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Cutting Edge: Episode 11

Jan 14 | 3:30 PM

Catch us live for some amazing news picks in the medical world with Dr. Mahadev Desai. Dr. Himanshu Desai, Consultant Psychiatrist talks about Daridoxerant- a new drug for insomnia, its dual orexin receptor antagonist (DORA) blocks the binding of orexins,leading to wakefulness. Dr. Alka Gandhi, Consultant Diabetologist, gives her take on Covid-19 associated with increased diabetes risk in youth. Dr. Viswesvaran Balasubramanian, a Pulmonologists shares his view on the beneficial role of biologics in treatment of bronchial asthma.

[Music] good evening everyone and glad you all could make it on a festive evening i'm dr naveeda and i welcome you all to the 11th episode of cutting edge with us we have tonight uh dr madhav desai who is a senior consultant physician from amphipad right so we begin our first tutorial that is about these no transplant we know that xenotransplant is something new as far as this particular story made a big headlines that a 57 year old gentleman mr david bennett who was terminally ill and everybody is denied that he is not fit for the human heart transplantation so at the university of maryland medicine they took the emergency use authorization on a composite ground for a weak transplantation big heart transplantation and after at least seven days of this operation he is still fine and he is having the oxygen but he is extubated and he's better that is the latest information that we have what is important is that this particular xenotransplantation involved the big heart but this pig is not something that we routinely see it's a genetically modified pig organ in the sense that the pig has some different proteins which can produce immediate rejections to the organ and that is why they had initially blocked knocked out the protein that is responsible which is present in pig and not in human that gene was knocked out and they also added six different human genes responsible for immune acceptance of the big heart and so there also added one more gene in the pig right to prevent the excessive growth of the pig heart only thing that remains to be seen is how the big heart will be accepted by the human heart we are two-legged persons and animals and pig is a four-legged animal and its heart is tuned to a different kind of the pressures physiology so that remains to be seen how it is going to be incorporated but important thing is that why we took this story is that this story may be appearing for the first time but india has the record of having the first zeno transplantation by one of the cardiothoracic surgeons from the guwahati named dr dhaniram barua when we were medical students he had performed this peak transplantation of the heart kidney and liver to a person called purno and unfortunately that patient died after seven days and then that doctor and his assistant were arrested and they were subjected to the any litigations and he had to be imprisoned for 40 days so sometimes we when you are ahead of the time also people probably may not be accepted but in fact that was the way the zeno transplantation has begun and even dr barua was recently interred for this and he said that i am happy to see that at least that day has come when the zeno transplantation has become now and that is mainly because of the different kinds of medicines we have to knock down the genes which are one which lead to the immediate organ rejection so let's hope that it solves the problem of the deficiency of organs which are for which so many terminal patients are waiting for the different organ transportations if you remember we had run the story in one of the netflix so about the big kidney transplantation and that patient is also doing very well we move on to the next story that is about the covet vaccines and myocarditis we hear time and again that cohen vaccines are going to cause causing many complications including the immune reactions and the thrombocytosis and recently a paper came in new england journal of medicine where 136 confirmed cases of myocarditis were reported but that was amongst the 5 million dosages that the patients received so in fact it come to only the very very small amount and all the patients were having a mild about 129 patients after 136 had the myocarditis which was benign or which recovered with minimum treatment and the overwhelming patients were all young and they were all between the age of 16 and 40 or 50 years and most of the none of the patients were amongst the cases were amongst the women girls or older people so the postulation was that probably it is the higher testosterone level in the adolescent boys and the young men which may somehow promote the adverse vaccine effect and probably the greater estrogen response amongst the cults and women i have some cardio protective effect what is important is that the myocarditis that occurred following vaccine was benign in the sense that the patients had only the chest pain but there was no ventricular dysfunction and the resolution also very quick and whoever admitted were there for a very short period and they were mainly seen with the mrna vaccines mainly with the pfizer or modern vaccines and what the researchers found out that if you have a vaccine the chances of getting mrna vaccines the chance of getting the myocarditis is probably one per 100 000 vaccine dosages as against that we know that the viral infections can also cause the myocarditis and by chance if you have the kovid in infections maybe you have four in thousand hundred thousand