Learning case for #doctors
1. 76-year-old man;
8-month history of statis #dermatitis, weakness and painful dysesthesias in the hands and feet.
Sensory-motor type #polyneuropathy was evident in a stocking-and-glove distribution, confirmed by nerve conduction studies.
#MedTwitter
2. Extensive testing including brain magnetic resonance imaging, spinal magnetic resonance imaging, and cerebral spinal fluid examinations were nondiagnostic.
Subsequently, serum vitamin B6 (VB6) levels were found to be low at 3.5 ng/mL (normal values: 6.0-40.0 ng/mL for males).
3. Oral supplementation with 60 mg/d of pyridoxal phosphate hydrate (PPH) was initiated, and 1 week later, VB6 levels rose to 39.3 ng/mL, and drastic improvements of polyneuropathy and dermatitis were observed. Pain reduced to 3 from 8 (scale of 0-10) after one week and 0 at 5 wk
4. The patient was wheelchair-bound on admission but became able to walk unaided within 3 weeks after initiation of PPH. As for dermatitis, a clear regression of the brown-reddish pigmentations was observed (Figure). Ref:doi.org/10.1016/j.amjm…
5. Causes/risk factors for VB6 deficiency- Alcohol dependence, chronic kidney disease, dialysis/post renal transplant, obesity, inflammatory bowel disease, post-bariatric surgery, Anti-Tb drug isoniazid, levodopa treatment in Parkinson's disease; pregnancy, rheumatoid arthritis.
6. Sources of VB6: Water-soluble vitamin B6 is widely present in many foods, including meat, fish, nuts, beans, grains, fruits, and vegetables.
Additionally, B6 is present in many multivitamin preparations for adults and children and is added to foods as a supplement to foods.

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More from @hyderabaddoctor

Dec 10
How can one reduce the risk of knee #osteoarthritis?

1. Knee osteoarthritis (OA) causes knee pain. It limits mobility, hampers physical activity and contributes to sedentary lifestyle, which in turn, increases the risk of obesity, diabetes, hypertension, heart attack and stroke.
2. Who are at risk of developing knee OA?
*Non-modifiable risk factors:
Female gender and older age
*#obesity: Increases the risk of knee OA three-times. It also accelerates the progression of disease.
#MedTwitter #orthotwitter #orthopedics
3. Knee injury: Traumatic joint injury is a major risk factor for osteoarthritis, particularly at the #knee (i.e. meniscal damage, anterior cruciate ligament rupture, or direct articular cartilage injury). Ref: doi.org/10.1097%2FBOR.…
Read 12 tweets
Dec 9
T3 testing is not routinely needed in managing patients with primary #hypothyroidism

1. Primary hypothyroidism is a common hormonal disorder, which is treated with levo-thyroxine (T4) replacement.
#MedTwitter #endocrinology
2. In order to assess the adequacy of T4 dose, some clinicians routinely order #T3 along with #T4 and #TSH (thyroid stimulating hormone). Is routine T3 testing really needed in cases of primary hypothyroidism?
3. Clinician would be able to determine the adequacy or over-replacement of levo-thyroxine (T4) dose on the basis of T4 and TSH levels.
*In cases of over-replacement, T4 will be elevated and TSH suppressed.
*In cases of adequate dosing of T4, TSH and T4 levels would be normal.
Read 6 tweets
Dec 8
Longer daily #sedentary time increases the risk of #Knee, #Hip and #back #pain

1. 20-25% of people aged 50 or more suffer from orthopedic problems such as knee joint pain, hip joint pain, back pain and knee stiffness. Sedentary lifestyle is a major risk factor for them.
2. In a recent study, men with sedentary time of 7.5 hours or more/day had 45% higher risk of orthopedic problems as compared to those with daily sedentary time of <7.5 hours.
#MedTwitter #ortho
3. A pink-collar job, physical inactivity during leisure time, and passive (e.g. riding in a car or train) versus active (e.g. walking or riding a bicycle) transportation- were more commonly associated with orthopedic problems in people with daily sedentary time >7.5 hours.
Read 5 tweets
Dec 8
Lowering the weights (dumbbells) alone is as effective as lifting+ lowering them (with only half the effort)

1. In a recent research, the effects of lifting+ lowering weights were compared with either lowering or lifting weights alone on biceps.
Ref: doi.org/10.1007/s00421…
2. The training group participants performed dominant arm elbow flexor resistance training in extended elbow joint angles (0°–50°) twice a week for 5 weeks.
#fitness #StrengthTraining #Resistancetraining #dumbbell #bicepsflex
3. The total training volume (dumbbell weight × number of contractions) in Lifting-Lowering (5745 ± 1020kg) was double of that in lifting (2930 ± 859kg) and lowering (3035 ± 844kg), because 3 sets of 10 contractions were performed for both directions in lifting-lowering group.
Read 8 tweets
Dec 7
Do night shift duties pose any risks on health?

1. Large number of people are employed in jobs that require working at nights and sleeping in daytime.
Is it healthy? Are there any health hazards associated with this routine?
Let's look at some of the research on this topic.
2. Type 2 #diabetes :
Night shift work, especially rotating shift work including night shifts, is associated with higher type 2 diabetes odds.
Working on #night shifts for >8 nights/month increases the risk of diabetes by 36%. Ref: doi.org/10.2337/dc17-1…
#MedTwitter
3. Hypertension: In a recent study, night shift workers were found to have a higher #hypertension risk than day shift workers, which increased with increasing frequency of night shift work. Ref: doi.org/10.1016/j.mayo…
Read 13 tweets
Dec 7
#hearingaids reduce the risk of #Dementia in people with #hearingloss

1. Age-related hearing loss is the most common sensory deficit in the elderly and has been identified as the highest modifiable risk factor for dementia (Livingston et al., 2020).
#MedTwitter #NeuroTwitter
2. In a recent meta-analysis, the usage of hearing restorative devices (hearing aids or cochlear implants) by participants with hearing loss was associated with a 19% decrease in hazards of long-term cognitive decline.
Ref: jamanetwork.com/journals/jaman…
3. Furthermore, usage of these devices was significantly associated with a 3% improvement in cognitive test scores that assessed general #cognition in the short term.
To be beneficial, hearing aids should be worn for a minimum 4 hours per day.
Read 5 tweets

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