Post Covid Cardiac Complications & Arrhythmias

Yes sir.

All right. Good evening everyone in India and good morning to those people in America. As you all know that we have been doing these zoom meetings now almost for two and a half months on various topics related to Covid post Covid stress related topics and many others. And today I want to proudly welcome Dr. Som Sekhar, Cardiologist and I think the only electrophysiologist in Andhra Pradesh. That is what I heard.

No, no, not now.

One of the very few. One of the very few electrophysiologists in Andhra Pradesh. So sir, thanks so much for joining us today. Second wave low. We found people dying because they are in ICU and they have respiratory failure and many other complications. Now if we do Covid second wave Tagindi but cardio complications. Post Covid syndrome. Long Covid. Symptoms identify Chadanjarindi than a long Covid anthem. Symptoms. Common headaches, Severe weight loss, Mental illness, depression, anxiety, Ghani nervousness, brain fogginess. Important component problems. So post Covid cardiac complications. Cardiologist, electrophysiologist, Dr. Som Sekar. Let us welcome him.

Good evening. Thanks Mr. Kiran Nageshwagaru and all. Please giving me this opportunity to just participate in this meeting and share our views. To be frank. Cardiology practice. Most of the time lungs involve chastity. Oxygen problem low part 2 patient key. Oxygen saturation 92 93, 94 stage oxygen 93 94. One or two weeks. Hospital daily daily to say 3020 to 30 opio may notice. Various problems Heart involvement in hospital Hospital patient warm Royal. Heart attack. COVID pandemic start in kotlo WhatsApp. Social media. Recording signature. Once the patient. Oxygen 80 75. Including Gundagoda oxygen Childhood first point infection lungs involvement. Heart attack. Inflammation body generate chemical molecules, cytokines even heart muscle good effect Heart pumping dramatic. Simple government layman language Suppose brain key current chart circuit type. So. Active infection. One percent mainly immediately after initial lockdown of India Lung involvement cardiac referral center. Once,second wave, second wave. Almost daily 4 to 5 patients 24 to 5 patients are 20 to 30. It is a big number. We made a protocol from now onwards main treaties and COVID patient police treatures and patient for 2 weeks routine follow up ECG Eco. Regularity. Including hospital employees, colleagues employees Main complaints are palpations palpations Tuesday 120 sinus states inappropriate sinus tachycardia Autonomic nervous system, Sympathetic system, parasympathetic system so autonomic disturbance. Symptomatically Fetlife1. Most important so post Covid low Notice while stentless in patients more blood clot in tendency so simultaneous rhythm disorders so most commonly sinus tachycardia Autonomic distance. Almost to follow up patients within one month normal autonomic distance Physical deconditioning Oxygen okay Nutrition because of long stay nicely and upon the psychological depression they could not make things so all these things lead to physical and emotional deconditioning A deconditioning. And. Almost 15 to 20 days low 50% of the patient normally I have at least 20% or 20 to 30% of patients one or two months symptomatic relief. When Mrs. Can Jason Center Chester they noticed that late Gadonian enhancement and MRI stand low 50% of people virus are inflammation. So Kani definitely heart lungs. Routine irregular beating May notice. Almost normal probably mri involvement. So most of the time. Irregular ectopic center ectopics more than 15 to 20% Austin and Conroein beats the Police Day irregular beats 15 to 20% almost pumping down so the unconsense Sorry MRI scan is normal. Okay Treat chest Any patient better order and ablation. So significant amount involvement. Definitely body checkup change quote important. Whatsoever changes but what I noticed there's significant derangement in the lipid levels so fasting lipid profile in fact, prolonged uses of steroids only Whether it is prolonged usage of steroids or direct involvement of COVID virus of adult gander is Ghani she had adrenal insufficiency and she presented severe esthenia weakness. They found that it is probably Edison's disease and adenal biopsy virus involved by in the only information or it is a prolonged cortisol induced suppression of hyper pituitary Overall. VP down on esthenia and a severe weakness palpitations Severe weakness and it is a lack of condition of the bodyguard palpations manifestation. Post op follow up significant elevated blood pressure.

Hello?

I think Dr.

Most of the time.

Yeah, yeah, yeah, yeah, yeah.

