tag:blogger.com,1999:blog-40708129386690921842024-03-18T02:31:14.195+05:30Best Neuro Doctor (A neurology blog by Dr Sudhir Kumar)I am a neurologist treating disorders of brain, spinal cord and nerves. I like educating public and doctors about various aspects of neurological illnesses. This blog is an attempt towards the same. I work at Apollo Hospitals, (Jubilee Hills and Kukatpally branches), Hyderabad (phone-0091-40-23607777/60601066/9618204512; drsudhirkumar@yahoo.com)
For ONLINE CONSULTATION, please click on the icon on the right hand side for details.Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.comBlogger77125tag:blogger.com,1999:blog-4070812938669092184.post-37790070701004385892022-05-13T19:30:00.004+05:302022-05-13T19:30:51.898+05:30A Teacher Who Changed My Life<p> </p><p align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 16.0pt; line-height: 107%;">A Teacher Who Changed My Life<o:p></o:p></span></b></p>
<p align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 16.0pt; line-height: 107%;">Dr Sudhir Kumar <o:p></o:p></span></b></p>
<p align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 16.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="line-height: 150%;">Christian Medical College Vellore has
played a vital role in changing the course and purpose of my life. Several
teachers have taken great personal efforts and have gone out of their way to mold
me into a person in right direction and with a meaningful purpose in life.
Today I would like to remember one such angel- Prof Mary Jacob, who taught
Anatomy to several batches of students.<o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;">I joined CMC Vellore in 1989 after
having done my schooling from Kendriya Vidyalaya, Bokaro Steel City, which was
a part of Bihar then. I faced several challenges after joining. The first and
foremost was the language barrier. It was a Herculean effort to converse in
English. Writing answers to “essay and short note” questions in English was
worse. In MaJa’s (this is how students used to affectionately address Dr Mary
Jacob) own words- “Your answers have the required information, however, due to multiple
grammatical errors, we cannot make out what you are trying to convey.” <o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;">It was the first time I was away
from home. Tamil was a new language as was the South Indian food. I was home
sick too. Another major problem I faced was- lack of discipline with regards to
studies. After having been under the watchful eyes of parents at home until age
17, this sudden freedom felt liberating. It was easy to while away precious time
with a few like-minded hostel mates. Playing carroms past midnight (until 2-3
AM) became my favourite pastime. Another newly found “passion” was going for
midnight strolls on Arni Road along with a few of my friends. Month-after-month
passed and before I could realize, the first semester university examinations
for Anatomy, Physiology and Biochemistry were on our heads. During the first
year, marks of our initial internal examinations had been sent to parents by
post. As expected, I had performed very poorly. When my parents enquired about
my abysmal performance, I just lied to them stating that other students too had
scored very low marks and it is not as easy to score in MBBS as it is to score
in 10<sup>th</sup> or 12<sup>th</sup> board examinations. University
examinations were another cup of cake though. Failing university examination
meant getting demoted to the B batch and risking losing 6 months. This had
never happened in my life. I was mortified by this thought, which was a
distinct possibility at that stage. What else can one expect from a student,
who hardly ever opened any of the textbooks for an entire year? With no alternative
options in sight, I studied 72 hours non-stop, and managed to somehow pass the
examinations (attending classes on a regular basis had also helped, as some
information from the class-room lectures had passively diffused in to my brain).
I had scored exactly 45/90 (the minimum required to pass) in Anatomy theory
paper (which meant that I was “pulled up” after awarding a few grace marks).
There was an essay question on urogenital diaphragm (which I had not heard until
then) and instead I wrote about pelvic diaphragm!<o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;">After the results came out, a few
of us were called for personal interaction with Maja. I was also part of this
“select few”. My hands were shaking with fear before I entered her office.
However, she had a smile on her face when she asked me to sit opposite her. She
made me comfortable asking about my home, family, and other general stuff. Then
she remarked about my poor command over English. She suggested me to start with
reading English newspapers (that were pasted just outside Men’s Hostel mess) in
entirety (from the first to the last line). She also invited me to come to her
home to collect a few English novels, which I could read later, so that my command
over English language improved. She asked me about the books I had read for
learning Anatomy, to which I answered “Chaurasia”. She was terribly
disappointed and suggested to me that I switch to reading books authored/edited
by “R J Last, Grant and Gray”. I was patiently listening to the valuable
suggestions a professor was offering to a student who had almost failed in the
just concluded examinations. The tone and content of the interaction suggested
that the teacher too had failed (along with the student). She seemed more eager
and more concerned that I do better in future. She had no anger and did not
utter a single derogatory word against me. She did not scold me either. She had
a genuine concern to help her student, in addition to having a motherly love.
Those 30 minutes of interaction with MaJa were life changing. I had never heard
of or seen a teacher who tried to reform students in such a positive manner. <o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;">When I came out of her office,
there was a new resolve within me. I felt I had let down an angel like MaJa and
needed to work harder to erase these memories. Her positive and encouraging
words had energized me. My new version was totally opposite. No late night
carroms in lower common room and midnight strolls on Arni Road became a thing
of past. I became a regular (from an occasional visitor earlier) to Gault
library in our second semester (Anatomy II and Physiology II). The study bug
hit me so badly that I tried hard to get the library timings extended from the
usual 11 PM to until 12 midnight. A few of us held several meetings with the then
Principal (Dr Booshanam Moses) and he put a condition that there should be at
least 10 students in the library at 11:45 PM when he would come for inspection.
I still remember convincing a few “fixed couples” to come and just sit in the
library for a few minutes when the principal would come for inspection. <o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;">Things were going well for a few
months when a tragedy stuck. I was admitted to CMC hospital with a painful and
disabling medical condition. Thankfully, it was promptly diagnosed and
appropriately treated. I am thankful to Prof M S Sheshadri and rest of Medicine
Unit 2 team for this. However, I still missed attending classes for more than a
month. This resulted in me lagging my classmates. After recovery when I joined
classes, I was again called by MaJa. She reassured me and appointed one of the
Anatomy tutors to take personal classes for me (for the portions that I had
missed in class). This was another gesture that I can never forget. She was
much more than a teacher, she was like a mother, a true angel. Her house was
always open for me and I could walk into her home any time for any help or just
for her words of encouragement. Her constant encouragement bore fruit and I
scored 78/90 in Anatomy II semester examinations. She had again called a few of
us for personal interactions (this time I was in the group that scored well).
She was extremely pleased with my performance; it seemed she had also done well
(and not only me) in the examinations. Just before leaving, she asked me the
same question- “which books did you read this time?” I answered- ma’am I did
read Last, Grant and Gray for the sake of gaining knowledge but I still read
Chaurasia for scoring marks. I can’t forget the exasperated look on MaJa’s face
after listening to my answer, but the emotion quickly turned into one of
satisfaction that her guidance and motivation has changed the path and
direction of her student’s life. <o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;">I continued to follow the path
shown by the legendary teacher throughout my MBBS and then also for my
post-graduation studies (MD Medicine and DM Neurology) at CMC Vellore. I had a
pleasure of treating her for an illness related to my specialty, while I was
working as a faculty there. The contentment and satisfaction on her face was my
“Guru-dakshina” (paying back to the teacher) to her. Blessed are the several
batches of students who have been taught by Prof Mary Jacob. I sincerely hope
that the batches that missed interacting with her during Anatomy days can get a
glimpse of her personality through this brief write-up and feel inspired. <o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p>Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-81718001087741845692020-04-23T00:15:00.002+05:302020-04-23T00:15:36.026+05:30HEADACHES ASSOCIATED WITH PERSONAL PROTECTIVE EQUIPMENT (PPE) <div dir="ltr" style="text-align: left;" trbidi="on">
<div class="WordSection1" style="page: WordSection1;">
<div align="center" class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 24px; margin: 0cm 0cm 0.0001pt; text-align: center;">
<b><span lang="EN-US"><span style="color: red;">HEADACHES ASSOCIATED WITH PERSONAL PROTECTIVE EQUIPMENT</span><o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 24px; margin: 0cm 0cm 0.0001pt; text-align: center;">
<b><span lang="EN-US" style="font-size: 10pt; line-height: 20px;">Dr Sudhir Kumar MD DM<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 24px; margin: 0cm 0cm 0.0001pt; text-align: center;">
<b><span lang="EN-US" style="font-size: 10pt; line-height: 20px;">Consultant Neurologist, Apollo Hospitals, Hyderabad<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 24px; margin: 0cm 0cm 0.0001pt; text-align: center;">
<b><span lang="EN-US" style="font-size: 10pt; line-height: 20px;"><a href="mailto:drsudhirkumar@yahoo.com" style="color: purple;">drsudhirkumar@yahoo.com</a><o:p></o:p></span></b></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Introduction<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Coronavirus disease 2019 (COVID-19) caused by SARS-CoV2 is a global pandemic, which has already affected about 2.6 million people belonging to about 200 countries. Healthcare workers (HCW) working in high-risk areas (such as emergency room, isolation wards, ICU, etc) are mandated to wear personal protective equipment (PPE), including close-fitting N95 face mask and protective eyewear (mainly goggles) while attending to the patients.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Aims of the Study<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">A recent study was conducted at Singapore (Reference: Headache, 30 March, 2020) to study the effects of PPE in development of de novo (new onset) headaches as well as their impact on personal health and work performance. The impact of COVID 19 on pre-existing headache disorders was also investigated.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Participants in the Study<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">158 healthcare workers participated in the study. 78% of them were in 21-35 year age group. 70% were females. Majority were either nurses (65%) or doctors (32%). 29% had pre-existing headache disorders (19% had migraine and 10% had tension-type headache).<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Main Findings of the Study<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Out of 158 healthcare workers, 128 (81%) developed de novo PPE-associated headaches. Persons with pre-existing primary headaches were 4.2 times more likely to develop de novo PPE-associated headaches. People using PPE for more than 4 hours per day had a 3.9 fold higher risk of developing PPE-associated headaches. HCW working in emergency department had a 2.4 times higher risk of developing PPE-associated headaches.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Clinical Characteristics of PPE-associated Headaches<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Headaches were bilateral in location. The location of discomfort corresponded to the areas of contact from the face mask or goggles and their corresponding head straps. Discomfort was described as a sensation of pressure or heaviness of affected sites in 87% and throbbing or pulling pain in 12%.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">The time interval between donning of face mask or protective eyewear and onset of headache was less than 60 minutes in most people. After removal of PPE, the headache resolved within 30 minutes.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Most people reported an attack frequency of 1-4 days in a 30-day period. The intensity of headache was mild in m</span>o<span style="color: blue;">st.</span> <span style="color: blue;">23% reported accompanying symptoms of nausea, vomiting, phonophobia or photophobia.</span><o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US"></span><span lang="EN-US" style="font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><br /></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<br /></div>
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoCfsU8E70Esz-r3_6KU7TJ3TJTyKeuyo4ltmXtZNXkBVKRq3C1wdfQpaGFlVMtqnohXKGnXO8nnyesDOmIxiQyjRmKt4yjkkYr0sYRWwyEurP6P7pY16fh16miWJEPdqSMvFyx1EElali/s1600/PPE.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="927" data-original-width="1600" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoCfsU8E70Esz-r3_6KU7TJ3TJTyKeuyo4ltmXtZNXkBVKRq3C1wdfQpaGFlVMtqnohXKGnXO8nnyesDOmIxiQyjRmKt4yjkkYr0sYRWwyEurP6P7pY16fh16miWJEPdqSMvFyx1EElali/s320/PPE.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="color: red;"><b>Various types of Face mask and Protective eye gear</b></span></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrc4R1j8EYT3sZ38lEx5weHtFcDF4h37zTnj9ogsvnqIwNeF7uE9eevhgssdHKpPm1NrK__9YSKRrWUs8Qwb4r-kDoPXXER7kMceV0ESSd2ER0guSNIbqnVYOo7r2s-Jhyphenhyphenm3bXQYfK2oLG/s1600/PPE+headaches.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="993" data-original-width="1600" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrc4R1j8EYT3sZ38lEx5weHtFcDF4h37zTnj9ogsvnqIwNeF7uE9eevhgssdHKpPm1NrK__9YSKRrWUs8Qwb4r-kDoPXXER7kMceV0ESSd2ER0guSNIbqnVYOo7r2s-Jhyphenhyphenm3bXQYfK2oLG/s320/PPE+headaches.jpg" width="320" /></a></div>
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 12pt; line-height: 18.4px;"><br clear="all" style="break-before: auto;" /></span>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt; text-align: center;">
<span lang="EN-US" style="font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman";"><span style="color: red;"><b>Location of headache in association with N95 facemask and protective eyewear</b></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span style="font-family: "Times New Roman"; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span style="font-family: "Times New Roman"; font-size: 12pt;"><span style="color: blue;">About 70% did not take any painkillers. 30% took either paracetamol or NSAIDs.</span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">83% opined that PPE-associated headaches resulted in a slight decrease in work performance.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Pathogenesis of de novo PPE-associated headaches<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">The proposed mechanisms care mechanical compression, hypoxemia, hypercarbia and stress.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">What could mitigate the risks of PPE-associated headaches?<o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">Shorter duty shifts and resultant shorter duration PPE usage could be a better strategy, 2. Better cushioning of head straps to minimize mechanical compression over scalp, 3. Reducing stress levels among HCWs.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt;">
<b><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Key points<o:p></o:p></span></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">New-onset headaches are common after using PPE (N95 mask and protective eye gears),<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">Healthcare workers in ED and those using PPE for more than 4 hours daily have a higher chance of developing headaches.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">People with pre-existing headaches have a higher chance of getting headaches.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">Headaches begin within 60 minutes of donning PPE and subside within 30 minutes of removing PPE,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">5.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">Headaches affect both sides of head and are usually mild in nature,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">6.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">Headaches respond to paracetamol and NSAIDs,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">7.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">Headaches decrease the work performance,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span style="color: blue;"><span lang="EN-US" style="font-family: "Times New Roman";">8.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman";">Shorter shift duration (resulting in shorter duration use of PPE) could be the way forward,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">9.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;">Though the primary aim of PPE is to reduce the risk of virus spread and transmission, we also need to make them user friendly in future.</span><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: blue;"><br /></span></span></div>
<div class="MsoListParagraphCxSpLast" style="font-family: Cambria; font-size: 12pt; line-height: 18.4px; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;">
<span lang="EN-US" style="font-family: "Times New Roman";"><span style="color: #660000;">Dr Sudhir Kumar MD DM</span></span></div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-31445613516198787942020-03-14T19:13:00.000+05:302020-03-14T19:13:07.833+05:30COVID 19 RELATED ANXIETY DISORDER<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; text-align: center;">
<b><span style="color: red; font-size: large;">Corona (Covid 19) Related Anxiety Disorder</span></b></div>
<div style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; text-align: center;">
<b><br /></b></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">Corona virus infection, better known as Covid 19 infection, which started in China about three months ago, has rapidly spread to about 150 countries. So far, about 1,50,000 people have been infected with Covid 19, out of whom about 5,500 people have died.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">Various forms of media (including TV, newspaper) and social media (facebook, whatsapp, etc) are full of news and information about Covid 19 infection. Various government agencies too have started awareness campaigns about Covid 19 infections and methods to limit its spread. Countries across the world have initiated partial to total shutdown. WHO has declared Covid 19 infection as a pandemic.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">A problem of this magnitude, affecting the entire world is rare and many people have not faced a similar situation in their lifetime. This has resulted in anxiety and fear of varying magnitude. Recently, pulmonologist Dr Chandrakant Tarke encountered two patients with extreme anxiety.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">Both patients were women, aged 23 and 30 years respectively, from Hyderabad, India. They presented with mild cold and no other significant symptoms. They had no risk factors to develop Covid 19 infection (no history of travel to Covid 19 affected countries or exposure to a Covid 19 infected patient). They had extreme fear that they were suffering from corona virus infection. They had developed obsessive trait of washing their hands multiple times with sanitizers despite staying at home and no exposure to outside. Clinical examination was normal except for hyperventilation. The fear had started after the news about Covid 19 infection in India started flashing on Indian TV channels. The fear became extreme on listening to Covid 19 awareness caller tune initiated by Government of India (which started with coughing sounds, followed by steps to prevent Covid 19 spread).<br />A diagnosis of anxiety disorder induced by fear of having contracted Covid 19 infection was made. Women were counselled and referred to psychiatrist for further management.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">With increase in the number of Covid 19 cases across the world and the disruption resulting due to it, we are likely to come across many more people suffering from Covid 19 related anxiety disorder. As a health care professional we need to be aware of it, promptly diagnose it (clinical diagnosis suffices) and advise appropriate treatment (counselling, referral to psychiatrist/psychologist).</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: red;"><b>Steps to prevent Covid 19 related anxiety</b></span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">1 .Avoid seeking constant updates about Covid 19 from TV channels or social media (updating twice a day- morning and evening- should be sufficient),</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">2. Do not constantly discuss about Covid 19 with your family, friends and colleagues,</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">3. Focus on the positive aspects of Covid 19- more than 80% have mild infections and more than 90% survive this infection,</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">4. Take steps to prevent Covid 19 (as already outlined across various media platforms)</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">5. Go for walks, exercise and engage in leisure activities (music, gardening, etc)</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">6. Consult a healthcare professional if you develop anxiety or fear related to Covid 19</span></div>
<div style="background-color: white; display: inline; font-family: Helvetica, Arial, sans-serif; margin-top: 6px;">
</div>
<div style="color: blue;">
<div style="background-color: white; display: inline; font-family: Helvetica, Arial, sans-serif; margin-top: 6px;">
<span style="color: blue;"><br /></span></div>
</div>
<span style="color: #660000; font-size: large;"><b>Dr Sudhir Kumar MD DM (Neurologist), Apollo Hospitals, Jubilee Hills, Hyderabad<br />Dr Chandrakant Tarke MD DM (Pulmonologist), Apollo Hospitals, Jubilee Hills, Hyderabad</b></span><br />
<div>
<div style="background-color: white; display: inline; font-family: Helvetica, Arial, sans-serif; margin-top: 6px;">
<span style="color: blue;"><br /></span></div>
</div>
<div>
<div style="background-color: white; display: inline; font-family: Helvetica, Arial, sans-serif; margin-top: 6px;">
<span style="color: blue;"><br /></span></div>
</div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-5095137862705127212020-01-15T14:53:00.000+05:302020-01-15T15:00:03.455+05:30IDIOPATHIC INTRACRANIAL HYPERTENSION<div dir="ltr" style="text-align: left;" trbidi="on">
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:Arial;
panose-1:2 11 6 4 2 2 2 2 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536859905 -1073711037 9 0 511 0;}
@font-face
{font-family:"Courier New";
panose-1:2 7 3 9 2 2 5 2 4 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536859905 -1073711037 9 0 511 0;}
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;
mso-font-charset:2;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1791491579 18 0 131231 0;}
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1791491579 18 0 131231 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:618488462;
mso-list-type:hybrid;
mso-list-template-ids:1628368222 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l0:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1
{mso-list-id:1616792760;
mso-list-template-ids:-963710870;}
@list l1:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l1:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:72.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l1:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:108.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:144.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:180.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:216.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:252.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:288.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:324.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l2
{mso-list-id:1727335223;
mso-list-type:hybrid;
mso-list-template-ids:-1049829788 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l2:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:45.0pt;
text-indent:-18.0pt;
font-family:Symbol;}
@list l2:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:81.0pt;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l2:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:117.0pt;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l2:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:153.0pt;
