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Cutting Edge Ep 3: The top 10 stories this week

Nov 12 | 3:30 PM

In this cutting edge episode, we will have Dr. Banshi Saboo, President of RSSDI, to give his views on the ADA’s drive on creating awareness with early detection of diabetes to prevent complications. The second expert Dr. Sushila Kataria, the senior director of Internal Medicine at Medanta Hospital, gave her views on the article ‘Antimicrobials: When 'Short Courses' Are Enough’ published in Medscape on the 3rd of November, 2021. The third expert for this session is from the field of Ophthalmology, Dr. Bakulesh Khamer, who gave his views on the USFDA approved eye drops for presbyopia and its relevance to the Indian population.

uh good evening everyone and welcome to our third episode of cutting edge um we have with us our host tonight uh dr mahadev desai who is a senior consultant physician at hcg hospital the floor is yours thank you uh good evening everyone we are meeting for the first time after diwali break so welcome you all and wishing you a delay belated diwali greetings and seasons greetings too and i am happy to see so many people right on dot including our friends and senior heroes dr carl welcome we begin our first story that's something that has happened if you have relatives in usa you know suddenly they'll say that time has changed this week so we are starting with the story we know that in the world there are 24 time zones depending on the position of the equator and the position of the that particular country so last sunday only in the usa the time has been fallen back they call it they change their clock in a way so is there an effect of daytime on the health of course in india we have got now only one time zone but it used to be three time zones before independence so are there any effects of time saving on the health and yes this has published in the 5th november in the web md and there are different studies which have proven that the time saver have also made difference in their health and in 2015 study in the sleep medicine it was compared the stroke incidences before and after the daylight savers and they could find that that this eight percent higher risk of strokes at the time of time savers and this has affected more the senior citizens that is those above the age of 65 are almost 20 percent more likely to be affected and especially people with cancers had 25 percent more likely to have stroke than during the other times of the year and in 2019 report also there was a higher risk of heart attack after both time changes but particularly during the daytime savings they either shift the clock to one hour or sweet back the to one hour depending on whether it's a march summer or end of the summer that is november so last 7th november they changed the time this time and in 2020 study they found that their fatal traffic accidents increased by 6 percent in the usc during the daylight saving time so daylight having time is not necessarily good for economy all the time there are definitely health hazards of the daytime savers that was the point we wanted to make as our student number 10 and especially people with the mental disorders also have large uh effects on the time zones differences and this may also affect and if you see that when we travel and we have the jet lag then also the sleep disturbs so if distance for the next six months we know that this has definitely effect on the health and probably more studies will come as the data is accumulated we move on to our next story that is the story about the american diabetes association's month of november we know november is the month for diabetes in ada and they celebrate the entire year for the education and advancement of the knowledge in the field of diabetes and in the first week ada came out with many awareness resources and education materials then this is the second week and this time the theme is the testing resources and how can we diagnose diabetes better and they have come out with a simple easy to understand or easy to do at our own resources that is called how to the big step up drive they call it and as we see in the next slide that how we can think that whether we are at a risk of diabetes we can explain to our patients also that you go through this questionnaire and the next third and the fourth week will have different uh drives of the diabetes so this was the story number nine where there was a diabetes test here there are seven points uh of the first point is about the age whether the age is between less than 40 years then you don't then you put zero points between 40 and 49 one point 40 50 to 59 two points and more than 60 is three points then if a person is a male then one point woman zero points if you are female and if you have been diagnosed with gdm anytime gestational diabetes then one point if any family members mother father sister brother had diabetes than one point and if there is associated high blood pressure diagnosed and one more point and if you are physically active then you don't get a point but if you are physically inactive you score one and depending on the weight that you have to put the score so all in all there are ten points and out of which if you're more than five points then it is the time that you consult your doctor or if our patient is already having that we should investigate for them whether there is a likelihood of diabetes or pre-diabetes after two days we are going to celebrate world diabetes day and at present the research society of studying diabetes in india are having an annual conference in andhan it's going on from 11th and will till 14th we cannot have a better person than the president of rssdi dr bansi sabu we asked him about his opinion about the world diabetes day and what are the initiatives that rssdi takes in india so let us hear from dr bansi sabu about the world diabetes day and its celebration [Music] first of all thanks for inviting me on this world diabetes day the theme is access to diabetes care the world diabetes day is celebrated by international diabetic federation where more than 200 country organizations are member of this idea and this world diabetes day is now recognized by world health organization also as we know that two-third of diabetic patients are from middle or lower middle