Dr Sudhir Kumar MD DM Profile picture
May 29 7 tweets 3 min read Twitter logo Read on Twitter
Effective treatment of #depression through psychological therapy is associated with lower risk of #stroke and #heartattack
1. 6,36,955 people with depression were treated with psychotherapy and were followed up for a median of 3.1 years.
#MedTwitter Image
2. Reliable improvement from depression was associated with a 12% decrease in incident risk of cardiovascular disease (CVD) at any given time, with similar results observed for coronary heart disease (CHD), stroke, and all-cause mortality (death).
3. Benefit was maximum in those aged 45-60 years. For this group, the improvement in depression was associated with a 15% decrease in cardiovascular diseases. In patients over 60 years of age, there was only a 6% decrease.
4. The reduction in all cause death rate was also highest in 45-60 year age group. Their mortality risk underwent a 22% reduction. This reduction was only 15% in the adults over 60.
5. Lesser improvement in people aged 60 or more could be related to the fact that improvement in depression may not lead to a significant increase in physical activity (as compared to younger people). Moreover, they could have additional risk factors such as high BP or diabetes.
6. The exact cause of this association is not known. Possible reasons:
*Improvement in depression can encourage people to engage in greater physical activity.
*Depression leads to greater inflammation including in blood vessel walls, which can explain higher risk of CVDs.
7. Take home message:
*Management of depression through psychological interventions may be associated with reduced risk of CVD.
*More research is needed to understand the causality of these associations.
doi.org/10.1093/eurhea…

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More from @hyderabaddoctor

May 30
Me: "Mr Raj, your wife needs operation, and it needs to be done soon."
Mr Raj: "But none of the previous doctors who treated her depression even remotely hinted at this possibility (of surgery)".

1. 55-year old Mrs Viji had started feeling sad in August 2022.
#MedTwitter
2. Their only daughter had moved to the UK for higher studies. It was assumed that her sadness was related to missing her daughter. However, the feeling of sadness increased over time. She became withdrawn and stopped participating in get-togethers with family and friends.
3. Mrs Viji did not improve even after one month, she was taken to a psychiatrist.
After detailed history, she was diagnosed to have severe depression, and was started on anti-depressant medications.
Counseling by a psychologist was also started.
#psychtwitter #psychology
Read 11 tweets
May 29
Investing in a second residential flat for earning rental income or for capital appreciation is not a wise decision

1. Annual returns are 2-4% (lower than 10-12% in mutual funds),
2. Lesser tax efficient (LTCG 20% vs 10% for equity beyond gains of 1 lakh),
#investments #Equity twitter.com/i/web/status/1…
3. Large capital is required to invest into real estate (Mutual funds need lesser capital)
4. Investment in real estate is illiquid (takes time to find the right buyer). For mutual funds, amount is credited into bank account within 2-3 days of redemption.
5. For property, additional costs include property tax, maintenance charges, cost of repairs and repainting. Tax needs to be paid even when the flat is unoccupied, and there are no tenants. These situations do not apply to mutual funds/equity investments.
Read 5 tweets
May 29
Food addiction is real and is related to #obesity and #diabetes

1. Food #addiction (FA) syndrome can be diagnosed by using Yale Food Addiction Scale (YFAS). There are 11 possible symptoms, which can be used to diagnose FA, as well as grade its severity.
#Diet #MedTwitter Image
2. Clinical diagnosis of food addiction (FA)
Individuals can meet a “diagnostic” score for FA on the current versions of the YFAS by endorsing at least two of the 11 behavioral indicators of addiction plus clinical impairment/distress.
#psychtwitter
3. Severity of Food addiction
Severity thresholds for this “diagnostic” score are defined by the number of symptoms endorsed
(mild: 2–3 symptoms;
moderate: 4–5 symptoms;
severe: 6–11 symptoms)
Read 6 tweets
May 28
Type 2 diabetes is associated with increased risk of developing dementia

1. Those diagnosed with diabetes before age 60 years had a nearly threefold increased risk for dementia compared to those who never developed diabetes, as per a recent study.
#MedTwitter #diabetes twitter.com/i/web/status/1… Image
2. Those aged 60-69 years at diabetes diagnosis had 73% higher risk of developing dementia and those aged 70-79 years at diabetes diagnosis had 23% higher risk of developing dementia.
The relationship with dementia was not significant for those aged 80 years and older.
#dementia
3. Mechanisms include glucose toxicity, insulin resistance & microvascular dysfunction of the central nervous system.
Glucose toxicity and microvascular dysfunction are associated with increased inflammatory & oxidative stress, leading to increased blood–brain permeability.
Read 5 tweets
May 27
Sometimes, we doctors need to go beyond our duty of writing medicines

1. 75-year old Mr Reddy: "Dr, we just returned from Char Dham Yatra yesterday and we wish to thank you for enabling us do this Yatra, what seemed impossible for past 4 years. Here is some "prasadam" for you." twitter.com/i/web/status/1…
2. Mr Reddy had been consulting for #Parkinsons disease (PD) for the past 8 years. He was doing fairly well, however, his motor symptoms had worsened for the past 2 years. He walked slowly and tended to lose balance especially while turning. He had fallen twice in past 6 months.
3. Reddy couple had shared about their wish to undertake Char Dham Yatra in the past few clinic visits.
I had suggested that we adjust the medications and take help of physiotherapist (to improve balance, gait & strength).
About three months back, I had given the green signal.
Read 7 tweets
May 26
Eyes are the windows into the Brain

Here, I discuss 9 situations where symptoms are related to eyes or vision, but disease pertains to brain or nervous system.
1. Sudden onset painless loss of vision- Optic neuritis (inflammation of optic nerve)- Multiple sclerosis
#MedTwitter
2. Sudden onset loss of vision on one half (left or right)- called homonymous hemianopia- usually caused by an infarct (clot) of occipital lobe of brain.

3. Inability to see on outer aspects of visual field (temporal visual field loss)- usually caused by pituitary tumor.
4. Drooping of one or both eyelids- called ptosis, usually caused by myasthenia gravis or third cranial nerve palsy.

5. Double vision (diplopia)- caused by 3rd, 4th or 6th cranial nerve palsies; also myasthenia gravis.
#neurotwitter #eyes #Neurology
Read 7 tweets

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