text-indent:-18.0pt;
font-family:Symbol;}
@list l2:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:189.0pt;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l2:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:225.0pt;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l2:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:261.0pt;
text-indent:-18.0pt;
font-family:Symbol;}
@list l2:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:297.0pt;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l2:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:333.0pt;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l3
{mso-list-id:1886406370;
mso-list-template-ids:899866888;}
@list l3:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l3:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:72.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l3:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:108.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l3:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:144.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l3:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:180.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l3:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:216.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l3:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:252.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l3:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:288.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l3:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:324.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">IDIOPATHIC INTRACRANIAL
HYPERTENSION</span><o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">What is Idiopathic intracranial hypertension (IIH)?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">IIH is a condition
characterized by raised intracranial pressure (ICP) of unknown etiology. It is
also known as benign intracranial hypertension or pseudotumor cerebri. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">What are the common symptoms of IIH?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">The commonest
symptom of IIH is headache. In some cases, visual blurring or double vision may
occur.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">What is the dreaded complication in patients with IIH?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">If IIH is left
untreated, there is a threat to vision. Partial or complete loss of vision may
occur. In many of these cases, vision may not revert to normal even after
treatment. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">How is the diagnosis of IIH confirmed?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;">The diagnostic
criteria for IIH, including those of the Dandy criteria as described by Dandy
in 1937 and later modified, are as follows (source: Medscape)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol"; font-size: 10pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->There
are symptoms and signs of increased intracranial pressure<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol"; font-size: 10pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->There
are no localizing neurologic signs (with the exception of a unilateral or
bilateral sixth nerve paresis)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol"; font-size: 10pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Cerebrospinal
fluid (CSF) may show increased pressure, but there are no cytologic or chemical
abnormalities<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol"; font-size: 10pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Neuroimaging
reveals no structural cause or hydrocephalus<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol"; font-size: 10pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->No
other causes of increased intracranial pressure found through workup<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;">Subsequent additions
to these criteria include the following <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l3 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol"; font-size: 10pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->The diagnostic lumbar puncture
should be performed with the patient in the lateral decubitus position<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l3 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol"; font-size: 10pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Magnetic resonance venography should be
included to rule out intracranial venous sinus thromboses<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue;">What are the common abnormalities of IIH
on MRI/MR Venogram brain?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.0pt;">
<span style="color: blue;">Brain MRI with gadolinium contrast venogram is the imaging modality of
choice, as it can effectively rule out meningitis/meningeal infiltrates,
hydrocephalus, mass lesions, cerebral venous sinus thrombosis, etc. In addition,
there are certain abnormalities, which are typically seen in patients with IIH:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol";"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Partial empty sella<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol";"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Flattening of posterior globe<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol";"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Distension of perioptic subarachnoid space<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 45.0pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="font-family: "symbol";"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Vertical tortuosity of orbital optic nerve<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue;">What is the role of lumbar puncture in the diagnosis
of IIH?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;">Lumbar puncture should
be done in left lateral decubitus. It confirms the elevated ICP, opening
pressure >200 mm water. Lumbar puncture also helps in excluding meningitis.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue;">What is the mainstay of treatment?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;">Medical treatment with
diamox (acetazolamide) is the primary treatment to be started in patients with
IIH. Starting dose should be 500-1000 mg per day and a maximum dose of 4 grams
per day can be used. Common side effects include paresthesia and tingling. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;"><span style="background: white;">Diamox to lower intracranial pressure is indicated when
there is </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;"><span style="background: white;">1) visual field loss on automated perimetry, </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;"><span style="background: white;">2) transient visual
obscurations, </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;"><span style="background: white;">3) binocular diplopia, or </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;"><span style="background: white;">4) pulsatile tinnitus. </span><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue;">Does weight loss help in patients with IIH?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;">Yes, a weight loss of
5-10% can lead to substantial reduction in reducing symptoms of IIH and
papilledema. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue;">Do patients with IIH need surgery?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;">There are a group of
patients that need surgery. Patients with severe papilledema with impending
threat to visual loss or those presenting with loss of vision require an early
surgery. Another group of patients who may need surgery are those that continue
to worsen despite being on adequate doses of acetazolamide. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue;">What are the surgical options in IIH?<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]-->Optic nerve sheath fenestration<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l0 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]-->CSF diversion procedures such as
theco-peritoneal or ventriculo-peritoneal shunt surgery. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><o:p><span style="color: #990000;">Dr Sudhir Kumar MD DM</span></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><o:p><span style="color: #990000;">Consultant Neurologist</span></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><o:p><span style="color: #990000;">Apollo Hospitals, Hyderabad</span></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><o:p><span style="color: #990000;">drsudhirkumar@yahoo.com</span></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<!--EndFragment--><br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-68012368233345024562020-01-04T17:16:00.002+05:302020-01-04T17:17:12.411+05:30Headache After Ischemic Stroke<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<b><span style="color: red; font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Headache after Ischemic Stroke</span></b></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><b><br /></b></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><b><br /></b></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><b>How common is headache after ischemic stroke?</b></span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">Headache is common in people with ischemic strokes. It can occur at onset of stroke symptoms or following stroke. It affects 6-44% of people suffering from ischemic stroke.</span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><b>What is the type of headache in this group of people?</b></span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">Headache is similar to tension-type headache. It is located in back of head and neck regions. It is not very severe. There is no nausea or vomiting. There is no photophobia (increased sensitivity to lights) or phonophobia (increased sensitivity to sounds) either. </span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><b>Who have a higher risk of getting headaches after ischemic stroke?</b></span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">1. Females have a higher risk than males.</span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">2. Those suffering from posterior circulation stroke have a higher risk. </span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">3. Prevalence is higher in North America and Europe, as compared to Middle East and Asia. </span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><b>How can this be treated?</b></span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">Medicines used for treating tension-type headache can be effective. These include amitriptyline or dothiepin (dosulepin) tablets. </span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">(Source: Neurology, Jan 7, 2020 issue)</span><br />
<span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="color: #660000; font-family: "arial" , "helvetica" , sans-serif;"><b>Dr Sudhir Kumar MD DM</b></span><br />
<span style="color: #660000; font-family: "arial" , "helvetica" , sans-serif;"><b>Consultant Neurologist</b></span><br />
<span style="color: #660000; font-family: "arial" , "helvetica" , sans-serif;"><b>Apollo Hospitals, Hyderabad</b></span><br />
<span style="color: #660000; font-family: "arial" , "helvetica" , sans-serif;"><b>drsudhirkumar@yahoo.com</b></span><br />
<br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-36406940479776215122020-01-02T23:17:00.004+05:302020-01-02T23:17:35.883+05:30MANAGING MULTIPLE SCLEROSIS IN PREGNANCY<div dir="ltr" style="text-align: left;" trbidi="on">
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">Managing Multiple
Sclerosis (MS) in Pregnancy</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">How common is this situation- pregnancy in women with
MS?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">MS is most often
diagnosed between the ages of 20 to 40 years. This is the age when most women
plan their pregnancies. Therefore, it is very common to find women with MS, who
are pregnant or those who are planning pregnancy. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">Which is a better option- starting MS treatment and
then planning pregnancy or delaying MS treatments until after completing
family?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">MS is characterized
by multiple relapses (when new symptoms occur). With each relapse, the
disability increases. These relapses are often more frequent in the initial
years after diagnosis of MS. Disease modifying drugs (DMD) can reduce relapses
and disability. Therefore, it is always better to start DMD and then plan
pregnancy. One should not postpone starting DMD after pregnancy/delivery. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">How does pregnancy affect MS?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Pregnancy does not
affect MS in the first trimester.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">The MS relapses
are lesser in 2<sup>nd</sup> and 3<sup>rd</sup> trimesters, which is good news.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">However, the
relapses become more frequent in the post partum period (after delivery) and this
higher risk persists until 6 months after delivery.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">How does MS affect pregnancy?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">By and large,
there are no adverse effects of MS on pregnancy. Women with MS have no extra
risk of miscarriage or birth defects in their babies; as compared to women without
MS. The mode of delivery too need not be altered just because the patient has
MS. <span style="mso-tab-count: 1;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">MS has no direct
effect on fertility. Women with MS may have sexual dysfunction resulting in lesser
libido. Male partners who have MS may suffer from erectile dysfunction. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">What MS medications are safe in pregnancy?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">No DMD has yet
been tested in pregnancy and hence none can be declared safe. However, recent
evidence suggests that some DMDs are less risky than others. Less risky DMDs in
pregnant women with MS include beta interferons (Avonex, Rebif, Betaseron) and
Glatiramer acetate. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">For prospective
fathers, beta interferon and Glatiramer acetate as DMD showed no risk to baby’s
health. Teriflunomide is detected in semen and it should be discontinued before
trying to conceive. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Steroids can be <b style="mso-bidi-font-weight: normal;">safely</b> used to treat MS relapses during
pregnancy. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">Will babies born to women with MS have a higher risk
of getting MS themselves?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Most cases of MS
are sporadic and most women with MS do not have a history of MS in their family
members. However, having a relative with MS does slightly increase the risk of
being diagnosed with MS. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">In UK, the
lifetime risk of being diagnosed with MS in general population in 1 in 330. The
risk increases to 1 in 48, if one of the first degree relatives has MS. If one
of the second-degree relatives has MS, the risk of being diagnosed with MS is 1
in 100. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;"><br /></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">an women with MS breastfeed?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Breastfeeding is
safe and can be continued as usual. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: magenta;">What impact does pregnancy have on the course of MS?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">There is limited
data on this topic. However, in one study, pregnancy and childbirth were
associated with lesser chances of developing severe disability. Women who gave
birth at any time (either before or after the onset of MS) were 34% less likely
to develop severe disability (as defined by need to use walking aid). </span><o:p></o:p></span></div>
<!--EndFragment--><br /><br />
(For more reading, Multiple sclerosis Trust, UK)<br />
<br />
<span style="color: #660000;"><b>Dr Sudhir Kumar MD DM</b></span><br />
<span style="color: #660000;"><b>Consultant Neurologist</b></span><br />
<span style="color: #660000;"><b>Apollo Hospitals, Hyderabad</b></span><br />
<span style="color: #660000;"><b>04023607777</b></span><br />
<span style="color: #660000;"><b>drsudhirkumar@yahoo.com</b></span><br />
<br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-18912254725719478142019-06-23T09:43:00.006+05:302019-06-23T09:43:53.210+05:30PSYCHOSIS (HALLUCINATIONS AND DELUSIONS) IN PARKINSON'S DISEASE<div dir="ltr" style="text-align: left;" trbidi="on">
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:303195210;
mso-list-type:hybrid;
mso-list-template-ids:1135524286 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l0:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1
{mso-list-id:667826974;
mso-list-type:hybrid;
mso-list-template-ids:606867170 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l1:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2
{mso-list-id:1789816243;
mso-list-type:hybrid;
mso-list-template-ids:592223854 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l2:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">HALLUCINATIONS IN
PARKINSON’S DISEASE</span><o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: #990000;">Main
symptoms of Parkinson’s disease</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="color: blue;">Parkinson’s disease (PD) is a slowly
progressive degenerative disease of brain. The major symptoms are tremors
(shivering), slowness of movements, stiffness and postural imbalance.<span style="mso-spacerun: yes;"> </span>These symptoms lead to motor disability and
interfere with walking, as well as with other activities of daily living.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: #990000;">Memory
impairment in Parkinson’s disease</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="color: blue;">The mental functions are usually normal in
patients with PD, however, 10% of patients can develop dementia (memory
impairment along with other cognitive dysfunction), especially in later stages
of illness. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: #990000;">What
are hallucinations?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="color: blue;">Other significant problem in people with PD
in later stages is hallucination. Hallucination is often visual. In this
condition, patient sees something, which is not there. For example, they may
see snakes or lizards in their room (which are not there), and get disturbed
with them. They may also see strangers in their house, which are supposedly
there to spy on them or harm them. These hallucinations are very upsetting for
the patient, making them anxious and depressed. Some patients also have sleep
disturbance due to hallucinations. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: #990000;">What
are the causes of hallucinations in patients with PD?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Adverse effects of anti-parkinsonian
medicines. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Infections such as urinary
tract infection or pneumonia,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Side effects of other
medications such as pain killers and sleeping pills,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Parkinson’s disease mimic such
as Diffuse Lewy body disease (DLBD). In DLBD, patients may have slowness and
rigidity (just like PD). However, they have prominent hallucinations and
dementia (unlike PD). Moreover, DLBD patients do not respond to levodopa
treatment. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: #990000;">Other
symptoms of psychosis in patients with PD</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Illusions,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Delusions especially paranoid<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Confusion,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Sleep disturbance<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="color: blue;">Delusion refers to a condition where a
patient believes in something, even when there is an evidence of the contrary. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: #990000;">How
common is psychosis in PD?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="color: blue;">About one third of patients with PD suffer
from psychosis. So, it is quite common.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: #990000;">How
do we manage psychosis in patients with PD?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="color: blue;">Management of psychosis can be done in a
stepwise fashion as outlined below:<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Underlying alternate causes
should be looked for and managed. This would include looking for infection and
offending drugs. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Comorbid psychiatric
conditions, such as anxiety and depression, if present, should be treated.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Minor symptoms such as vivid
dreams or minor hallucinations (which are non-disturbing in nature) do not
require any treatment.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Anti-parkinsonian drugs should
be reduced or stopped. First to eliminate are trihexiphenydyl, amantadine and
selegeline/rasagiline. If psychotic symptoms persist, then, the next drugs to
be reduced are dopamine agonists (ropinirole and pramipexole), entacapone and
levodopa. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">In people with cognitive
impairment, cholinesterase inhibitors such as rivastigmine or donepezil can be
used.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Anti-psychotic medication-
quetiapine is the most commonly used. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">The first and only FDA approved
drug for treating PD psychosis (hallucinations and delusions) is PIMAVANSERIN
(Nuplazid). The dose is 34 mg capsules once daily. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<span style="color: blue;"><span lang="EN-US"><br /></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<span lang="EN-US"><span style="color: #660000;"><b>DR SUDHIR KUMAR MD DM</b></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<span lang="EN-US"><span style="color: #660000;"><b>Consultant Neurologist</b></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<span lang="EN-US"><span style="color: #660000;"><b>Apollo Hospitals, Hyderabad</b></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<span lang="EN-US"><span style="color: #660000;"><b>04023607777</b></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<span lang="EN-US"><span style="color: #660000;"><b>drsudhirkumar@yahoo.com</b></span></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<span lang="EN-US"><span style="color: #660000;"><b>https://www.facebook.com/bestneurologist/</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<!--EndFragment--><br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-87313379995892555502019-02-05T17:28:00.001+05:302019-02-06T07:54:51.067+05:30MIGRAINE IN CHILDREN<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="color: red;">MIGRAINE IN CHILDREN</span><o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">What is migraine?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Migraine refers to a condition where the sufferer gets
repeated headaches.</span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">What are the other
symptoms of migraine?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">People may have nausea or vomiting associated with
headaches. They also do not like noise or light during the headache episodes. Some
children with migraine may not have headache and they may present with only
repeated abdominal pain. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Do children suffer
from migraine?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Yes, children do suffer from migraine. 10-25% of children
may suffer from migraines. Before puberty, migraine is more common in boys.
After puberty, it becomes more common in girls. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">What is the earliest
age when migraine can affect children?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Migraine has been reported in children as early as 18 months
old. About half of the children with migraine have their first attack before
the age of 12 years. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">What is the cause of
migraine in children?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">In most cases, there is a combination of genetic and
environmental factors. Children with one parent with migraine has 50% chance of
getting it, whereas children whose both parents have migraine have 75% chance
of getting migraine. Most children with migraine have at least one close family
member suffering from it.</span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></b></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">How does migraine
affect children’s quality of life?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Migraine in children can be as disabling as in adults.
