of time they have been grossly discriminated against the approved resolution plan so as i said the consultant take only a very very small bigger amount against the dues while the full timers would get practically everything that they due to them so this is about our fifth story and we need to wait for the outcome of the story quickly we'll run the poll we move on to story number four which is an interesting story of a male biological plot this male budget clock is in relation to the potentials the fertility potentials of the milk we are talking about most of the ivf that usually is the female counterparts which is look for or their fertility potential but in this particular article it is mentioned that the male biological clock is also equally important for the outcome of the naivf as well as the type of the if at all there is any abnormality post to the successful implantation so the outcome says that the article says that if a male is more than 45 years compared to the male of 25 years the male would need five times longer to achieve the pregnancy and it is the sperm count motility are definitely affected with the age but not the morphology morphology means seems up till now probably we in the ivf it is the female fertility potential which is just more by the amh i suppose anti-malaria and hormone and also the ultrasounds and the other studies that fsh they study but males i am not sure we'll have a we have an expert opinion and expert comments from dr swati gawai but what we need to see is that the males having an high bmi or alcohol consumption or smoking definitely have an impaired sperm productions and also the article says that if you want to improve the outcome the cryoprecision at a younger age as well as the pre-implantation genetic testings are very important for a successful outcome of an ivf procedure so we have dr swati gawai his opinion and about request to doctor hello everyone and i'm very glad to be part of this session today on male biological clock usually whenever a couple comes to us with an infertility we just consider the age of the mother over the years of practice i've noticed that the age of the father is also very important so what happens in an advanced paternal age though the semen analysis has shown that there is increase in the concentration of the sperm cells the actual reason behind this is decreasing the volume of the stream so this decrease in the semen volume might be causing some changes in the internal environment for the sperm cells and ultimately i think these changes might be responsible for increasing the incidences of miscarriages freedom boards and steel balls in such couples with advanced pattern knowledge so just how we do for an infertile woman with advanced maternal age of preserving the over cells we can consider preserving these concepts as well in such advanced patterns cases secondly uh we are already using implantation genetic testing for emma's metabolism it can be used in couples with advanced paternal age as well today early i think this cryo preservation and pg tools for such couples with advanced ages in future thank you thank you very much i saw you you are also probably live on the so and you can also give your comments later on also if you wish so thank you and this was the story about a male biologic clock we need to remember the the advanced pattern is a very important factor and the couple if they want to plan at a later date they should have at least started their preparations and the young at younger age the sperms can be cryopreserved and as the age advances there are chances of some chromosomal abnormalities or even i just read that the chances of sizophrene is almost three times higher if the paternal age is advanced more than 45 years so this was our story number then we come to story number three again interesting story this time the story is about the surgeons and the use of antibiotics in this surgery for appendisectomy this was a study which is published on 26th october in new england general of medicine there are two arms in the study and one arm the patients received only the antibiotics and they were not offered the surgery the other numb the surgery was i mean only the one sort of prophylactic antibiotic was given and the patients were subjected to appendicomi and the outcome is surprised many of the investigators themselves they found that the antibiotics have an accepted phosphine or treatment for most patients with appendicitis the after antibiotics almost seven out of ten patients uh appended sacrament could be awarded or in the bind by four years almost 50 persons did not require surgery so the outcome is that the antibiotics are as good as surgery for most of the patients of course there were few caveats also that patients who had appendicol with uh had more complications and higher chance of appending sector in the first 30 days so it's very important again from all of us that if the patients are dependent societies we need to find out whether it's a myeloma synthetic whether the diagnosis is confusing if the diagnosis confirmed whether it falls in the mild appendicitis and second part it is there any chance of having an appendico lit because if appendical leak is present which i was told that the sonologist and the radiologist can easily give their in their reports in that case probably the patients would end up in surgery we have doctor tejas nayak who is a pediatric surgeon and very eminent senior sergeant and a good teacher and he has his comments unfortunately he is not in our state right now so he we had to take his bites otherwise he will be there on live on this show you can have dr t just comments hello hello i'm doctor snyder the issue of antibiotics as the main line treatment in appendix one cannot say it is fully settled let us see a few issues first starting from the past practices