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Cutting Edge: Episode 12

Jan 21 | 3:30 PM

Watch Dr. Shailesh Talati, oncologist sharing his view on role of probiotics in preventing- Chemo brain include deficits in memory, attention, executive and processing speed skills after chemotherapy. Dr. Jitu Jethani, an Ophthalmologist gives his take on ‘Defocus lens’ which was significantly associated with slower myopia progression. Dr. Pratibha Dileep, Critical care specialist, talks about the role of balanced multi electrolyte solution (BMES) Vs saline in management of critically ill patients.

[Music] good evening everyone and welcome to the 12th episode of cutting edge i'm dr and our host for tonight is uh dr mahadev desai a senior consultant physician from amdhabad let's get started yeah good evening everyone welcome dr dr prativa and dr jithu zetani and dr taluparikan all the seniors we are very happy to receive you all on the 12th episode of cutting edge and we begin our first story it's a very unique story and with a lengthy one but trust me i have just shortened down to almost one-fourth of what i could have said otherwise it's a story of a 30-year-old woman who suffered a polytrauma during the suicide bombing at the brussels airport on 22nd march of 2016. she was rushed to the icu of the hospital of the brussels belgium and in a state of cardiac arrest secondary to severe blood loss and she also had sustained fractures at the hip as well as the thigh and after aggressive multidisciplinary interventions and partial amputation of the iliac bone as well as the fixation of the broken femur she was stabilized and revived unfortunately on day four she developed a septic shock due to surgical wound infections over the left thigh despite antibiotic coverage that was given a standard one augment in five percent eso vector she received that's not the end of the story in fact the bacterial culture showed poly microbial organisms culture and the enterococci pseudomonas enterobacter cycloc and klebsiella pneumonia were isolated and the treatment was started according to culture and sensitive reports but after starting point of long-term treatment and high doses of antibiotics he received so much of antibiotics that sea level virtually most of the complications that we know of of the antibiotics she developed febrile neutropenia because of the meropenem she developed deafness because of the amica seems to develop renal tubulopathy because of the colistins you also develop pancreatitis because of degas cycling and as if it is not enough sea level of macro mycosis because of the critical illness 20 days 25 days after admissions requiring complete gastrectomy and spinach and six weeks of antifungal treatment after more than four months of intensive antibiotic therapy they have an excellent pharmaco clinical pharmacology and microbiology setup and they could do the therapeutic monitoring of the drugs and all the drugs were given and a skin graft was applied over the left eye in july 2016 see sustained injury on 22nd march 2016. however luck would have been that she developed a sinus track there was a prevalent discharge and there was the skin graft was also out and all the external filtrators holes also plus the external fixator has to be removed and the phone was debrided 170 days after the injury the surgical biopsies this time saw only organisms of klebsiella anemone and there were two types of klebsiella pneumonia and unfortunately they were resistant to all the drugs they were giving and all the drugs they are known but they continued in the hope that probably that infection can be localized and individual it might be working and but the femur was not uniting the wound was not healing so clinically they decided to turn the phage therapy that is the first time they tried this phage therapy phase therapy is a bacteriophage is a virus which kills the bacteria and they have repository of so many bacterophages in their laboratory and they found out one particular strain of bacteriophage that is a virus which they could get it from the sewage water in 2012 and they have kept it and they tried in the laboratory and it was working very well against this particular cleft cell and the morning so they wanted to give it but the ethics committee took long time to approve it when they approved it there was no consensus among the physicians to give it so the treatment of bacteriophage was put on hold on 21 february that is 702 days after the injury 2018 the pages were locally given because the physician would not allow an iv therapy of an unproven one so only thing that they agreed was giving a factor bacteriophage locally and it was given by keeping one catheter inserted into the wound and the it was decided to give it only for six days so that the vector which also would not develop any immune reactions or long term complications to the great surprise and relief of the patients there was a dramatic improvement in clinical microbiological and radiological improvement and the wounds also started healing the skin graft was retained and antibiotic reference or discontinued after three months of surgery and on seven nine eight days post injury a week later the fixator was also removed and when they started writing this manuscript three years after the incident the antibiotic phage combination treatment the patient has regained amputation mobility and she was help with the aid of crutches he walks he participated in the supporting sporting events and there were no signs of recurrent glyph cell animal infection so this is a case of a battle of a woman and the bethel pathologist bacterologist microbiologist they all combine an intensivist even though she com had so many com complications because of the treatment and because of the infection she survived because of a novel treatment that was a bacterial treatment we move on to the another story there's a story about the cardiovascular disease screening