Children with migraine miss school twice as often as compared to those without
migraine. They also suffer from anxiety, depression, and mood swings, and may
not be able to focus in studies. They may also not enjoy sports and other
recreational activities. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">How is the diagnosis
of migraine confirmed in children?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">In most cases, the patient’s history and clinical
examination are enough to make a diagnosis of migraine. However, in some cases,
a brain scan may be needed to exclude other causes. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">How is migraine
treated in children?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Migraine can be effectively treated in children with
medications. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">For acute severe headaches, helpful medicines include paracetamol,
ibuprofen and triptans (such as sumatriptan, zolmitriptan and rizatriptan).</span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">To prevent headache episodes in future (migraine
prophylaxis), propranolol, Flunarizine, topiramate or valproic acid may be
used. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><b>What measures can the children take to reduce the headache episodes?</b></span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">1. Sleep adequately,</span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">2. Eat food on time,</span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">3. Avoid stress,</span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">4. Certain triggers such as cakes, chocolates, Chinese food, too much TV/phone use, can be avoided/reduced. </span></div>
<div class="MsoNormal">
<span style="color: blue; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="color: #660000; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><b>DR SUDHIR KUMAR MD DM</b></span></div>
<div class="MsoNormal">
<span style="color: #660000; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><b>Senior Consultant Neurologist</b></span></div>
<div class="MsoNormal">
<span style="color: #660000; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><b>Apollo Hospitals, Hyderabad</b></span></div>
<div class="MsoNormal">
<span style="color: #660000; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><b>04023607777</b></span></div>
<div class="MsoNormal">
<span style="color: #660000; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><b>drsudhirkumar@yahoo.com</b></span></div>
<div class="MsoNormal">
<span style="color: #660000; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><b>https://www.facebook.com/bestneurologist</b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-1852144303958623312018-12-31T23:06:00.001+05:302018-12-31T23:06:09.259+05:30HEMIFACIAL SPASM<div dir="ltr" style="text-align: left;" trbidi="on">
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:34350105;
mso-list-type:hybrid;
mso-list-template-ids:-1670766272 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l0:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1
{mso-list-id:1626234591;
mso-list-type:hybrid;
mso-list-template-ids:-1383164604 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l1:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">HEMIFACIAL SPASM</span><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">What is hemifacial spasm?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Hemifacial spasm
(HFS) refers to sudden episodic involuntary contractions of muscles on one side
of the face. <o:p></o:p></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbzl4N3d1rI3t1V20_Vqjiv2g3vk51TCXumlkDit5fIzjpXyMy4zhREoSppZ_MqYBG_UlDLzYU-UJwzKfhcDUG1GX_xcsXRxh_4ytZhC_rnRsnGizWh-jjv_XlTygpXcaZiog-spelxFR8/s1600/HFS_BeforeSurgery_NoNerves_RGB.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1233" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbzl4N3d1rI3t1V20_Vqjiv2g3vk51TCXumlkDit5fIzjpXyMy4zhREoSppZ_MqYBG_UlDLzYU-UJwzKfhcDUG1GX_xcsXRxh_4ytZhC_rnRsnGizWh-jjv_XlTygpXcaZiog-spelxFR8/s320/HFS_BeforeSurgery_NoNerves_RGB.jpg" width="246" /></a></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;"> </span><span style="color: yellow; font-size: xx-small;">(Swedish)</span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">Who suffer from hemifacial spasm?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Hemifacial spasm
occurs in people all over the world. It occurs more commonly in people aged
40-60 years. It affects both men and women, however, slightly more common in
women.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;"><br /></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">What causes hemifacial spasm?<o:p></o:p></span></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">In most people, there is no
specific cause for hemifacial spasm, when it is referred to as idiopathic.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">In some people, there is
compression of facial nerve (that supplies facial muscles) by a blood vessel.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">In some others, the compression
could be due to tumors, aneurysms (abnormal balloon-like dilatation of the
vessel wall), etc.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Medical problems of brain such
as infarct (blood clot in brain) or multiple sclerosis can also cause HFS. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;"><br /></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">What investigations are
usually needed?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: blue;">A detailed clinical examination needs to be performed by
neurologist. This would confirm the diagnosis. The diagnosis is based on
clinical examination and no test is needed for that. However, MRI with MR
Angiogram brain is needed to exclude secondary causes (as listed in points 2-4
above). <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;"><br /></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">How is hemifacial spasm
treated?<o:p></o:p></span></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Botulinum toxin (botox) is the
treatment of choice. Botox injections are given in the affected muscles. The
benefit is seen within a few days and the effect may last upto 6 months.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Those who refuse botox or cannot
afford it can be treated with medications such as carbamazepine, clonazepam or
baclofen tablets.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Those who do not respond to
botox or medicines can be treated with microvascular decompression (MVD)
surgery. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;"><br /></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">Can there be a serious
complication due to hemifacial spasm?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: blue;">If all secondary causes have been excluded with MRI of brain, we do
not expect any serious complications. However, frequent closure of eyes can be
a hindrance for safe driving. Moreover, it may lead to awkward situations,
especially in front of people of opposite gender. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;"><br /></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">What is the long-term
outcome of hemifacial spasm?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: blue;">Both botox and MVD surgery are effective and safe treatments,
leading to excellent long-term outcome. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: blue;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: #cc0000;">DR SUDHIR KUMAR MD DM</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: #cc0000;">CONSULTANT NEUROLOGIST</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: #cc0000;">Apollo Hospitals, Hyderabad</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: #cc0000;">drsudhirkumar@yahoo.com</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: #cc0000;">https://www.facebook.com/bestneurologist/</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span lang="EN-US"><span style="color: #cc0000;">04023607777</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<!--EndFragment--><br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-18149705543524800582018-12-30T21:34:00.004+05:302019-01-17T18:19:12.046+05:30ACADEMIC MEETINGS, CONFERENCES, CME- DR SUDHIR KUMAR<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<span style="color: red;"><b>PARTICIPATION IN ACADEMIC MEETINGS, CONFERENCES, CMEs </b></span></div>
<div style="text-align: center;">
<span style="color: red;"><b><br /></b></span></div>
<div style="text-align: center;">
<b><span style="color: #cc0000;">Dr Sudhir Kumar MD DM</span></b></div>
<div style="text-align: center;">
<b><span style="color: #cc0000;">Consultant Neurologist</span></b></div>
<div style="text-align: center;">
<b><span style="color: #cc0000;">Apollo Hospitals, Hyderabad</span></b></div>
<div style="text-align: center;">
<b><span style="color: #cc0000;">drsudhirkumar@yahoo.com</span></b></div>
<br />
<span style="color: blue;">Participation in academic meetings is an important method of learning from experts and imparting knowledge to colleagues and peers. These meetings provide platforms to meet colleagues, learn and share from each other.</span><br />
<br />
<b>2019</b><br />
<b><br /></b>
<b><span style="color: red;">January 12th 2019: </span><span style="color: #660000;">CASE-BASED APPROACH TO VERTIGO MANAGEMENT</span></b><br />
<b><br /></b>
<b><span style="color: blue;">Panelist, along with guest speak Prof Michael Strupp (Germany)</span></b><br />
<b><br /></b>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3PGCWHWfyv6TcrAXIQgEflV-XHklfeJs9diol1dJQBwb2o5lSu67v-qN7SiSFLHJceEIdUbDUCoi8kJzqQ9blzwREL3BJO_sZpF-TySx7bT3kDwHDpNGRGbgL6Ly1F3F621jTaCxpPQz3/s1600/VERTIGO.JAN12.2019.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="742" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3PGCWHWfyv6TcrAXIQgEflV-XHklfeJs9diol1dJQBwb2o5lSu67v-qN7SiSFLHJceEIdUbDUCoi8kJzqQ9blzwREL3BJO_sZpF-TySx7bT3kDwHDpNGRGbgL6Ly1F3F621jTaCxpPQz3/s320/VERTIGO.JAN12.2019.jpg" width="185" /></a></div>
<b><br /></b>
<b><span style="color: red;">January 16th, 2019:</span> <span style="color: #660000;">Brighter outcomes; Advancing epilepsy management</span> (Guest speaker: Prof Pavel Klein, Washington DC)</b><br />
<b><br /></b>
<b>Moderator for a panel discussion on "Balancing seizure control with better quality of life" </b><br />
<b><br /></b>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaf4XNzBSnlzZm5K7Z1y4py7Ni7FmiL-YGklrnK6SGNoJV9XY_fh6a8U0jmjzkc53UdyIgb8Um-FwSexbpXB9ZGLc7Y8roc4juzTomSyoVoewKeurdbTVdiXbqRFDMVdaPPRtWfSr9WDhg/s1600/Epilepsy.Jan17.2019.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="810" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaf4XNzBSnlzZm5K7Z1y4py7Ni7FmiL-YGklrnK6SGNoJV9XY_fh6a8U0jmjzkc53UdyIgb8Um-FwSexbpXB9ZGLc7Y8roc4juzTomSyoVoewKeurdbTVdiXbqRFDMVdaPPRtWfSr9WDhg/s1600/Epilepsy.Jan17.2019.jpg" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpxaahU9RyQq_YBZlStY01Ix8Tn3X5mYNQnSD6Hu1QIj34Mmp7itWpWMUfCqkkHXEHRXQN_Vym0GRrVp6zlnV39cKWitLyR8ekgN9UuFs1-6cifI8I-8_WTGqHVCe0VdSmJ6X8NGeIdHQ4/s1600/Epilepsy.Jan17.2019.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="810" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpxaahU9RyQq_YBZlStY01Ix8Tn3X5mYNQnSD6Hu1QIj34Mmp7itWpWMUfCqkkHXEHRXQN_Vym0GRrVp6zlnV39cKWitLyR8ekgN9UuFs1-6cifI8I-8_WTGqHVCe0VdSmJ6X8NGeIdHQ4/s320/Epilepsy.Jan17.2019.jpg" width="240" /></a></div>
<b><br /></b>
<b><br /></b>
<b>2018</b><br />
<br />
<b><span style="color: red;">1. Obstetric Medicine update 2018 </span></b>(Hyderabad): <span style="color: blue;">Delivered a lecture "When stroke strikes pregnancy"</span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_nwgBGqQOC0lwfG0-KJMPVxjtmoZTpF6FvDZy4z0NxRb58qAyE7sD3i-xhpaW3sn-wpSM4XBi04qyn5K408Yk6k1WhszApkl_ijWR9S0vosCJEPRpu7A4hXGb2QnWxt9GkWgJoHQaGqlr/s1600/48359389_1698200353628512_8893769520640950272_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_nwgBGqQOC0lwfG0-KJMPVxjtmoZTpF6FvDZy4z0NxRb58qAyE7sD3i-xhpaW3sn-wpSM4XBi04qyn5K408Yk6k1WhszApkl_ijWR9S0vosCJEPRpu7A4hXGb2QnWxt9GkWgJoHQaGqlr/s320/48359389_1698200353628512_8893769520640950272_o.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGwTYI236ldBUry9T72bw5HZeWkCNjESBfQvqWS5njbBM3_hOykeYFpP-H-gQ5ub1l0PG2r0fLWu0orKDpMdZREUDZaSKXipEHYXXmZAC2ABJsS9lwPY95OWXo5YUfuEMExSEgMTknYmlq/s1600/48357179_1698199853628562_2629001704388952064_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGwTYI236ldBUry9T72bw5HZeWkCNjESBfQvqWS5njbBM3_hOykeYFpP-H-gQ5ub1l0PG2r0fLWu0orKDpMdZREUDZaSKXipEHYXXmZAC2ABJsS9lwPY95OWXo5YUfuEMExSEgMTknYmlq/s320/48357179_1698199853628562_2629001704388952064_o.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6sFv7IbWCN6BvuTixtd9epHfvsGnl9dQsHwdzCBCLlJgH_xi1aFLKGqqQk2Bk6DsydfeQuLAtcWVW9BC0uUjkP7YRyTN-Mjbe5mmaLOeNv08b1SA40kKEDBVrkTI6Qd9OqPmQ-4-7s-D_/s1600/47143892_1683250861790128_5683659612981559296_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="1080" height="189" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6sFv7IbWCN6BvuTixtd9epHfvsGnl9dQsHwdzCBCLlJgH_xi1aFLKGqqQk2Bk6DsydfeQuLAtcWVW9BC0uUjkP7YRyTN-Mjbe5mmaLOeNv08b1SA40kKEDBVrkTI6Qd9OqPmQ-4-7s-D_/s320/47143892_1683250861790128_5683659612981559296_o.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmXICdrqBbe97l5p2Ep9DpSEqFnfuWzmdSXogdeG1HbEIUNW6VkEG6ck1NFBWuYHyDNRxOxLJ_pFswd1ge0NCxT2FEDn59U6rfO_7z2h7KzQL3AwiGkL8o9q9z-hi1UaY0ERZsG6J3ja-F/s1600/47320961_1683250505123497_1113323061483929600_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1393" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmXICdrqBbe97l5p2Ep9DpSEqFnfuWzmdSXogdeG1HbEIUNW6VkEG6ck1NFBWuYHyDNRxOxLJ_pFswd1ge0NCxT2FEDn59U6rfO_7z2h7KzQL3AwiGkL8o9q9z-hi1UaY0ERZsG6J3ja-F/s320/47320961_1683250505123497_1113323061483929600_o.jpg" width="278" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBh8dCRhDnUgcKErfyYsVMRCX2Bg-YzsGlWUa5jAzG7QooKwpvCVG_nuv3rlWnq2kD926PuMivVy1oau_Pcf2zptJKEokGMjnTEENzIWtowc4gL-_t-EbMFbJYTb0N33fxewrelTnFyLdj/s1600/47378499_1683250611790153_8533707255277682688_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="993" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBh8dCRhDnUgcKErfyYsVMRCX2Bg-YzsGlWUa5jAzG7QooKwpvCVG_nuv3rlWnq2kD926PuMivVy1oau_Pcf2zptJKEokGMjnTEENzIWtowc4gL-_t-EbMFbJYTb0N33fxewrelTnFyLdj/s320/47378499_1683250611790153_8533707255277682688_o.jpg" width="198" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwr6EXPlYDkctgd829ec_9Urn_4bp8iL4ewmmzdUXUVd1n9HxRg2o3dfuBYE9qHmhWREWa2z5hBBq4fXLHtOJ-f9dOfJwLZckcgJvZaM34QgNocpR8Vr55DLuxu-zFN0eiPRFa2eY4M_Nt/s1600/47386520_1683250765123471_2924361760611762176_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="934" data-original-width="1600" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwr6EXPlYDkctgd829ec_9Urn_4bp8iL4ewmmzdUXUVd1n9HxRg2o3dfuBYE9qHmhWREWa2z5hBBq4fXLHtOJ-f9dOfJwLZckcgJvZaM34QgNocpR8Vr55DLuxu-zFN0eiPRFa2eY4M_Nt/s320/47386520_1683250765123471_2924361760611762176_o.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<br />
2. <b><span style="color: red;">Neuro Critical Care Update 2018</span></b> (Hyderabad): <span style="color: blue;">Organised the second Neuro critical Care update 2018 on 16th December 2018 at Apollo Hospitals, Hyderabad. There were ten lectures taken by experts and it was attended by about 70 doctors. I spoke on the topic "Current management of cerebral venous sinus thrombosis)". </span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6x5Vr5mEKWioKj8IFj_NUwg4ipiniVWcC8NcVU3j7XZQ7fWOA-rqVGA5gPqFKmKHxls6yy8pTVtQLEzNp1fsesm1K1eXx_t3pFPAkHcSFYYzt7IcoVwKUVd4b4gNPkwwsAzYy767xiVv9/s1600/48363723_10157928370790410_2969903893011496960_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="978" data-original-width="1600" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6x5Vr5mEKWioKj8IFj_NUwg4ipiniVWcC8NcVU3j7XZQ7fWOA-rqVGA5gPqFKmKHxls6yy8pTVtQLEzNp1fsesm1K1eXx_t3pFPAkHcSFYYzt7IcoVwKUVd4b4gNPkwwsAzYy767xiVv9/s320/48363723_10157928370790410_2969903893011496960_o.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJIHYdSpeqmoirr61LBtzhWC2CSSCRkKyeQI_8Z_An0usKCiaFS9vkVHkp3kVW35NsgNGy7qda3wJN3RWh3a0WMx5knvzeCzIfrk29W4wlihuO5arEyOWgDmiaiqJao0ZIUPOeJfq3vif-/s1600/48415882_10157928371370410_3000342790094716928_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1140" data-original-width="1600" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJIHYdSpeqmoirr61LBtzhWC2CSSCRkKyeQI_8Z_An0usKCiaFS9vkVHkp3kVW35NsgNGy7qda3wJN3RWh3a0WMx5knvzeCzIfrk29W4wlihuO5arEyOWgDmiaiqJao0ZIUPOeJfq3vif-/s320/48415882_10157928371370410_3000342790094716928_o.jpg" width="320" /></a></div>
<br />
3. <span style="color: red;"><b>EPILEPSY EXPERT GROUP MEETING </b></span>(13th December 2018, Hyderabad). <span style="color: blue;">In this meeting, I spoke on the topic "Zonisamide as a monotherapy in partial onset seizures."</span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB-B0NQp0-THuvnWb4iYbmAWJ0CRsrKcF_-xXCP020MVVLymtMUOTls9Z_SH2nS3NN08mP8oU5E3s2jPtzFLQcl3DW8OG-Fg45CxKWFEwQ6jtoyYo0h3egFRep8a1WWu3AAd7B3O-wra50/s1600/48355056_10157920488200410_8774776425208086528_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="710" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB-B0NQp0-THuvnWb4iYbmAWJ0CRsrKcF_-xXCP020MVVLymtMUOTls9Z_SH2nS3NN08mP8oU5E3s2jPtzFLQcl3DW8OG-Fg45CxKWFEwQ6jtoyYo0h3egFRep8a1WWu3AAd7B3O-wra50/s320/48355056_10157920488200410_8774776425208086528_n.jpg" width="236" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEW4wFYB2kR3qoVaWhUxKudHqzvr-sE08cha4XJBrX2PhnUC2DY3KERARz6TNo6nUL9OSG1yj7dh6q9IFP6nSdrvNLtlZ7ah5IdEoGyN6IlhGBUILT8UZP1hGCyF6c03LmF0AQ1d8L3TAI/s1600/48213542_10157920467390410_5221816367983886336_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEW4wFYB2kR3qoVaWhUxKudHqzvr-sE08cha4XJBrX2PhnUC2DY3KERARz6TNo6nUL9OSG1yj7dh6q9IFP6nSdrvNLtlZ7ah5IdEoGyN6IlhGBUILT8UZP1hGCyF6c03LmF0AQ1d8L3TAI/s320/48213542_10157920467390410_5221816367983886336_n.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLT9wwW-AzPxopl6chI4eKUW2Mu_gC_PsuEKHeulzYrvqv2aQkC-K6Pbn2NYQaI6pFDZL4GkV_hRh6WkDAVSnWZ2GS1hJQKb7eRx3V_dft0C5GS1pdZeG3mcbD295EkDMk03WMKO5PtzV5/s1600/48362549_10157920467160410_8254299729794433024_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="720" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLT9wwW-AzPxopl6chI4eKUW2Mu_gC_PsuEKHeulzYrvqv2aQkC-K6Pbn2NYQaI6pFDZL4GkV_hRh6WkDAVSnWZ2GS1hJQKb7eRx3V_dft0C5GS1pdZeG3mcbD295EkDMk03WMKO5PtzV5/s320/48362549_10157920467160410_8254299729794433024_n.jpg" width="240" /></a></div>
<br />
4. <span style="color: red;"><b>STROKE ACADEMY MASTERCLASS</b></span> (8th-9th December, 2018, Mumbai)<br />
<br />
