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Let's trust science: my Top 5 papers on Covid-19

Jun 24 | 3:55 PM

Let's Make no mistake: The challenge is huge and unprecedented. If a typical virus is a riddle wrapped in a mystery inside an enigma, the coronavirus known as SARS-CoV-2 is all that and more. All that research focus has led to a remarkable amount of information in a remarkably short time. Let's explore top 5 scientific research papers on COVID-19 with expert interventional cardiologist Dr. Kamal Sharma.

we have a amazing guest with us so dr kamal sharma uh he's a uh by profession he's a senior interventional cardiologist the chief of interventional cardiology at sal hospital also associated with you and meta he has published tons of papers written eight textbooks in his uh academic uh uh career he got 22 gold medals uh something for which he was quite famous and um yeah so he uh he uh did the world's first vegal now stimulation device implant as part of the anthem study that is one of the major achievements and he discovered the winking coronary sign of vsr on angiography also called the kamal sharma sign i am really too uh too junior to understand that but uh probably dr sharma you might want to talk about it at some point uh about how that discovery happened and uh how it made an impact so kovald has uh definitely upstaged our life and made a lot of changes uh in in our everyday life behaviors everything a lot of things which were never talked about uh are now the center of attention uh and and uh have come into the limelight so for example public health uh completely you know ignored topic uh and now it's all about public health for example adult vaccination uh for long it has been uh not really in the focus uh something as simple as hand washing uh in india we've really not uh been hand washers so uh i just want the audience to put in a few things which comes to your mind uh are there three or four things which come to your mind uh put it in the comment box which were absent pre-covered absent from conversation absent from folklore we never talked about it it was ignored uh and and both covered it has suddenly become very very important so so are there a few things which you could put down and we'll we'll have some surprise gifts for uh a few interesting answers that we can get so mask absolutely uh quarantining yeah we never talked about quarantining hand hygiene i said i would say public question which is the topic of the day people started writing more and i i think i'm going to touch upon that that's when i was getting to dr kamal sharma so uh that was exactly what i was getting to uh we had lock up not locked down uh mental health yeah uh mental health has been a major uh focus area over the last six to twelve months uh herd immunity yeah lack of manpower uh sterilium uh perfect so uh yes as dr pharma said uh one of the things which really has come into the uh focus uh thanks to comedic research to the extent that we we've called it an infodemic and and there's just been a paper tsunami which has happened uh for sure but i think we can only be thankful to it so it's good it's created a culture of uh science a culture of research published a lot he's written hundreds of papers so so i requested if him if he could choose five papers uh which he which according to him in his personal completely personal opinion are like the best papers uh on kobe to his knowledge and also tell us uh why he thinks these are uh his top five uh in the process it will be fun to know what are these top five papers but in the process we also hope to understand his mindset as to why he chose this five and so maybe in the future when you choose a topic start writing a paper you could probably keep some of these things in mind so with that i will uh i will hand it over to dr mark thank you rowan for inviting me for so your topic look my favorite my five favorite research papers and kovitz so i was initially confused whether i was to choose five papers that i have written on covet because i had written 20 of them but then i realized that that's that's not the fun i should not have you know all my papers coming in as my five my favorite so i've included one paper um as you said i mean people say there is info damage you know people are publishing left right now what not but i feel why you should not because this was the science that nobody knew i mean this here it was a science where people were talking about giving anything and then i remember you know somebody copying a picture from a science book where it mentioned corona voice viruses cause it's a family of course causes common cold and it can be treated by diabetic pca and then somebody shared it and it went viral you know people were talking that kind of funny things when this sign started and that's why when i chose five papers as everyone clearly said my mindset i have chosen not primarily based on which of them had the highest impact factor or which of them were had the best of the literature reviews or which were the ones which were most cited but i have chosen from five different arenas five different kind of perspectives and how they impacted our life not because of the kind of content primarily they had of course that is one of the reasons but i chose them because of various perspectives and how the science changed our way we look at life and covet one of that should come find its place is called recovery trial the one trial the mother of trial the trial driven by funding from who included every country which had coveted