cases that can have myocarditis so all in all the balance is in favor of getting the vaccines and even if the myocarditis occurs it is benign and not life-threatening so covered vaccine should not be just for the sake of the complications of myocarditis now this is a very very interesting story in the sense that we know that our attention fluctuates sometimes we are deeply concentrating sometimes we are inattentive and in the middle of something if something goes wrong we suddenly become we focus suppose we are driving a car and suddenly a dog or the cattle comes in front of us we become suddenly become conscious about it and put our bricks so that particular reason is the what we call it a blue spot there is a blue spot in our brain that is called a locus cellularis locus cellularis is a very tiny 15 ml cluster of cells which are in the pons which is near the fourth of the floor of the fourth ventricle and these are the cellul local cellular is the one which is the main source of neurotransmitter neuro noradrenaline we know that noradrenal is one of our main important neurotransmitter for any of the immediate response which coordinates the stress memory and attention and this neuro noradrenaline because of the collect connections of these local cellular race to almost every part of the brain that it brings about immediate change in our attention and this was a study published in the science daily in the 7th of january as an opinion article in the trends in cognitive science in the first week of january and what the scientists did was they tried to find out that how this sudden change in that tension occurs and eeg studies have shown that there are different types of brain waves or oscillations and they are related to the activity of the brain we know there are alpha beta theta gamma and delta values on eg and most of the conscious patients persons are having the alpha activities and this alpha activity is at the running at the frequency of around 10 hertz and they are slow rhythmic fluctuations and they are the one which suppress the active processing of sensory inputs when we are doing the laser work or relax work this alpha activity is in work but suddenly something happens and the norwegian comes in two way and it changes the frequency of the brain oscillations and researchers wanted to find out that how this happens and whether nor adenyline is responsible for this so what they did they recorded the pupil size we know that people size changes with the adrenaline adrenergic stimulation so what they said was how the researchers responded to any cognitive task that was asked for whether they did the task correctly and along with that they studied the effect on the people the dielectricians and what they found was that the pupil size which is an indicative of nor adrenaline activity and the alpha oscillations disappearing happen together so alpha oscillations alpha rhythm is one which is as we said is suppressed by the noradrenaline and that is how they suggested that it is the local cellularized or a blue spot which brings our focus of attention when it's required in emergency and that is how they could find out that it is the noradrenaline and the locus cellularis which helps us in our focusing the attentions we move on to the next story that is story number seven this is about the importance of breastfeeding we know breastfeeding usefulness in the infants we know that it definitely helps in reducing the infection childhood infections and the respiratory infections and in mothers also we know that breastfeed being is good for the mother for preventing the breast and the ovarian cancers but this particular study focuses on which is published in the journal of american heart association uh before three days it has it is a meta-analysis of eight studies which involved more than 11 lakhs paris women they divided the 11 million paris women into two groups the group which has women who had breastfeeding done anytime up to 12 months and another group which had not breastfed breast wasted at all and what they found that the 82 percent of the women had had breastfed any time and the time period of the observations and about one leg women did not have breastfeeding and they followed up these patients for ten point women for ten point three years and they could find that amongst both the groups there are four fifty four thousand events of cardiovascular death uh twenty six thousand uh coronary artery 30 000 strokes and almost 10 000 fatal cardiovascular events were recorded but what they found out that the comparing paris women had who had ever breasted the chances of getting all these events were much less than the one who had not breastfed so the and also there was a progressive reduction of all cvd parameters uh during the lifetime of durations right and starting from press spring for few months to up to 12 months and mainly the idea of bringing this story is that the we as the responsible practitioners have to insist on the breastfeeding advantages to all the prospective mothers because we know that the breastfeeding can bring about the many good part health part in the fetus as we've said again repeating that it reduces the infections in the children also the less respect infections but in mother it reduces the not only the breast and ovarian cancers but now this study has conclusively proved that that it definitely reduces the cardiovascular mortality and the who also recommends that children should be exclusively breastfed for the first six months and up to two years along with the complementary feeding so this