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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
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Dec 23 • 6 tweets • 2 min read
Low Blood Pressure (BP) is also a risk factor for ischemic stroke

1. High BP is a well-known risk factor for ischemic and hemorrhagic #stroke .
In a study, low BP was also shown to increase the risk of ischemic stroke.
doi.org/10.1210%2Fjc.2…

#MedTwitter #neurotwitter
2. People with baseline BP<110/65 mmHg had 88% higher risk of ischemic stroke after average follow up of 6.7 years, as compared to those with BP 120-129/70-80 mmHg.

*People with BP>160/100 mmHg had 47% higher risk of ischemic stroke.
3. In another study, low pre-stroke BP was associated with higher risk of all cause death and cardiovascular death.
Patients with average SBP<120 mm Hg and at least one comorbidity (smoking, heart disease, cancer, or dementia) had the highest mortality risk.
4. Low systolic BP at presentation in patients with acute ischemic stroke was associated with an increased risk of in-hospital mortality and complications, specifically heart failure, gastrointestinal bleeding, and sepsis. Whether cause or effect- not known.
5. References
a. doi.org/10.1161/stroke…
b. doi.org/10.1161/STROKE…
6. Conclusions
* Low BP increases the risk of ischemic stroke.
* Low BP increases the risk of in-hospital death and long-term death in patients with ischemic stroke.
*Patients with low BP at admission have higher rate of complications.
*Target BP should be 120-130/70-80 mmHg.

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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 24
Case of a woman in whom “Runny Nose” was caused by a Brain Disease

1. 35-year-old woman presented with intermittent #runny #nose and #headache of one month duration.
Local physician suspected #sinus infection, treated her with a course of antibiotics, with which she improved.
2. Symptoms recurred one week back after which she consulted me for a “permanent cure of her sinus infection”.
I decided to delve deeper into the history.
#MedTwitter #neurotwitter
3. Runny nose occurred only from left nostril. It occurred 4-5 times per week.
Discharge from nose was watery and it increased on bending the head downwards.
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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 24
Older adults with greater muscle strength have lower risk of depression

1. Depression is common among older adults and its prevalence has increased over the past three decades. Depression increases the risk of suicides, stroke, heart attack, high BP and disability.
#psychtwitter
2. Preventive strategies, including increasing muscle strength can reduce the incidence of depression by 25%.
Handgrip strength is an easy-to-use, fast & reliable indicator of both sarcopenia (age-related loss of muscle mass) and dynapenia (age-related loss of muscle strength).
3. In a study comprising 1,15,601 adults aged 50 or more from 24 countries, with 7.3 years follow up, higher levels of handgrip strength were associated with lower risk of depression.
There was dose-response seen: Greater the hand grip strength, lesser was the risk of depression
Read 10 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 23
Heavy #coffee consumption can increase the risk of death among people with severe #hypertension

1. In a recent study, drinking 2 or more cups of coffee per day increased the risk of death by 2 times in people with BP>160/100 mmHg.
#MedTwitter
2. There was no additional risk of death in people with normal BP of those with grade 1 hypertension (BP<160/100 mmHg).

*Drinking coffee up to 1 cup/day was found to be safe in people with or without high BP.
3. In contrast, green #tea consumption was not associated with an increased risk of cardiovascular disease deaths across all categories of BP.
Read 8 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 22
A #runner who would #swing his left arm more than the right
1. I have been running outdoors for two years. Over a period of time, one gets familiar with fellow runners- specially their style, pace & endurance. This post is about one of those runners, who was a regular (like me)😆
2. He had one odd style- he would swing his right arm lesser than the left while #running or #walking.
He would continue in the same style for about 60-70 minutes of his #RUN.
His #pace was excellent- 60 minutes for a 10 km run.
#MedTwitter #neurotwitter
3. Our interaction was limited to "Good mornings".
Six months had passed since I first saw him. At this point, I noted that I could outpace him on a few occasions (I was much slower than him to start with).
I had started to think about possibility of a #neurological #disease.
Read 11 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 22
Problematic #alcohol use is common among #physicians

1. Problematic alcohol use can adversely affect physicians’ health as well as their ability to provide excellent healthcare to their patients.
A meta-analysis was recently published on this topic.
#MedTwitter #psychtwitter
2. Problematic alcohol use included hazardous, potentially hazardous, risky, at-risk, harmful, problematic, or heavy drinking or alcohol use, as well as alcohol misuse, alcohol dependence, and alcohol use more than low-risk guidelines and alcohol use disorder.
3. Survey included 52,000 physicians from 17 countries (from data published between Jan 2006-Mar 2020).

Results showed problematic alcohol use varied widely regardless of measurement method used.

The rate was 0%-34% with AUDIT, 9%-35% with AUDIT-C, and 4%-22% with CAGE.
Read 10 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 21
Psychosocial #Stress increases the risk of #stroke

1. A longitudinal study (2007-2021) was conducted on 27,000 people from 32 countries belonging to various continents to assess the relation of self-reported stress and risk of various types of stroke
#MedTwitter #neurotwitter
2. Increased stress at home and at work (within the previous 12 months) increased the risk of stroke by 95% (1.95 times) and 170% (2.7 times) respectively, as compared to no self-reported stress. Recent stressful events increased the risk of stroke by 1.3 times.
3. This association was consistent for all stress domains, including work stress, home stress, and financial stress. The association was independent of socioeconomic status, occupation, and educational level & remained significant after adjustment for cardiovascular risk factors.
Read 11 tweets

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