I got a call from outside. Okay. All right. Most of the times steroids almost asteroids. Maintain. We all know hydro steroids can cause increase in blood pressures so there is a single patient who presented with heart failure. Hypertension Blood pressure. It is probably secondary due to hyper cortisolism Iatrogenic hypercard. The antagonist. Sorry. So significant impact on heart. But 90% though there are problems involved and there though they are There are damages of heart in the form of heart attack. Over to blood pressure over to hypercots Evaluate this recognize Jesse treat medications but maybe less than 10% maybe requiring some intervention. Less than 10% yeah, but what is important?

Yeah, if you. Dr. Swamshekar Dr. Swamshekar Garch. 2 weeks Logani 3 weeks Logani Okasari Cardiologist General physician Symptoms. Palpitations. 90% of the time it is benign. It is nothing to really worry about. But there is a small risk also this could tell the doctor that maybe there is something serious also going on. Or two weeks. Okay. Lighting. Other testings Doctor can decide. So think about it. After Covid. Cardiac complications after even during and after. Palpitations already Martial rendu heart failure, Congestive heart failure, heart attacks. So These are the three primary cardiac complications. February Local Research published cardiac MRIs.

Last.

Year cardiac patients underneath COVID patients underneath Chachpaina Valani Autopsy chase involve in the. Wakakarno ace2 receptors. Lagani ACE2 receptors yakaraitemana Coronavirus Willie A spike protein thank attach Otundo ACE2 receptor and the lunglow Ekonodam lungs Bhaga effect heart logoda ES2 receptors. Marwan Kundanai myocarditis inflammation heart low inflammation cardiac MRIs lagani autopsy lagani apoptosis center. A cardiac function. Irritation on the matter. That is what most likely leads to the arrhythmias Heart rate, examination problems, Cytokines Tom Lo inflammatory material cytokines. Patient Iclav inflammatory cytokine septic shock Myocardial depression Heart function.

So.

Heart problem it starts manifesting. Maybe after a week or two weeks. Then they suddenly start getting these symptoms again because they are not anymore in icu. Maybe our time Lord recognize Covid may the too much focus. So there are multiple things that can lead to cardiac problems After Covid. Especially hospital ICU especially two to three weeks time. That is the most important thing. Okay, so that is in general the summary of what we have discussed so far.

So. Organs basic heart to hemoglobin, Ecg. Patient symptoms abnormal findings. Further higher investigations. Lipid profile. Okay, so. Fasting Li profile And if patient already heart patient recover only even a body electrolyte center sodium potash so so ECG echo cholesterol, electrolytes Uriac reactors but important symptoms. But. Even we have noticed without drugs. So heart slow. So Elanti abnormal findings. The halter test center holder and our external loop recorder. Irregular beating. Response to therapy symptomatic treatment to or is in a complications bite Banyan further evaluation responsibility Further test physician Ghani treating cardiac better.

Excellent, Excellent. So. Heart failure, weakness, the myocarditis, inflammation, fluid.

Overload.

Dysautonomia spectrum autonomic system. Heart attacks.

Virus are the AC receptors at like the lung. Slow heart muscle onto any blood capillaries. So corona cells activate Automol I could cytokines, cholesterol, plaques, even a deposit immediate thrombosis. So most of the time. As a patient, icu patient. So though we gave immediately blood clot license. All patients who are admitted. Capillaries of pulmonary circulation itself clot I thromboembolism. Most of the times. Example. Patient, colleague, doctor, relative.

So.

Okay. In fact brainstem stroke. Brainstem killer blood supply clotting. So this is one thing we have to understand in the clotting case. Example patient key one week mild fever in a 40 year male. Tachycardia and a heart. Emergency cardiac profile and chase down water. Mild blood clot impedance. So. Almost half of the supply. So. A slight change in our physical condition. So mild pulmonary thromboembolism. So blood clotting tendency. Blood clotting tendency critical. Any slight suspicion. 51 years male, left mid cerebral artery occlusion. So he had only sensory symptoms within window period of general trauma. That is a different issue. Yeah, yeah, yeah.

Important point. Very, very important. Let us say. Okay, one week, two week, three weeks symptoms. Okay. Then again symptoms start. That is one of the best ways that you can recognize. That is always the best way to recognize. Whether it is simple sensation loss. Ghani. Never ignore it. Immediate within three hours. Treat Chase Nizanga stroke thrombolysis and Jastamu chest reverse change stroke knee. Okay, so symptoms which in a Ventane you need to notice renduous. So then also you had to think. Important. Lungs low clot form not uncommon. Not uncommon. Especially severe symptoms when the hospital.