when it was considered that once diagnosed appendicitis of any grade should be operated if patient has presented within a certain amount of time then the principle came that if the mild appendicitis has been treated conservatively with antibiotics then the patient must undergo an appendisectomy at a convenient time at a later date within last few decades the new principles which have come up and have been successful is in treating attacks of mild appendicitis solely with antibiotics without surgery and it has been seen on followers that most of them do not get a second bow of empty sites so that is fine the issue here is the issue are you really treating appendicitis we have fairly good criteria and armamentarium to confirm that it is appendicitis but a few cases of some other conditions which may be alarming may escape us so first principle is when you are treating a mild case of appenicitis the mild should be qualified very stringently and then treated with a pen with antibiotics particularly keeping the patient under observation preferably in initial days indoor treatment second is if there is any doubt of any other condition it is better to do further investigations and operate if we find that it is not a case of a mild or a simple appendicitis like if there are signs of complications then it is better operated when in doubt the principle in surgery always is of paramount importance that when in doubt operate antibiotics have further role when you are treating a case of appendicitis with an operation a pre-operative short of antibiotic is justified to be continued post-operatively if there are indications for that like frank pass or surrounding severe inflammation or patients condition or the blood counts justifying it i think if these two major principles of use of antibiotics in appendicitis is followed then few patients will have to undergo any misery because of either false diagnosis or a second bout of appendicitis thank you so we have heard dr snag's opinion about the appendisectomy versus the antibiotics treatment for an appendicitis and that we also had discussed with few of the surgeons in our group and they were also of the same opinion that the conditions that were mentioned in the u.s study do not imply to our side we have probably we keep the hospital hospitalizations for appendix for only one day and then we can we discharge the patient so the cost of treatment probably the patient is kept in the hospital is much more and if we base by chance the patients and there have been instances when the patients appendix has appendicitis has been missed perforated and the patients have succumb so the overall consensus of the surgeons was that the in our setup appendi societies if it is mild and confirmed maybe for the first time we may go for the antibiotics but once then there is an appendix which is disease it's better that it is out sooner than better we move on to the next story again very interesting story and that is about the american heart association is issues guidelines for the chest pain uh how to go go ahead with the chest pain up till now there have been guidelines for the diseases but this is for the first time they have come out uh yesterday only in the the american heart decision has come out with the guidelines in the journal of circulation about how to deal with the chest pain we know when the patient presents with the chest pain in an opd or in an emergency room there are so many differential diagnoses that come forward and amongst even cardiac patients also we have so many conditions to be thought of so they have come out with the 10 points and the they have given the acronym of chest pains itself so they said that seek stands for the chest pain chest pain does not mean only pain even if the patient complains of pressure feeling of pressure squeezing brahman in our setup is also considered as a pain equivalent breathlessness and the pain going to the chopping going to the back and if that happens in a patients who had a who is a high risk of the having a cardiac then we have to keep in mind so that's very very important that evaluate the chest pain that is the first part when the person is in the opt or in the ear the second part is if there is a chest pain with the slightest doubt of it being a cardiac origin the first thing that we do is high sensitivity propane in case proponents we have been doing it but the conventional troponin test it becomes positive about three or four hours after the microbial injury has started while the hs troponin the high sensitivities propane can give us a smaller quantity of troponin can also be tested in the laboratory and it gives an earlier diagnosis so the next thing that we do whenever there is a doubt about the chase pain being and it could be an acute coronary syndrome is hs proponent that's very very important then we have to go for the early care when there is an acs acute coronary syndrome then we have to go for to find out with the serial ecg's echocardiogram cardiovascular involvement and the early care is an acute coronary syndrome then we have got to go for the study of the status of the vascular and so early care is required patient need to be seen by the cardiologist and further followed up so acute correct syndrome is something that is very well established guidelines we don't need to discuss the question comes when the patient doesn't seem to seemingly have the chest pain of cardiac origin the third part for the fourth part is an s stands for share we need to involve the patients in decision making that's very very important the foreign countries here also we need to know now that the patients and the relatives know so much about the conditions uh thanks to the media and the google and everything that we need to involve them in the decision making they should not feel that they were left out for