study insists for the recipient for the cardiovascular benefits too then we move on to a very interesting new molecule that has been recently approved and it is likely to come into the market in the month of may in usa uh this is called a dairy doxy rant we know that there are many hypnotics and sedative drugs used for the insomnia insomnia is an unsatisfactory sleep either in terms of sleep onset or sleep maintenance or early awakening and we generally use the drugs like benzodiazepines or non-diazepines called z drugs sulphide and other drugs we sometimes use antihistaminic drugs also for their sedative side effects but they all have the potential of habit formations and also they produce date times and affects the daytime activity so this particular drug is a new action of drugs this works on a receptor called orexin receptors right so these drugs are the orexin receptor antagonists and this is approved in usa with the formulations of 25 and 50 milligram based on the phase 3 trial of about 1800 patients who of insomnia which were in 160 clinical trials in 18 countries and this particular drug is called the dora we know that so many of us are having children and girl children are familiar with the dora right so this is a dual origin receptor antagonist and it blocks the binding of orexin which is one of the neuropeptide which promotes the awakening and it suppresses the sedative part so it is a very very important drug and it definitely has improved not only the sleep on sleep onset is also affected total sleep time and the latency to persistent sleep is all positively affected with the use of the peridocine and definitely there is an associated improvement in the daytime functioning and sleepiness in the mood is also reduced that is what the clinical trials have suggested so it's a new drug and there are many other drugs previously coming in the u.s market in the this particular group but we are not aware whether any of these oroxin receptor antagonists are available in indian market so we have dr himanshu desai with us and he would be showing more light about this newer drug and how they treat the insomnia at present of time so dr himanshu desai if you are there would want you to be live dr iman sudasa is a very senior consultant psychiatrist and he's been our regular uh expert on available and at last minute thank you himanshu being with us and please have some light sleep is is the main issue uh as a psychiatrist we are seeing because almost all our patients are having pain complaints is is a slips sleep disturbance and our many of our medications produces sleep also so we are every day we are dealing with sleep every day in and out and when we are using benzodiazepine there are certain issues with the benzodiazepine it produces tolerance because after some day it will not produce the same effect so we'll have to increase the dose second thing is that uh the problem is with slip induction so almost all benzodiazepines are almost same in sleep induction next day hangover is very much common with longer acting benzodiazepines even that group drug sometimes it is not always to some of the people so habit formation is again a major issue with with all these medications so we are we are always looking for something newer thing which gives a very good sleep sleep for particular time duration so next step anyone can can work better and they don't have any any hangover type of things so we are always looking after whatever drugs were there they were working through gaba receptors so this receptor is very new for me i have heard it from the very first time so this is something new and i think this will change whole whole practice of treating sleep issue sleep issue is very common after certain age sleep issues again very common in in younger age group also those who are working with with gadgets and everything so sleep is is really a notorious thing so if we can treat them in a better way with most effective way enough and they don't have any hangover no tolerance so we are looking for such null volatility and i hope this molecule will change whole slip architecture previously in between there was one molecule had come and which was affecting to the slip architecture like alpha beta gamma wave but it has not changed the whole market scenario when it was launched it was saying that hamilton was the name and it was going to change the scenario but it does not change the scenario so we are looking for something new to to change the sleep architecture also thank you the only thing that point of caution here is that they are supposed to be having the control substance use regulations because they all have the potential for the substance abuse that is what the literature says so right so habit formation would be again a major cause so we are also looking for something which does not produce habit formation also right thank you very much being with us thank you sir this particular is a study which is uh we can say the negative study in the sense that up till now vitamin d has been promoted for and everything and everything right and yes last was a decade for vitamin d where vitamin d was supposed to be something great for each and every topic but this particular uh study that appeared in the landsat diabetes and endocrinology on the 10th of january and this was a randomized double blind receiver controlled trial of in the australians of more than 60 years and there the vitamin d was supplemented in one group and vitamin d was not simply another group they had given 60 000 units of vitamin d every month for five years and then