income countries and their access to diabetes care now care mean here not only medication access to insulin therapy as well as access to doctor who can treat diabetes or the center they are not available to many of these developing countries so keeping this theme of access to diabetes care is to improve the care for persons with diabetes all across the globe whether they are in low or middle income countries or they are in the world they should get the medication at most cost effective at the same time with the best treatment center so this is the reason why we had kept for next two years this theme of access to diabetes care we are celebrating this fourteenth number is a birthday of dr mente who discovered insulin before 100 years in 1921 so actually it is 100 years of celebration of discovery of insulin so when access to diabetes care i'm talking one of the not availability of insulin in our rural area or many of our type of diabetic patients who are not affording and they can't get the insulin and because of that either they die or they develop complication so i think for india specifically if i talk the access to diabetes care from rssdi i will say that insulin should be available to all needy patients who are insulin efficient and primarily it should be available to them free of charge by public hospitals [Music] so one of the biggest initiatives which we have taken from rsdi at national level we met health ministers we talked with different state governments also the pediatric diabetes should be considered as one of the diseases like there are 31 pediatric diseases are notified by the government of india health ministry if type 1 diabetes is also included in that below the age of 25 all these children or young adults are all these children liable to get medications and insulin therapy from the government of india or from the state that's number one the gujarat government had agreed and now they have already included this is pediatric diabetes is one of the disease where they should get the treatment from all chc hospital free of charge and insulin will be available to them by the government hospital but what is more important is not just insulin it is diabetes education now what we are trying to do is that how we can improve the education for these caregivers and for the patient so one we had created a diabetic educator course under the rssdi and across the country we are trying to create educator for the physicians or for the diabetic care center as well as for the public hospitals or in government hospitals in even rural areas the second big initiative which we have taken to train and educate district coordinator from each district we identified one doctor who is responsible for multiple activities in that district and also representatives these rural doctors can also treat their diabetic patients the way the treatment of diabetes is in bigger cities [Music] anyone who is mbbs or above who is having interest in treating diabetes or having interest in research in diabetes they can become member of rsa the membership fees is very very nominal it is 5 000 rupees once in a lifetime it's not like the western organization where we have to pay every year the advantage is we have our own journal which is every two months one doctor can have it and that is all related to research it is indian international journal of diabetes in developing countries then we have our newsletter which is a related to diabetes all the activities across the country which is also given to all our members and plus lot of other activities which we do and on our website which is very interactive a lot of information and e-modules are there thank you thank you dr sabu for sparing time we know that he is such a busy person and right now he is the chairperson on holding the conference with over more than 5000 delegates are already there and he is extremely busy but and arrestia and dr sabu especially they are doing a great work and they are spreading the forefront on the education front we move on to our story number eight that is about the pre-operative management of gastrointestinal and pulmonary medicines spaqi consensus statement spki stands for the society of perioperative assessment and quality improvement we know that so many patients are undergoing treatment day in day out and those who are involved in the management of patients perioperatively these particular guidelines are for the pulmonary and gastrointestinal medicines without knowing the effect of this medicine sometimes the patients are receiving drugs and post operatively they develop delirium or fever or agitations we have to go back and think of some other conditions and we may unnecessarily do many investigations like electrolytes and sugar and everything and the cause may be the drug that has been continued so this particular article appear in the myoclinic proceedings on 1st of november and here the main thirst is that the patient who has been on chronic stable medicines and they are safe should not be discontinued but particularly the pulmonary medicines which have to be continued throughout and before the day of surgery and including the day of surgery are the inhalers like vitagonist or steroids or anticholinergic inhalers have to be continued we know after kovid we have been using anti-fibrotics particularly orphinendone and the intent in navi but nintendo definitely has some leading complications so that has to be kept in mind and inform the surgeons and their studies but by and large they are very safe so are the leukotriene antagonists like montelukas the phosphodiesters inhibitors like cylindrical or nasal systems are safe but what is more important and take the message is about the drugs which should be put on hold on the day of surgery so many of our patients are routinely receiving anti-staminics or bronchodilators like theophylline or anti-cold medicines like phenylephrines refrigerant it has been shown conclusively that these medicines are can be responsible for the post-operative delirium or agitations and the theophylline is known to cause many tachy arrhythmias so it's that we keep in mind these factors and make the change in the operative notes that these medicines should be withheld at the be on the day of surgery likewise in gastrointestinal medicines also the patients who are on chronic