So.

Hospital.

Important.

That is the single most important thing. Yes, sir. That is a very good point.

Yeah.

Important points. Multi system inflammatory syndrome adults law.

I don't have personal experience, but when more than two systems involved, we have to suspect conditional faces. She is a doctor. Gastrointestinal symptoms are lung symptoms. Inflammation. Inflammation. Key consequence. More than two organs involved. Occupation. She had Covid recovered subsequent. She had significant mucosal involvement. She told only one word. Absolute severe diarrhea. Yeah, yeah. And severe shortness of breath. But ct, ctpa, both are normal.

Yeah.

Lung positive. Diarrhea, fever, mucosal involvement. She had skin DASH also. So E condition low. This happened two months after the first COVID infection. Antigen positive. Almost a week she started to have this manifestation. Maybe I. I don't know at that point of time whether she had mild abdominal pain, Lung flow, heart flow, brain splankenic. Circulation, Gut circulation or thrombosis format children low. I have seen a child presenting with bubble gangrene and almost one and a half feet of bubble was removed. So weird symptoms. Definitely multi system involvement. Our patient reaches because it is inflammation only steroids. Second day of steroids. Her shortness of death dramatically improved, right? Until her CRP was high. Diameter is also quite high. So because of that high DDMR and negative ctpa we suspected splankenic circulation. Probably somewhere thrombosis is going on under the diarrhea and mild vague abdominal symptom. May be due to that thing Only under diarrhea and anticoagulation therapeutic. Hm. Even she improved subsequently over a week time and completely cured. And in particular condition we always say thrombo inflammation term rather than a plain inflammation. The thrombo inflammation day because it involves the endothelial cells involve and a pulmonary artist involve one lead arterial capillary level, microvasculature level involvement and that order arterials, bronchi, bronchial arteries, CTP and normal Only patient ventilation, perfusion dispatch. So more than one system involvement routine. Strongest aspect in that matter though children and mono occupation to COVID negative again. 29 year old had bilateral renal artery thrombosis with infra renal aortic occlusion with no this thing antibodies positive. But he received what is called vaccine. We don't know.

Yeah.

What is what.

Yeah, yeah.

In such scenarios we have to suspect and be proactive. That's what I personally feel.

Yeah, yeah. Especially positive symptoms. Three to four weeks. That is when a multi system inflammatory syndrome adults children three to four weeks. Then you start getting certain symptoms. Skin dry Shaggati after salt. Diarrhea, heart rate palpitations, difficulty breathing. Positive on the okay, three four weeks symptoms. You have to see a doctor. Actually as a doctor he passed away. He got a mild COVID positive and then suddenly he collapsed after three to four weeks. I believe it is because of the mess Multi organ inflammatory syndrome.

But she is this madam. She's a professor of mine. She is an endocrinologist. Because I told probably I'm suspecting this madam. Why don't we start along with therapy some small dose of steroid. We start only 32 milligrams a method twice. Day two she had relief. Day three she was absolutely fine.

Yeah.

And we gradually tapered over a week time she is back to normal. So yeah, we have to keep open.

Definitely. Never before there was a disease like Covid where the spectrum is so wide wide range of symptoms from Everything essentially from everything. Everything.

It make us revise our physiology to biochemistry, to genetics, to microbiology.

That's true. Absolutely true. Right now there is so much fear about children. What is going to happen to them. Attach ie up to cell slow country Replicate ie Then it causes problem. Gabati initial phase learning. ES2 receptors. Delta variant. Delta plus variant. So it increases the risk in children also to some extent. But not to the extent that you should completely get paralyzed with fear and worry too much. However, you need to take precaution precautions. Definitely a tease. Kovali masks Petco. So precautions important every single person. Symptoms but the problems. Rare occasions low A multi organ inflammatory syndrome. So it could be one in one million. But why do you want to take risk? Right? Why do you want to take risk? Even one one that one child also. So you got to be extremely careful. That is what all I want to tell everyone. Questions can we take? We have another 10 minutes or so. We'll take some questions. Srikanth, it seems you have a question. You want to speak up?

Yes sir. Yes, sir. So my brother.