I<span style="color: blue;"> was a faculty in this meeting, where I spoke on the topic "Quality monitoring in stroke care".</span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqmWHzqapSPRPV1B-dvVgU1z737hV3EOySpr8aXxkRbJIOAN7CVaDYK-X1uWODRWUDIii5qFk5g2_qnyYYn9-ZU83O_dCQedrO2Dk14nT6qdxLftSMhYWR7JKJWjyhBFrGWFzTGeSAAUts/s1600/48088886_10157908055735410_4756836263556808704_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1153" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqmWHzqapSPRPV1B-dvVgU1z737hV3EOySpr8aXxkRbJIOAN7CVaDYK-X1uWODRWUDIii5qFk5g2_qnyYYn9-ZU83O_dCQedrO2Dk14nT6qdxLftSMhYWR7JKJWjyhBFrGWFzTGeSAAUts/s320/48088886_10157908055735410_4756836263556808704_o.jpg" width="230" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinBC07lce-bj6o3ax3EWJRf9rGU9F4fVTB5PEcg7Q8zUeCAfcRMmnbUL-3V_jCP1xdLaVjCosfilOcVbUgRghgkca-WS35Wl5GUD3RRf0zHtUJAcfQhqVhrl0VSI_aftf5rQtphMQt_BHS/s1600/47682684_10157908058765410_7723625867192041472_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1138" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinBC07lce-bj6o3ax3EWJRf9rGU9F4fVTB5PEcg7Q8zUeCAfcRMmnbUL-3V_jCP1xdLaVjCosfilOcVbUgRghgkca-WS35Wl5GUD3RRf0zHtUJAcfQhqVhrl0VSI_aftf5rQtphMQt_BHS/s320/47682684_10157908058765410_7723625867192041472_o.jpg" width="227" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji__oJv6L6IpPOXB1lcOddHTKx93AAbGTeEp3Knt2odCS7HSRsl-26dVmrYfs_Pa714GeM_nL86ag6K7ktkswsADcoC6pOQQckaakr8kwmBiPzcXd8tqUGeh1liprPt5hKDg3iNMZz-Gpk/s1600/47687987_10157908051425410_6107762035456475136_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="574" data-original-width="960" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji__oJv6L6IpPOXB1lcOddHTKx93AAbGTeEp3Knt2odCS7HSRsl-26dVmrYfs_Pa714GeM_nL86ag6K7ktkswsADcoC6pOQQckaakr8kwmBiPzcXd8tqUGeh1liprPt5hKDg3iNMZz-Gpk/s320/47687987_10157908051425410_6107762035456475136_n.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCR75O9ef7jjeWlN11UBP7iZ3bbNuUIOeC4EFBa8_XQPGOtKt6ovK65hoavC6usZoAy2s9Z2NMunvL2fv4l8x8jey-WMq1m0d83h8cU1SemMgW-MM6T52GyvbMvQMZuSXlO2ReMuCySBc-/s1600/48225603_10157908051235410_6779917957649661952_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="616" data-original-width="490" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCR75O9ef7jjeWlN11UBP7iZ3bbNuUIOeC4EFBa8_XQPGOtKt6ovK65hoavC6usZoAy2s9Z2NMunvL2fv4l8x8jey-WMq1m0d83h8cU1SemMgW-MM6T52GyvbMvQMZuSXlO2ReMuCySBc-/s320/48225603_10157908051235410_6779917957649661952_n.jpg" width="254" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgI1H10Sy_-bb8lC8UnIh-nz1O38BgfnnN3uQYben7rRqQ2jlWXeofb9A9jY4_a9Ffkp3PqYXRD4pGPlhc4xSdi8xs-hw4b9R5aaBHqrLUYlgGnWM9wadswOongnGnDUbIDPLcrOrR3Fl-L/s1600/47688043_10157908051125410_391809422369751040_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="720" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgI1H10Sy_-bb8lC8UnIh-nz1O38BgfnnN3uQYben7rRqQ2jlWXeofb9A9jY4_a9Ffkp3PqYXRD4pGPlhc4xSdi8xs-hw4b9R5aaBHqrLUYlgGnWM9wadswOongnGnDUbIDPLcrOrR3Fl-L/s320/47688043_10157908051125410_391809422369751040_n.jpg" width="240" /></a></div>
<br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-20330759492681960772018-12-30T19:31:00.002+05:302020-01-04T11:54:53.459+05:30PUBLICATIONS IN PEER-REVIEWED JOURNALS-DR SUDHIR KUMAR<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<b><span style="color: red;">PUBLICATIONS IN PEER-REVIEWED JOURNALS</span></b></div>
<div style="text-align: center;">
<b><span style="color: red;"><br /></span></b></div>
<div style="text-align: center;">
<b><span style="color: #660000;">Dr SUDHIR KUMAR MD DM</span></b></div>
<div style="text-align: center;">
<b><span style="color: #660000;">Consultant Neurologist</span></b></div>
<div style="text-align: center;">
<b><span style="color: #660000;">Apollo Hospitals, Hyderabad</span></b></div>
<div style="text-align: center;">
<b><span style="color: #660000;">drsudhrikumar@yahoo.com</span></b></div>
<br />
<span style="color: blue; font-size: large;">Publications are an important means of disseminating knowledge. Many scientific journals are available online, making the access easier. In the initial part of my career, I was not keen on publishing, as I thought, the main duty of a doctor is to treat sick patients. As I was a faculty in a teaching college (CMC Vellore) during 2001-2004, teaching postgraduates was an added responsibility, leaving less time for writing and publishing. However, Prof mathew Alexander, my teacher in Neurology at CMC Vellore, stressed on the importance of publishing. This resulted in multiple publications in peer-reviewed journals. These are listed below:</span><br />
<span style="font-size: large;"><br /></span>
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:3 0 0 0 1 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
text-decoration:underline;
text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-noshow:yes;
mso-style-priority:99;
color:purple;
mso-themecolor:followedhyperlink;
text-decoration:underline;
text-underline:single;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2001<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">1. V
Markandeyulu, T P Joseph, T Solomon, J Jacob, <u>S Kumar</u>, C
Gnanamuthu. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.pubmedcentral\.nih\.gov\/picrender\.fcgi?artid=1281530&amp\;">Stiff-man
syndrome in childhood.</span> <i>J R Soc Med. </i>2001; 94:
296-7.<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2003<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/aug2003\/aug-801-802\.htm\0022 \\t \0022_blank\0022 ";">Adverse
effects due to poor patient understanding of the antiepileptic medication
prescriptions.</span> <i>Indian Pediatr </i>2003; 40: 801-2<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">3. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/nov2003\/nov-1111\.htm\0022 \\t \0022_blank\0022 ";">Inappropriate
prescription of corticosteroids in respiratory infections.</span> <i>Indian
Pediatr </i>2003; 40:1111.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">4. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/qjmed\.oxfordjournals\.org\/cgi\/reprint\/96\/9\/688\.pdf\0022 \\t \0022_blank\0022 ";">Overdiagnosis
of cerebral malaria in patients admitted with neurological dysfunction.</span> <i>Q
J Med </i>2003; 96: 688.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">5. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jrsm\.org\/cgi\/reprint\/96\/8\/422-a\.pdf\0022 \\t \0022_blank\0022 ";">Medically
unexplained symptoms.</span> <i>J R Soc Med </i>2003; 96: 422.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">6. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.pubmedcentral\.nih\.gov\/picrender\.fcgi?artid=1126806&amp\;">Representation
of South Asian people in randomised trials: study results are interesting but
not final word.</span> <i>Br Med J</i>. 2003; 327: 394. </span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">7. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/qjmed\.oxfordjournals\.org\/cgi\/reprint\/96\/10\/778\.pdf\0022 \\t \0022_blank\0022 ";">Management
of shock in children with severe P. falciparum malaria.</span> <i>Q J Med</i>2003; 96:
778.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">8. <u>Kumar S</u>, Alexander
M, Markandeyulu V, Gnanamuthu C. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni514560_074310\.pdf\0022 \\t \0022_blank\0022 ";">Guillain-Barre
syndrome presenting in the anti-HIV seroconversion period.</span> <i>Neurol
India </i>2003; 51: 559.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">9. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.nmji\.in\/archives\/volume%2016-4July%20August%202003\/16-4%20final%20pdf\/correspondence\/correspondence\.pdf\0022 \\t \0022_blank\0022 ";">Nimesulide:
How safe is it?</span> <i>Natl Med J India </i>2003; 16: 233-4.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">10. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni512285_075622\.pdf\0022 \\t \0022_blank\0022 ";"><span style="mso-bidi-font-weight: bold;">Predicting long-term morbidity in Indian
patients with ischemic stroke</span>.</span> <i>Neurol India</i>. 2003;
51:285-6. </span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">11. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni514554_071141\.pdf\0022 \\t \0022_blank\0022 ";">Steroid-induced
myopathy following a single oral dose of prednisolone.</span> <i>Neurol
India.</i> 2003; 51: 554-6.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">12. Sudhir
Kumar. </span><span lang="EN-US"><a href="http://bjp.rcpsych.org/cgi/reprint/183/4/365.pdf"><span lang="EN-US" style="font-family: "times new roman"; text-decoration: none;"><span lang="EN-US">Prophylaxis of
depression in older people</span></span></a><a href="http://bjp.rcpsych.org/cgi/reprint/183/4/365.pdf"><span lang="EN-US" style="font-family: "times new roman"; text-decoration: none;"><span lang="EN-US">.</span></span></a></span><span style="font-family: "times new roman";"> <i>Br J Psychiatry.</i> 2003;
183:365.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">13. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni512283_075823\.pdf\0022 \\t \0022_blank\0022 ";">Management
of ocular myasthenia gravis coexisting with thyroid ophthalmopathy.</span> <i>Neurol
India. </i>2003; 51:283-4.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">14. Sudhir
Kumar. Distal asymmetric spinal muscular atrophy involving upper
limbs. <i>Indian Pediatr</i>2003; 40:1211-2<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">15. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.pubmedcentral\.nih\.gov\/picrender\.fcgi?artid=259197&amp\;">Health
of indigenous people- health of aboriginal communities can be improved by
innovative methods.</span> <i>Br Med J. </i>2003; 327: 988<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">16. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.nmji\.in\/archives\/volume%2016-4July%20August%202003\/16-4%20final%20pdf\/correspondence\/correspondence\.pdf\0022 \\t \0022_blank\0022 ";">Differentiating
traumatic neuritis from poliomyelitis.</span> <i>Natl Med J India.</i> 2003;
16: 232-3.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">17. </span><span style="font-family: "times new roman";">Sudhir Kumar. Anticonvulsant-hypersensitivity syndrome
in a child. <i>Neurol India. </i>2003; 51: 427</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">18. Sudhir
Kumar. Prognosis in children with head injury: Inaccuracies in the
analysis. <i>Neurol </i>India 2003; 51: 427-8.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">19. </span><span style="font-family: "times new roman";">Sudhir Kumar. Delayed diagnosis of myasthenia
gravis due to prior empirical therapy with corticosteroids. <i>Annals of
Indian Academy of Neurology</i> 2003; 6:171-2.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">20. <u>S Kumar</u>,
Hannah V, M Alexander, C Gnanamuthu. <span style="mso-bidi-font-weight: bold;">Rapidly progressive dementia as a presenting feature of acute
disseminated encephalomyelitis (ADEM). </span><i>Annals of Indian Academy
of Neurology </i>2003; 6:167-70.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">21. Sudhir
Kumar. Mechanical ventilation in Guillain-Barre syndrome. <i>Neurol
India. </i>2003; 51:559-60.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">22. Sudhir
Kumar. Factors affecting functional recovery in ischemic stroke.<i> Neurol
India </i>2003; 51:561.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2004<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">23. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni521122_075323\.pdf\0022 \\t \0022_blank\0022 ";">Recurrent
seizures: An unusual manifestation of vitamin B12 deficiency.</span> <i>Neurol
India</i> 2004; 52:122-3.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">24. Sudhir
Kumar. </span><span lang="EN-US"><a href="http://www.indianpediatrics.net/feb2004/201.pdf"><span lang="EN-US" style="font-family: "times new roman"; text-decoration: none;"><span lang="EN-US">O</span></span></a><a href="http://www.indianpediatrics.net/feb2004/201.pdf"><span lang="EN-US" style="font-family: "times new roman"; text-decoration: none;"><span lang="EN-US">verweight and
obesity in children.</span></span></a></span><span style="font-family: "times new roman";"> </span><i><span style="font-family: "times new roman";">Indian Pediatr</span></i><span style="font-family: "times new roman";"> 2004; 41:200.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">25. Sudhir
Kumar. Missed and delayed diagnosis of neonatal meningitis. <i>Indian
Pediatr</i> 2004; 41:959</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">26. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni524507_070803\.pdf\0022 \\t \0022_blank\0022 ";"><span style="mso-bidi-font-weight: bold;">Vitamin B12 deficiency presenting with an
acute reversible extrapyramidal syndrome</span>.</span> <i>Neurol India.</i> 2004;
52:507-9.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">27. Sudhir
Kumar. Improving clinical course in congenital hypomyelinating
neuropathy. <i>Indian Pediatr</i> 2004; 41:1171.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">28. Sudhir
Kumar. <span style="mso-bidi-font-weight: bold;">Artemether in children with
severe malaria.</span> <i>Indian Pediatr</i> 2004; 41:520-1.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">29. Sudhir
Kumar. Unusual cause of recurrent flaccid paralysis in a child. <i>Neurol
India.</i> 2004; 52:126.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">30. Sudhir
Kumar. Clinical characteristics of organophosphate-induced delayed
polyneuropathy.<i>Neurol India. </i>2004; 52:128-9.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">31. Sudhir
Kumar. <span style="mso-bidi-font-weight: bold;">Nadroparin in acute
ischemic stroke.</span><i> Neurol India. </i>2004; 52:273-4.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">32. <u>Kumar S</u>,
Alexander M, Joseph M, Gnanamuthu C. <span style="mso-bidi-font-weight: bold;">Symmetrical peripheral gangrene: association with adrenaline
administration.</span> <i>Critical Care Asia </i>2004;2(1):19-21<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">33. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jrsm\.org\/cgi\/reprint\/97\/2\/98\.pdf\0022 \\t \0022_blank\0022 ";">Conversion
disorder in childhood.</span> <i>J R Soc Med. </i>2004; 97:98</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">34. <u>S Kumar</u>,
M. Alexander, C. Gnanamuthu. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni524494_065043\.pdf\0022 \\t \0022_blank\0022 ";">Recent
experience with Rett Syndrome at a tertiary care center.</span> <i>Neurol
India </i>2004; 52:494-5.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">35. <u>S Kumar</u>,
N. Kesavalu, E. Chandy. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni524523_064138\.pdf\0022 \\t \0022_blank\0022 ";">Periodic
lateralized epileptiform discharges in a child with solitary cysticercus
granuloma.</span><i> Neurol India</i> 2004; 52:523-4.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">36. S Kumar, M.
Alexander, C. Gnanamuthu. Refractory status epilepticus due to cerebral
venous thrombosis during late pregnancy with successful outcome. <i>Annals
of Indian Academy of Neurology.</i>2004; 7:305-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">37. Sudhir
Kumar. A trial of antiparasitic treatment for cerebral cysticercosis.<i>N
Engl J Med </i>2004; 350:1686.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">38. Sudhir
Kumar. <span style="mso-bidi-font-weight: bold;">Epidemiological study of
neurological disorders. </span><i>J Indian Med Assoc.</i> 2004;
74:108.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">39. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jrsm\.org\/cgi\/reprint\/97\/4\/208\.pdf\0022 \\t \0022_blank\0022 ";">When
to start drug therapy in epilepsy.</span> <i>J R Soc Med. </i>2004;
97:208.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">40. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.nmji\.in\/archives\/Volume%2017-1JanuaryFebruary%202004\/17-1%20final%20pdf\/Selected%20Summaries\/SS2\.pdf\0022 \\t \0022_blank\0022 ";">Withdrawal
of ventilatory support in the intensive care unit.</span> <i>Natl Med
J India </i>2004; 17:28-9.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">41. Sudhir
Kumar. Acute reversible mania as a presenting feature of vitamin B12
deficiency. <i>Annals of Indian Academy of Neurology. </i>2004;
7:309-11.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">42. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jrsm\.org\/cgi\/reprint\/97\/7\/332\.pdf\0022 \\t \0022_blank\0022 ";"><span style="mso-bidi-font-weight: bold;">Epilepsia partialis continua stopped by
insulin.</span> </span><i>J R Soc Med </i>2004; 97:332-3.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">43. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/oct2004\/1050\.pdf\0022 \\t \0022_blank\0022 ";">Psychogenic
non-epileptic seizures.</span> <i>Indian Pediatr </i>2004; 41:1050-2.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">44. Sudhir
Kumar. Paradoxical worsening of neurological status after starting
d-penicillamine therapy in a patient with Wilson's disease. <i>Annals of
Indian Academy of Neurology</i> 2004; 7:401-402.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">45. </span><span style="font-family: "times new roman";">Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.nmji\.in\/archives\/Volume%2017-1JanuaryFebruary%202004\/17-1%20final%20pdf\/correspondences\/CR\.pdf\0022 \\t \0022_blank\0022 ";">Why
do doctors make errors?</span> <i>Natl Med J India </i>2004;
17(1):53-4.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">46. Sudhir
Kumar. Calvarial thickening and cerebellar atrophy following chronic
phenytoin usage.<i>Annals of Indian Academy of Neurology</i> 2004; 7:403.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">47. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jpgmonline\.com\/temp\/jpgm503216_060450\.pdf\0022 \\t \0022_blank\0022 ";">A
patient's opinion is often valuable.</span> <i>J Postgrad Med</i> 2004;
50:216.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">48. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni523307_011148\.pdf\0022 \\t \0022_blank\0022 ";">Memantine:Pharmacological
properties and clinical uses.</span> <i>Neurol India</i>2004:52:307-9.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">49. <u>Kumar S</u>,
Kumar PR. <span style="mso-bidi-font-weight: bold;">Mimetic facial
paresis. </span><i>Annals of Indian Academy of Neurology.</i> 2004;
7:405.</span><span lang="EN-US" style="font-family: "times new roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">50. </span><u><span style="font-family: "times new roman";">Kumar S</span></u><span style="font-family: "times new roman";">, Kumar PR. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jpgmonline\.com\/temp\/jpgm503204_011041\.pdf\0022 \\t \0022_blank\0022 ";">Skin
branding.</span> <i>J Postgrad Med</i> 2004; 50:204.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span style="font-family: "times new roman";">51. </span><u><span lang="EN-US" style="font-family: "times new roman";">S Kumar</span></u><span lang="EN-US" style="font-family: "times new roman";">, M
Alexander, C Gnanamuthu. Manual (low-volume) plasmapheresis: an effective
and safe therapeutic procedure in acute neurological illnesses. Annals of
Indian Academy of Neurology 2004; 7:439-40.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">52. Sudhir Kumar. Bisphosphonate
therapy for polyostotic fibrous dysplasia. Indian Pediatr. 2004;
41:1069-70.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">53. <u>S Kumar</u>, M Alexander, C
Gnanamuthu. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni524518_010707\.pdf\0022 \\t \0022_blank\0022 ";">Heterogeneity
in clinical presentation of acute disseminated encephalomyelitis.</span> Neurol
India. 2004;52:518-9.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">54. <u>S Kumar</u>, S Aaron. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni524517_010355\.pdf\0022 \\t \0022_blank\0022 ";">Internuclear
ophthalmoplegia as the sole presenting symptom of inflammatory demyelinating
lesion of the brainstem.</span> Neurol India 2004; 52:517-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">55. Sudhir Kumar. Rheumatological
manifestations of leprosy. Indian Journal of Dermatology, Venereology
and Leprology. 2004; 70:250.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">56. Sudhir Kumar. Dermatological
findings in chronic alcoholics. Indian Journal of Dermatology, Venereology
and Leprology. 2004; 70:317.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">57. <u>S Kumar</u>,
Rashmi. Psychosomatic illness among patients attending medical outpatient