stable medicines like for their ibd like amino salicylic acid or drugs like condensattron antiometic drugs and the proton permitters are safe but one word about the ondenzetron ondenzetron is pursued more safe but it has definitely some side effects like it can prolong the acute interval and if it's given with the drugs like linus solid or with remodel it can create serotonin syndrome so worth keeping in mind and we should not be crossing the total dose of 32 milligram for under central see another important just like parliament medicines which drugs to be held on the day of surgery are the anticholinergic drugs anti-spasmodic drugs anti-diarrheal drugs antacids bupropion and laxative these are the drugs to be omitted because of the many side effects including the uh antiqua allergic drugs having the side effects so it's what message we take from this particular study is that we have to be very carefully see the when we go for the pre-operative assessment or when the anesthetic looks at the patient that they should see the list of the drugs and which drugs to be continued and which drugs to be kept on hold on the day of surgery move on to the seventh story that is treating young adults with high ldl may be cost effective this appeared in the american journal of cardiology in this november issue and up till now we have not been advocating the therapy of statins in patients who are under the age of 40 but this particular study examine the prevalence of race ldlc in the u.s national health and nutrition examination survey what they call it nhne survey and what they found that the race ldl in young adults between the age of 18 and 39 years is associated with atherosclerotic cardiovascular disease what we call it ascvd later in the life most young adults have elevated the lc but they do not receive the lipid lowering treatment so this particular article suggests that all young patients under the less than 40 years also if they have ldlc more than what 130 milligram it is highly cost effective if they receive the statin because we know that statins now are in the following range and stating should be given along with the lifestyle interventions in this age group to prevent the risk of asud and improve the quality of life in the later years so the message is young adults with high ldl should also receive the statements this will probably come in the next guidelines i'm sure another interesting story story number six is the double antiplatelet therapy we know that many of our patients would undergo an angioplasty or who undergone who had acute coronary syndrome or who had the bypass surgery they received double antiplatelet drugs like aspirin either clopidogrel or the ticagrelor or passo grill and this has been accepted for the upcoming circulation and what they have done that see one of the best study for the double entrepreneurs that study itself is called dap study this particular study in was for the aspirin plus clopidogrel the study had 25 000 patients who were receiving they were in two groups one received the dapt that is double antiplatelet drugs for 30 months and one received for the 12 months and they were all the patients were undergoing either endo with angioplasty either stand or bypass and this is the gold standard for anti-double and trials so dfpt trial was the one which was done in 2009 and it ended in 2014. but now it is 2021. what the authors suggest that whatever type of devices that were being used in the those years may not have much more improvement now so it is better that we re look at whether we need to continue dapt now also in the same duration of time and that's exactly about the study that what they did this was done in with israel and what they did they found out the patients who were having dapt that is eight eight six four patients and they compared with the registry of patients of over five lakh sixty eight thousands uh and what they compare the characteristics of all these patients who received double antiplatelet drugs aspirin in clopidogrel or ticagrelor and what they found out that subsequently after 12 months the most of the patient's benefit was less and the bleeding risk were more so the message of this study was that that double entrepreneur drugs should be relooked because now we get better stent that probably we do not need but the bleeding risk remains so it's very very important practical point of view because we are into the practice that we know that patients who are receiving double in the drugs and god warfare god forbid and if they need to undergo any surgery then we have to withhold the surgery for five days because the drugs like lopidogram very high half-life so we have to wait for five days or we have to be ready with the bleeding complication so maybe if this third is is further explored and more wider studies are done maybe we have the shortening of the duration of the dapt or the indications we spoke to one of the cardiologists and we wanted to know about his opinion about the double drugs that the cardiologist dr jacob so let us listen from him what he has to say hello friends i am dr rohit jacob consultant physician at graf and ar medical center careta the topic for today's discussion is a famous article which states estimation of dual antiplatelet therapy study treatment effects in contemporary clinical practice so there was a very reputed study which was conducted called as duct study and this is an adapt of what we call as the extended duct study so according to the study a patient who has undergone percutaneous coronary intervention like angioplasty with a drug eluting stent for how long should the dual anti-platelet therapy be continued normally it is continued for about a year and whether it should be continued beyond one year or not is the debatable and controversial topic according to this study there were two groups which were categorized where patients above 18 years of age with a drug-eluting stent was given dual antiplatelet therapy for a year and then observed after continuing the dual and therapy for more than a year to estimate what were the benefits and what were the risks the common variables which were judged in this particular study include strength thrombosis risk of myocardial infarction microscopic risk of stroke risk of major cardiac events and major cerebrovascular accidents