there were about 20 over 21 000 participants uh divided equally into 10 600 odd for vitamin d group and the placebo group and then they collected the blood samples also some of them and they studied the vitamin d levels uh between the persons who had received the vitamin d which was obviously higher than the persons who did not receive the vitamin d the levels in vitamin d persons who have received were around 115 nano mole and those who did not receive had around 77 nanomoles but the outcome primary endpoint was what was the all cost mortality in the during the period of observations and after five years when the study they said that there are 1100 dates and almost equal in both the groups 538 in the placebo group and 5 62 in the vitamin d group so practically five point one five point three percent groups and when this did the exploratory study and they found that after two years in fact the patients who randomly received vitamin d had a numerically higher hazard ratio for cancer mortality of course that was not the primary aim it was just the observations and the object the conclusion was that the vitamin d in the dose of 60 000 should not be given inadequately unless we have done the vitamin d levels which are very low to begin with just for and supplementing vitamin d casually should not be the order for people who are more than 60 years because it does not have a cardiovascular benefit for deficiency we are treating that is different then uh story number four that is about the very important story about the kovid associated increased diabetes in the youth we are here we are talking of the incidence of kovid neo-onset covet diagnosis or hyperglycemia in persons who are here right there are two large database in the u.s health systems they are called one is iqvia and another is health verity and they have published their mobility and mortality weekly report by the cdc and they have a huge database and they study they just analyze how many patients had that code of diabetes right during this period pandemic period and they divided the iqr database and the health variety database have different kinds of the inclusion correct the iqe database has compared the all the patients who were diagnosed with kovid who are under the age of 18 years right between march 20 20 and february 21 and there are about 80 000 uh individuals who had covet diagnosis and they compared with the agents ex-match people during the same period who did not have kovid and they also studied another cohort where there was a pre-pandemic group that means and previous year with whether they had respiratory infections or no respiration function and how many of them were diagnosed with the diagnosis of diabetes so three groups is covered under 18 years or without 18 years in the same year and previous year any respiratory infections and the health rarity had four like 39 000 youth diagnosed with koved in this same period march 20 to june 21 and they were compared with agents ex-match patients without covid but this particular have not the cohort of pre-pandemic or the previous years covet we have dr alka gandhi with us and i'll call upon her once i finish with uh one more slide madam please so what the outcome was that the new diabetes of new onset diabetes was diagnosed almost 166 percent higher in the iqr group and 31 percent health verify group ability groups and they also found that the in iqvia they found those with covid19 were 116 percent more likely to develop diabetes than thor is the pre pandemic acute respiratory illnesses so definitely this particular fundamentalness is there are more diagnosis of diabetes and in both the in the both the databases the diabetic ketoacidosis at the diagnosis was also a very prominent diagnosis and it was present in 48 persons uh in the iqvia and 40 persons in the health rarity and unfortunately the limitation of the study was that they could not because it's a database analysis they could not find out whether it is type 1 or type 2 diabetes they just followed the code of diabetes in that analysis and the second part is they could not say whether it is a transient or permanent diagnosis of dialysis diabetes but the postulations of why there is diabetes uh more is diagnosed during the time of it the some of the postulations were it could be a direct effect of the sarskohi virus on the expressions on the ac2 receptors which are also there in the pancreas or it could be a stress hyperglycemia resulting from the cytokine storm and the alternating glucose metabolism or because of the steroid treatment given in the hospitalized patients but to be frank there were only 1.5 to 2.2 percent of the diagnosis having the steroids as a treatment and one more postulation was that probably is a weight gain during the time that could also be one of the contributing factors for covid uh the diabetes as a diagnosis in the community the youth but diagnosis of covedon youth itself is have definitely something to be discussed and we have dr alka gandhi is a senior consultant diabetologist from mumbai welcome madam and very thankful to you for coming on this festive day to our platform and we want your expert opinion about the ovid and diabetes in the youth thank you dr desai i completely agree you know this pandemic has really given rise to another tsunami of diseases and one such disease is going to be diabetes now as we have studied uh right from the pathophysiology the the disease is new and so we are still getting new and new things about it but definitely yes there is more uh number of diabetic patients now as we know either