in psoriasis this appeared in jama dermatology on 19th of january it appeared as an editorial the editorial title was also very catchy that psoriasis and cardiovascular diseases an ounce of prevention is worth a pound of cure normally we know that the psoriasis patients are usually under the care of either the dermatologist or the rheumatologist if they have psoriatic arthritis and we know that psoriasis as an internal medicine special we know that psoriasis psoriatic arthritis are also inflammatory conditions and they are because of the immune disregulation and all chronic inflammatory conditions would lead to accelerated cardiovascular diseases for which they have to be screened and timely given the treatment american heart association and american college of cardiology has also identified these chronic inflammatory diseases like psoriasis as an enhanced risk inducing factor for asubd that is atherosclerotic cardiovascular disease and we know that statin therapy substantially reduces the cbd risk and it's a very safe multiple trials have so that stay safe and inexpensive but this particular editorial also quoted the study in the same journal of jama dermatology where a survey was carried out by the dermatologists and rheumatologists for the screening of probable screening of this for cbd in the patients who are having psoriasis or psoriatic arthritis and of all the doctors who are registered in the national registry were asked unfortunately the uh the survey was responded by very few dermatologists and the rheumatologist and including they also include the patients national psoriatic foundation patients registry and they could send invite to them also by email and they could get a very small number of persons responded but whoever responded at least the good part was the doctors who are ready to screen and these patients were also ready to go for the screening for cardiovascular diseases that's very very important so the overall editorial comments were that because of the poor response it is not possible to generalize that this is the state of office but the important part is the american academy of dermatologists and the national scientific foundation guidelines as of now they do not recommend for all patients they recommended cvd screening for patients who have to be started biological therapy or phototherapy or in the patients of psoriasis who have disease covering more than 10 percent of the surface area so our points of learning in this paper is that at least all patients who are having chronic inflammatory disease be it psoriasis psoriatic arthritis inflammatory bowel disease or any such disease it's better that we start screening for cbd and statin therapy is one of the most valuable treatment that has so far unquestionably shown the efficacy as far as the cvd reduction is concerned so then we move on to the next paper that is about the patients of carcinoma breast having the chemo brain and the use of probiotics this appeared on 18 january 2022 it was a double-blind ramdema study where in 159 patients suffering from stage 1 to stage 3 breast cancer who required adjuvant chemotherapy these patients were randomized to receive either a regimen of probiotic which is of three capsule twice a day right 80 patients and 79 patients received the identical placebo only and the chemotherapy the probiotic capsules contain the standard probiotic organisms like bifido bacterium then lactobacilli and enterococcus with all 210 milligram each what they found out was that the patients who have got chemo receiving chemotherapy and patients who are having carcinoma breast sometimes they complain of symptoms which are almost like the memory disturbances or the executive function or difficulty in executing the task and they attribute the researchers attribute this to the disruptions in their internal value of the gi tract and that leads to the neural inflammations and that lead to this what they gave the term chemo brain and the probiotics try to stabilize this colonic and bacterial disruptions and there how thereby reduces the symptoms of chemo brain and we know it's very safe and easily available it can be given and the researchers pointed out also that it the patient does not have to take continuously this treatment they can take intermittently or at the time of chemotherapy and the long-term effects with the prevention of initial cognitive impairment would definitely help and reduce the neurogenerative trajectory of the patients with all these disturbances we have doctor so the cartes is and consultant medical oncologist from nasik and we want madam your opinion about this paper and what have you to say about this over tumor thank you so much sir um it was a very lucid presentation from your end and pertaining to this paper i would really want to congratulate the authors on the um design of the study uh it is one of its kind uh in this probiotic chemotherapy um area there are many many many papers and majority of them have looked into what is the effect of probiotics in reducing the chemo-induced gi toxicity here what they have tried to do is look into the neural inflammation part of it the concept the theory the hypothesis is very very apt inflammation is a major part of cancer physiology it is one of the hallmarks of cancer and during chemotherapy also this phase of new inflammation is actually you know uh it is increased to a level which uh uh is very difficult for the patient to take in terms of the toxicity uh so uh this link of neuro inflammation and is a correlation with you know the hypothalamic cells which actually do not lose their memory uh signals which is i mean i uh the paper is still not out it is only in the form of abstract but they have used uh various scales which are very much um accurate in measuring the acute memory retention of the patient and that during before the one one day prior to the uh first cycle of chemotherapy and uh 21 days later uh from 21 