Do you hear me?

Yeah, we can hear you.

So my brother got Covid and after cured. So he feels very sick. And after every bath he feels sorry. So immunizations?

Yeah.

Sure. So Srikanth.

Yeah, probably 15 days back and he got cured. Not 15 days. One month. Close to one month. And he got cured 15 days back.

Yeah, one month back. So. Post Covid symptoms. But was he hospitalized at the time?

No, it's a home treatment. And he got. I mean lung infection, hospital checkups. But he cured from home itself.

They treated him steroids?

No, no, not at all. I guess.

Okay, oxygen levels.

But.

Bit of oxygen level. But everything went well and he got cured.

So I.

He got like a negative result and everything. But after 15 days like he feels very sick. Very, very, very sick. Means he's able to do everything but very. He's not active like earlier.

Did you see the doctor again?

No, I didn't ask him. They stay in India. So I think they are visiting. I guess if I'm not wrong. But. But the one major difference which I found is after bath he feels very shivery. Till last week.

Yeah. So two things. Shortness of breath. Steroids. Wilder than Jepta Naru. So usually these people. I mean some people they just get better. Even if you use steroids or don't use steroids. They just get better. Kabuthe me brother Vishyan lo symptoms you could differentiate is symptoms progression.

I feel it is progressive. But first one week after curing, I think till next next 10 days. He got feel shivery now. But he feels very sick. That is the only difference.

That's the point. Usually first one week, 10 days slow symptoms test change doctor involvement in the light. After the first week especially end of second week symptoms moderate to severe disease. So early maybe. So I think you need to take him to the doctor. Get him checked and. The doctor will decide. Inflammatory markers. I think it will give an idea.

Sir, One moment. Sir. I don't know where it is coming from.

Yeah, Someone is making iPhone.

Yeah.

Hello?

Yeah, sorry, who is that? Can we please. Yeah.

Yes.

So.

Progression of the disease Rendu. Maybe the Kovit is getting better, but something else is happening. Okay. The diagnosis, treatment. You definitely have to take him to the Dr. Opinion, sir.

Yeah. Antigen test repeat second week low damage. Organs damage. So virus negative damage. Most important home isolation manage this one most important. Pulse oxygen temperature. 92. 95. Saturation 97.95°. Saturation. Dropout reserve 30, 40% reserve onto the body. Low saturation 95. Question 90. So you progressive the pulse rate? 5 minutes or 6 minutes walk test at least 3 minutes. Two weeks. Three weeks, four weeks that three weeks. So. Inflammatory markers. Definitely. He needs the evaluation.

Many people are entering. Yeah.

Take them out.

Yeah, I'm trying to take them out.

Can you block them?

Yeah.

Yeah.

Yeah.

Virus. Actually ours is open linked. Right.

So can you. Can you lock it? If you don't mind.

Sure. Sorry for that.

And definitely sir. Thank you. And I have one more question. I live in Singapore. Even myself and my wife got six months pregnant. She both. Both got first dose of Pfizer vaccine. And can you tell me what is the drawbacks of MRNA vaccine? See, myself is okay. I'm more worried of my wife. Like I saw some negative in MRNA vaccines. I feel inactivated vaccines are much better than MRNA for pregnant women. Can you tell me what is the drawbacks? I'm okay to see myself. I'm interested to get vaccine I got and my wife got. But I just more worried of what is the problems of MRNA vaccines in the future.

Actually, MRNA vaccine is a newer technology the way that they have done it. And so far all the studies that have shown showed minimal side effects. Okay. And the risk for any kind of adverse reaction is rare.

Not adverse reactions. The. I mean genetically will it cause any problems for the baby? Like. Because that is the only concern. I really intentionally did the vaccine. But I later I realized I couldn't have done for for my wife. Because here is very safe in Singapore better than any other country, I would say. But however, I got vaccinated for my wife. That's the only concern. So did I proactively did or like did I mistake or. That's the only concern because some documents. I used to read the documents very lot. So I saw some genetically. Genetically it makes some difference in the long run right now. But because Denmark has proved initially the vaccine was prevented to prevent it for what is this? Pregnant women. But Denmark proves that it doesn't make any harm. But they say they also don't know what is the future cause because they don't have sufficient data.

Yeah, simple. There is no clear basis to think that way that is going to somehow genetically modify the infants or the baby's genes.