department. J Indian Med Assoc. 2004; 102:330-1.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">58. <u>S Kumar</u>, S Nair, M
Alexander. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jpgmonline\.com\/temp\/jpgm504311_004808\.pdf\0022 \\t \0022_blank\0022 ";">Carcinomatous
meningitis occurring prior to the diagnosis of large cell neuroendocrine
carcinoma of the uterine cervix.</span> J Postgrad
Med. 2004;50:311-2.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">59. <u>S Kumar</u>, P Ravi Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.ijdvl\.com\/temp\/ijdvl706361_004636\.pdf\0022 \\t \0022_blank\0022 ";">Multi-segmental
Neurofibromatosis.</span> Indian J Dermatol Venereol Leprol2004; 70:360-2.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">60. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni522270_004521\.pdf\0022 \\t \0022_blank\0022 ";">Differentiating
paralytic rabies from post antirabies vaccine polyradiculoneuropathy. </span>Neurol
India 2004; 52:270.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">61. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.nmji\.in\/archives\/volume%2017-4%20julyaugust%202004\/selected_summaries\/Oral_glucose_tolerance\.pdf\0022 \\t \0022_blank\0022 ";">Oral
glucose tolerance test in patients with unexplained peripheral neuropathy.</span> Natl
Med J India 2004; 17:206.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">62. Sudhir Kumar. Nimodipine in
severe head injury. Neurol India 2004;52:392-3<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">63. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.nmji\.in\/archives\/volume_17_5_September_october\/Correspondence\/correspondence\.pdf\0022 \\t \0022_blank\0022 ";">Communications
skills: is there a need for training?</span> Natl Med J India 2004;
17:280-1.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">64. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/bjp\.rcpsych\.org\/cgi\/reprint\/185\/5\/437\.pdf\0022 \\t \0022_blank\0022 ";">Pituitary in psychosis.</span> Br
J Psychiatry 2004; 185:437-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">65. <u>Kumar S</u>, Jacob J. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni524436_002646\.pdf\0022 \\t \0022_blank\0022 ";">Variability
in the extent of sensory deficit after sural nerve biopsy.</span> Neurol
India 2004; 52:436-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">66. Kumar S. An uncommon cause of
shoulder pain in acute ischaemic stroke. J Indian Med Assoc 2004;
102:594-6.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2005<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">67. </span><span style="font-family: "times new roman";">Singh S, <u>Kumar S</u>, Joseph
M, Gnanamuthu C, Alexander M. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.blackwell-synergy\.com\/doi\/abs\/10\.1111\/j\.1440-1673\.2005\.01348\.x?journalCode=ara\0022 \\t \0022_blank\0022 ";">Cerebral
venous sinus thrombosis presenting as subdural haematoma.</span> <i>Australasian
Radiology</i> 2005;49:101-3.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">68. Sudhir
Kumar. Factors leading to underdiagnosis or under-reporting of AIDS. <i>Trop
doct. </i>2005; 35:124.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">69. <u>S Kumar</u>,
J Vijayan, J Jacob, S Aaron, M Joseph, M Alexander, C Gnanamuthu. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.ingentaconnect\.com\/content\/rsm\/td\/2005\/00000035\/00000004\/art00003\0022 \\t \0022_blank\0022 ";">Cervical
spine injuries in 64 attempted suicidal hangings in India.</span> <i>Trop
Doct </i>2005;35:198-200.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">70. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/feb2005\/182\.pdf\0022 \\t \0022_blank\0022 ";">Factors
precipitating breakthrough seizures in well-controlled epilepsy.</span> <i>Indian
Pediatr </i>2005; 42:182-3.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">71. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.jpgmonline\.com\/temp\/jpgm51175_010904\.pdf\0022 \\t \0022_blank\0022 ";">Severe
autonomic dysfunction as a presenting feature of Wilson's disease.</span> <i>J
Postgrad Med </i>2005; 51:75-6.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">72. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/may2005\/492\.pdf\0022 \\t \0022_blank\0022 ";">Wilson's
disease presenting as status epilepticus.</span> <i>Indian Pediatr.</i> 2005;
42:492-3.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman";"><span style="color: blue; font-size: large;">73. Sudhir
Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/mar2005\/296\.pdf\0022 \\t \0022_blank\0022 ";">Tongue
biting and epilepsy. </span><i>Indian Pediatr </i>2005; 42:296.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">74. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/june2005\/621\.pdf\0022 \\t \0022_blank\0022 ";">Painful
mononeuritis multiplex in idiopathic thrombocytopenic purpura.</span> Indian
Pediatr 2005; 42:621-2.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">75. <u>Sudhir Kumar</u>, Rashmi. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/july2005\/721\.pdf\0022 \\t \0022_blank\0022 ";">Branding:
A harmful practice.</span> Indian Pediatr 2005;42:721.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">76. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.indianpediatrics\.net\/aug2005\/833\.pdf\0022 \\t \0022_blank\0022 ";">Valproate-induced
bleeding: report of two cases and review of literature.</span> Indian
Pediatr 2005; 42:833-4.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">77. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni533361_003936\.pdf\0022 \\t \0022_blank\0022 ";">Neurofibromatosis
type 1 manifesting with Tourette syndrome.</span> Neurol
India2005;53:361-2.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">78. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni533362_003854\.pdf\0022 \\t \0022_blank\0022 ";">Punding
in Parkinson's disease related to high-dose levodopa therapy. </span>Neurol
India 2005;53:362.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">79. Sudhir Kumar. Thyrotoxic
periodic paralysis. Thyroid Research & Practice 2005; 2: 12-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">80. Sudhir Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni531125_081115\.pdf\0022 \\t \0022_blank\0022 ";">Calcified
vertebral artery and dense basilar artery sign in a patient with basilar
territory infarction.</span> Neurol India 2005;53:125.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">81. Aaron S, <u>Kumar S</u>, Vijayan J,
Jacob J, Alexander M, Gnanamuthu C. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni53155_081302\.pdf\0022 \\t \0022_blank\0022 ";">Clinical
and laboratory features and response to treatment in patients presenting with
vitamin B12 deficiency-related neurological syndromes. </span>Neurol
India 2005;53:55-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">82. <u>Kumar S</u>, Prabhakar S. Guillain-Barre
syndrome occurring in the course of Dengue fever. Neurol
India 2005;53:250-1.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">83. Datta SS, Premkumar TS, Chandy S, <u>Kumar
S</u>, Kirubakaran C, Gnanamuthu C, Cherian A.Behaviour problems in children
and adolescents with seizure disorder:</span><span lang="EN-US" style="background: rgb(230 , 214 , 122); font-family: "times new roman";"> </span><span lang="EN-US" style="font-family: "times new roman";">associations and risk factors. Seizure:European Journal
of Epilepsy 2005;14:190-7.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">84. Garikapati R, <u>Kumar S</u>,
Prabhakar S. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.blackwell-synergy\.com\/doi\/pdf\/10\.1111\/j\.0013-9580\.2005\.t01-2-64204_4\.x?cookieSet=1\0022 \\t \0022_blank\0022 ";">ATL
in refractory epilepsy with normal MRI-volumetric criteria?</span> Epilepsia 2005;
46:600.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">85. <u>Kumar S</u>, Chandy
E. Asymmetric depression of amplitude in electroencephalography
leading to a diagnosis of ipsilateral cerebral tumor. Annals of Indian
Academy of Neurology 2005;8:33-5.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">86. <u>S Kumar</u>, G Rajshekher, S
Prabhakar. Management of myasthenic crisis. Neurol India 2005;53:241.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">87. S Kumar. Preventive therapy of
migraine. Neurol India 2005;53:243.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">88. <u>S Kumar</u>, G Rajshekher, S
Prabhakar. Positron emission tomography in neurological diseases. Neurol
India 2005;53:149-55.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">89. S Kumar. </span><span lang="EN-US"><a href="http://www.ijccm.org/temp/IJCCM9111_090020.pdf"><span style="font-family: "times new roman"; text-decoration: none;">Recombinant
activated Factor VII for acute intracerebral hemorrhage.</span></a><a href="http://www.ijccm.org/temp/IJCCM9111_090020.pdf"><span style="font-family: "times new roman"; text-decoration: none;"> </span></a></span><span lang="EN-US" style="font-family: "times new roman";">Indian Journal of Critical Care Medicine 2005;9:11-13.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">90. <u>S Kumar</u>, P Ravi Kumar, N
Manasseh. Massive pneumocephalus and meningitis following spine
instrumentation. Annals of Indian Academy of Neurology 2005;8:55-7.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">91. S Kumar. Guillain-Barre syndrome in
leprosy patients. Indian J Lepr. 2005;77:162-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">92. S Kumar. Cranial nerve
involvement in leprosy. Indian J Lepr. 2005;77:177-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">93. <u>S Kumar</u>, G Rajshekher, S
Prabhakar. Dense basilar artery sign preceding basilar artery territory
infarction. Annals of Ind Acad Neurol 2005;8:321-2.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2006<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">94. <u>S Kumar</u>, Badrinath HR. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni54124_085919\.pdf\0022 \\t \0022_blank\0022 ";">Early
recombinant factor VIIa therapy in acute intracerebral hemorrhage: Promising
approach. </span>Neurol India 2006;54:24-7.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">95. S Kumar. Plasmapheresis in
acute disseminated encephalomyelitis. Indian Pediatr2006;43:77-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">96. SS Datta, <u>S Kumar</u>. Hypomania
as an aura in migraine: case report. Neurol India 2006;54:205-6.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">97. SS Datta, <u>S Kumar</u>. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni542200_080957\.pdf\0022 \\t \0022_blank\0022 ";">Clozapine-responsive
cluster headache. </span>Neurol India 2006;54:200-1.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">98. SS Datta, R Jacob, <u>S Kumar</u>,
S Jeyabalan. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/dodd\.cmcvellore\.ac\.in\/inst_reposit\/article\/anp2006\(18\)55\.pdf\.pdf\0022 \\t \0022_blank\0022 ";">A
case of subacute sclerosing panencephalitis presenting as depression. </span>Acta
Neuropsychiatrica 2006; 18: 55-7.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">99. SS Datta, TS Premkumar, S
Fielding, S Chandy, <u>S Kumar</u>, JM Eagles, A Cherian. Impact of
pediatric epilepsy on Indian families. Epilepsy and
Behavior. 2006;9:145-51.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">100. <u>S Kumar</u>, M Alexander, C
Gnanamuthu. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni543283_065715\.pdf\0022 \\t \0022_blank\0022 ";">Cranial
nerve involvement in patients with leprous neuropathy. </span>Neurol
India 2006;54:283-5.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2007<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">101. S Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni55181_080910\.pdf\0022 \\t \0022_blank\0022 ";">Expansion
of traumatic intracerebral hemorrhage: treatment implications with recombinant
Factor VIIa.</span> Neurol India 2007;55:81.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">102. S Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.annalsofian\.org\/temp\/AnnIndianAcadNeurol10161_080817\.pdf\0022 \\t \0022_blank\0022 ";">Basilar
artery thrombosis.</span> Annals Ind Acad Neurol 2007;10;61-2<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">103. <u>S Kumar</u>, G Rajshekher, S
Prabhakar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.annalsofian\.org\/temp\/AnnIndianAcadNeurol103187_080611\.pdf\0022 \\t \0022_blank\0022 ";">Isolated
complete third nerve palsy due to midbrain hemorrhage: clinico-radiological
correlation.</span> Annals Ind Acad Neurol 2007;10:187-8.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">104. S Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.neurologyindia\.com\/temp\/ni552174_080722\.pdf\0022 \\t \0022_blank\0022 ";">Thrombolysis
with tissue plasminogen activator: Protocol violation is not an option.</span>
Neurol India 2007;55:174.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">105. S Kumar. <span style="mso-field-code: " HYPERLINK \0022http\:\/\/www\.ijdvl\.com\/temp\/ijdvl736433_080457\.pdf\0022 \\t \0022_blank\0022 ";">Pseudoxanthoma
elasticum and cerebral ischemic stroke. </span>Indian J Dermatol Venereol
Leprol 2007; 73: 433-4.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2008<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">106. <u>S Kumar</u>, G Sandhya, R
Reddy, G Rajshekher, S Prabhakar. Idiopathic transverse myelitis:
corticosteroids, plasma exchange, or
cyclophosphamide? Neurology 2008; 70:160.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">107. G Rajshekher, <u>S Kumar</u>, S
Prabhakar. Reversible electrophysiological abnormalities in hypokalemic
periodic paralysis. Indian Pediatrics 2008;45:54-5.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">108. <u>S Kumar</u>, G Rajshekher, S
Prabhakar. Isolated bilateral ptosis as the presentation of midbrain
tuberculoma. Neurol India 2008; 56:212-3.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">109. <u>S Kumar</u>, G Rajshekher, S
Prabhakar. Platelet glycoprotein IIb/IIIa inhibitors in acute ischemic
stroke. Neurol India 2008;56:399-404.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2009<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">110. <u>S Kumar</u>, R Reddy, S
Prabhakar. Contralateral diaphragmatic palsy in acute stroke: An
interesting observation. Ind J Crit Care Med 2009; 13:28-30.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2010<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">111. <u>S kumar</u>, G Rajshekher, C R
Reddy, J Venkateswarlu, S Prabhakar. Intra-sinus thrombolysis in cerebral
venous sinus thrombosis: single center experience in 19 cases. Neurol India 2010;58:225-9.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">112. R Lath, <u>S Kumar</u>, R
Reddy, G R Boola, A Ray, S Prabhakar, A Ranjan. Decompressive surgery for
severe cerebral venous sinus thrombosis. Neurol India 2010;58:392-7.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2012<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">113. S Bhuvaneshwari, Sujith Chandy, <u>Sudhir
Kumar</u>. A prospective, double-blinded, crossover study to determine the
equivalence of the serum levels and the peak level toxicity of
diphenylhydantoin (Eptoin ER). Journal of Clinical and Diagnostic
Research. 2012;6:783-786.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2013<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">114. Varghese GM, Mathew A, <u>Kumar
Sudhir</u>, Abraham OC, Trowbridge P, Mathai Differential diagnosis of scrub
typhus meningitis from bacterial meningitis using clinical and laboratory
features. Neurol India 2013;61:17-20<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">115. <u>Sudhir Kumar</u>, Chenna Rajesh
Reddy, Subhashini Prabhakar. Striatal toe. Ann Ind Acad Neurol.
2013;16:304-5<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">116. S Bhuvaneshwari, Sujith Chandy, <u>Sudhir
Kumar</u>. Equivalence of the steady state concentrations of two dosage
regimens of phenytoin using computer optimisation programme OPT6. International
Journal of Pharmaceuticals and Biological Archives.2013;4:899-902. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2016<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">117. Kumar S. Hypertension and ischemic
stroke. Hypertens J. 2016;2:39-43.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">118. Kumar S, Reddy CR, Prabhakar S.
Bilateral putaminal necrosis in a comatose patient with metabolic acidosis.
Indian J Crit Care Med. 2016;20:745-8. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2017<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">119. Kumar S. Hypertension and hemorrhagic
stroke. Hypertens J. 2017; 3:89-93.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2018<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">120. Kumar S, Rohatgi A, Chaudhari H,
Thakor P. Evolving landscapes of multiple sclerosis in India: Challenges in the
management. Ann Ind Acad Neurol 2018;21:107-15.</span></span><br />
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;"><br /></span></span>
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;"><b>2019</b></span></span><br />
<h2 style="text-align: left;">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">121. </span></span><span style="color: blue; font-size: large; font-weight: normal;"><span style="background-color: white; font-family: arial, helvetica, clean, sans-serif;">Ramesh V, Narreddy S, Barigala R, Kumar Chennamchetty V, Kumar S, Rao J, Nanda S, Varahala S. 1374. Diagnostic Utility of Whole Body Positron Emission Tomography-Computerized Tomography (PET-CT) in Patients with Suspected Central Nervous System Tuberculosis: A Retrospective, Descriptive Study. </span><i style="background-color: white; font-family: arial, helvetica, clean, sans-serif;">Open Forum Infect Dis</i><span style="background-color: white; font-family: arial, helvetica, clean, sans-serif;">. 2019 Oct 23;6(Suppl 2):S498–S499. doi: 10.1093/ofid/ofz360.1238. PMCID: PMC6808727.</span></span></h2>
</div>
<span style="color: blue; font-size: large;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
</span></b>
</span><br />
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">Books, Chapters, monographs<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">1. Elizabeth Chandy, Sudhir
Kumar. Atlas of Electroencephalography in Adult &
Child. Mattethra Group Publications, Cochin, India, 2004.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">2. Sudhir Kumar. Cerebrovascular
diseases in the elderly. In Progressive General Practice- Geriatrics
issue. Ed, Alka Ganesh. CME series of Christian Medical College, Vellore,
India, 2002.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">3. Soumitra S. Datta, Sudhir Kumar,
K.S. Jacob. Clinical approach to dementia. In Textbook of Psychiatry,
Bangalore.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">4. Sudhir Kumar. Muscular
dystrophies in children and adolescents. In Update in Pediatrics Volume 1,
1st edition, Mathur & Mathur Eds, 2005.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "times new roman";"><span style="color: blue; font-size: large;">5. Sudhir Kumar. Neonatal
Meningitis. In Textbook of Neonatal Emergencies. Ed Prof Suraj Gupte,
Peepee Publishers and Distributors, New Delhi, 2006<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="color: blue; font-size: large;"><span lang="EN-US" style="font-family: "times new roman";">6. Sudhir Kumar, Subhash Kaul. Approach
to a patient with hemiplegia and monoplegia. Progress in Medicine 2017.