they may be pre-diabetes who are just detected because of this illness or the lifestyle changes which have you know gained the patient have gained weight and that a lot of junk food which has led to increase in weight and increase incidences of diabetes again the sas ob2 virus like viral infection of the pancreas leading to a acute illness is also very common and when we see dka again bk can be because of dehydration or stress induced so we don't know that when we see decay at diagnosis we cannot decide between type 1 and type 2 of course as we uh or you discussed in this study so we need to do further investigation whether we want to classify into type 1 or type 2 and stress hyperglycemia again yes plus the anti ah covet treatment whatever whether it is antiviral agents or steroids which are giving rise to high blood sugar levels that is also seen very commonly so yes there are newer incidences what we have seen also was that there are definitely the sugar levels go exponentially high we had had patients where when many of our colleagues also said that sugar levels would be anything from 600 to 800 also without much of the symptoms of hyperglycemia so that's what we used to label as happy uh hyperglycemia like happy hypoxia that was labeled for patients who had symptoms but did not have the symptoms and that oxygen levels were less so we had experience of such patients also did you also encounter such patients adam there were hyperglycemia yeah so what happens is again i would say the hbunc at diagnosis would help us to identify what is happening and hyperglycemia as we all know many times it is asymptomatic so even irrespective of forward infections there are many patients who just went for a routine lab checkup and they turned out to be having even hbanc of 13 or 15. so exactly we don't know whether it's because when we say happy hypoxia we are sure it is just because of overt infection right but this happy i hyper messy me i'm not sure is because of covered because it may be present because before it also what has happened is because of lot of noise on social media i think people have started taking sugar more seriously blood glucose taking are done more seriously because they have understood that it is one of the risk factors of increasing the severity of infection so that is why i think there is more testing more monitoring and which has got us to you know get to know any baby we have a pandemic and the pre-diabetic patients or yes those who are not knowing that they are diabetics are very high i would say 50 percent of patients don't know so maybe we are just finding those who are already diabetic yeah that is an unmasking unmasking of the uh as we also see the uh incidence of diabetes also is increasing in younger population irrespective of this so i would say yes diabetes in young is seen more in last year but whether it is only post-coverage or because of it the health awareness is increased and maybe the patients are or the people are going more to the doctors and they have got to know that they have got problems right right so only time will say but definitely people have started inquiring and accepting that it could that could be diabetes and we have to undergo this testing yeah so what happens is we were promoting that we want blood sugar level as fifth vital sign apart from tpr and bp and now this pandemic has proved it you know that you should monitor blood sugar level of any patient who you are seeing in the casualty or opd because you cannot just uh be sure that he will not be having high blood sugar levels right and the sixth one is pulse oximeter so the six vitamins yes yes six vital signs yes so thank you very much madam and we'll definitely seek your expert opinion when we need you thank you so much thank you my pleasure my pleasure thank you very much there is another interesting uh study this is uh something that is an eye-opener for us also because this is the title looks very interestingly stated in pregnancy stated in pregnancy as of now or had been earlier now had definitely been not to be used but this retrospective court study has shown yeah that there are 469 women who had been exposed to statin when they were not knowing about the con concept conception and they were studied and they were studied with the another 4690 match controls who had no state in exposure and what was studied which appeared in the jama on 30th december was that they studied and they tried to find out the metagenesis terogeneicity or congenital malformations among the women who had been exposed to this and based on this the fda has for the first time requested that we should remove the strongest warning which is a contraindications so straight in contraindications word is removed by the fda advisory board but still they have given the caution that pregnancy during pregnancy unless it is something definitely must we should avoid the statements for the simple reason that for three or four months or six months if somebody doesn't take the state in it will not affect as much to the term outcome of the atherosclerosis and definitely there have been some some disadvantage of persons who have been expo accidentally exposed to the covet that they had low birth weight and definitely the greater chance of preterm birth and a lower one minute afghar score but there were no congenital anomalies and there were also they had tried to find out that whether the patient the pregnant women who had just received the statin where there was any adverse effect on the mother of the fetus and they did not find any but people who had stayed