impact everybody was too allowed and you can choose any drug everything that you wanted to investigate was part of recovery track so recovery actually looked at everything you know people were saying oh the anti-anti-hiv drugs should work because they work in hiv then everything should work they thought hydroxychloroquine works because chinese have used it and then somebody's you know antiviral will work so everything that you can imagine was part of aspirin should i spit in a day keeps a doctor away you know and rather than apple you remember when my my teachers group i mean your doctor made his age that's what they learned and in my age group we learned statins a day keep a doctor away so statin also is part of that so whatever you thought of had some possible theoretical mechanism that could explain or evaluate this was part of a recovery trial and what it came out with every drug you can see the name list here lopi navi written away corticosteroid hydroxychloroquine azithrop azithromycin toscilisumab biologicals immunological aspirants uh synthetic antibiotic neutralizing antibodies which is now available what uh president trump took and now is available in india baris anakirina a dimethyl fumarate infliximab high dose steroids and what it came out with this was the first paper dexamethasone what worked steroids worked and this is the first publication that came from the recovery collaborative group which was published in fair again this is a subgroup of that paper i'm not touched upon the original paper when it was published and came out if people call it a poorly designed underpowered what whatever it was a science at its best recovery trial stands out as a rare bright spot it results in demonstrated benefit benefits of steroid dexamethasone and to some extent oscillation map while showing the lack of efficacy of azith azithromycin colchicine conversation plasma hydroxychloroquine anti-hiv drugs ongoing amps include right now paracetam and of course a couple of days back we had the neutralizing antibodies which actually came up with their efficacy and now they've been approved so that was the paper one well this this this was the mother of all kogit trial which actually proved that you can choose hydrosteroids the problem is how in india we extrapolate overdo and overuse and kill people kill the trial data and designs into our own flexible methodologies the trial was about dexamethasone in pneumonia in hospitalized patients who are desaturating given only in normal dosages or high doses not supranormal supraphysiological doses which have actually caused been given in outpatient department without desaturation at the first drop of at when ct scans were positive which is the extrapolation and abnormal usage is the same so barring that extrapolation i think we have saved a lot of lives using steroids also so how to interpret trials is something which is not part of the topic right now but i think with time we'll i'll touch upon that as well we look we have to interpret the molecule in the trial design trial design was of 10 days only tapered off dexamethasone uh bd dosage in the first five days and then odors is next five that's the short ten days in hospitalized desaturating covert pneumonias that's all where it stands nothing more nothing less that's when you give so that was one coming to second paper this is a paper again it's cited well published from pakistan now i remember this paper because couple of my students were working on this what has happened is learning online everybody is talking online everyone has launched the platform and we have now netflix floating in here why is this all happened i mean does it work does it have a science does it have a publication to support it and this is a paper which was published in eric by uh adnan mohammed about online learning i mean covet 19 and a student's perspective we all think about what is convenient for the teacher but i think it's more important to realize what is convenient for the student and the student's perspective was published by medical students in an online publication it's cited very well now almost 300 plus times and if some of my students are there who are planning to write a paper along with me which we have done a survey of all the medical colleges spread across gujarat and we had drafted a paper and we were planning to submit you can see that this paper concluded that 71 plus patients felt that they were well qualified to use computer 73 students had proper internet facility and 78 felt that the con conventional classes were more effective as compared to online learning now this is something that we all should be scratching our heads and this is why everyone netflix is so important because the classical teaching that underwent the primitive mode of learning online was found by 78 respondents in pakistan not as good as conventional so unless we can get into a conventional like online mode this paper tells us that it's not worth it so this is again from a huge population base that they've started all medical students and that's how they come out with this conclusion uh again 50.8 student voted against the possibility of effectively competing entire course through online learning so nobody wants this to be in the current mode purely an academic only mode of learning for that physical classes to go i think online will have to get probably more realistic rather than virtualistic as it exists third paper is a paper for called predictors of death now this is important this is one of the most uh well-cited