Published by Association of Physicians of India (API) (Can be accessed at </span><span lang="EN-US"><a href="http://www.apiindia.org/pdf/progress_in_medicine_2017/mu_27.pdf"><span style="font-family: "times new roman";">http://www.apiindia.org/pdf/progress_in_medicine_2017/mu_27.pdf</span></a></span><span lang="EN-US" style="font-family: "times new roman";">)<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<!--EndFragment--><br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-56555016770966044582018-06-17T00:07:00.000+05:302018-06-17T00:07:13.294+05:30DO THE MARKS IN AN EXAMINATION REALLY MATTER A LOT?<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; text-align: center;">
<span style="color: red;"><b>HOW IMPORTANT ARE THE MARKS IN AN EXAMINATION?</b></span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px; text-align: left;">
<span style="color: red; font-family: Verdana, sans-serif;">Anuja’s suicide</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue; font-family: Verdana, sans-serif;">When I was 10 year old, I remember once, there was a crowd gathered around Anuja’s (name changed) house, who lived about 100 meters away from our house. I too wanted to go there to find out what was happening, but was not allowed by my parents. Later on in the evening, I came to know that she committed suicide by hanging, as she scored only 81% marks in her tenth board examinations, which was well below her parents’ and her expectations. We hear several similar stories from different parts of our country. Depression, stress and anxiety are common before & during examinations. If one does not score high marks, they feel worthless, unfortunately leading to suicide in some cases.</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: red; font-family: Verdana, sans-serif;">Mental problems among students</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue; font-family: Verdana, sans-serif;">I have been increasingly seeing young students with various psychological problems, such as sleep disturbance, anxiety, headaches, poor memory, body pains, decreased energy and depression. Fear of exam or fear of scoring low marks in an exam are the main reasons for these symptoms.</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: #cc0000; font-family: Verdana, sans-serif;">But is scoring high marks so important?</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="font-family: Verdana, sans-serif;"><span style="color: red;">Marks have limited importance:</span><br /><span style="color: blue;">1. One needs to score “pass” marks in order to get promoted to the next class, which ranges from 35-50% in various classes/schools/colleges. </span><br /><span style="color: blue;">2. One needs to score “qualifying” marks in order to become eligible to write competitive exams for UPSC, engineering, medical, etc (which ranges from 50-75% in various exams).</span></span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue; font-family: Verdana, sans-serif;">3. Class XII marks are taken into account for admissions into graduate courses of a few good colleges (which can be as high as 99% in some cases).</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="font-family: Verdana, sans-serif;"><span style="color: red;">Drawbacks and demerits of marks:</span><br /><span style="color: blue;">1. There is no perfect correlation between marks and knowledge. A student with good knowledge may score lesser marks and someone with lesser knowledge may get very high marks. </span><br /><span style="color: blue;">2. Examinations, unfortunately, do not assess the practical knowledge, intelligence, judgment and application of a student; they mainly assess the retention, recall and memory abilities. Communication skills, ability to deal with difficult situations, and interpersonal skills, which are so important in real life, are also not assessed by the “marks” system.</span><br /><span style="color: blue;">3. Marks obtained in 10th and 12th board exams do not have any meaning in the job/occupation one chooses later. For example, no patient of mine has ever asked me my marks from school or college days (however, I would be proud to tell those figures, as I scored high in most of the exams).</span></span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="font-family: Verdana, sans-serif;"><span style="color: #660000;">So, what should students do?</span><br /><span style="color: blue;">1. One should study to gain and acquire knowledge. Understanding the concepts is more important than just memorizing them. </span><br /><span style="color: blue;">2. Marks do not matter much and obtaining high marks in an exam should not be the sole goal. </span><br /><span style="color: blue;">3. Studies would be a pleasure, if it is taken as a means of gaining knowledge, rather than a means to score high marks in an exam. </span><br /><span style="color: blue;">4. One should study “round-the-year” and not just before the exams. This would reduce the pressure prior to the exams. </span><br /><span style="color: blue;">5. There is no need to feel bad, if one gets” low” marks in an examination. Most of the great men & women in the world were not class toppers in their school or college days.</span></span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue; font-family: Verdana, sans-serif;">I would be pleased to have your comments on this article.</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue; font-family: Verdana, sans-serif;"><br /></span></div>
<div style="background-color: white; display: inline; margin-top: 6px;">
<span style="color: #990000; font-family: Verdana, sans-serif;">DR SUDHIR KUMAR MD DM<br />Consultant Neurologist<br />Apollo Hospitals, Hyderabad<br />drsudhirkumar@yahoo.com</span></div>
<div>
<div style="background-color: white; display: inline; margin-top: 6px;">
<span style="color: #990000; font-family: Verdana, sans-serif;">https://www.facebook.com/bestneurologist/</span></div>
</div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-39463755721351921152018-06-14T16:00:00.000+05:302018-06-14T16:00:36.419+05:30WHAT IS AILING THE HEALTH OF OUR YOUNG GENERATION?<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; text-align: center;">
<b><span style="color: red;">WHAT IS AILING THE HEALTH OF OUR YOUNG GENERATION?</span></b></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">Mr Parvesh (name changed), a 33-year old, was rushed into emergency department last night with sudden onset of chest pain and breathlessness. He was at his office at 11 PM, when he felt uneasy. He lied down on the sofa outside his office to take some rest. His friends found him unconscious and rushed him to the hospital. On arrival in ER, his pulse and BP were un-recordable. ECG showed features of massive heart attack. He was given the best cardio-pulmonary resuscitation, followed by the best medical care. All in vain, he passed away within four hours. </span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><br />Mr Parvesh is not alone. In my practice over the past 25 years, I have seen many young people (mostly men) in their 30s and 40s coming to the hospital with features of heart attack and brain stroke. This is unusual, as during my medical school training in early 90s, we were taught that heart attacks and brain strokes affect only older people in their 60s and 70s or even later. Now, about 40% of people suffering from heart attacks and brain strokes are young people (<50 years of age). </span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<br /><span style="color: red;">So, what factors are responsible for this “undesirable” change?</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">1.</span><span style="color: #660000;"> Expectations to achieve everything as early as possible</span><span style="color: blue;">: Achievement and success are good things, but not at the cost of health. Young people work long hours. In my interaction with people, I have observed that 13-15 hours work schedules are not uncommon. Add to this, 1-2 hours of commute time, where is the time to unwind? Where is the time to relax with family and friends? Our bodies are not machines (even machines break down, when overused). Heart and brain work best, when working hours are 8-9 hours, with good breaks in weekends.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">2.</span><span style="color: #660000;"> Working from home, working on weekends and even during holidays</span><span style="color: blue;">: Breakthroughs in communication (internet, mobile phones, etc) have their advantages; however, there are drawbacks too. People are in “work-mode” 24X7, 7 days a week, and perpetually. There is no time, when a person totally disconnects from work. Constant work or thought of work takes a heavy toll on the body, especially the heart and brain.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">3. </span><span style="color: #660000;">Lack of sleep</span><span style="color: blue;">: We need at least 7-8 hours of sleep in order to refresh and recharge. However, younger people are not getting more than 4-5 hours of sleep per night. Demanding work schedules, use of gadgets and late night socializing are some of the reasons for lesser sleep duration. Lack of sleep is strongly associated with higher risk of diabetes, high BP and cholesterol; all of whom are risk factors for stroke and heart attacks.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">4. </span><span style="color: #660000;">High stress levels</span><span style="color: blue;">: I see many young people in my clinic, belonging to various industries such as IT & software, banking & finance, education, etc. More than 90% of them say they are under stress. Stress is related to jobs as well as personal lives. So, if one felt that not getting a job or not getting married are reasons to be under stress, think twice; those with good jobs and good spouses are also equally stressed, if not more. This cannot be real. Jobs and families need to be cared for and modeled to give joy & happiness.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">5. </span><span style="color: #660000;">Greed for material things beyond one’s means</span><span style="color: blue;">: Peer pressure is very high. One wants to own a good car and a good house in 30s and even in 20s. As the incomes are low, many end up taking huge loans to fund these dreams. People are also spending more than their means on education of children and vacations. Paying EMIs are no fun! Any unexpected expenditure and reduction in income takes a toll on health and stress levels rise. One must live within their means and avoid taking loans to fulfill the “desires”. We need to be satisfied with what we have and avoid competing with “neighbours or friends” in acquiring materialistic things.</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue; font-family: Helvetica, Arial, sans-serif; font-size: 14px;">6. </span><span style="color: #660000; font-family: Helvetica, Arial, sans-serif; font-size: 14px;">Unhealthy diet and habits</span><span style="color: blue; font-family: Helvetica, Arial, sans-serif; font-size: 14px;">: Fast foods, irregular food habits and "eating out" have become common. We need to remember, home food is the best and healthiest. “Outside” food is high on taste (due to high amount of salt, sugar and oil) but low on nutrition. </span><br /><span style="color: blue;"><span style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;">Most people are not exercising. Moreover, they use vehicles for travelling short distances. Walking as a habit is dying. Most people use lifts and staircases are “hidden” (only to be used in case of emergency or fire)! People sit for long </span><span style="font-family: Helvetica, Arial, sans-serif;"><span style="font-size: 14px;">duration</span></span><span style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;"> (at work, while watching TV, etc). Sitting is as dangerous as smoking, if not more. </span></span><br /><span style="color: blue; font-family: Helvetica, Arial, sans-serif; font-size: 14px;">Pollution is increasing- both air and water. Their negative impact on health is well known.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">7. </span><span style="color: #660000;">Poor financial planning</span><span style="color: blue;">: Younger people do not invest wisely. Either the savings are kept idle in the banks (for a meager interest of 3-4%, which is taxable at the highest slab) or they invest most of their savings in real estate (bought at high prices, with no scope of growth in the near future). The best investment asset class is equity. For someone with less time, investing in equity mutual funds via SIP (systematic investment plans) are the best. You can expect a return of 10-12 % per year (with current tax rate of 10% on the profits, if redeemed after one year).</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">8. </span><span style="color: #660000;">Ignoring health checkup</span><span style="color: blue;">s: Our body does give warnings. Any abnormal symptom such as headache, dizziness, tiredness, breathing difficulty, chest pain, etc should be seriously taken and a doctor should be consulted. Even if there are no symptoms, preventive health checkups can help in detecting diseases in early stage, which can be treated well.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: red;">So, what can younger people do to live longer and healthier?</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;">1. Find a job that you like (which may not be with the biggest pay cheque).<br />2. Work for reasonable hours (8-9 hours on average).<br />3. Cut-off from work when out of office, on weekends and while on vacation (except for occasional emergencies.<br />4. Take regular vacations with family and friends.<br />5. Sleep well (on an average 7-8 hours per night). Avoid doing regular night shift duties.<br />6. Exercise- it can be anything you like, such as walking, jogging, cycling, etc. At least 30 minutes per day and 5 days per week.<br />7. Prefer home food as much as possible.<br />8. Keep expenses as per your income. Avoid taking loans as much as possible.<br />9. Start investing early after analyzing your financial needs and goals.<br />10. Don’t ignore small warnings about health. Consult a doctor and have preventive health checkups.</span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b><br /></b></span></div>
<div style="background-color: white; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: #660000;"><b>Dr Sudhir Kumar MD DM</b></span></div>
<div style="background-color: white; display: inline; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-top: 6px;">
<span style="color: #660000;"><b>Consultant Neurologist<br />drsudhirkumar@yahoo.com</b></span></div>
<div>
<div style="background-color: white; display: inline; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-top: 6px;">
<span style="color: #660000;"><b>https://www.facebook.com/bestneurologist/</b></span></div>
</div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-31906532153596505952018-03-27T23:39:00.002+05:302018-03-27T23:41:53.029+05:30FREQUENTLY ASKED QUESTIONS ABOUT HEADACHE<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<b><span style="color: red;">FREQUENTLY ASKED QUESTIONS ABOUT HEADACHES</span></b></div>
<br />
<span style="color: blue;"><br /></span>
<span style="color: blue;"><br /></span>
<span style="color: blue;">Headache is a common disorder. A large number of people suffer from headaches. Migraine and tension headaches are the commonest causes of headaches. They are not life-threatening, however, they cause significant disability, as pain impairs the quality of life. In some cases, headaches can be caused by serious causes, such as brain tumor, brain hemorrhage, brain fever, etc. </span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">The current interview focuses on the common causes of headache. How should we diagnose migraine? It can be diagnosed based on symptoms in most cases. When should one consult a doctor for headache? When should one do a brain scan? How do we treat headaches? To get answers to these and other questions, please watch this interview. The link of the youtube video with the interview is:</span><br />
<br />
<a href="https://youtu.be/VgBvamY5kS0" target="_blank">https://youtu.be/VgBvamY5kS0</a><br />
<br />
<span style="color: blue;">Feel free to post your comments or ask any queries.</span><br />
<br />
<br />
<b><span style="color: #990000;">Dr Sudhir Kumar MD DM (Neurology)</span></b><br />
<b><span style="color: #990000;">Senior Consultant Neurologist,</span></b><br />
<b><span style="color: #990000;">Apollo Hospitals, Hyderabad</span></b><br />
<b><span style="color: #990000;">04023607777</span></b><br />
<b><span style="color: #990000;">drsudhirkumar@yahoo.com</span></b><br />
<a href="https://www.facebook.com/bestneurologist/" target="_blank"><b><span style="color: #990000;">https://www.facebook.com/bestneurologist/</span></b></a></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-61201803817439124952018-03-26T07:28:00.000+05:302018-03-26T07:43:14.120+05:30FREQUENTLY ASKED QUESTIONS ABOUT EPILEPSY (HINDI)<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<b><span style="color: red;">FREQUENTLY ASKED QUESTIONS ABOUT EPILEPSY</span></b></div>
<br />
<span style="color: blue;">Epilepsy is a common neurological illness. It can be easily diagnosed and treated. People suffering from epilepsy can lead normal lives after treatment. Despite this, there are lot of misconceptions about this disease. There is a social stigma attached to epilepsy and epileptic patients. </span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">In this interview (in Hindi language), I have discussed the symptoms, diagnostic techniques and treatment options for people suffering from epilepsy. The link to youtube video is given below:</span><br />
<br />
<br />
<a href="https://youtu.be/BzAzkOxecJs" target="_blank">https://youtu.be/BzAzkOxecJs</a><br />
<br />
<br />
<span style="color: blue;">Please go through this video interview to learn more about epilepsy. Feel free to post your comments and queries.</span><br />
<br />
<b><span style="color: #660000;">Dr Sudhir Kumar MD DM (Neurology)</span></b><br />
<b><span style="color: #660000;">Senior Consultant Neurologist</span></b><br />
<b><span style="color: #660000;">Apollo Hospitals, Hyderabad</span></b><br />
<b><span style="color: #660000;">04023607777</span></b><br />
<b><span style="color: #660000;">drsudhirkumar@yahoo.com</span></b><br />
<a href="https://www.facebook.com/bestneurologist/" target="_blank">https://www.facebook.com/bestneurologist/</a></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-11958519153985925682018-01-04T21:51:00.000+05:302018-01-04T21:51:28.595+05:30DRINKING WATER FOR A HEALTHY LIVING- All you ever wanted to know<div dir="ltr" style="text-align: left;" trbidi="on">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">WATER INTAKE AND HEALTH</span><o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Water forms 60% of
our body weight and is essential for life. It should be consumed in adequate
amounts for proper functioning of various organs.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US"><span style="color: blue;">Normal water intake<o:p></o:p></span></span></u></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l3 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US">Men</span></i></b><span lang="EN-US">: 3.7 liters per day<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l3 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US">Women</span></i></b><span lang="EN-US">: 2.7 liters per day (Pregnant and breast-feeding women need more
water). <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">20% of this comes
from food (fruits, vegetables, beverages, etc) and the remaining should be
consumed in the form of plain water. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US"><span style="color: blue;">When do we need more water?<o:p></o:p></span></span></u></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l2 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US">Exercise</span></i></b><span lang="EN-US">- Exercise leads to water loss in the form of sweating. So, we
should consume water before, during and after exercise. Avoid drinking too much
water as it can be harmful; it could dilute the body fluids leading to
hyponatremia (low sodium). <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l2 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US">In hot climates</span></i></b><span lang="EN-US">- Water loss is more via perspiration and sweating, and hence, more
water is needed.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l2 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US">During illnesses such as
fever, vomiting and diarrhea</span></i></b><span lang="EN-US">. All these
conditions lead to water loss and this loss needs to be replenished. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US"><span style="color: blue;">When should the water intake be reduced (less than
normal intake)?<o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">In some diseases, water
intake needs to be reduced (under the supervision of a doctor). These are:<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Chronic kidney disease,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Heart failure,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Chronic liver disease,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hyponatremia (low sodium)- some
cases are treated by restricting fluid intake.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US"><span style="color: blue;">How do we know whether our water intake is normal
or not?<o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">If you rarely feel
thirsty and if the colour of your urine is light yellow (or colorless), your
water intake is probably adequate. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US"><span style="color: blue;">What is the best way of getting our daily water
requirement?<o:p></o:p></span></span></u></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Plain water is the best (safe,
inexpensive, easily available and has zero calories).<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">20% of water can also come from
fruits, vegetables, juice, milk, tea/coffee, etc<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l0 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Soft (carbonated drinks),
sports drinks, energy drinks and alcohol should not be routinely relied upon to
complete the daily quota of water. Sports drinks may be taken if one does
rigorous exercise for one hour or more. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US"><span style="color: blue;">Can more water intake help in weight loss?<o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">The answer is yes.