all of these variables were studied and it was found that dual antiplatelet therapy you do more harm than benefits if continued for more than one year in so in such cases what we routinely do in general practice is continue a dual anti-platelet therapy like aspirin and clopidogrel so that it can prevent any risk of bleeding and avoid all the associated risk factors considering that benefit still remains the same benefit so my personal recommendation is continued dual antiplatelet for one year following which single therapy single drug therapy is more than sufficient thank you thank you dr jacob i we also personally feel that the anti-platelet therapy dual entity therapy should be continued up to 12 months only and after that on a usual case basis if he has more chances of thrombotic risk factors then maybe we continue under watchful observations but in most of the reasons it is not required to continue the dual antiplatelet that was the message we wanted to pass on right now it's a time for a brick yeah so uh could i'll just start the polls uh so we finished the 10th uh the top 10 to six stories and we will run a poll uh to find out what your your favorite story was so far um so let us know what was your favorite story that you've heard up to now so there are five options uh you all can scroll on the screen to see all the five options that you all have just heard about okay so most of the words have gone to uh young adults with high ldl that was 31 of the words for that story uh so moving on to the next uh section yeah now we move on to the story number five which is a very interesting story but we know most of the things that is going but now it has come officially that is published in the circulation about the american heart associations and dietary guidelines which is habits and evidence based we have been practicing to our patients about many of these things so some of the things may look as if you have been practicing but now it has come within ways of evidence based medicine so the association summarizes the evidence that address sustainability and enumerate the several challenges including the societal factors that make it more difficult to adapt or maintain healthy lifestyle so what say that what are the heart healthy lifestyle and heart healthy food that we should follow on to our advise our patients so the most first and foremost thing is we have to try to maintain the ideal body weight and for that we have to manage in such a way that our energy intake and expenditure are balanced in such a way that we maintain the ideal body fat then needless to say that yes we must eat more plenty of variety of fruits and vegetables and as they say that we our dish should be colorful or we should eat plenty of colors every day right then we must choose whole grain foods and products right and we must use healthy source of proteins right mostly plants and a regular intake of fish in seafood those who cannot take or do not want to take fish or seafood they can take the supplements of the fish oil also and another is the liquid plant oils rather than the tropic oils and coconut oil and palm oil are definitely more saturated fats and this would be avoided what is important in this message is that we must read the label of any oils that we purchase whenever there is a label of hydrogenated or partially hydrogenated that means it's not a good oil right and particularly also our advice should be depending on what kind of oil is to be used for what purpose if it is used for deep frying purpose practically all oils are bad maybe the olive oil is little better than the others it all depends on what is the smoking point of that particular oil so we should be knowing about the smoking point and for what we are using if you are using for the simple salad dressing the oil is different but if you are using for frying and we must discourage repeated frying that's very very important because that generates more trans fats and which is the most unhealthy of the oils then we must also encourage to choose minimally processed foods instead of ultra processed foods because processing definitely takes away many of the vitamins and it also adds lot of salt for increasing the shelf life so processed foods should be avoided we must minimize the intake of beverages and foods with added sugars because it adds sugar which is non-nutritive calories and also adds the caffeines then we must choose and prepare foods with little or no salt again there is a more thirst on avoiding salts we know it's a something which is definitely more in our particular indian patients and though we need to consume not more than three or five grams of salt we end up consuming more than 10 grams at any given time then if you do not drink alcohol don't start if you choose drink to a limit and we will are going to have one more story about this so we'll talk more then and other to the guidelines regardless of whether the phone is prepared or consumed so this is about our story of the evidence-based dietary guidelines published by the american heart associations and as i said our story number four is moderate alcohol consumption should not be recommended for health reasons if you see health permits in india i am sure most of them are for alcohol permits are that they have got low hdl or their anxiety or insomnia and this particular study appeared in pl os it is the public life of public library of science which is an open journal but peer reviewed one so the articles are definitely go through the same scrutiny and the article appeared in second november and they have this was in northern germany and what they did they found out the they studied the cohort of 4009 30 residents aged 18 to 64 years who ran at random the general populations and what they studied what they found out that the compared to the earlier belief that those who take moderate alcohol have better cardiovascular safety or outcome or those who do not take alcohol more risk and what they found out that it's not so there were some cardiac events in people who have left alcohol or they were abstain but what they found out and dug out from their detail histories that that is probably because of their previously unhealthy habits and because of the smoking that you are undergoing so the national institute of alcohol abuse and alcoholism of usa they