paper from lancet i've chosen it for a couple of reasons one that it is from lancet one of the well-cited papers and again it's it's a national registry one of the reasons why i've chosen it is because of the giant giant data set that it has it has got or you can see uh almost everybody you count the numbers it's 17 million patients that they've analyzed it's a huge data that people have in our country we don't have any publication which is more than a million of or a billion plus patients database so they identified what kills what the incovit 19 it's the older age group it's the age group uh which they compared the male gender deprivation socially deprived are more likely to die obeys and those with comorbidities smoking history of cancer chronic liver disease all of them had a higher hazards ratio of patients dying of covet 19. now that's how you know whom to target whom to chase whom to hospitalize whom to screen and go more aggressive this is first this was the published in 21 the data was pre-print available in 2020 and i think this is one paper that actually told us that we were looking to be looking out more for elderly patients looking out for those who are poor moment those who are smokers those who are having history of cancer or those who are already on immunosuppressive therapies again it also looked at racial differences while non-white ethnic groups had higher odds compared to the whites these were the more socially deprived group and the hazards was twice the blacks would die more than twice asians would die to end 2.3 times higher than the caucasians and a lower odds than white for the death was uh for southeast south asians was only 0.7 now this is something surprising you know why when people talk about indian debts being under-reported i think we'll have to quote this paper it's not just maybe there is under-reporting i'm not for or against it but we always had lower mortality even from the uk paper which tells us the asian south asians had 0.78 odds compared to caucasians so so this again goes on to tell us that genetically there might be a susceptible reasons that ethnic differences may exist for mortality for the same variant of the virus that may exist you said that it's a it's based on a massive data series uh india's population is uh higher than most other countries and um we've what's your advice to anybody who's trying to take up a study how do you get the data so is it that institutes are not willing to give data what's the issue here everywhere everywhere i mean see in the initial phase institutes there was no nobody to actually capture data where were the people too willing to take rounds in the private hospital i mean the people were literally forced to be assigned duties as to who's doing what duty and once that happened the volumes were so huge that the data captured and tribal was not adequate and once that was there the basic tenet of analyzing data drafting a paper and submitting it is not incentivized what's the advantage of the same is what the common question is asked in teaching institute they say a promotion button i mean we are linking and and that also doesn't actually translate into so papers are written for promotion so i mean the fortunate guy that i have a team which looks after all the things including work and drafting but i think if you have the ability in look at it in west in west everything goes after paper i have i have a group of my colleagues on twitter and they all they do in that group is tweet about their new paper i mean they're never tweeting what straws they took or what they ate or what they were wearing i mean it's it's it's a it's a badge of honor that you fear i think we'll have to cultivate that ethics amongst the fear itself the other cardiologist appreciating a cardiologist when he writes a paper and secondly it being incentivized not only in departments not only in positions not only in terms of respect but also in terms of finances because in india research papers are not financed when you look at west every research is financed by a grant that comes we have we have icmr which does the same kind of funding but how many of the institutes actually apply to icmr for funding for a investigator initiated project for that matter and look at even industry support there are industry support that you can get for an investigative initiated project but there are certain points which are uh asking people to you know wonder if this is actually uh there are there are racial biases involved into it that a caucasian initiated investigator initiated project would go through but probably if the project is coming from india investigator initiate project may not get through so there are issues and i think uh uh the aptitude and the drive that to have the papers being written incentivized in all terms with terms of respect finances is important once that jumps in that that peeps in only then the paper publication right now when i write papers you know the guys who write with me are the interns who are willing to go to us these are the guys because they know after us emily the matching they will be required how many papers you have so most of the that's the situation my residents or my co-faculties i have to coerce them to write papers with me then the guy who's us-bound who's just finishing his step one or step two he will come to my office sir i want to write paper with you sir please give me something so that i can write that's how the culture has to come unless uh that comes in i don't think the things are going to change and