in for more than three months prior to pregnancy they should may remain on the pregnancy or statin during the pregnancy but again this remains the off label uses of now but at least we have now reason to believe that at least it doesn't cause any congenital malformations and that was based on the very simple mechanistic explanation for the use of statin we know that statins work and decreases the cholesterol so it was presumed not proven but presumed that probably because it reduced the cholesterol it will have malformations the fetus during the period of organisms if the states are given but there was no other studies which has proved this and really we have to wait for the further trials but as of now at least we can say that statins are not unsafe if they had to be taken because of some other reasons next we move on to a very interesting story this is the predicting sepsis in general genetic separates sepsis diagnosis by the genetic markers in er we know that whenever we are suspecting sepsis in emergency room or in icu it's a very very critical diagnosis serious diagnosis and as of now we have very limited diagnostic facilities for the correct diagnosis of sepsis and when we say sepsis sepsis we know is a disregulated immune response to the infections leading to multi-organ failure or maybe death so we need to diagnose as early as possible we need to start the appropriate antibiotic as early as possible and that is not possible without a precise diagnosis and many times we fail to find out the focus of the infections or the type of organisms and our bedside assessment right now is up to the clinical parameters like the sofa score or q sofa score or lactate levels and we may say blood culture and all but that doesn't give you the exact diagnosis of this apses so the molecular technologies have given us the new tool that is the rna sequencing these rna sequences have picked up the genetic signatures or genetic markers for different types of sepsis induce the endotypes they call it or the types which are different depending on the type of sepsis underlying cause and here the genetic markers in the form of rna sequences has been studied from one single blood within the first two hours of the emergency presentation so all patients who are having a sepsis right or suspected sepsis where the blood were collected for the rna sequencing and they have collected from 348 patients for four from the emergency room uh patients and one from the intensive care unit thus to see whether the same markers continue to be present in the iso patients also and also from the 44 healthy controls and the gene expression profiles were analyzed and this was they just wanted to see whether this particular genes which are present in a particular patient when they are correlated with their physical findings right correlated with the mortality or the type of diagnosis and whether they actually predicted the outcome in the form of the death or multi-organ failure and their accuracy was around 80 percent and then they applied the rtl facial intelligence right for the gene analysis and they were able to differentiate for five different types of subtypes of the mechanistic uh type of the rna sequencing and they call it endotypes so five different types of endotypes were uh stratified and they could find that the patients who had sepsis and their rna sequencing would show that he could be one of these depending on the type of genes that are present in that particular sample it could be neuro neutrophilic suppression type that is they call it nps it could be inflammatory type they call it inf it could be innate horse defense type that is isd or it could be interferon type ifn or it may be just an adaptive what this study highlighted was that depending on the type of phos endotype that is seen from the particular sample we can predict the outcome in the form that the first two this neutrophilic suppression type and the inflammatory type are associated with severe infections and bad outcome or the negative outcome as against the lower to the the adaptive types and also the response of do the treatments whether we give the il-6 inhibitors drugs in the interferent type of the particular sub type endotype that seen in that particular patient so definitely the endotypes had varying overall severity with as i said nps and inf has a definitely more serious outcome than the uh the adaptive type which has a relatively benign course and this will definitely help in tragedy of the patients in the icu of course this is true preliminary but they have gone in detail and tried to find out that how many of them these particular sequences remain in the icu also and they could find that the nps and inf varieties have definitely been found even in the iso patients that means they had a severe inflammatory response and sepsis and they have to be treated differently so this is our story of genetic markers in sepsis and the our story number one which is the review article uh published yesterday in the new england journal of medicine it is on the biologics program asthma we know bronchal asthma is a very a lifelong diseases and there are almost around 300 million people worldwide and out of this 10 percent of the adults and 2.5 children are having a severe asthma and they have a reduced quality of life they have increased risk of exacerbations hospitalization and even death this particular review article highlights more about the different types of asthma characteristics and in particular severe asthma if a particular patient of asthma has the different inflammatory markers