the critical decision so after chest pain high sensitivity propane the early care for the acs next is they're sharing the decision making process telling them about everything pros and cons of whatever decision we want to take and then testing is not routinely required if it is a low risk patience if the patient is young the ecg is absolutely normal patient is under the observation 30 minutes there are no risk factors no family history of coronary disease no obesity no topic or no alcohol so it doesn't run a risk and the high sensitivity we had already done it was negative in that case there is no need to go for the detailed test that's one of the important takeaway from these guidelines then comes the pains the pain pathways and there are clear-cut pathways that we need to have in the all emergency rooms then that the clinical decision can make if the patient has this patient has so we need to go by the algorithms and then algorithms should be fixed for the institution that should be pasted in the emergency room or your consulting room and you can also discuss that with the patients if there is a pain where the ecg is normal abnormal if they see so this chemical obviously you know go for the cs or the high sensitivity proponent reports if the ecg is normal clinically also there is no pericardial rub or no alcohol irregularity or no higher low blood pressure something like that then we can straight away uh go for it's a non-cardiac pain so this is how the pathways should be followed and there are details of this you can go through these particular guidelines then what are the accompanying symptoms this is very very important that accompanying symptoms also need to be known and it's particularly it is mentioned that in the women patients there are more nausea vomiting abdominal symptoms or about these symptoms of chest pain perspiration so that need to be looked for and then identify patients who are likely to benefit from the further testing so as i said there are subsets of patients who had a history of previous coronary events or undergone the angioplasty or the bypass surgery or patients with a known diabetic hypertension this kind of patients if they come with the chest pain obviously they fall in a high risk and they need to uh be further tested and that testing can be the different types of testing now the most important testing that this advice that if there is a slightest doubt of the it being a cardiac pain but not acs not acrylic syndrome then this will be offered to coronary calcium score and ct and geography coronary angiography multiply ct scan or topography is the has moved ahead ahead of even the stress testing because if the patient has pain which could be cardiac origin ideally we should avoid stress testing at that point of time so it is the coronary calcium score and ct angiography that is preferred at this point of time and that has been clearly said if that is not available in a center then there may be other trees like the the stress echocardiogram can also be performed but these are the way we identify the persons who need to be investigated whether it's an investigation related to the anatomy of the circulatory system or the functional part of it we have the nucleus scan also available then the next very important is that any pain which does not look cardiac should be mentioned as non-cardiac and not atypical so they say non-cardiac is in atypical is out so any pain which is not cardiac should be mentioned is non-cardiac pain rather than an atypical pain so the atypical word is out of the definitions of a pain which is around the chest and then they said there should be a structure risk assessment should be used again just like the pathways we said that we order certain tests and then we evaluate the state depending on the structures and then we tell the patients what next what next whether it should go for the any invasive or conventional angiography and further so this is what is the chest pain guidelines given and the details are available on net and very exhaustive details are there there are beautiful slides also and one can go through it and then our story number one it's a very very interesting story it appeared before a week and uh i must acknowledge one of the our audience or members dr apurva prabha this is also given this story but we already had shortened this story as number one but there was this story came from as a suggestion from one of our members in the audience so thank you dr apurva for this and we want to encourage many of our members to have as many stories as possible so that and if you give it the first two three days we can have more discussion lively discussion and prepared for the many part of it so thank you very much dr apurva so this is a story of a lady at who at the age of 42 years in spain uh suddenly lost her visions because of the toxic of optic nerve involvement and for 16 years she remained without vision all her children husbands he just could not see any of them because of the total blindness so the there was one researchers who was doing on the optical and the brain implants and the blame processes was and see a great that come what way whatever may be an experimental nature of the study i want to be the first person so that lady named the varna gomes she appear remain volunteered for the visual processes implantations directly into the brain is a very small tiny 4 millimeter square of the optical the implant which has 96 electrodes on it and this was implanted in her brain directly over the occipital cortex and then that implant the prosthesis had to be trained to see and she had to go almost daily to the laboratories of the hospital for six months and she continued going there for six months and then after six months on one day she said that yes i can see the light vertical light then she could say that i can