we'll always be having faculties writing two papers for promotion otherwise and that too in some ghostly journals where they are not much you know valued or interacted upon or cited upon which has got no point uh in that subsetting so we'll go to we'll go to public patterns then the fourth paper which i like this is not actually a paper this is from nature nature is as you know one of the most reputed group of journals its most sighted and most highest impactful group and i thought i should be doing justice in all terms not only i chose various subgroups from where i chose paper but i also choose did try to do justice to good group of journals so one was uh the paper that came from the biggest trial called recovery then i talked about landsat and i think i'll not be doing justice if i did not talk about something from nature now this is not a paper this is a review article actually and they looked at the what we were saying in fodemics you know torrent of covet science changed research publication in seven charts then they have come up with a metrics metrics of growth where the kind of papers that have come in and you can see as the time has gone by from jan 20 to now the proportion of paper with coin 19 had surged in the first wave and probably it's coming back for the second as well and the number of papers for the other non-covet were low so there is infertilemix as you mentioned most importantly where do we stand this is what you raised look at the color line in india india the publication in april may june july it's remained static compare this with the countries like china they have jumped and you know used this as an opportunity even though they had very few paper to start with but as the numbers went down the papers were not getting accepted soon look at the us look at europe they have started picking up for the loss of the chinese not us so when you were comparing it in terms of modality if you're looking at it as terms of commodity publication is a commodity i think us and the europeans are encashing on to the chinese laws indians are still to make up for that commodity gap that exists we should have done it more often we should have published more especially when we have the second largest population in the sub's third is mortality we should be publishing the maximum instead of uh the westerner guys who teach us what to use and what not to use so that's the paper number three and there were seven slides on to that but i skipped on to them because i thought that would make my presentation too crowdy but somebody can go into and search into the paper patterns on nature group and they'll find out and then i had to do justice to myself rather than quote everybody's paper this is my paper uh which we published we call it decryption study and this is done at a time when it see you remember the first wave people were not getting articles here and they were all bush beating around and getting their hrcts done and the physician would also say ct carrillo patient will also come and say bhara city karaoke and they will not get an rt pcr done in the initial phase a lot of you had would have realized that and seen that in that phase we realized that we should be looking at ct not being reported as coveted not only that but does ct help and this is the study which i did with one of the imaging center amit gupta was the co-author with this uh i was the other first author to it we looked at hrct especially mild and asymptomatic this was that phase when the patients were getting a lot of ct done when they were even asymptomatic or mildly symptomatic especially if they had a coveted contact in family or they were doctors themselves who were treating covet patients and we found out even in that subgroup that almost 50 of the patients even when they were mildly symptomatic had hrcp changes of covet and not only that they had ct score more than 17 which was called severe in almost 3.22 so even some of them were harboring covet pneumonia to the extent three point two percent were higher burning covered pneumonia so we had proposed this paper as a as that when there is non-availability of rt pcr kits you could have used this as a screening modality to be confirmed with rtpcr or the till the test is awaited this was published in first wave again we sent it to an international journal the international author fine sends it to two reviewers they both mention fantastic and then the editor-in-chief realizes oh this is a caucasian non-caucasian paper the paper is returned for a third review and then the third reviewer sends us across a long list of redo to do and in the meanwhile the we realize that by the time this paper is going to get published uh the ct will lose its value so we were in rush to publish it so that it can be impactful for the day-to-day usage into our practice and that's why we then went ahead and published it in an indian journal in general of radiology the indian generals the society journal that we have so uh this is the decryption study as we call there were more papers to talk about so i've touched upon five papers one the mother of all trial two uh online learning how life has changed use of ct as the one paper that i talked about in four damage on publication is fourth and one of the largest series which is a predictor of mortality to know who are high risk and what level is science has to be dealing with in our day-to-day life and how they can be impactful that's how i had chosen these five topics rohan over to you yeah thank you very much sir so a fantastic uh diverse