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.
4. The cause of epileptic fits was high blood sugars, a condition known as epileptia partialis continua. Medicine chosen (phenytoin) to treat fits could further increase his blood sugar levels.
I suggested to stop phenytoin and start insulin (actrapid) infusion.
#diabetes
5. Fits completely stopped when blood sugar level reduced to 150 mg/dL.
All anti-epileptic drugs were stopped, and he was maintained only on S/C insulin.
He had no further seizure episodes and was discharged to home soon.
6. High blood sugar (hyperglycemia) can cause repeated focal motor seizures (fits).
Hyperglycaemia increases the metabolism of gamma-aminobutyric acid and thereby lowers seizure threshold.
7. It is particularly important to remember non-ketotic hyperglycaemia as a cause of persistent focal motor seizures since administration of phenytoin may do harm by worsening blood sugar control.
These patients do not require long-term antiepileptic drug prophylaxis.
8. I had treated this patient more than two decades ago, and this patient report was published in the Journal of Royal Society of Medicine (JRSM)
doi.org/10.1258%2Fjrsm…

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Running is not detrimental to #knee #cartilage

1. The general health benefits of #running are well-established, yet concern exists regarding the development and progression of #osteoarthritis
A recent research examined the effects of running on knee cartilage using MRI scans.
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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%.
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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 .
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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.
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jamanetwork.com/journals/jaman…
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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.
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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.
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n.neurology.org/content/100/5/…
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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
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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
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