Now.

There is no data because pregnant women with ISKNI is study chelledu number one. So no one will be able to tell answer this question scientifically until after 10 years later or maybe five years later. So in any kind of situation we have to always see what is the risk and benefit in doing something. We had to use our common sense so far based on all the information that we have. Nothing like that is proven or it is found to have any major problem by the scientific community. So when you put all those things together, to me, taking a vaccine while someone is pregnant is very prudent because the benefits far outweigh the risk. Pregnant women research shows that they have a higher risk to progress to severe disease and also death mortality. So from that point of view, having a vaccine taken by a pregnant woman is important.

Yeah, yeah, agree sir. But the thing is here is much safer in Singapore. I as you know like Singapore is much, much better in terms of the safety and we never go out hardly. We went three months back when everything is good. But I feel. I felt this I would have. I would have done mistakenly for my wife because here is very.

I would.

I would have done it for once she got delivered.

Yeah, that's the only worry.

That is the only worry which I have.

Can I interrupt for a minute?

Definitely, definitely.

Yeah. I have to go through thoroughly but mother chance 0% periodically. Or at low incorporate spike protein. Antibodies produce unless human genome or DNA Loki amalgamate. Baby transmit MRNA can't transmit through the placenta to the chain. Preservatives. It is so Atlanti Johnson and Johnson worldwide the thrombotic tendency. I think you can comfortably forget about the complications for child theoretical understanding.

Yeah, makes sense. And also there is a. After they have done the vaccination pregnant people and then retrospectively when they actually look at it, they found the baby is also protected and there is some passage of the antibodies also. So I hope that that puts your worry to rest at least for the time being.

Yes, definitely. Thanks. Thank you guys.

You're Welcome. I think Mr. Anthony has a question. He has a raised hand.

Sir, this is Anthony, I'm calling from Hyderabad. Yeah, I have a typical case because we are also in treatment of COVID A doctor I does this on a social activity.

Okay.

This one case, what we have seen is a person who has already a comorbidity having cancer with alm. He has been diagnosed with COVID for three times in four months of times. Okay. First time he got treated at home, everything went on very good. Second time also he was treated at home. Still his antibodies what were developed and what we have seen were absolutely fine. Third time when he had this infection of COVID what we have observed is his CT value was much higher comparative to first and second time his CT value was 14, 14 out of 25. Then we have suspected something like Tom Brasses and all those things. His saturation level slowly was falling down. So then we got him admitted in the hospital and seen that everything went on good and he is now completely recovered. Now what we have seen in his case is frequent temperatures and he's got mouth ulcers and he's so weak as what happens in Covid as post Covid syndrome he's completely weak. And his food intake is also much less comparative to the early stages. And what we also now, now he has been treated with cancer phase one of all his chemos. Okay. Now presently they have stopped even the chemos because of this Covid issues. So how can we further treat him? Or how can we explain him what all precautions he has to be taken. And the very unfortunate thing is he is not vaccinated.

Yeah, yeah.

So yeah.

Okay, the first question. 3 times infection test positive. Covid has actually caused the infection infectious symptoms, especially cancer unaware you can have a prolonged shedding of the virus antigen Armata and so the antibody. So when you actually do the RT pcr you can actually have it positive for a prolonged period of time. Even in non cancer patients. Sometimes definitely in the cancer patients. So test positive Covid Maldi Maldi attack chasing the another nowadays. But every individual situation or symptoms in Bhatti are time low. Jerry in the batty. We had to make that decision here.

Sir, 1, 1 second sir, here we have seen that every time when we have treated him he was been again negative. So we have done the rtpcr it was found out to be negative first time. Second time we have done the RTPCR again.

It.

It has come out to be negative. When he had symptoms, when we tested him, because he was going to the hospital very frequently for chemos. Then somehow, sir, how was he treated earlier? In the first stage he was given a small dosage of steroids with Fabi flu.

Okay.

And even in the second time, also the same kind of treatment, small methyl prednisolone of 8mg and Fabri flu again we were worried to give him fabric flu for the second time. Okay, sorry, sorry. Second time it was very mild. We never. We had never given him a fabulous. Only small steroid and some antibiotics after that. Third time he was in the hospital, got treated with methylprednisolone. High doses and then high doses in the sense, not the regular dose. What we use at home. When you consider IV, you can understand 30 or 40.