see the horizontal light and then she started recognizing the shapes so there was uh obviously the wave of jubilations amongst all of them and that's a big hope for more many people who have the blindness and the author was so grateful that she he added gomez as one of the co-author for this paper that published so this is the this is a story that definitely gives a big hope to the patients who are blind and where all attempts are tried and nothing has worked so this is our story number one uh over two will so the results demonstrate that safety and efficacy of the chronic intracortical micro stimulations while a large number of electrodes in the human physical cortex showing a potential for restoring the functional vision in the blind so secret identifies i said line shapes and simple letters and now it's all ongoing and the processes has to be trained and she may need to go for the removal of the process in an again another process is after what they have learned from the processes she is really a very brave lady we salute to her and over to dr so the most favorite story is dane implant for blindness we have 45 votes for it so and the second most favorite was the first one so so let's just quickly go through the comments yeah sure yes um uh dr sorbia says it was a tough choice for the yes sir um implants for brightness then um dr brushali sees a very informative presentation so thank you we will also like some of them to come forward if there are raised hands and yes sir if anyone wants to ask questions or share anything please come on stage raise the hand and come on stage and share your experience oh so dr apulva prabhu desai says thank you for the mention sir to thank her for taking the initiative uh so we could actually start the quiz as well uh yeah sure so you just have to swipe and we can start the quiz so you can write the answers on on the comment section a b c d whatever is the option i think everyone is getting it right yes they are all with us throughout the presentations we can move on to the next is there a second yes for how long the brain clock can persist even after covet 19 infections i think we have the right answer again yeah that was what we found was seven point four months so seven to eight is correct but the literature says it can be there up to even two years also but that remains to be seen because we haven't have two years up after the covet so obviously we cannot talk about that at this point of time yes sir is it all oh which is not a key message from the latest guidelines which i think we have mixed answer for this one so yeah that it's very important that high sensitivity problem is definitely prefer early care of symptoms has to be there and chest pain can go beyond the chest the only thing is that usually it's the women who are more likely to take something symptoms rather than the pain yes so what do you yes i think we're done with the quiz and uh the winners will be announced very soon uh so on 31st we have a event a session on finance uh by doctor by c ratchana rana day then we have a session on november 3rd where rohan desai and then we have on november 8th by dr molina patel it's a gynecology session and if anyone wants to ask any question please raise your hand and come on stage and share your experience meanwhile we can say that the next friday is because of their part of the diwali holidays we will not be meeting so we'll meeting straight next day on the 6th the 13th of november 13 or whatever that comes yeah um why we have people still coming up on stage i'd like to quickly announce the winners for the quiz uh so for the first uh question we have dr sahil for the second question we have dr ashish and for the third one we have dr sharma netflix team will get in touch with you all soon uh to give away your prices thank you so there's a question in the comment also in government hospitals new guidelines can't be maintained anything you want to say about it and can you crisp the content of chest pain management doctor swati aru is asking about it now you don't get the questions correctly uh dr can you please come on stage and ask the question talk to swati no i could get her question the questions it that how do you evaluate the chest pain so chest pain can have cardiac and non-cardiac cause among the cardiac cause over the chest pain is one obviously the ischemic heart disease which could be the chronic stable angina or unstable angina micro infection then there can be pericardial pain there can be pain because of the dissection of the aorta they're communicating because of the pulmonary embolisms these are the cardiac cause of pain the non-cardiac vein could be pleurisy pneumonia pneumothorax costochondritis esophagitis these are all these so there are going to be some accompanying symptoms it's over the overall we have to see the patient as a whole any patient who said this is the first time the pain is a past middle east patients and nausea breathlessness if your hypotensions and if the ecg is also corroborative then there is no questions and actual correct syndrome but but for other things it's better that we wait for another 20-25 minutes and take the second ec it's very important that first ecg may be normal the clinical exams are normal but in the symptoms of chest pain and it could be cardiac it is better that we go for the second ecg after 20 minutes and meanwhile we send the blood for the hs troponin and again the clinical examinations will rule out conditions like the pericarditis the pericardial rub or fluorescence the plural drop or if there is a differential in the pulse in the blood pressure than the dissections all these things are becomes a part of the and we avoid giving the pain strong painkillers like the nsaids because had it been a cardiac pain then probably it would be giving more complications so best thing is to