collection of papers and before you mentioned the diversity of source which hadn't occurred to me but also the diversity of topic so recovery is automatic recovery is you know selects itself into any top 5 top 10 list but the online medical education or the a paper on papers itself was interesting and then of course the hrc people by you so so very interesting collection the question i had was um so publishing uh probably goes to uh so if anybody wants to publish a paper it probably goes through four pages and please correct me or add to it but the first stage is uh figuring out what to write uh or what problem to study second is the data collection and the statistics part uh third is the writing part um and and or the manuscript and the fourth is the uh getting it published now um each of these uh seems like uh uh a massive uphill battle especially the second and third one uh a very few people reach the fourth stage so so you know that doesn't seem like a big problem but uh at least the whole data collection and statistical analysis uh seems very alien to us as doctors and obviously we've started studied a bit of biostatistics a bit of t-test anova uh chi square etc but uh good papers which get published obviously uh are based on sound statistical uh uh grounding so uh i want you to spend a couple of minutes on each of these four stages and uh just just make it easy for us uh if if people here want to publish then tell us how these four challenges can be tackled so i think it's a very valid breaking up of the whole writing of papers because otherwise the the way it is understood is more than five four stages but i think when you've made it more practical and those are the four stages the first is to know the topic so first is that how is your paper different if you're going to talk about incidents of diabetes in patients of covet 19 there'll be so much already written and published there is nothing new unless you are doing something unique or different or evaluating a science which does not have much of the evidence that paper is not going to go through so don't choose a topic either you are contradicting it say you say no diabetics don't get covered then it is fine otherwise if your diabetes are more likely to get perceived there is nothing new that you are coming up with because already people like i mentioned in my paper uh in decryption study my worry was that if next for three months this guy is going to keep me hanging for not getting it published in that international journal my paper will have no value because by then the ct would itself become so rampant and sweet which happened in second wave then i if i would have sent this paper and second wave my paper was going to be of no value i mean who's going to publish value of ct scan in mild or asymptomatic people are you how unethical that you're getting a ct done for an asymptomatic in a second wave but that was a time when there was a noise yeah not only data yeah and no rdpc are available and people were going and getting a ct done just because they have taken a covet duty for 15 days they would the doctors would go and get a ct done so at that time it was so important so timing is important like like beta blockers in heart failure i mean if you were writing beta blocker in heart failure say uh in madhya by his time doctor madhuri's that time people would say yeah you're making heart failure worse when you give each a blocker till somebody thought that beta blocker would work alter the myocardial energetics and improve heart failure and then came this data that beta failure beta blockers actually improve heart failure so unless you can tweak the thing unless you can change the dial the way the science is practiced unless you have something which is path breaking different abnormal anomalous to what exists in literature that topic is not going to that's number one number two you mentioned is data collection now for that you must understand that whatever data you're collecting will require patient consent whether you're doing prospective retrospective or you're doing uh just blinded data it will require at least the ethics committee to get the approval for you so make sure that when you start dating collection ethically you are approved or availed or ethical committee's consideration of the cons of the hospital from where you're taking the uh publication that it is approved by ethics committee so data collection should include like the way you take history starting from name age gender education socio-economic background like we present in case in mbbs what we are trained so all those points are nothing but the same columns are to be created and then you add it on top of it investigations lab and outcome and prognosis so that's it the data what you need to collect is the data that you see in your clinical examination so that's that's number two of what you collect you do it when you have data you can analyze if you don't have data you can't analyze so if you may have it's better to capture 20 more things rather than you know 10 less things because more you can discard later on but less you include and you will have to choose points which are relevant for the topic that you've chosen so when you chose the topic uh say diabetics in uh covet and you've not done fasting ppbs in a1c then that purpose is lost so once you've defined the title you'll have to choose those markers reflected duration of diabetes how long the diabetes what medicine is taking for diabetes so that parameter has to be included in your data capture so