days from the last chemotherapy they have repeated the all the neurocognitive scales that they have used i think they've used three of them and they have seen a substantial difference so the patients who received the probiotics did have a better memory so um this is very very significant if you look at look into the neurocognitive effects of chemotherapy many a times it is difficult for the patients to you know express and they usually go into some form of somatic uh symptom which we search attribute to some other side effects or you know just put it as a psychological effect we never go ahead and you know categorize it into what exactly which neurocognitive area of the brain is getting hampered so i i was really impressed by the lucid uh distrib description of the neurocognitive effects that they have done and also i would really want to see how the patients have tolerated the placebo in the abstract uh sorry the probiotic the in the abstract they have mentioned that it has been very well yeah yeah no gi side effects that is interesting we we have many papers which have uh told that probiotics do not increase chemo induced gi side effects because the papers which looked into reduction in the gi side effects actually had to also give a comment whether they increase it or not because ultimately we are giving a cocktail of medicines to the patients whose bowel is not functioning very well you know many times these medicines especially we are looking into breast cancer patients they have they are receiving anthracyclines which cause mucositis both in the mouth esophagus as well as in the small and the large intestine so um it would be a really very interesting to see what was the um side effect profile of the of these patients who received it and also i would want to see the long term outcomes because um if they have not looked into it i would want to initiate a study because cancer sub groups which are not very doing not doing very good especially the triple negative breast cancer where there are there is a lot of early relapse so we should definitely try to see whether this reduction in inflammation by these probiotics can have an augmented effect of chemotherapy and the disease free survival of these patients and i just wanted to ask how often do we get these chemo brain symptoms do we try to find out that how often we get and correlate with this kind of catheterization chemotherapy related cognitive impairment cr ci that's what they say used cognitive impairment i am sure it exists right now i can't even tell you the percentages because uh more often than not we ignore these symptoms uh these are these usually are part of the quality of life assessment um scales that we do for the newer therapies in these patients where they're tested most of them in the metastatic setting but in the daily opd's we are incapable of you know getting an assessment of these patients uh regarding their neurocognitive well-being actually i should not say impairment we should be actually keeping a watch on their well-being and i am sure there must be some or the other effects that are happening which the patients many times may not be telling us or we may be failing on our part to ask such questions which you know so thank you thank you so much having you and having your expert inputs will definitely be require your inputs in future also thank you so much thank you we move on to the next story thank you welcome dr prativas he is an intensivist at decidus hospital uh we move on to the story number five that is about the effectiveness of the thrombectomy in the stroke even after six to 24 hours this appeared in the landsat on 15th of january we know that whenever there is a major stroke if the patient presents within the six hours we have the thermolytic therapy but most of the time we do not do much except the conservative medical line of treatment after six hours so this particular paper analyzed the it was a meta-analysis of many studies of which they selected six studies and they found out what was done over a period of 11 years they found out the papers in which there they just tried to find out that all patients underwent endovascular surgical therapy that is the thrombectomy what happened to them so in all there are 505 persons out of which 266 had interventions and 239 did not have interventions and they tried to study the outcome of these patients uh in 90 days whether they had the disability uh which is they calculated or they assessed by the modified ranking scale on zero to two and what they found out was that thrombectomy was definitely associated with a higher rate of independence in activities of the daily living on the modified ranking scale of zero two two then the best medical therapy that the other the placebo group of the control group received and there was no significant difference between the intervention in the control groups when analyzing the 90-day mortality or the symptomatic intracellular hemorrhage this was pertaining the major arterial involvement where they were the underwent thrombectomy so the overall conclusion was that if the patient raises little late later than six hours and if there is a redu reversible ischemia they should be offered with thrombotic therapy in the form of the endovascular thrombotic neurosurgical interventions so this was the paper about that dr patiba if you have to comment you can comment right now also and any of the members can also raise their hands and give their expert inputs you also encounter many patients of stroke right in your intensive caring and critical care united side good evening sir good evening welcome thank you very much for attending thank you thank you sir thank you sir i i'm basically not an neuro intensivist but i do come across some patients of neurocritical care and thromboectomy if it is done early in the course of events usually has better results so my comments probably are not really very uh evidence you have