Dr Sudhir Kumar MD DM Profile picture
Apr 4 7 tweets 3 min read Twitter logo Read on Twitter
Common cause of nerve damage is often overlooked due to lack of awareness

1. 41-year old Mr Sheel presented with tingling, burning sensation & numbness of both feet of one year duration. Symptoms were present throughout the day, however, they worsened during nights.
#MedTwitter
2. Mr Sheel consulted a general physician, who ordered a few blood tests, which were all "normal". He suspected a diagnosis of peripheral neuropathy (damage of nerves in feet) and referred him for a neurologist's opinion for confirmation of diagnosis.
#neurotwitter
3. Neurologist evaluated Mr Sheel and found evidence of sensory neuropathy involving lower limbs (confirmed by nerve conduction studies). He also ordered a few additional blood tests, which were all "normal". He advised nerve biopsy test to find out the cause of nerve damage.
4. Mr Sheel consulted me for 2nd opinion before undergoing invasive test (nerve biopsy). I reviewed the history & after clinical examination- agreed with a diagnosis of peripheral neuropathy affecting sensory nerves.
However, on review of blood tests, I could spot the diagnosis.
5. HbA1C (glycated hemoglobin) done on two occasions were abnormal- 6.1 & 6.4 respectively and Fasting blood sugar was 120 mg%-consistent with a diagnosis of pre-diabetes.
My final diagnosis was Pre-diabetes with peripheral neuropathy. No further tests were needed at this stage.
6. Pre-diabetes is a common cause of peripheral neuropathy, causing tingling, burning and numbness of feet. In many studies, more than 10% patients (maximum up to 77%) with pre-diabetes were found to have peripheral neuropathy. Reference:
doi.org/10.1136/bmjdrc…
7. Take home message:
*Pre-diabetes should not be taken lightly, as it is a risk factor for nerve damage, as well as for #stroke and #heartattack.
*Lifestyle modification (diet and exercise) should be advised to people with pre-diabetes to prevent complications related to it.

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More from @hyderabaddoctor

Apr 6
Do anti-seizure medications (ASM) prevent late post-traumatic epilepsy?

1. Traumatic brain injury (TBI) is unfortunately a common cause of disability and death. Seizures after head injury can adversely affect the outcome of patients with TBI. Does early ASM help?
#MedTwitter
2. A recent systematic analysis looked at the possible role of ASM in preventing early & late post-traumatic seizures, and in reducing the risk of death.
cp.neurology.org/content/13/3/e…

#TBI #epilepsy #neurotwitter
3. The risk of early post-traumatic seizures (occurring within the first 7 days after injury) was significantly reduced in the group taking anti-seizure medications. Image
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Apr 5
Middle-aged woman had repeated chest and left arm pain mimicking angina, but the cause was neurological

1. 55-yr old Mrs Viji presented with left-sided chest pain, radiating to left arm for two months. Pain occurred intermittently and it awakened her from sleep.
#MedTwitter
2. Mrs Viji was a diabetic and hypertensive (well-controlled) and was a regular morning walker (5 km daily). She had no chest pain during her walks.
She had occasional tingling sensation and numbness in left arm. She was anxious that she was going to suffer a heart attack.
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Read 7 tweets
Apr 5
Serving Alcohol in Medical Educational Conferences

1. I have attended 100s of medical conferences since 2001. Some of them are sponsored & some are not. However, one common theme is serving alcohol in >90% of these academic conferences. Is it a correct practice?
#MedTwitter
2. I know at least one incident where one senior doctor died, possibly triggered by heavy #alcohol consumption.
I also remember several incidents where doctors were heavily drunk and had to be escorted to their rooms by their colleagues or hotel staff.
3. If you happen to witness the table where alcohol is served, it resembles a busy vegetable market or a shop with discount sale, where doctors would be pushing one another to get their quota of booze ASAP (free in most cases, as payment is done by sponsors or organizers).
Read 4 tweets
Apr 4
1. Vaccines recommended for healthy adults
2. Vaccines recommended for high risk individuals
3. Immunization for all adults with normal immune status
Read 5 tweets
Apr 3
How to reduce the risk of becoming a patient?

1. I see a few patients who tell me: "Doc, I hate taking medicines, or doc, I don't like coming to hospitals".
My answer to them is usually: "You should rather hate diseases and reduce the risk of becoming a patient".
#MedTwitter
2. But is it possible to reduce risk of becoming a patient?
Yes, it is possible, and that is a better option than deciding to not take medicines or not consult a doctor, when suffering from a disease.
So, what can one do to reduce the risk of diseases and increase longevity?
3. These 10 lifestyle factors can reduce the risk of diseases & increase lifespan:
*Regular exercise
*Healthy food
*Regular night sleep (7-9 hours)
*Maintain BP 130/80 mmHg or lesser
*Maintain normal blood sugar. Keep HbA1C as low as possible
*Maintain normal non HDL cholesterol.
Read 4 tweets
Apr 3
1. Many can benefit from these fixed return saving instruments

1. Senior citizen saving scheme: 8.2% interest
2. Sukanya Samriddhi yojana: 8% interest
3. Mahila Samman Saving certificate: 7.5% interest
4. Public provident fund: 7.1% interest
#FixedIncome #savings #investments
2. Senior citizen savings scheme

*For people aged >60 yrs
*Can invest from Rs 1000 to 30 lakhs
*Duration for 5 years (extendable by 3 years)
*Interest is paid quarterly on the 1st day of April, July, October and January
3. Sukanya Samriddhi yojana
*Account can be opened in the name of girl child below age 10
*Payment: Rs 250 to 1.5 lakhs per year for 15 years
*Maturity after 21 years
*Can be availed for maximum of two daughters per family
Read 5 tweets

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