that's the collection of data that's what the data capture would mean third is drafting the paper drafting a paper is light so that's what i'm coming to so dropping a paper would require a statistical like analysis so for statistical analysis chi-square is good one but there are a lot of online software available and i'm sure if you're comfortable doing online education and online stuff you can always choose them one of them that very commonly i commonly use is called spss free versions are available and there are now the current and updated versions which are paid available but free versions are equally good enough like version 28 is also available now but they say but anything like 21 22 is freeware which can you can be used for doing statistical analysis is like filling the data sheet into the zero one modeling where it's null kind of it's present or absent or diabetes absent you write 0 diabetes present you write 1 put the excel sheet important to the spss and spss will calculate and give you all the statistical parameters that are required but you should know what you're looking at for example if you're doing a prevalent study then you'll have to look how many diabetics in out of number of what patients so that will give you the prevalence and then you'll have to look at the other parameters what are its associations what are this mortality mortality outcome compare between the two groups compare between the various groups multivariate analysis univariate analysis so those kind of special special statistical analysis will require a statistician's help which you can take when your team you will have to guide them as to what you are trying to compare between what two terms they can do they will not understand that the fasting and ppbs will go along with blood pressure to be analyzed or not so you will have to tell them they will just do the numbers they know of the numbers they don't know the clinical significance of them so you have to tell them the what number is to be correlated to what once you have told them the statistician will be able to do it once that is done then you will have to search literature for the similar kind of papers that they've been published people want to write paper from day one but they have not read even a single paper before writing a paper paper on that topic that is not how it will work you'll have to first read couple of papers that have been written on that topic how they've been written what are their outcomes what are their how are you different from that how is your outcome different from the outcomes that have already been known like they are saying 10 mortality appears in 30 mortality so that difference also has to be captured and then in discussion that will have to be mentioned also like in previous study done by so and so this was the mortality in our indian and our subset this is the mortality so that uniqueness will only come once you've read a paper so drafting a paper would again require you to read the paper first again different journals want it to be written in different fashion and different methods in different designs and you'll have to subscribe to that pattern of writing only because the certain journals don't allow you to mention say exclusion inclusion criteria separately but has to be part of methods then you can't create a new heading of inclusion exclusion criteria it will go inside the method section only so that you will have to read under what sections and how they want the paper to be drafted so mostly universally most of the papers are drafted now in a universal standard format which includes uh you're defining the aims and objectives the methods the results and the conclusion that's how the abstract is written so once you've done your data you write an abstract and once you're done with an abstract you actually end up highlighting and expanding the whole idea this is how i do you can actually drop the whole thing and create an abstract which is what people usually do but because i have to work with a lot of guys who are novices or new into writing so first i have to give them from the data analysis what is what we have concluded and this is the abstract in 100 words now try to expand the same including the discussion and then revert back to me and then i again work upon it add the references references have to be updated once don't talk about a paper published in 1800 for something that you are studying right now you'll have to quote references which are published for recently and say 5-10 years back a maximum ideally speaking in 2020 or 2021. so unless that is done the discussion part will not be relevant so for relevance the referencing will have to come for the current setup for the current papers once that is done the correspondence again the paper goes through multiple levels of screening first your paper is submitted the editor will look into the paper if he feels that the paper is good enough for example you've written a paper of diabetes in comment let's stick to that example and you end up submitting in a heart failure general do you think it will go through no you'll have to find out a journal which looks into either diabetes or it looks into kovid if you are choosing an inappropriate journal that paper is not going to go through so you have to identify with journal you have to submit that paper once you've identified the journal and you submit into that journal the editor will see that paper and if that paper is suitable for that journal you'll send it to a peer review and then the reviewers will see it