Most probably no high dose. That is still methyl British.

Yes, still it is low.

Some people they got thousand milligrams. So there's a point so high dose. So it is the appropriate dose.

30 to 40.

Yes. Yeah. Understandingly it is appropriate doses.

Yeah.

A saturation levels went down to 80 slowly after four or five days it got good saturation levels and Rome air he was. When he got discharged, it was 92, 93.

In how many days he get discharged?

Six, seven days, sir.

Six, seven days.

Okay.

Seven days.

Lungs cities can just.

First time CT scan JSMO it was plain second time CT scan JSON it was plain third time when the CT scan was done, it was 14 by 25.

So. Ikara, this becomes a very complex situation. Just talking about things without actually seeing the reports evidence. Ghani Meghata Ani. What is his age?

He is 47, sir.

What kind of cancer?

Alm.

Okay.

Yeah, yeah. So, you know, I'll. I'll give some general pointers. Okay. Specificante and I choose. But the general pointers.

Yeah. When you come out, I can also understand because I am also going through all his test parameters. So I can tell whether those have been done or not.

Yeah. So one of the things to consider is Amlatti immunity. There is a chance that the virus was never controlled by the immune system. Then again, he is getting infected or the virus actually is still in there. It is never totally checked Anamata. So that's the reason it is Maliha Gadam Mali Replication Paragadam and then actually getting symptoms. That is my impression based on what you are saying. And the Only thing that I don't understand is third time symptoms. 80 to 85% the oxygen saturation. But actually it gotten better within a week. Usual Covid low 80 to 85% immune system problem within a week improvement.

Yes, it can happen.

Yes, it can still happen. And also the other point is because his immune system is weak, right. It is not fighting as strongly with the virus. And so cytokine storm, gani inflammation and then is getting treated with steroids, getting better and then again it is coming back. That is the impression that I got. I also want to ask Dr. Somshaker what he thinks.

Even I feel same because of low immunity. Probably is behaving as if a chronic carrier sort of thing. And late immune mounting might have damaged a little bit in the third. But I personally also feel same. What is. I agree with you.

Yeah. Yeah. So I think the answer really here is in my opinion again is the treating doctor who should make these decisions. But I'll give generalized guideline. I think taking the AML under control might actually help.

Okay.

That is going to boost his immune system and that is going to give him. Because I'm sure he already even though he has poor immune system. I'm sure because of these recurrent infections, his immune cells are primed, whether it's T cells or B cells to some extent. And now if you take away the aml, I mean it is not easy as what I'm saying. But actually if you treat the AML well then aml, acute myeloid leukemia, maybe it is going to give him a boost to his immune system. But that again you have to discuss with the doctor and see how to do that.

Yeah. So what can be the. Okay, what can be the precautions that has to be taken? Sir. Now because he is having frequent fever complaint and we have checked, we have checked all the parameters, the creatin levels.

Everything seems could be because of AML also.

Okay.

Because of COVID It could be because of aml.

It okay.

Another thing that you need to keep an eye on is when someone has bad immunity. Covid is not the only one that can cause infections.

We really have to have to praise God in this issue because three times diagnosing Covid and still is keeping good. We really have to feel thank God for him actually. And second thing is what we have observed is his platelets were very low because as you know, aml. It happens. Yeah. After the COVID treatment they are better. Now where the platelets come have come down to 50, 60,000 now is above the levels that is one changes what what we have seen. Okay. And second thing is his potassium levels fell down when the COVID treatment was going on. So we have suspected whether it might be the fevers, frequent fevers maybe because of the potassium levels. Steroids, steroids.

Steroids can have improved the potassium because they also have all those children like effect on the.

Okay.

Yeah.

So which was treated well. And we really have to appreciate the government doctors here in Andhra Pradesh. Okay. Though I am in Telangana I should really appreciate the doctors because he was cured in the government hospital sir. And the protocol that they have followed is absolutely fine.

Yeah. The main point here is because I want to see if there is anyone else has questions. The main point here is I think treating AML and getting it under control. I think if they can do that it's going to help his overall well being because AML estate can be problematic. But the hematologist oncologist who is on the case. I'm sure we'll be able to help you with that.

Okay, thank you so much sir.

Yeah, you're welcome. Any last questions? One more question and then we'll close this session. Any last questions?