encounter yes that's true that's true but even this paper suggests that we should be offered them right with the help of the neurosurgeon first few hours best chances of revival in these patients right thank you so much we'll need your export open in the next paper to come here yeah definitely yeah so this story is about we already talked about the use of probiotics in the cancer chemotherapy of the breast this this particular paper appeared two days back in the english yesterday only on the channel of medicine this was about the oral microbiome in recurrent seed efficient infections we know that patients who had recent hospitalizations or antibiotic exposure or undergone gi surgery they are predisposed to clostridium difficile infections and they end up with the recurrent diarrhea maybe the blood in the stool and it's unless you think of it properly it goes undiagnosed so this is a study where is a phase 3 double-blind randomized placebo control study where 188 patients who had three or more episodes of clustering deficient infections and one of the episode is the one during which they were included and either they received the placebo which is an identical capsules or an capsule containing the oral microbiome which was prepared from the purified permeability spermicidase is one of the organisms which are present in the human colon and which is supposed to be healthy and which keep the bile acid concentration in such a way that the patients do not get diarrhea but when the patients receive antibiotics this particular organisms are destroyed and that is why the bile acid concentration gets disrupted and the patients develop diarrhea so this was the hypothesis and they wanted to prove it as the primary efficacy point as the superiority of this particular ase are capsules over the conventional treatment and both the groups were receiving the conventional standard of care antibiotics whether it's a vancomycin or reduxomycin which is the standard of care in this kind of setup and what they found out that the seed efficient infection was 12 percent in the patients who received the oral microbiome as against 40 persons in the placebo group who received only the standard of care and there were more the most adverse events were mild to moderate after the treatment and they were mainly in the gi uh symptoms the scr109 that is the oral microbiome containing formicutes definitely was detected in the as early as one week after the therapy started and it was definitely found that whatever microorganisms they should get in the stool had the organisms which were definitely inhibiting the spore germinations of the c difficile and the system symptom resolution of the deficient infections after it may be standard of care antibiotics and oral administration of sar was superior to placebo in reducing the risk of recurrent episodes so this one more evidence of the treatment other than the antibiotics the antibiotics will take care of the present infection but it will not restore the microbiome and that is why the patients are likely to get recurrent infections so this particular treatment when available would definitely have the complete treatment of the seed efficient in the form of the radication as well as preventing the recurrence then move on to our story number three which is an interesting one which is from the ophthalmology and this is about the use of the focus lens for myopia we know that after the lockdown impositions the students have remained more in-house indoor and more because of the online virtual teaching they also had to use the uh short distance vision for a much more longer period we also know from our basic knowledge that the in children the myopia increases because of this kind of over exposure to the near distance vision so what the study there were two parallel studies in this particular paper the one group of students who were prescribed this particular lens which is that lens and about that we have an expert to talk about i'll just uh first narrate the paper and then invite dr jithenra who is our experts from baroda who is a senior ophthalmologist so first about the paper so children were divided into two groups in the one study the students who were given the focus lengths were observed for the progression of the reflective error and the myopia and the second group of patients uh students were the one who was given single vision lens for the same purpose and what they found that the both were given for a different period but they calculated overall remove the period during which there was only the single vessel a single vision lens was used and this i leave it to the experts what they found that the myopia progressed very rapidly in the school children during the period when there were more coffee related lockdown measures in both the groups right the optical treatment with dims a specific refocus lens significantly associated with slower marker progression compared to the single vision lens treatment during that lockdown period and the we know that generally the time spent in indoor and outdoor decides the progression of the mafia so this particular paper is in emphasizing about the use of the focused lens so we have dr chitendra who is from senior ophthalmologist from barona and he would be giving his expert opinion explain us about what is this defocused lens and how do we use it and do we use it or not yes dr g welcome and thank you very much basically what they have what they have done is that they have incorporated the defocus segments so that is not there in the center if i can share an image i can tell you uh yeah yeah so if you see this image that the normal single uh single power lens what it does is it focuses the image right in the center the black black arrows are there which is right in the center but because the curvature of the eyeball normally this will focus there will be a hyperopic defocus so what happens is that this particular area of retina or