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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
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Dec 18 • 9 tweets • 4 min read
Elevated #Homocysteine levels increase the risk of #stroke

1. Homocysteine (Hcy) is a sulfur-containing amino acid produced by the demethylation of the essential amino acid methionine, and the normal level is 5-15 µmol/L. High Hcy levels can increase the risk of stroke.
2. Total Hcy elevations above 15 µmol/L are an independent risk factor for ischemic stroke.
The risk of stroke is two times higher in people with Hcy >15 µmol/L as compared to those with Hcy level <10 µmol/L.
#MedTwitter #NeuroTwitter
3. The risk of #death is 43% higher in patients with ischemic stroke, who have elevated Hcy levels.
Hcy is not only a risk factor for, but is also correlated with, stroke severity, worse #prognosis, and stroke recurrence.
4. High Hcy levels caused by metabolic disorders of Hcy are an independent risk factor for #hypertension, myocardial infarction, peripheral arterial occlusive disease, venous thrombosis, hemorrhagic strokes, and myocardial infarction.
5. Male gender, #smoking and #vitamin B12 deficiency are associated with elevated levels of homocysteine in blood.
6. Studies on high Hcy levels as cause of ischemic stroke have found that Hcy damages endothelial cells, increases vascular smooth muscle, inflammatory process, oxidative insult & enhances production of fibrinogen leading to abnormal coagulation together with platelet dysfunction
7. Supplementation with folic acid, vitamin B6 and B12 can lower elevated homocysteine levels.
8. Take home message:
*Elevated Hcy level >15 µmol/L is an important risk factor for stroke in young.
*In addition to screening for traditional risk factors (such as high BP, sugar and cholesterol), we should screen for homocysteine levels too.
10. References
1.doi.org/10.1161/01.str…
2.doi.org/10.3389/fnsys.…
3.doi.org/10.1097%2FMD.0…

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More from @hyderabaddoctor

Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 19
Case of a man who shaved only on right side of face
1. 70-year-old man was brought to OPD three months ago by his son, with a complaint that he had stopped shaving on left side of face for one week. He was also not using his left hand even though he had no weakness in that hand.
2. This abnormal "behavior" started all of a sudden.
When his family members pointed this oddity, he retorted by saying, the left side of face did not belong to him.
Even when he was presented with water or tea from left side, he would stretch his right hand to receive them.
3. Family members were taken aback by his "odd behavior" and decided to seek medical opinion.
His BP was 170/110 mmHg and blood sugar was normal.
He had no known medical illness. #MedTwitter #neurotwitter
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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 18
Green Mediterranean diet (GREEN-MED) lowers visceral adipose tissue

1. Standard Mediterranean diet (MED) is a healthy diet option and causes weight loss in obese. In a study, GREEN-MED diet was compared with MED diet, over a period of 18 months (both groups exercised equally).
2. Both the green and standard Mediterranean diet groups achieved similar weight loss (–6.2 kg and –5.4 kg) compared with the standard healthy diet guidelines (HDG) group (–1.5 kg).
#MedTwitter #weightloss #obesity #Mediterranean #diet
3. However, the green Mediterranean diet group had a greater reduction in #waist circumference (–8.6 cm) than the standard Mediterranean diet group (–6.8 cm) and HDG group (–4.3 cm).
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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 16
The less we eat, the longer we live

1. This seems to be true.
A recent extensive review of studies done in geographies with maximum 100+ aged people showed that most of them practiced some form of calories restriction (CR) right from childhood.
#fasting #Longevity #MedTwitter
2. Calorie restriction (CR) is defined as consuming fewer (10-30% lower) calories as compared to usual.
This can be achieved by either intermittent fasting, or time-restricted feeding or substantially reducing carbohydrate intake.
#nutrition #HealthyEating
3. In ageing, #Insulin increases and insulin sensitivity decreases, which increase the risk of #diabetes, #obesity and #cardiovascular diseases. CR reverses these- reduces insulin levels and increases insulin sensitivity. #Glucose levels also reduce with CR.
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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 15
Examining pulse of a patient with “MOTOR NEURON DISEASE” helped me find a cure
1.Motor neuron disease (MND) or amyotrophic lateral sclerosis (ALS), is a progressive neurological disease causing severe weakness and wasting of muscles. It has no cure and results in death in most.
2. A 50-year old man consulted me 6 months ago for a second opinion. He had complaints of difficulty in swallowing, slurred speech, weakness and wasting of muscles of arms and legs, which had progressed over previous 9 months.
#MedTwitter #neurotwitter #ALS #MND
3. He was seen by neurologist and after needle electromyography; diagnosis of ALS was made. In view of grave prognosis, patient wished for second opinion. On examination, he had muscle fasciculation, wasting of tongue, arms and leg muscles. Deep tendon reflexes were exaggerated.
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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 15
Intermittent #fasting (IF) results in remission (A1C<6.5%) of type 2 #diabetes (T2D)

1. According to a recent trial on IF in people with T2D, 47% achieved remission at 3 months and 44% were still in remission at one year.
#MedTwitter
doi.org/10.1210/clinem…
2. Group following IF had 5.9 kg #weightloss at 3 months, as compared to only 0.3 kg weight loss in the control group.
3. This study presented a novel type of intermittent fasting. The intervention consisted of 6 cycles (3 months) of 5 fasting days followed by 10 ad libitum days, and then 3 months of follow-up (with no fasting days).
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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 14
A woman who had a constant urge to move her right leg while sitting or lying down

1. 42-year old woman consulted me last month with complaints of constant urge to move her right leg for past 12 years. Symptoms occurred mostly in evenings and nights.
#MedTwitter #neurotwitter
2. She would develop crawling sensation and discomfort in right leg while sitting for long or lying down, which would go away only after she jerked or vigorously shook her leg.
She remained reasonably well during the day.
3. These symptoms occurred on daily basis causing sleep disturbance (she could #sleep only 5 hours at night).
She felt tired during day and found it hard to concentrate.
She was unable to sit for long while travelling or during meetings during daytime.
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