have also cautioned that almost 95 thousands of people die in usa every year and also that alcohol is definitely related to the incidence of more carcinoma of the breast and that's why it's better that please do not prescribe alcohol on a health crown or alcohol should not be one of the reasons for the permit that is what the study says ah another interesting story story number three uh this appeared in the midscape on third of november and this is for the first time that the fda approved and i drove for presbyopia we know that up till now only thing that we have is the glasses right raised by up here is that age related changes which require the uh use of glasses for the near visions in the adults so usfd has appeared approved a drug uh called pilocarpine drops which is a one person 1.25 percent carbohydrate drops and one a person puts that drop that his pupils is constricted and that will lead to a better near visions and this effect lasts for about six hours and this may be a good for the people who do not want to use glasses for cosmetic reasons or for they cannot just wear the glasses and we talk to one of our senior ophthalmologists and researchers basic researchers dr bakulis kamar about what is the status of these particular pilocarpine drops in the use of press biopia and we thought that it's something great and it will change the face of the people or it will reduce the glasses used but let us see what dr bakulis kumar has to say about the race myopia and the eye drops where spasm recognition is not significant and constriction of people is also not significant however this product provides benefit only around one third of the people who used in a trial so if you want to use it try it but don't go with an idea that everybody will get equal benefit in those one third of the population who benefited the benefit was improvement of reading three more lines three more lines means if you are able to read large layers without glass you will be able to read three smaller versions of the later on the chart with this drops and effect will be pick at one hour and will be minimal at four hours to six hours so if you want to use it for a longer period you will have to use it multiple times and there is no harm in using this drug as multiple times since this product is not available and not likely to be available in india in the near future the option is we have a two percent pilot mapping available and you can put equal amount of artificial tears and dilute it to one person and one percent is also likely to give identical effect if used in appropriate way in a appropriate individuals place biopsy usually starts at the age of 40 and continues till lifetime in the early part of age group which is 40 to 45 the requirement of prescribing glasses is small and they are likely to benefit maximum while at the later part above 55 the requirement is significantly higher and they are likely to benefit less so if you fall in that group which is 40 45 and if you don't want to use it you can use this product to carry these drops and you can put it multiple times two to three times a day hello make sure that you don't put it at the bedtime hello because if you use it on a longer term use on a daily basis three to four times a day we indian being pigmented people are likely to get pigment dispersal and meiotic pupil and which may become permanent feature so don't put it at a nighttime so that the pupil gets dilated and the permanent effect is not there it was very interesting and i could hear that pillowcarpen is a welcome medicine but only thing is it has a very limited use especially in the first few years of the press later when the patients loses now it has more problems it may not be as good as it is in the early part but it's a welcome medicine we move on to our story number nine story number two that means we go in the reverse order it's a very interesting story about the use of antimicrobial drugs we know that national medical council is celebrating next week the anti-microbial stewardship program so the story number two is about watch which appeared in the midscape in the on the third november about antimicrobials when short courses are enough conventionally we give antibiotics in anything from seven to ten days or sometimes we give 14 or 21 days and this particular write-up has suggested that it's not necessarily every time the antibiotic course has to be full that is 7 to 10 days or 15 days it's better that we see the patients see whether the patient's signs of infection is improved and depending on the organisms and the setup whether it's a community acquire hospital acquired infections we can cut down the course of the antibiotic and without any harmful effects in fact we save the antibiotics from going into the resistance so this uh story uh says that if the conditions like acute bronchitis right and patients like adults with that copd then maybe five days of antibiotics is good enough and even community acquired pneumonia in the patient who is a commun immuno competent five days antibiotic score may be good only thing is you have to evaluate at the end of five days and likewise and uncomplicated you take infections are the cystitis may be in a patient who is not pregnant right and the nitropharantoid is the first drug of choice obviously and or even we can give sulphur time to for three days or one oz of phosphomycin and likewise uncomplicated pyelonephritis generally pneumonia and pilonephritis we tend to give antibiotics for much longer period but this article says that it's time that we start seeing the patient at the end of five days and decide whether the antibiotics will be continued or not so this was the story and we had dr susilla kataria who is in the senior consultant at the medanta haryana and we asked about the anti-microbial stewardship program to her and what are her views on the story so please let us listen what madam has to say hi i'm dr sushira qatarian i found the article on shorter course of antimicrobial therapies in various infections very clinically relevant i think it is very important for all of us clinicians to ask a question before starting antibiotic whether antibiotic is really required secondly it is important to stop antibiotics when it is not required we all are sometimes so that we we should have some good anti-microbial