to it and then once the reviewers have find the feel that that's worth it and there are certain changes that are required they will send across you with their comments then you need to reply to that comments make the necessary changes in your draft and then submit the final version which may then be accepted or not accepted and once that is rejected you'll have to again make necessary changes using the comments and submit it to some other journal which again falls into the same process so most of the journals have a strike rate ranging from 10 to 30 so it's very likely that after three submissions you'll get one through if you are lucky good enough otherwise you'll have to be patient and keep writing because for 100 papers to write i've written 500 manuscripts then my hundreds have come that's how my 200s have come so you'll have to be patient corresponding writing submitting revising redrafting reframing and taking the corrections as their inputs like i remember one paper which is now today i've got acceptance for it's called channel study which we looked at ckd patients and coronary artery disease and that paper was published now accepted in indian heart journal our reputed journal from the highest reputed journal in cardiology in india is indian arjun which is a cardiology society channel so indian art journal is accepted but i remember when i submitted it the first time what i was talking about and what my conclusion right now is is so different because what i started off is something that the reviewers did not find to be palatable they said when i said that the ckd event rate was slightly higher in one subgroup and the other sub as compared to ckd5 versus c3 they said no no because the ckd is a heterogeneous group you don't categorize and compare secret stage three versus sticky sequence h4 and stage five so then i had to present overall outcome of the secret subgroup as a group per se rather than between secret 364 and 65. so then your perspective of writing changes and then once i corrected it it got accepted it took me six months with continuous correspondence that this paper got through so you'll have to have patience you'll have to draft accordingly and that's how the paper goes through amazing sir so uh just summarizing some of the takeaways i took from what you said so first uh choosing the problem is important uh don't choose something too obvious uh very unlikely to get published at the same time you can't choose something too niche uh uh but but yeah so so uh but but definitely not choosing something uh too obvious on on analysis and data collection i think the takeaway is that um take help from somebody who knows stats uh include them in the team from your department friend colleague etc taking help is a great idea on publication i think what you try to convey is that write a lot with writing you get better so your initial papers may not be papers you would be five years later be very proud of but uh they are important they are important stepping stones somebody who is known to you know has been publishing few papers he will be able to get tell you with his experience he will become co-author he may become not a co-author that's a different story but when you take help like what this is what the final students who are now planning to go to us do i mean they've realized that kamal sir helps them out very interesting insight from the last part of your answer was that listen to the reviewers they are not your enemies it may hate to feel rejected uh and uh keep getting pushed back but i think the way you uh pivoted your thought process uh and you accepted their feedback uh and eventually you ended up getting published uh on something which is very different from where you started i think that's very interesting um i think we'll uh we will come to a wrap sir uh it's been a while just one question i want to end with it's it's a very difficult question to answer and i understand you can't generalize but how long does it take to publish a paper how many hours of work goes into a good paper so i think again that improves as you become more mature because i remember writing my first paper took me a month to write now i finish a paper while on drive you know when i'm being driven from my clinic to my home i'm through a draft which is pre-prepared by student and i'm done in 45 minutes correcting it editing it on my cell phone i have my word file installed into my mobile and that's where i work on it so i think with time it you you learn to how to do it because then you are in knack of it you know how to the fixed language the fixed format this is how it has to go this is what is accepted this is a standard universal methodology of writing a paper once you learn it then it becomes very easy so on an average i would say it would take a month for you but once you collect it with draft i think one two days of revision and then submission that's it and then it doesn't take much excellent very inspiring uh i mean if if we could get to that stage it would be fabulous thank you so much sir uh for for finding time uh you you had a hectic weekend and you made it work so really appreciate loved the conversation learned a lot

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dr. Kamal Sharma

Dr. Kamal Sharma

Chief of Interventional Cardiology, SAL Hospital | Author | Researcher | Innovator

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dr. Kamal Sharma

Dr. Kamal Sharma

Chief of Interventional Cardiology, SAL Hospi...

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