observe we can give nitrites that is a so disorder or nitroglycerin as one of the sublingual tablets and the patient is supine and also for the high potency relief of the symptoms and if there are acg changes any changes that rewards after giving the nitroglycerin we also can give aspirin and we also give the high dose of statin if it is an acute coronary syndrome without otherwise we just monitor them and we also advise at least the weight side echocardiogram is possible when that's also one of the important regional wall motion abnormality can also be a pointer to an ischemic origin of the faith and then we have to wait for the reports and then deal accordingly uh so there are one more question yeah from doctor so what is the best time for sending blood for his drug after onset of symptoms first sample we have to send as soon as possible because if there is doubt and we can also send the second sample after one hour and we can see the rising uh in the hs otherwise usually the first report we expect around one hour one hour after one hour the levels because it's a very very minor quantity in the nanogram that we get the result so even if it is a very high sensitive it may not pick up a very small quantity that is just because the process has just begun the microbial injury is begun but first sample has to be as soon as possible the second sample is after one hour and also we take as i say the serial ecg and monitor the patient symptoms even on monitor we can see whether the sd segment is going up down or that there are any arrhythmias all indicative of ischemic origin of the pain so there's one more question um after covert vaccination uh can development numbness tachycardia vaccinations the most of the symptoms that we get are the first week and there is more of the at the injection site of soreness or heaviness of the hand or myalgia or fever that can last for a maximum up to seven days the some of the complications that are mentioned elsewhere we have hardly seen it but there have been instances of the thrombocytosis because of the immune mediated injury to the platelets the kovid in vaccines also trigger antibodies against the platelets and that produce the thrombocytopenia and thermocytosis thrombocytosis and that can produce these symptoms so if the patient any time has developed headache or the neurological symptoms in the atexia or other complications they should be investigated but at least we have not seen it and they are extremely rare and they have seen more with the vaccines other vaccines than what we use we use kobe steel and covax in we haven't seen those kind of the complications but the fever uh is the one only thing is the god forbidden of the patient is in the incubation period of kovid then there could be some symptoms because of the covariant that can be attributed to the vaccines that we have seen that pistons become positive in four or five days the rtpcl becomes positive so vaccine vaccinated persons cannot become positive because of the vaccines so it is probably the coincidence patient was in incubation period and just took the vaccines and he developed the covariate infections not because of the vaccines yes sir so there's one more question um so why young patients are affected with cardiac attack nowadays oh there it's a big story there are so many things the uh our lifestyle changes the stresses the food habits the sedentary lifestyle all have changed the demography of the all diseases the epidemiology of all diseases and it's world war right that the younger persons uh younger persons are becoming more and more uh not only because of the genetics but because of the change in the lifestyle and the overall change in the society structures and more ambitious more stress right we invented all these gadgets to save our time and they are to consume our time so that's where the problem starts right so it's multi-factor it's not one single factor and we need to have the overall holistic approach when we attend these patients also but yes the when i was a resident doctors my boss would scold me if i take the ecg of a person's of that 30 years now i will scold if he doesn't take the ecg of a patient is coming with 20 years or 25 years the youngest patient is marketing fox and i have seen his 19 years he's studying the college school studies students will bring him and we say that you need argent and geography so that's the scenario so acute coronary events are not at all a rarity in the younger populations because of the multi factors including the stress the lifestyles the food habits and sedentary lifestyles yes so so thank you so much for a wonderful session thank you i'm sure everyone is looking forward for the episode three and thank you so much everyone for attending the session and we are waiting for their stories yeah so please give us your suggestions in the comment section and also you'll see the recording of this session after three to four days in the app and thank you so much everyone and see you again on the episode wishing you all a very happy seasons and diwali and festival seasons so stay safe and stay healthy and always maintain the coed appropriate behavior we have yet not declared that the recovery is gone so it's our duty and also from the fire crackers and all for the injuries part so stay safe healthy thank you thank you so much everyone

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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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About Medflix

Medflix is a new platform by PlexusMD, India's most active and trusted doctor community. On Medflix, you can discover live surgeries, discussions, conferences and courses from some of the top doctors and institutions across the world. Join clubs in your areas of interest and access hundreds of amazing live discussions everyday.