worship practice in hospitals only by these means we can control the infections as well as emergence of resistance thank you dr katarias we really made our point very clear that as far as the antibiotics are concerned antibiotics should not be treated like antibiotics or analgesics and antibiotics are not the drug for all bugs many viruses we don't need antibiotics so first and foremost thing that we always ask is whether the antibiotic is required and i for one believe that if we at least think twice before prescribing but it's temptation and our patients ask for antibiotics right i have read somewhere which is very interesting to say that it takes one minute to write in prescription antibiotics and take 15 minutes not to write the prescription antibiotics so that's where all that she said is the inertia part but any case for the story number one can you just put down what could be the story number one for the week till i just look for it story is related to a very common problem that we are facing right now and the future generation is gonna face and the i think we got one of them guested right right so if you read the newspapers or if you see the tvs what appears right now is the cop 26 anybody what is cop 26 so this is story is related to the first case with cause of death mentioned as climate change right it's not that this the first person died of the climate change but somebody has the guts and the conviction to put the cause of death is climate change that is why we put it as the first case otherwise it has been reported that almost 5 million people die of the climate change related diseases but this was the first unusual case reported in canada that doctor merrill was the one who just wrote down that this person died of climate change as one of the cause of deaths he was a 70 year old lady who had bronchial asthma and we know that in canada in june there was severe heat strokes and this particular unfortunate lady had many pro health related problems at that time and that is why when she succumbed the doctor mentioned that the cause of death is the climate change so this is the first world case case where the cause of death is mentioned as climate change but as i said earlier also to repeat that more than 5 million people die of the climate change and incidentally today is the last day of the conference of the cop 26 it is being held in uk glasgow and it is held by the uk and italy combined and our india also represented it and there have been many results in past and one of the important resolutions if we can manage to bring down the rise in the temperature every year the earth is being warmer by at least three degree centigrade and the whole idea is to bring down that rise in the temperature to 1.5 degree and it's not only the government that has to do that we also have to play our part we have to go for the as much forestation we can do how much trees we can plant how much less fuels we can use and the world is also moving for less and less coal consumption and greener and wetter and cleaner air and the world so let us hope that we sensitize one and all for the right change for the next generations otherwise they'll say what did you do when we asked the younger ones what are they doing they'll say what did you do so let's not hear that and we end the week with the story that we have to all collectively help to change the climate for better living so that's all from my side uh so we'll just move on to the polls section so in the uh top five stories do let us know what was your favorite story uh again there are five options and uh you all will be able to see it on your screen so just swipe up and down and you all can see all your five options all right so everybody like the case of climate change that's good to know and hopefully we'll be planting more trees after this uh now it's time for the part of the session where y'all are legally waiting we'll move to the quiz section um so for people who've joined in new uh we'll we are going to be picking up questions from the stories that we've heard so far and the first person to come up with the right answer for every question uh netflix is gonna be sending you all a prize uh so could we just have the first uh question yeah sure uh so you all will have uh options abc you all can put them in the comments section so get ready uh and yeah and that's your first question uh y'all can put down the correct answer in the comment section and i'll wait for a couple of seconds and then we'll go on to the next question i think i could we can see many right answers yes that's nice so we yeah all of y'all are paying attention that's good okay moving on to the second question um same thing applies uh what you all feel is the right answer y'all can just note it down in the comment section all right and let's move to the last question for today uh the correct answer you can put it in the comment section and we'll wait for a few seconds on the slide all right uh till the team figures out who the three winners are for the first question uh we have dr akshi gupta and for the third one uh we have dr shweta bhartwaj uh so these are the uh winners and we'll get in that the team will get in touch with you all soon too and get more details from y'all to send your and i think we can conclude our session tonight here uh thank you so much just request that any of the viewers if you come across any interesting stories and if you want to run that story or get some expert opinion on that we can do that so please uh send stories to netflix or and to our editorial members and you can reach out there and give the stories and we'll develop on it so thank you very much and once again have a good appropriate behavior we know that the third wave could be there any time and we do see that more cases are coming up and reported cases are there and even there have been few mortalities also so make sure that we pass on the message of code appropriate behavior and stay safe and stay healthy thank you good night and we see you again next friday at 9pm thank you all thank you good night all

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dr. Mahadev Desai

Dr. Mahadev Desai

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dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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