This is because many times, thirst is confused with hunger. So, whenever you
feel hungry, drink water first. People, who consume more water, end up
consuming less salt, less sugar and less saturated fats (this leads to weight
loss).<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">A bottle of water before main meals could aid in
weight loss.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US"><span style="color: blue;">Replace soda with water, tea of coffee to fight
diabetes<o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Yes, you heard it
right. The habit of having a “soft drink” (carbonated beverage) to quench your
thirst can increase your chances of getting diabetes, as it contains high
amount of sugar. Replacing soda/soft drinks with water, tea or coffee (without
sugar) leads to lesser chance of getting diabetes. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">Is drinking water on empty stomach in mornings useful?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Yes, drinking
water in morning on empty stomach is helpful. Most of us have not had water for
about eight hours prior to getting up, leading to mild dehydration. So, one
should consume 2-3 glasses (600-800 ml) of water in mornings. This helps in
improving bowel movements & urination (leading to release of toxins). This
would also reduce hunger, leading to lesser consumption of carbohydrates and
fats (thus promoting weight loss). <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: blue;">Providing water dispensers in schools could also be a
cheap method of reducing obesity in children. </span><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7ay8gAv97CNFkBD1pp_9zcOIr0yHjH8E8h4edl4rxDEIeHAbKM_8CBRrJqSpcK-wa8AX5_n6-S0HLctrAdVyaeGEqBw07CRGG3ZRWLh1DT2QPQIsQSBPWe8QNGwd-HN1wffSUixTrZn9B/s1600/dreamstime_xs_44066082.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="312" data-original-width="480" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7ay8gAv97CNFkBD1pp_9zcOIr0yHjH8E8h4edl4rxDEIeHAbKM_8CBRrJqSpcK-wa8AX5_n6-S0HLctrAdVyaeGEqBw07CRGG3ZRWLh1DT2QPQIsQSBPWe8QNGwd-HN1wffSUixTrZn9B/s320/dreamstime_xs_44066082.jpg" width="320" /></a></div>
<br />
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Dr Sudhir Kumar MD
DM (Neurology)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Consultant
Neurologist<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Apollo Hospitals,
Jubilee Hills, Hyderabad<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><a href="mailto:drsudhirkumar@yahoo.com">drsudhirkumar@yahoo.com</a><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">04023607777/60601066</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">https://www.facebook.com/bestneurologist/</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"Courier New";
panose-1:2 7 3 9 2 2 5 2 4 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536859905 -1073711037 9 0 511 0;}
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;
mso-font-charset:2;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
mso-themecolor:hyperlink;
text-decoration:underline;
text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-noshow:yes;
mso-style-priority:99;
color:purple;
mso-themecolor:followedhyperlink;
text-decoration:underline;
text-underline:single;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:325255910;
mso-list-type:hybrid;
mso-list-template-ids:-764668200 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Symbol;}
@list l0:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l0:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Symbol;}
@list l0:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l0:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Symbol;}
@list l0:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l1
{mso-list-id:422990142;
mso-list-type:hybrid;
mso-list-template-ids:-1161765186 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l1:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2
{mso-list-id:1163817391;
mso-list-type:hybrid;
mso-list-template-ids:1499774078 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l2:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3
{mso-list-id:2000841770;
mso-list-type:hybrid;
mso-list-template-ids:-2102624116 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l3:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<!--EndFragment--><br />
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com3tag:blogger.com,1999:blog-4070812938669092184.post-42520465513255866372017-11-06T08:42:00.001+05:302017-11-06T08:42:44.239+05:30TEST YOUR KNOWLEDGE ABOUT STROKE<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; text-align: center;">
<span style="color: red;"><b>TEST YOUR KNOWLEDGE ABOUT STROKE</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; text-align: center;">
<span style="color: red;"><b><br /></b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: red;"><b>1. STROKE is a disease that affects:</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: blue;">A. Heart<br />B. Brain<br />C. Kidney<br />D. Lungs</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">2. Common symptoms of stroke include:</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>A. severe chest pain<br />B. Fits or convulsions<br />C. Paralysis of face, arms, legs, slurred speech<br />D. Breathing difficulty</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">3. If someone suffers from stroke at 9 PM,</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>A. He can go to OPD the next day<br />B. He should rush to the nearest general physician<br />C. He should rush to a hospital with 24X7 CT scan and neurologist on call<br />D. He can try home remedies for the night.</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">4. Is there a treatment available for patients with stroke, which would minimise disability</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>A. Yes<br />B. No</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: red;"><b>5. Common risk factors for stroke include all the following EXCEPT</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>A. Diabetes mellitus<br />B. Hypertension<br />C. Running on treadmill<br />D. Smoking</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">6. Which of the following measures is NOT helpful in preventing a recurrence of stroke in a person who has suffered stroke?</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>A. Taking Aspirin<br />B. Controlling BP and sugars,<br />C. Quitting smoking,<br />D. Skipping breakfast, if overweight</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">7. Physiotherapy helps in better and faster recovery of stroke survivors.</span><br /><span style="color: blue;">A. True</span><br /><span style="color: blue;">B. False</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">8. Stroke affects only older people</span><br /><span style="color: blue;">A. True</span><br /><span style="color: blue;">B. False</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">9. Proportion of population that may suffer a stroke in their lifetime</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>A. 1 in 10<br />B. 1 in 8<br />C. 1 in 6<br />D. 1 in 4</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">10. Stroke is treated by</span><br /><span style="color: blue;">A. Neurologist</span><br /><span style="color: blue;">B. Cardiologist</span><br /><span style="color: blue;">C. Nephrologist</span><br /><span style="color: blue;">D. Chest physician</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>Please go through these questions and answer them. Answers are posted below</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b style="color: blue;">----------------------------------------------------------------------------------------------------</b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>*****************************************************************************************************</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>Thank you for going through the questions. Here are the answers:</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">1. B</span><br /><span style="color: blue;">Stroke affects brain. It most commonly occurs due to blockage of blood supply to a part of the brain. In some cases, it can also occur due to rupture of a blood vessel.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">2. C </span><br /><span style="color: blue;">Common symptoms of stroke include sudden onset facial weakness, weakness of arm or leg, slurred speech, loss of vision on one side, imbalance while walking or severe headache.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">3. C</span><br /><span style="color: blue;">Stroke is a medical emergency. The brain tissue can suffer irreversible damage, if not treated within the first four hours. Therefore, the patient should be rushed to a hospital with 24X7 CT scan facility. The treatment is administration of clot-buster therapy under the guidance of a neurologist.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">4. A</span><br /><span style="color: blue;">Clot-buster therapy with tissue plasminogen activator or tenecteplase within the first four and a half hours after stroke onset can minimise disability.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">5. C</span><br /><span style="color: blue;">Running on treadmill is a healthy exercise and protects from stroke.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">6. C</span><br /><span style="color: blue;">Skipping breakfast is an unhealthy habit. Moreover, it does not help in reducing weight.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">7. A</span><br /><span style="color: blue;">Physiotherapy is very helpful in faster recovery of stroke survivors. It should be started as early as possible.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">8. B</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>Stroke predominantly affects older people, however, it can affect all ages, including children.</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">9. C</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>Stroke is a common cause of death and disability (along with heart attacks and cancer) in the world, and affects i in 6 people in their lifetime.</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: red;">10. A</span><br /><span style="color: blue;">Stroke is a disease of brain and is treated by neurologist.</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>I hope you enjoyed this mini-quiz. I would love to hear your comments or any further queries.</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b><br /></b></span></div>
<div style="background-color: white; display: inline; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-top: 6px;">
<b><span style="color: #990000;">Dr Sudhir Kumar MD DM<br />Senior Consultant Neurologist<br />Apollo Hospitals, Hyderabad<br />drsudhirkumar@yahoo.com<br />04023607777/60601066</span></b></div>
<div>
<div style="background-color: white; display: inline; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-top: 6px;">
<b><span style="color: #990000;">https://www.facebook.com/bestneurologist/</span></b></div>
</div>
<div>
<div style="background-color: white; display: inline; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-top: 6px;">
<span style="color: blue;"><b><br /></b></span></div>
</div>
<div>
<div style="background-color: white; display: inline; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-top: 6px;">
<span style="color: blue;"><b><br /></b></span></div>
</div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com1tag:blogger.com,1999:blog-4070812938669092184.post-18265878635904600702017-11-06T08:38:00.000+05:302017-11-06T08:38:06.041+05:30"BRAIN" FOODS THAT HELP PREVENT NEUROLOGICAL DISEASES<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<b><span style="color: red;">"BRAIN" FOODS THAT HELP PREVENT NEUROLOGICAL DISEASES</span></b></div>
<br />
<br />
<span style="color: blue;"><b>Choice of foods is important, when it comes to prevention and treatment of certain neurological disorders. The article on this topic was published in November 2017 issue of B Positive magazine, a health and wellness magazine.</b></span><br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijXGVaq1fZsp9XN9tzYLTEkciojxUGp5lLzhgIrlIqorLZJDl5WhG_Co5qMOd5KkGWcc7IicvJmiK96AkbnlJ_9WSWBHkWJQn5C-3VKfIKHBErgnAhQbj_JFHm_hYn52rlY_y01bStJuis/s1600/Dr+Sudhir+Kumar-page-001.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1229" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijXGVaq1fZsp9XN9tzYLTEkciojxUGp5lLzhgIrlIqorLZJDl5WhG_Co5qMOd5KkGWcc7IicvJmiK96AkbnlJ_9WSWBHkWJQn5C-3VKfIKHBErgnAhQbj_JFHm_hYn52rlY_y01bStJuis/s320/Dr+Sudhir+Kumar-page-001.jpg" width="245" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2eXnX2w6r_P9IiUAFYHtQOvjlPkNc3l9_BDctJG8kPrNyXoXsPzr7jCrugqa-JudVw3m0_RRb0Pnee-V9YE65VRwN4lVPy55aYsP0eV69qTHtqKEb7vSIRsQvk3ImrkXjHw_MHyFR4HzT/s1600/Dr+Sudhir+Kumar-page-002.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1229" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2eXnX2w6r_P9IiUAFYHtQOvjlPkNc3l9_BDctJG8kPrNyXoXsPzr7jCrugqa-JudVw3m0_RRb0Pnee-V9YE65VRwN4lVPy55aYsP0eV69qTHtqKEb7vSIRsQvk3ImrkXjHw_MHyFR4HzT/s320/Dr+Sudhir+Kumar-page-002.jpg" width="245" /></a></div>
<span style="color: #990000;"><b>Dr Sudhir Kumar MD DM (Neurology)</b></span><br />
<span style="color: #990000;"><b>Consultant Neurologist</b></span><br />
<span style="color: #990000;"><b>Apollo Hospitals, Hyderabad</b></span><br />
<span style="color: #990000;"><b>04023607777/60601066</b></span><br />
<span style="color: #990000;"><b>drsudhirkumar@yahoo.com</b></span><br />
<span style="color: #990000;"><b>https://www.facebook.com/bestneurologist/</b></span><br />
<br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com1tag:blogger.com,1999:blog-4070812938669092184.post-9425574511955789732017-10-29T12:31:00.000+05:302017-10-29T12:45:31.823+05:30STROKE: RISK FACTORS, SYMPTOMS, TREATMENT AND PREVENTION (Times of India article)<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEmn3HsodGv7KdYz924Vi_FyqcggIu4z78Ar1CqWnymjeglruVBWdhh0zIsUPFYTI90mf4G-g1vSVBVg07ewinehfGSGu27ABNtJT58ivWL8hNFLoiJiOuyHtP5wjyeSb0ohAVOu0sOJ09/s1600/29_10_2017_105_e1d77a88ed552d0b04df18d6a3d587a3-page-001.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="649" data-original-width="1349" height="305" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEmn3HsodGv7KdYz924Vi_FyqcggIu4z78Ar1CqWnymjeglruVBWdhh0zIsUPFYTI90mf4G-g1vSVBVg07ewinehfGSGu27ABNtJT58ivWL8hNFLoiJiOuyHtP5wjyeSb0ohAVOu0sOJ09/s640/29_10_2017_105_e1d77a88ed552d0b04df18d6a3d587a3-page-001.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="text-align: left;">
<span style="color: red; font-size: small;">On the occasion of World Stroke Day (29th October), an article published in Times of India newspaper, to raise awareness about the diagnosis, treatment options and prevention of stroke. </span></div>
<div style="text-align: left;">
<span style="font-size: small;"><br /></span></div>
<div style="text-align: left;">
<span style="font-size: small;">The article can be accessed in Times of India (Hyderabad edition), dated 29th October 2017 (Page 31), at the following link: <a href="http://epaperbeta.timesofindia.com/Article.aspx?eid=31809&articlexml=WORLD-STROKE-DAY-Avoid-a-brush-with-a-29102017105014" target="_blank">http://epaperbeta.timesofindia.com/Article.aspx?eid=31809&articlexml=WORLD-STROKE-DAY-Avoid-a-brush-with-a-29102017105014</a></span></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<span style="color: blue; font-size: small;"><b>Dr Sudhir Kumar MD DM</b></span></div>
<div style="text-align: left;">
<span style="color: blue; font-size: small;"><b>Senior Consultant Neurologist</b></span></div>
<div style="text-align: left;">
<span style="color: blue; font-size: small;"><b>Apollo Hospitals, Hyderabad</b></span></div>
<div style="text-align: left;">
<span style="color: blue; font-size: small;"><b>04023607777/60601066</b></span><br />
<span style="color: blue; font-size: small;"><b>drsudhirkumar@yahoo.com</b></span></div>
<br /></td></tr>
</tbody></table>
<br /></div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com1tag:blogger.com,1999:blog-4070812938669092184.post-9451455335338209592017-09-12T22:47:00.000+05:302017-09-12T22:48:44.688+05:30HOW TO MAKE YOUR MIND STRONG?<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-family: "times new roman";">HOW TO MAKE YOUR MIND STRONG!<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US" style="color: blue; font-family: "times new roman";">The mind is probably the strongest organ of the
body. When the mind believes, anything is achievable, nothing is impossible! It
is said, success or failure is more often decided in the mind, than the actual
event itself. Thus, in the toughest sports tournaments, the players with
stronger mind usually prevail.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-family: "times new roman";">Traits
of a Strong Mind<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US" style="color: blue; font-family: "times new roman";">A strong mind always looks at the positive aspect
of things, because with regard to everything in life, there are both, positive
and negative aspects. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Winners always focus on the positive aspect. Halfway in a marathon
race, a person with a weak mind thinks, “half the distance is still yet to go
and I may not be able to complete it well”. On the other hand, a person with a
strong mind thinks, “I have finished half the race well, I can easily finish
the second half equally well”. Needless to say, the runner with the stronger
mind succeeds. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">A person with a strong mind has a lot of self-belief. “When you do
not believe in yourself, how can others believe in you?” So, you need to strongly
inculcate the sense of self-belief in yourself at all times. This is considered
as s stepping stone towards success. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Another feature of a person with strong mind is that he/she is
always hopeful. They always hope for and expect a good outcome. Even when the
whole world thinks otherwise, a person with strong mind always hopes for
success. You would certainly agree to this one- how many times you have seen
players winning a match from almost a losing position?! So, it is obvious that
unwavering hope and self-belief are important for winning, even from “losing
situations”. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">A person with a strong mind looks at only the good qualities in
another person and oversees the bad traits. Every individual has both good and bad
qualities. It is always easy to focus on negative qualities of a person and
criticize him. It takes a person with strong mind to focus on good qualities of
others and appreciate them. This virtue makes them appear more congenial among
masses. After all, no one likes a person who is always critical about him or
her. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">The most important quality in a person with strong mind is their
ability to control emotions. Emotions and sensitivity are important for good
social interactions; however, exaggerated emotional responses may interfere
with daily life. A person with a weak mind may suffer from sadness and
depression after a failure. On the other hand, a person with strong mind treats
failure as a medium to work on flaws and successfully outgrows them. If one
remains pre-occupied with negative emotions after a failure, there is no time
and energy left to sharpen the skills to excel later. However, the person with
a strong mind puts the failure behind and works harder in order to succeed at
the next available opportunity. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Anger is a negative emotion, which a person with strong mind lacks.
Strong-minded people are able to smile at all instances and events and strongly
believe in letting bygones be bygones, because they know that anger does not
solve a problem; on the contrary, it may aggravate it. Everyone likes a smile
and appreciation- who likes getting reprimanded?! There is no wonder, then that
people who often smile have a large number of admirers as compared to those who
get angry with small issues. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-family: "times new roman";">The
Making of a Strong Mind<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US" style="color: blue; font-family: "times new roman";">From the above discussion, it is quite evident
that a strong mind is vital for a fulfilling and successful life. So, is the
“strong mind” inherited from one’s ancestors or can one do something to make
the minds stronger? Well, here’s how you can build a strong mind. Just follow
these methods: <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "times new roman"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Regular exercises not only help you making physically fit, but also
impacts your memory and thinking skills. There is a release of good chemicals
such as endorphins and dopamine post-exercise, which elevate our mood and keeps
depression away. So, stay active!<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "times new roman"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Good nutrition is important to keep the brain strong. Timely
balanced meals are the key. So, dig into foods that are good for the brain. These
foods include fish, eggs, broccoli, asparagus, spinach, blueberries, dry fruits
like almonds and walnuts, etc. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "times new roman"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Ensure adequate sleep of seven to eight hours at night, as it relaxes
the body and mind. The mind gets re-energized after a restful sleep and is
ready to take on the everyday challenges of life. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "times new roman"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">The brain gets bored and inactive with a monotonous schedule and
activities, and the risk of cognitive impairment increases with this schedule.
On the other hand, challenging the brain with newer activities, such as
learning a new language or playing a musical instrument, would make the brain sharper
and stronger. This also boosts the self-confidence in a person. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "times new roman"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Avoiding smoking and alcohol as both these vices <span style="mso-spacerun: yes;"> </span>have a negative influence on brain and mind
functions, making them weaker and prone to mental illnesses. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="color: blue; font-family: "times new roman"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US" style="color: blue; font-family: "times new roman";">Socialize whenever you can! Isolation and loneliness are
detrimental to brain and mind and make them weaker. On the other hand, greater
social interactions, especially spending quality time with family and friends
are healthy for brain and makes it stronger. <o:p></o:p></span><br />
<span lang="EN-US" style="color: blue; font-family: "times new roman";"><br /></span>
<span lang="EN-US" style="color: blue; font-family: "times new roman";">(</span></div>
<div class="MsoNormal" style="line-height: 150%;">
(This article was first published in the September 2017 issue of B POSITIVE, a health and wellness magazine)<br />
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #660066; font-family: "times new roman";">Dr
Sudhir Kumar MD DM (Neurology)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #660066; font-family: "times new roman";">Apollo
Hospitals, Hyderabad<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #660066; font-family: "times new roman";">04023607777/60601066<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #660066; font-family: "times new roman";">drsudhirkumar@yahoo.com<o:p></o:p></span></b></div>
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"Courier New";
panose-1:2 7 3 9 2 2 5 2 4 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536859905 -1073711037 9 0 511 0;}
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;
mso-font-charset:2;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:325941913;
mso-list-type:hybrid;
mso-list-template-ids:-1476884434 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Symbol;}
@list l0:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l0:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Symbol;}
@list l0:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l0:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Symbol;}
@list l0:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;
font-family:Wingdings;}
@list l1
{mso-list-id:1746873218;
mso-list-type:hybrid;
mso-list-template-ids:1167989652 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l1:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<!--EndFragment--><br />
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-24666892397067484822017-08-23T08:01:00.000+05:302017-08-23T08:07:14.815+05:30FLUOROQUINOLONE ANTIBIOTICS CAN INCREASE THE RISK OF BENIGN INTRACRANIAL HYPERTENSION<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px; text-align: center;">
<b><span style="color: red;">FLUOROQUINOLONES CAN INCREASE THE RISK OF BIH</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px; text-align: center;">
<span style="color: blue;"><b><br /></b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>Antibiotics are commonly prescribed for treating infections. Although they are generally safe, sometimes, rare and serious adverse effects can occur.</b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>In a recent research study, fluoroquinolones and tetracycline group of antibiotics were found to increase the risk of developing benign intracranial hypertension (BIH). Fluoroquinolones include some commonly used antibiotics such as ciprofloxacin, lev<span class="text_exposed_show" style="display: inline; font-family: inherit;">ofloxacin, norfloxacin, ofloxacin and moxifloxacin.</span></b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b><span class="text_exposed_show" style="display: inline; font-family: inherit;">The adverse event of BIH was noted within 15 day and 30 day period of starting fluroquinolones. The risk of developing BIH was about five times more than non-users. </span></b></span></div>
<div class="text_exposed_show" style="background-color: white; display: inline; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif;">
<b></b><br />
<div style="color: blue; font-family: inherit; margin-bottom: 6px;">
<b>Patients with BIH present with headache, double vision and tinnitus (ringing sound in ears). If left untreated, there is a risk of vision loss.</b></div>
<b>
<div style="color: blue; font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
Fluoroquinolones can also increase the risk of seizures and confusion, especially in older people.</div>
<div style="color: blue; font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
The research study was published in the August 22, 2017 issue of Neurology Journal and can be accessed at the following link:<br />
<br />
<a href="http://www.neurology.org/content/89/8/792.full" target="_blank">http://www.neurology.org/content/89/8/792.full</a></div>
<div style="color: blue; font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
<br /></div>
<div style="margin-bottom: 6px; margin-top: 6px;">
<span style="color: magenta;">Conclusions</span></div>
<div style="color: blue; margin-bottom: 6px; margin-top: 6px;">
1. Fluoroquinolones can increase the risk of BIH, and hence caution is needed while prescribing them.</div>
<div style="color: blue; margin-bottom: 6px; margin-top: 6px;">
2. Patients who are taking fluoroquinolone antibiotics, and develop headache, double vision or tinnitus, should consult a neurologist.</div>
<div style="color: blue; margin-bottom: 6px; margin-top: 6px;">