choroid or sclera tries to catch up with the hyperopic defocus so what this plus 3.5 or dims or defocus integrated multiple segments they do is they create a myopic defocus which is there in this particular photograph in red so what it does is it defocuses the peripheral vision not the not the central part so the central 3.5 millimeter is having normal sharp vision which is the normal power and peripherally they have small small lens threads so what these translates would do is they will not create a hyperopic defocus but they will create a more physiological kind of image which will prevent the progression of myopia so lockdown one part of this particular study is that lockdown has indeed increased the prevalence of myopia which is there in our patients also we had our own reports from india also and dims does help and but the dims at least in india is an expensive option at this point of time because they are importing the lenses from europe but there is another treatment like low concentration atropine which also can be used for for preventing the myopic progression so this is a this is a new technology it is there since last couple of years and it has been used first time because covet was an unprecedented situation and it had forced most of the children indoors more screen time all of these things have been implicated in progression of myopia and this particular lens has been used uh in this particular situation to reduce the progression of myopia excellent very good how often how expensive it is just to how does it reduce the progression of these myopia it uh yeah so it cuts down the progression by it reduces the progression by reducing the axial progression so it is useful only if the myopia is progressing excellent if the eyeball size is increasing posteriorly only then it will reduce the rather it will reduce the growth at which it is increasing so the growth will be cut down by 60 percent there is no reversal of glass power the only problem with this particular study was that the two the two study groups were studied differently and they had done sacroplasia one was under tropical tropical silk plain and another one was with cyclomentolate both the drugs are inherently different in their usage although the authors have written that in their limitation but it is a strong limitation right and that means it's not useful may not be useful in the adult do you mean to say so okay so there's a wonderful study by jason yam which they have quoted reference number 27 what they have said is that it is more useful when the kids are more than 12 years of age and that is why they have said that probably in their study it was undermined because their mean age was 10.3 to 10.7 years so they said that probably their effect was not as good since uh it affects more after 12 years of age so whereas the alternative therapy of low concentration atropine works more when you use it till 15 years of age can we use atropine for a longer period indefinite period uh so low consideration atropine in a in a dosage of point zero one percent which is hundred times dilution of one percent which is standard available has been used for over a period of two two and a half years in rcts uh which were published by audrey chia in ophthalmology 2006 there was a follow-up study when they had used it for almost five years and they published it in 2012 both in general of ocular therapeutics and in ophthalmology so there is a lot of data on safety efficacy of low concentration atropine point zero one percent there's an interesting anecdote and a there's an interesting study i mean an interesting thought behind it so what they had done was they had diluted one percent by a hundred times and in our medical science normally if we dilute the drug by 100 times we believe that it is you know sort of homeopathy or it can be used as a placebo and to their surprise they found that it was indeed effective even at the concentrations of 0.01 so that is how it uh it was actually the mimicking the placebo arm and that is how it came into uh usage in 2012. excellent excellent thank you very much for giving in detail explanation about that when we read this paper we thought of you because we would obviously not knowing what was this defocus and thank you very much and it was pleasure having you and will definitely take her benefit in future also thank you yeah we move on to the next paper yeah this is a paper which again is very interesting very common and we have dr pratibha with us for discussing this particular paper this is about the use of iv fluids in intensive care in a critically ill patient this has again appeared in the new england journal of medicine on 18th of january it's a double-blind randomized controlled trial here two different types of iv fluids were used in critical ill patients patients who are very ill or those who could die in the next 90 days or those who had the severe multiple organ failure or traumatic brain injury were obviously excluded and here they gave two different kinds of solutions one was they call it balance multiple electrolyte solutions called plasma light 148 and with the sodium concentration was 140 potassium was five and magnesium was three and another was our standard isotonix line that is point nine percent saline which obviously is more sodium and chloride and this particular was a bike country that is australia and new zealand have participated and there were about five thousand odd cases in 553 icus uh half of the patients were assigned to the balance multiple electrolyte solutions and the other half were given the saline and the just wanted to know about the primary outcome was the death from the any cause in the 90 days after randomizations and the secondary outcome was the requirement of renal replacement therapy or rise in the creativity in the during the icu state what they found out that the number of patients died numerically were same in both the groups with a little