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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
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Jan 31 • 7 tweets • 2 min read
Carefully observing a patient walk 20 steps gave clue to diagnosis

1. 1995- I was a first year MD Medicine PG at CMC Vellore.
35-yr old Rami from Midnapore had got admitted with fever of unknown origin of 6 months duration. No cause had been identified despite extensive tests.
2. It was a hectic day with 8 new patients admitted from emergency. It was past midnight, when I managed to examine Rami. During examination, she took a washroom break, for which she walked about 20 steps in all. After she returned to her bed, she was breathless .
#Medtwitter
3. She was unable to talk in complete sentences. Her pulse rate was 140/min. High #pulse rate could be partly explained by #fever, but it was beyond what was expected for a fever of 102 degrees Fahrenheit (pulse rate can rise by 10 beats/minute per degree rise in temperature).
4. By now, I had a clue what the possible cause was. Got an opinion from Cardiology PG at night, who "clinically ruled out" any cardiac problem but I wasn't convinced. I wanted her echocardiogram, so I pushed her wheelchair myself (hospital staff were busy) to Echocardiogram room
5. At Echo room, happened to meet the same Cardiology PG, who was not impressed seeing me there. Dr Jacob Jose (Cardiology HOD) saw our "verbal altercation" and offered to do Echocardiogram himself.
Result of cardiac Echocardiogram confirmed by suspicion.
6. Echo showed mitral stenosis (narrowing of heart valve) & features of infective endocarditis (infection of diseased valve). This was the cause of Rami's fever, which had remained unidentified for 6 months.
I left with a smile (could hear scolding of Cardiology PG by Dr Jose).
7. Take home message
*Simple observation of breathlessness & high pulse rate (with minimum physical effort) gave a clue towards possible heart disease.
*Heart valve infection (endocarditis) is a well-known cause of prolonged fever (& responds well to antibiotics).
#CardioTwitter

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More from @hyderabaddoctor

Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Feb 1
Uncontrolled #epileptic fits stopped by #insulin

1. A man aged 75 had for five days experienced tonic-clonic #seizures involving the right side of the face and right upper and lower limbs at a frequency of 20-30 per day. He had mild weakness of right arm and leg.
#MedTwitter
2. Patient was admitted in ICU under Medicine Unit. MRI brain and lumbar puncture were normal. New onset diabetes was detected for which he was treated with subcutaenous insulin.
Fits persisted despite treatment with midazolam and phenytoin. He was referred for neurology opinion
3. Patient was conscious but appeared exhausted. Review of blood tests showed high glucose of 350 mg/dL and mildly low sodium levels.
The diagnosis was obvious by now.
Read 8 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Feb 1
Poor sleep quality and sleeping <7 hours during adolescence can increase the risk of multiple sclerosis later in life

1. A recent case control study done at Sweden looked at the association between sleep duration (& quality) in teens and risk of multiple sclerosis in later life.
2. Compared with sleeping 7–9 hours/night during adolescence, short sleep (<7 hours/night) was associated with 40% increased risk of developing multiple sclerosis (MS).
3. When patients rated their sleep quality during adolescence as poor, the risk of developing MS in later life increased by 50%.
Read 7 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 31
Head Injury increases the Long-term Mortality Risk in Community-Dwelling Adults

1. Even a single #head #injury could increase the risk of all-cause #death by 66%, as reported in a long term (27 years) follow up study conducted in USA.
#MedTwitter
jamanetwork.com/journals/jaman…
2. The association between head injury and death over long-term was dose-dependent.
111% higher risk of death was noted with two or more head injuries as compared to 66% higher risk of death after one head injury.
3. Those with mild head injury had 2.12 times higher risk of death as compared to those with no history of head injuries.
The risk of death increased to 2.87 times, if the head injury was moderate, severe or penetrating (as compared to those with no head injuries).
Read 5 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 31
Moderate-to-heavy #alcohol consumption increases the risk of #stroke in #younger adults

1. Alcohol consumption is one of the important modifiable risk factors for stroke in young adults.
A study was conducted in Korea to determine the association between alcohol & stroke.
2. Of 1536668 patients (mean age 29.5 years, 71.5% male, and median follow-up of 6-years), 3153 experienced an incident stroke (incidence rate, 0.37 per 1,000 person-years).
Adults who consumed more than 105 g/week of alcohol had higher risk of stroke, especially brain hemorrhage
3. Conclusion
Young adults who engaged in moderate-to-heavy drinking demonstrated a higher risk for incident stroke, especially hemorrhagic stroke
n.neurology.org/content/100/5/…
Read 4 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 30
Female physicians have higher infertility rates and pregnancy complications

1. Female physicians, particularly surgeons, have a significantly greater incidence of #miscarriage, #infertility, and #pregnancy complications compared to the general population
doi.org/10.1097/sla.00…
2. In another study, of 692 female surgeons, 290 (42.0%) had a pregnancy loss, more than twice the rate of the general population.
*Female surgeons operating 12 or more hours per week during the last trimester of pregnancy were at higher risk of major pregnancy complications
3. Female surgeons had fewer children and were more likely to delay having children because of surgical training.
Incidence of postpartum depression and musculoskeletal problems were also higher in them
#MedTwitter #Doctors
doi.org/10.1001/jamasu…
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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 28
A young woman who would repeatedly experience the smell of burning incense (when in reality none burnt)
1. It was nearing the end of a busy OPD, when 27-year-old Radha was brought for consultation, accompanied by her husband and mother-in-law. They all looked anxious.
#MedTwitter
2. Radha married Raj a year ago. All went well until three months after marriage and the family was very happy.
One day at 11 PM, Radha started complaining that someone is burning incense at home, when all were actually sleeping. They considered it a dream & asked her to sleep.
3. These episodes increased in frequency and occurred 3-4 times every week. She would complain of burning incense smell at different times of day or night, and these symptoms would last only a few minutes.
Her family thought it's a God's message to her to pray with more devotion
Read 10 tweets

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