Yeah.

Kirangaru sir myself Vamsi there. I am from Vijayawadasar. Ah yes sir I have one question actually morning I heard one news in news channel regarding in Assam one doctor got affected with multi. I mean variants in corona regarding alpha variant and a delta variant for her and. But she is looking. She looks good and her health everything is fine but can I know that this kind of variant is there any vaccine commonly is there any trials are available to get it to. To treat these kind of mixed kind of things for Covid.

Yeah. So alpha variant definitely MRNA vaccine Pfizer Ghani we already know that even for the delta variant UK has released a study in the results saying that it whether you use a mRNA vaccine like Pfizer leather AstraZenka Oxford variety there is a 9 89-90% protection from severe disease and hospitalization. Okay. Vaccine these quotamic protection was on the ultimate and you can render point vaccine infection prevention complete your Covid Rakunda prevention. So what they have clearly said Is Delta variant 2 doses of vaccine you will have 89 to 90% protection. NJP Alpha variant key you put on the delta variant alpha variants though Walker dose this Kundai Ghanaka around 60% protection. Rendezvous 90% protection. Delta variant you have around 35 to 40% protection. Rendu Dos kunde Ghanaka you have actually similar efficacy as in alpha variant almost 90% protection, energy. So the point is take vaccine and that is going to help you even it is a new variant.

Yeah, fine, sir.

Thank you, sir.

Yeah.

Okay sir, any tests which you recommend after post Covid, sir, sequence of tests which has to be done.

There is no need to just routinely do any tests. However, if there are symptoms that are persistent, they're not getting better or if there are new symptoms, then further testing is warranted. Dhaniki. Almost every single COVID patient, especially hospitalized Ie Onawadu. I think they should come back to get it checked. How things are going in two to three weeks after hospital discharge.

Okay.

Thank you, sir.

Oh yeah, okay. Actually we had a very Good session with Dr. Yeah.

Nice to participate in this.

Yeah. And we learned a lot of new things from him today about the cardiac complications after Covid. So any final words from you?

You concluded very nicely.

Yeah.

I think it's a good interact session. Helpful for everyone, I think.

Thank you. Thank you very much. And you all have a nice evening. Bye.

Thank you sir.

Thank you so much, sir.

Thanks to Srinija and Nagasar Rao.

Thank you sir.

Thank you very much.

Behind the scenes work and helping.

Thanks for the knowledgeful sessions. We are more than happy to organize.

Very, very knowledgeable sharing session.

Yeah. Okay sir. Bye then.

Yeah.

Thank you sir. Bye.

Bye. One single suggestion. It would be better to intimate whether by collecting the mail IDs or something so that we can have these kind of interactive sessions at least two times or three times in a month. Sir.

Thank you so much Anthony for reminding me. Actually yeah. We do have a WhatsApp group where we are asking everyone to join so that they will be intimated about these sessions prior. So I'll share the link now. I actually forgot because of the so many things happening. This was an open session. So our link being getting populated very very well. Could join. I put WhatsApp link share chestnut. Whoever is interested please join in that.

Yeah. Please ma', am.

Just give me one second.

Thank you.

Yeah.

Both the doctors. Thank you so much. I'll take the list and I'll leave.

Yeah, thank you. Thank you. Yeah, bye.

So most of the people are Telugu speaking people.

Yes, ma'.

Am.

Can I have the number, ma'?

Am?

WhatsApp number.

Yeah, I am just sharing you the link so that WhatsApp number the group.

Okay.

Okay.

Actually.

No, you can do one thing, madam. You can just put it as the WhatsApp details.

Yeah.

On the top itself. You can make it as a template.

Yeah.

See. Is everyone able to join? Just please continue. Anthony Garamira active governor. I'll be waiting for you.

I. I have already joined, ma'.

Am.

Great. Thank you so much. Yeah, I'll keep you informed. Anthony Garu There are a few more documents like few information that Dr. Kiran has made regarding Covid. There's a wonderful book he had written too. A simple handbook guide for all the like vaccines. Gurin Chabani Andi 7 keys. Ani Chappi made a book Kanmata which has all the.

I actually was impressed with the session that he had missed with Malik Parshuri.

Oh amazing. Amazing.

So that's how I started like interacting seeing his YouTube. Then I found out because you know madam Indian.