increase in when the percentage points in the group but practically it was insignificant and likewise even the requirement for renal replacement therapy was also not much difference and the serum created was also difference of only 0.01 milligram in the icu state so the outcome of the study as for the researchers was that there is no difference whether you use balance multiple electrolyte solutions or saline in critically ill patients early also there were lot of studies some over them suggesting the balance multiple electrolyte solutions with the claim that when we use too much of sodium chloride only we are afraid of the hyperchloramic metabolic acidosis and the acute kidney injury but this particular paper did not find much of the adverse reactions and the number of acute kidney injury or rising creatinine were no difference in both the groups so we have doctor pratibha dilip she is a senior critical care specialist of the cyrus hospital and definitely her inputs would be more important to clarify about this paper welcome thank you sir thank you very much for inviting me uh it's it's quite an interesting study actually sir and the very fact that more than 5000 patients were enrolled the study becomes uh quite a strong study and it's a good meta-analysis with most of the groups where with low bias effect were selected so this is a this is a reasonably dependable study and the data which is uh proven beyond doubt that the normal cell line is little deleterious in comparison to our isolite solutions which uh could be which which could come in various names so like plasmalite or isolite what we use even sometimes ringer like it's also is used in the same manner but uh i i think there is one issue with the study one is that in normal conditions we don't use uh say suppose 2.5 liter fluid has been used we we never use only saline in normal conditions or similarly we know we never use only isolite or we we don't use ring electric we always have some proportion of it coming as normal saline and some proportion of it coming as lingua selected so this study is actually slightly deviating from normal practice where only normal spine has been used or only ringer selected have been used or only plasma light has been used so that way uh translating these data into normal practice can be slightly difficult that is one thing second thing is uh as very rightly they have found that subgroup which is associated with sepsis has benefited more whenever the isolite solutions were used while subgroup with trauma have uh had more uh mortality which is i think uh we have seen in normal this thing also because all head traumas we we don't want to we rather like to keep these patients slightly hypernatremic rather than even isonatorimic so they are using these isolite solutions can be dangerous so this is again a very well proven thought i think if the study could have been done with some proportion and if it has been tested in different subgroups then it would have been probably more clinically meaningful but otherwise the design of the study was pretty good and quite uh i think it requires a subgroup analysis in a little more depth this is what i feel but cost weight how much is the difference between the plasma like tremendous tremendous difference five to six times plasma light costs somewhere around i think 270 rupees while uh our normal cell line or uh the ringers licked it would cost 45 50 rupees like that so normal in icu where do you use the more often plasma lights or kind of other solutions sir i am little old-fashioned i don't use it very frequently i am happy with ringer selected and normal slime very occasionally if the patient is hypernatremic i prefer to go for plasmalite our hepatologists they are very fond of using plasmalite they feel that especially in liver patients this is superior i have slight uh difference of opinion on that because even liver patients they tend to develop dilutional hyponatremia very frequently many of them have ascites and many of them have volume expansion so giving them slightly hypotonic solution is not a very good idea right and how often you get the problem hyperchloramic metabolic acidosis that's what they claim when they promote this kind of all lights so hyperchloric metabolic acidosis occurs mainly if you use only normal celling right because uh normal saline is actually not normal saline normal saline has 150 milligrams of sodium and 150 milligrams of chloride which is quite high in comparison to a plasma so what we tend to do is we use it uh one one is to one normal saline with ringer selected so that takes care of that hyperchloremia and by and large usually if the patient is hypovolemic hyperchloremia is more commonly seen so rapid correction with normal saline alone can make it worse so instead if we do it either one is to one or one is to two normal cell inverse and ringer selected usually that problem doesn't come i think that's what most of the ic also follow the same that they use normal saline and being elected alternately alternatively unless there is a contraindication for ring reflected correct right that you are afraid of the liver uh especially liver injury sometimes sadly we can get hyperkalemia because ringers like it has some amount of higher potassium so we can get uh hyperkalemia right so much thank you so much prathibha it was really a very indeed pleasure having you and your inputs again you would love to have your kid or another technical care based issues thank you so much it's so nice to see you on a different platform yeah thank you yeah yeah thank you very much this is a story which is something new as far as our understanding of the multiple sclerosis is concerned this uh and as per this story the epstein-barr virus is most likely the cause of multiple sclerosis we know multiple sclerosis is a chronic inflammatory demyelinating conditions affecting the brain in the spinal cord we know that it's up till now what we think