they have divided into type 2 high inflammation and type 2 low inflammatory markers what they mean by type 2 high inflamed markers are persons on whom the samples of the sputum or the blood show eusenophilia or when they were studied for the exhale elevation exhaled nitric oxide elevations persons having asthma patients were having increased ionosonophilia or sputum or their inhalation and showing more nitric oxide these are the patients who fall in the category called type 2 high inflammations and they are because of the particular cytokines called interleukin 4 5 or 30. and so the biologic treatments should be directed to ntil for ntl5 and ntil-13 while the type 2 low inflammation markers ah this categories are the one where they have got more of a neutrophilic type of infiltrations or maybe possible sighting that means there are few lymphosa neutrophils and few exonophiles or there may be an overlap between the eosinophils and neutrophils but this particular vertical article focuses mainly on the importance of different types of biologic therapy in type 2 inflammatory inflammations and they so that 50 percent of the mild to moderate asthma patients are almost eligible for this therapy and they fail to respond to this inhaled corticosteroids or even steroids when we know that when the steroids are given for a long period there are many side effects right so the biologications are definitely effective and add on therapy and they will reduce the steroid uh reduces the steroid dose or may eliminate strokes particularly in usually type of asthma and here they'll in detail analyze the efficacy of different types of the biologics for asthma one of the first biologic which was approved or the anti-ig monoclonal antibodies called omalisumab and this particular works on the fc fragment of the ige and it reduces the free ig levels and thereby binding the ig and reduces the mass cell deregulation and the effects of these immunoglobulins ige and eosinophils on the precipitation of an acute asthma exacerbations it is given subcutaneously and it's approved over the age of six years then there were other biologics which are one for the il5 that is mepolizubabe and rest let's resume then there was another for the il five receptors and that is the benzerial zoo map and il-4 and inhibitors is the nuclear map duplicate is another important interesting commonly used drugs in the western countries that is not only for the asthma but also for the atopic dermatitis and allergic sinusitis so all these drugs have a definite advantage and role to play in the bronchal asthma particularly in the persons who do not respond to steroids in the continuity exacerbations and repeated hospitalizations and they also gone a step ahead and they found that not only the persons having the usability type of asthma but the broad spectrum that is the epithelial cytokine see the respiratory alveolar epithelium also triggers the responses and if you can block the triggers which are responsible for the release of this just because of the what they call it thymic stromal life of lymphoma protein thymics normal lipoprotein or tslp and they have devised the drugs which are the anti interleukin 33 and anti-interleukin 25 and these drugs are also showing a broad spectrum of the effect not only on the xenophobic but non useful asthma also so all these are very new for us we know but the point is whenever the patient has asthma we should be looking for the eosinophil count eosinophil in the blood usable in the sputum and if acid is available exhale nitric oxide this excel nitric oxide is released because of the interleukin 13 which produces these levels and we should also give a thought serious thought for starting the biologics in because they have found to be very good drugs and very good resolutions of the symptoms of asthma and reduce the exacerbations this is all that we have to say about these stories on this week and we move on to our the quiz sections right so be ready for the quiz and so the first question is fda removes the word particular word for state in using pregnancy what was the word they have removed that is contraindications continue the word is used use different statin or use the combination therapy yeah i think it was fairly easy right the options were not that good i would say so we want to the next which is the new drug the new drug derogation approved in fda for treating what particular psychiatric illness depression insomnia or social compulsive disorder or mania yeah our expert has helped us in giving everybody the correct answer so move on to the next question that is about which is the first biologic agent approved by the fda for the treatment of asthma is it metabolism map resilience or dopamine the idea of putting these questions is one to revise the important stories and second also to involve uh participate of the audience and to make it a little more uh interesting yeah so thank you very much most of them you correct their answers that is yeah so we have the results here for the first question uh we have the winners dr anmol jindal for the second question we have doctor atul parikh and for the third question we have dr smith so um congratulations all the winners and someone from team netflix will get in touch with you this week um to deliver your prices um thank you so much for tonight thank you so much for coming in yeah thank you good night good night everyone

BEING ATTENDED BY

Dr. Murtuza Zozwala & 537 others

SPEAKERS

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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