as an ecology is usually some viral infections we have eb virus herpes virus so many viruses are implicated but none have been proved so far and it occurs so slowly that's very difficult to point point one as an ideology but this particular very unique paper what they did was uh in u.s military recruitment persons they always collect the blood when any person is recruiting the us military and that blood is collected basically for hiv and every year twice in a year they collect the blood so what these researchers have done was they collected the samples the u.s military people have repositive about more than 62 million blood samples preserved all over these years so what they did was they collected the samples from those persons right who did not have eb virus to begin with number one and this found out how many of the military recruits had multiple sclerosis and they just match the equal people who did not have the multiple scleros or in fact they took more number of patients persons who did not have multiple sclerosis so and this they studied for 20 years period and what they found out that there were 801 multiple sclerosis cases and equally met one five six six uh persons who did not have multiple sclerosis and what they studied was the levels at what stage of the uh their pro lifetime they converted into positivity for the eb virus so anti antibodies to the b virus was at what stage they got it and they also studied the a particular serum levels of what they call it as uh neurofilament light chain neurofilament light chain is a substance right which is present which is indicative of damage to the brain and that is considered to be the biomarker for the multiple sclerosis or preclinical evidence of the multiple sclerosis so what they studied was when did the cohort who had multiple sclerosis got eb virus infections when did they get this neurofi filament chains and they proved in fact they would accept one patient out of 811 had eb virus preceding the neurofilament detection in their blood so what they say that there is a definite causal role of eb virus in the multiple sclerosis and what they suggest that if we can now extrapolate the studies to the more presence of patients having multiple sclerosis maybe the scientists would give more efforts to develop the vaccines and then that vaccines can prevent multiple sclerosis because we know that once the multiple sclerosis occurs we have very limited treatment and the by the time the patient is diagnosed there is irreversible damage to many parts of the brain so maybe we may have the vaccine for eb virus and there may be a cure or the prevention for multiple sclerosis and we also know that eb virus also is one of the india intel uh ecological cause for the burkitt's lymphoma so maybe by giving eb vaccines we may be able to get the some of the disease uh prevented so this is something we thought that is very interesting because up till now we know that epstein-barr virus definitely is almost present in if you go for the estimates antibodies in our idle populations more than 90 percent would have positive enter by abstain by virus level so and that is why we cannot say that up before these studies we could not say that eb virus is the etiological agent then the question would come why would not other pieces develop it but here they proved that before the biomarker for the multiple sclerosis appeared in the blood they had zero converted from their previous level of no antivirus infections except one patients who had multiple sclerosis but he did not have eb virus so they said probably he developed it after the last blood collections or maybe sometimes we just do not get the right level detected in time so very interesting study of the eb virus as probably the cause of multiple sclerosis and maybe we'll have more papers to substantiate this claim of this researchers but a very well studied and they said there's almost 32 fold rice uh chances of getting my my multiple sclerosis after the baby infections so that's all about all these stories and we would love your comments but before that we have quiz right depending on all the stories that we uh run through so the first quiz is which type of lens retards the progression of myopia in children is it names progressive lens single vision lens or the bifocal lens i could see that most of the people have given the right answer uh let the back office decide the winner we move on to the next question please that is which drug therapy significantly reduce the risk of cbd in patients with psoriasis uh to be fair i would say it was not only this phoriasis any drug which can reduce the cbds would have been the question but because we ran the story of psoriasis it was in connection of that we have put these patients otherwise anyway the answer remains taken by all means and the next is which viral infection has shown correlation with the causation with multiple sclerosis is verizola cytomegalovirus eb virus or h.i virus thank you very much most of the people have right yeah most of them have given the right answers and and i think we have further winners here so for the first question uh we have dr shreya ashitosh for the second question uh we have dr priyanka kasala and for the third question we have dr vishwana um so congratulations everyone and we'll soon be getting in touch with all of you all uh to send out your prizes and uh till then y'all can keep sending us news that you all come across and that you all would like to see on cutting edge and thank you everyone for uh coming here and enjoy the weekend yeah thank you good night have a good say stay safe stay healthy

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dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

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dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

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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.