3. Patients who have suffered from BIH in the past should avoid using fluoroquinolones, as much as possible.</div>
<div style="color: blue; margin-bottom: 6px; margin-top: 6px;">
<br /></div>
<div style="margin-bottom: 6px; margin-top: 6px;">
<span style="color: #660000;">DR SUDHIR KUMAR MD DM<br />Consultant Neurologist<br />Apollo Hospitals, Hyderabad<br />drsudhirkumar@yahoo.com<br />04023607777/04060601066</span></div>
</b></div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com2tag:blogger.com,1999:blog-4070812938669092184.post-15116068162351971082017-08-12T00:05:00.003+05:302017-08-12T00:05:27.234+05:30EDARAVONE- A NEW HOPE FOR PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
<span style="color: red;"><b>EDARAVONE- A NEW HOPE FOR PATIENTS SUFFERING FROM AMYOTROPHIC LATERAL SCLEROSIS (ALS)</b></span></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
<b><span style="color: blue;">Amyotrophic lateral sclerosis (ALS) is an uncommon degenerative disease of nervous system, mainly affecting the motor nerves. The common symptoms of ALS include weakness of arms and legs, difficulty in swallowing & speaking and breathing problem. The symptoms of ALS continue to get worse over time and most people die within 3-5 years after diagnosis, often due to respiratory failure.</span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhri2GM9uR9xeMm7W9BOyFgW_C5NBW_oglOxA0bqakHrwXCeMfvnJAqxpJSkwWl0KWRNzB0LXap09HsZSB0YFu0VM29i_ZvwnvqyWG0PsZoDNm0_inVDZxeQfdxqcJENgmz8gfFPxSM1_iH/s1600/1424840058662.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="349" data-original-width="620" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhri2GM9uR9xeMm7W9BOyFgW_C5NBW_oglOxA0bqakHrwXCeMfvnJAqxpJSkwWl0KWRNzB0LXap09HsZSB0YFu0VM29i_ZvwnvqyWG0PsZoDNm0_inVDZxeQfdxqcJENgmz8gfFPxSM1_iH/s320/1424840058662.jpg" width="320" /></a></div>
<div style="text-align: left;">
<b><span style="color: blue;"> Stephen Hawkings (suffering from ALS) <span style="font-family: Courier New, Courier, monospace; font-size: xx-small;"> AFP</span></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">There is no cure available for ALS. There is only one medication, RILUZOLE, which was approved for treating ALS in 1995. Riluzole can be used to slow down the deterioration in muscle strength. However, it has limited benefit in most patients. (In India, riluzole is offered free of cost to patients with ALS by Sun Pharmaceuticals). </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">Now, there is a new hope for patients with ALS. A new medicine, EDARAVONE INJECTION, has been approved by US FDA to treat patients with ALS.</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">What is basis of Edaravone efficacy?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">A research was conducted in Japan on more than 100 patients suffering from ALS. Edaravone injections were given for a period of six months. After six months, patients who received edaravone had better functional status and better quality of life (as compared to those who did not receive edaravone). </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">Which patients with ALS would benefit from Edaravone injections?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">Patients with ALS of less than two years duration, with mild disease severity, would benefit from edaravone. In addition, they should not suffer from any respiratory failure. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">What is the treatment regimen?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">Patients are given edaravone injection 60 mg per day as intravenous infusion (given over 60 minutes) for 14 days. </span></b><b><span style="color: blue;">Then there is a gap of 14 days.</span></b><b><span style="color: blue;"> Edaravone injection is supplied as 30 mg/20 ml vials (in India). In US, it is usually supplied as 30 mg in 100 ml. So, two vials would be needed per day. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">In second month, the injection is given on 10 out of 14 days. There is a gap of 14 days. This is continued for five months. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">So, in total, patient receives 64 doses of edaravone injections (60 mg each time) over a period of six months.</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">How long is the treatment continued?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">As of now, there is efficacy and safety data for six months, so, it should be continued for total of six months, as per the schedule mentioned above. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">Is Edaravone treatment safe?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">Yes, there are no serious adverse effects with edaravone. Minor side effects are similar to placebo. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">Do we need to reduce the dose of Edaravone in patients with kidney or liver disease?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">There is no need to reduce the dose in patients with renal or liver function impairment. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">What is the cost of edaravone injections?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">Each 30 mg vial costs about INR 400 (in India). So, the per day cost is about INR 800. The total cost of 64 days course of edaravone would be INR 51,200 (approximately 800 USD). Additional room rent, nursing charges, doctors fees, etc may be incurred. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: red;">How about Riluzole?</span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">Riluzole tablets should be continued together with edaravone injections. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;">So, in summary, now we have a new drug for ALS, which is the first drug approved in 22 years for ALS after Riluzole. </span></b></div>
<div style="text-align: left;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: left;">
<b><span style="color: #660000;">DR SUDHIR KUMAR MD DM</span></b></div>
<div style="text-align: left;">
<b><span style="color: #660000;">Consultant Neurologist</span></b></div>
<div style="text-align: left;">
<b><span style="color: #660000;">Apollo Hospitals, Hyderabad</span></b></div>
<div style="text-align: left;">
<b><span style="color: #660000;">drsudhirkumar@yahoo.com</span></b></div>
<div style="text-align: left;">
<b><span style="color: #660000;">www.facebook.com/bestneurologist/</span></b></div>
<div style="text-align: left;">
<b><span style="color: #660000;">04023607777/60601066</span></b></div>
<div style="text-align: center;">
<br /></div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-81989332728024836322017-07-14T08:26:00.000+05:302017-07-14T08:26:11.355+05:30TELEMEDICINE CONSULTATION IS AS GOOD AS TRADITIONAL CONSULTATION FOR NONACUTE HEADACHES<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px;">
<b><span style="color: red;">TELEMEDICINE CONSULTATION IS AS GOOD AS TRADITIONAL CONSULTATION FOR NONACUTE HEADACHES</span></b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px; text-align: left;">
<b style="color: blue;">The traditional method of consultation involves a patient visiting a doctor's clinic. The doctor takes history, performs clinical examination, orders investigations (as necessary) and prescribes medicines. This is the "gold standard" when it comes to accurate diagnosis and correct treatment.</b></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>However, there are a number of limitations for the traditional method of consultation: </b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>1. Lack of <span class="text_exposed_show" style="display: inline; font-family: inherit;">time on the patient's side due to his/her work/family assignments; </span></b></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><span class="text_exposed_show" style="display: inline; font-family: inherit;"><b>2. Lack of a specialist in his native place; </b></span></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><span class="text_exposed_show" style="display: inline; font-family: inherit;"><b>3. Limited number of choices of specialists in his native place; </b></span></span></div>
<div style="background-color: white; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><span class="text_exposed_show" style="display: inline; font-family: inherit;"><b>4. Higher costs (travel costs, need to skip work, etc).</b></span></span></div>
<div class="text_exposed_show" style="background-color: white; display: inline; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px;">
<div style="font-family: inherit; margin-bottom: 6px;">
<span style="color: blue;"><b>In this digital era, telemedicine consultations are feasible. This could include email chatting, audio or video consultation. By this method, a patient can choose a doctor in any part of the world, timing of consultation can be flexible and the costs are lower.</b></span></div>
<div style="font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>However, the major concern is the accuracy of telemedicine consultation. This issue was addressed in a recent research in patients with nonacute headaches. About 200 patients were treated on the basis of telemedicine consultation and another 200 patients with traditional method of consultation. At the end of one year, there was no difference in the outcomes in either group.</b></span></div>
<div style="font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>There is a fear of missing secondary causes of headache such as brain tumor, bleeding in brain, infection of brain, etc. One would need to provide 20,200 consultations by telemedicine to miss one such case. That is an extremely low risk.</b></span></div>
<div style="font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>In conclusion, telemedicine consultation seems to be an ideal alternative to traditional consultation for patients with nonacute headaches.</b></span></div>
<div style="font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
<span style="color: blue;"><b>This study was published in recent issue of Neurology Journal (July 14, 2017 issue) and can be accessed at the below link:</b></span></div>
<div style="color: #1d2129; font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
<a href="https://l.facebook.com/l.php?u=http%3A%2F%2Fwww.neurology.org%2Fcontent%2F89%2F2%2F153.short&h=ATPTlIYs-njZDV3A7gsakjocs4KS-VZv28SCv1tFh3N-UP-_qwBobfb5BAisnmmrDRzIvxpm_p5sIjPLOfmtXvKeKkIzK9mD2sxnL3h9zLcOyzTWJ-5rbtwNR6c9ThI-xXGnP9zh-KWtcIWLVJ5eVTOModV4&enc=AZMDq2SzB6DIViLI7v0PMU5kK50G7WO65I1sbi3Kr4uDin1hREkUhwP5hvvbSn-QuycG17pdSsSCJdt78Ovh5TbaFLfYoMNIj1MSANIsPAIqtuS2ovyu50vba8YDEEe5FvkKQ_aBACVkoFHnnhfpsJenCehOlsFXD3VMiJFlCaT88w43GizUQrRUpdVYWXeZDb9tdpsECfOjr-y1IOmY7w_g&s=1" rel="nofollow noopener" style="color: #365899; cursor: pointer; font-family: inherit; text-decoration-line: none;" target="_blank">http://www.neurology.org/content/89/2/153.short</a></div>
<div style="font-family: inherit; margin-bottom: 6px; margin-top: 6px;">
<b><span style="color: #990000;">DR SUDHIR KUMAR MD DM<br />CONSULTANT NEUROLOGIST,<br />APOLLO HOSPITALS, HYDERABAD<br />drsudhirkumar@yahoo.com<br />04023607777/60601066</span></b></div>
</div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-54030932385906607962017-06-16T08:05:00.000+05:302017-06-16T08:05:59.550+05:30DEEP BRAIN STIMULATION (DBS) IN PARKINSON’S DISEASE<div dir="ltr" style="text-align: left;" trbidi="on">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">DEEP BRAIN STIMULATION
(DBS) IN PARKINSON’S DISEASE</span><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">Major Symptoms of Parkinson’s disease</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Parkinson’s
disease (PD) is a progressive neurological disease, characterised by tremors,
rigidity, slowness of movements and postural imbalance. Though it is more common
after the age of 40, people younger than 40 can also get affected (when it is
known as young onset PD).<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Other symptoms of
PD include low volume speech (sometimes totally incomprehensible),
expressionless face, reduced blink rate, reduced arm swing while walking,
stooped posture, small handwriting (called micrographia), short-shuffling steps,
tendency to fall forwards. Many people also have pain and aches in the affected
limbs. Sleep disturbance and restless leg syndrome are common comorbid
illnesses in people with PD. Severe memory impairment is NOT a feature of PD,
however, in advance PD, mild memory impairment may occur in about 10% of
patients. Similarly, loss of bladder control or erectile dysfunction is not a
feature of PD. When these features are present, one should suspect multiple
system atrophy (MSA). <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">Diagnosis of PD</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">The diagnosis of
PD is still best made on the basis of clinical examination by an experienced
neurologist (preferably trained in movement disorders, though not a must). PET
and DaT scans are available to help in the diagnosis of PD, but they are not
superior to a good clinical examination by an experienced neurologist. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">Treatment of PD</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">Treatment of PD is
still primarily medical and DBS is not the first option. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">The most effective
medicine is levodopa-carbidopa combination. If a patient does not respond to
levodopa treatment, we should doubt the diagnosis (it may not be PD). Even
though levodopa is the most effective medication, we should delay starting it
by 2-3 years, to avoid side effects and lack of efficacy later on. Other
medications in use are pramipexole, ropinirole, trihexiphenydyl, selegiline,
rasagiline, amantadine, entacapone, safinamide, etc. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><span style="color: red;">Role of Deep Brain Stimulation (DBS) surgery in PD</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">DBS was approved
for PD in 2002. In the past 15 years, about 1,35,000 patients worldwide have
undergone DBS for PD.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US"><span style="color: red;">What does DBS
surgery involve?</span><span style="color: blue;"><o:p></o:p></span></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;">A neurosurgeon
places the leads (thin wires) that carry electrical signals to specific areas
of the brain. Then, the surgeon places a battery-run neurostimulator (like a
pacemaker) under the skin of the chest. <o:p></o:p></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHlcQfHlH4qTsE9NJkQlvKMBHj4tsLYLf_eyrPsZ6NziHpUKqYEKDH6Nm38KtFMnIacen3KDeQT9Cx7KEb_xSJe57B9XCV4LLNXMmqcmcnmyjcEfbVviZQAIeEJdPqx2izLN6WdL_bOHUl/s1600/dbs-family-md-lg.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="280" data-original-width="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHlcQfHlH4qTsE9NJkQlvKMBHj4tsLYLf_eyrPsZ6NziHpUKqYEKDH6Nm38KtFMnIacen3KDeQT9Cx7KEb_xSJe57B9XCV4LLNXMmqcmcnmyjcEfbVviZQAIeEJdPqx2izLN6WdL_bOHUl/s1600/dbs-family-md-lg.png" /></a></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: blue;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="color: blue;"><span lang="EN-US">The surgeon may
use a programming device to adjust the settings. </span><span style="background: white; mso-ansi-language: EN-IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">You may have a device, similar to a remote control, which allows you to
turn the system on and off and check the battery. You may also be able to
adjust the stimulation within options programmed by your doctor.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background: white; mso-ansi-language: EN-IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">A neurologist initially evaluates a patient to determine whether he or
she is the right candidate for DBS surgery. Then, further evaluations include
brain imaging (MRI, CT, PET, etc), neuropsychological testing, UPDRS scoring,
etc. Once the patient is found to be suitable for DBS, he is referred to the
neurosurgeon. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="background: white; mso-ansi-language: EN-IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><span style="color: red;">Which patients are likely to benefit from DBS surgery?</span><span style="color: blue;"><o:p></o:p></span></span></i></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">The diagnosis
of PD should be definite.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patient has had
PD for five years or more.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patient
continues to respond to levodopa, even though the response may or may not be
good.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">There are motor
fluctuations, such as on-off phenomena, with or without dyskinesia.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Various medical
treatments have not had desired benefit.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">PD symptoms are
severe enough to interfere with activities of daily living. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: red;">Which patients are NOT likely to
benefit from DBS surgery?</span><span style="color: blue;"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patients with
atypical Parkinsonian symptoms,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patients with
multiple system atrophy (where bladder and sexual dysfunction are prominent
symptoms),<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patients with progressive
supranuclear palsy,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patients with
dementia or severe cognitive impairment,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patients with
unstable psychiatric illnesses,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patients with
advanced PD, who are confined to bed/wheelchair; despite being on medications,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patients with
NO response to levodopa therapy,<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: red;">Who are the best candidates for DBS surgery in PD?</span><span style="color: blue;"><o:p></o:p></span></span></i></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Excellent
response to levodopa therapy,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Younger age,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Mild or no
cognitive impairment,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Few or no axial
(affecting neck or trunk) motor symptoms,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Absence of or
well controlled psychiatric disease. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: red;">Are there any complications of DBS surgery?</span><span style="color: blue;"><o:p></o:p></span></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">DBS surgery is generally safe if performed by a trained group of
specialists. However, complications may occur in upto 3% of patients, which
include:<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l2 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Bleeding
(hemorrhage) in the brain, <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l2 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Infection, <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l2 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Stroke,<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l2 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Speech
impairment <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l2 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Erosion,
migration or fracture of the lead, <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l2 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: blue;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Death<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: red;">What to expect after DBS surgery?</span><span style="color: blue;"><o:p></o:p></span></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">Most patients report a reduction in severity of symptoms after surgery.
Tremors, dyskinesia, slowness all respond to the surgery.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">PD medications, however, can not be stopped even after DBS. Most
patients still need to take medications, however, at much lower doses. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">The benefits are seen at five years after surgery, however, the effect
tends to wane in later years.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">DBS does not alter the disease progerssion, and disease continues to get
worse even after DBS.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: red;">Is MRI safe after DBS?</span><span style="color: blue;"><o:p></o:p></span></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">Yes, MRI can be safely done after DBS surgery.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: red;">What is the cost of DBS surgery ?</span><span style="color: blue;"><o:p></o:p></span></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-ansi-language: EN-IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="color: blue;">The cost of surgery is approximately INR 9,00,000 to 10,00,000. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: #660000;"><b>Dr Sudhir Kumar MD
(Med) DM (Neuro)<o:p></o:p></b></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: #660000;"><b>Senior Consultant
Neurologist<o:p></o:p></b></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: #660000;"><b>Apollo hospitals,
Hyderabad<o:p></o:p></b></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: #660000;"><b>http://www.facebook.com/bestneurologist/</b></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: #660000;"><b><a href="mailto:drsudhirkumar@yahoo.com">drsudhirkumar@yahoo.com</a><o:p></o:p></b></span></span></div>
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:Arial;
panose-1:2 11 6 4 2 2 2 2 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536859905 -1073711037 9 0 511 0;}
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
mso-themecolor:hyperlink;
text-decoration:underline;
text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-noshow:yes;
mso-style-priority:99;
color:purple;
mso-themecolor:followedhyperlink;
text-decoration:underline;
text-underline:single;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0cm;
margin-right:0cm;
margin-bottom:0cm;
margin-left:36.0pt;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:595.0pt 842.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:27922416;
mso-list-type:hybrid;
mso-list-template-ids:1331434424 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l0:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l0:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l0:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1
{mso-list-id:1007054188;
mso-list-type:hybrid;
mso-list-template-ids:205159436 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l1:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l1:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l1:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2
{mso-list-id:1082724576;
mso-list-type:hybrid;
mso-list-template-ids:-65243156 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l2:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l2:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3
{mso-list-id:1977291499;
mso-list-type:hybrid;
mso-list-template-ids:1106544052 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l3:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-18.0pt;}
@list l3:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style>
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-ansi-language:EN-US;}
</style>
<![endif]-->
<!--StartFragment-->
<!--EndFragment--><br />
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US"><span style="color: #660000;"><b>04023607777/60601066</b></span><o:p></o:p></span></div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com0tag:blogger.com,1999:blog-4070812938669092184.post-91153895622159186322016-12-08T08:17:00.001+05:302016-12-16T22:06:37.281+05:30RESTLESS LEGS SYNDROME<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: center;">
<span style="color: red; font-size: large;"><b>RESTLESS LEGS SYNDROME (RLS)</b></span></div>
<div style="text-align: center;">
<br /></div>
<span style="color: #cc0000;"><b>CLINICAL FEATURES OF RLS</b></span><br />
<br />
1.<span style="color: blue;"> Irresistible urge to move legs accompanied by uncomfortable or unpleasant sensations in the legs,</span><br />
<span style="color: blue;">2. The urge to move legs is more during periods of immobility or rest,</span><br />
<span style="color: blue;">3. The urge is partially or completely relieved by movement,</span><br />
<span style="color: blue;">4. The urge to move legs is more in evenings or nights as compared to day time (or is present only during evenings or nights).</span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">These symptoms should occur at least three times per week, and should be present for at least three months, before we can put a label of RLS. Also, these symptoms should cause significant distress or impairment in social, occupational and daily life. </span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">85% of patients with RLS also have periodic leg movements (involuntary forceful dorsiflexion of foot lasting 0.5-5 seconds, occurring every 20-40 seconds throughout sleep) at nights. </span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">Many people suffering from RLS also have sleep disturbance at nights and daytime fatigue. </span><br />
<span style="color: blue;"><br /></span>
<span style="color: #cc0000;"><b>What age-group patients are affected with RLS?</b></span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">Symptoms of RLS may start in infancy, however, most patients are diagnosed in their middle ages. There is often a delay of 10-20 years in diagnosis.</span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">RLS is quite common and about 5-15% of population may be affected. </span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">Women are more commonly affected than men, in a ratio of 2:1. </span><br />
<span style="color: blue;"><br /></span>
<span style="color: #cc0000;"><b>What are the causes of RLS?</b></span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">Majority of cases of RLS are idiopathic (no obvious cause) due to a disturbance in brain neurotransmitters (dopamine or serotonin). These are also called primary RLS. 25-75% of idiopathic RLS is familial with a genetic component. Familial cases start early (<45 years of age) and progress slowly.</span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;">RLS is called secondary RLS, if it is caused due to another disease. There are several such causes:</span><br />
<span style="color: blue;"><br /></span>
<br />
<ul style="text-align: left;">
<li><span style="color: blue;">Peripheral neuropathy,</span></li>
<li><span style="color: blue;">Iron deficiency,</span></li>
<li><span style="color: blue;">Folate deficiency,</span></li>
<li><span style="color: blue;">Magnesium deficiency,</span></li>
<li><span style="color: blue;">Diabetes mellitus,</span></li>
<li><span style="color: blue;">Rheumatoid arthritis,</span></li>
<li><span style="color: blue;">Renal failure,</span></li>
<li><span style="color: blue;">Vitamin B12 deficiency,</span></li>
<li><span style="color: blue;">Frequent blood donation,</span></li>
<li><span style="color: blue;">Pregnancy,</span></li>
<li><span style="color: blue;">Drug-induced (neuroleptics, antidepressants, beta blockers, lithium, alcohol, caffeine).</span></li>
</ul>
<div>
<span style="color: #cc0000;"><b>Are there any tests needed to confirm the diagnosis of RLS?</b></span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: blue;">No tests are needed to confirm a diagnosis of RLS, and the diagnosis can be made on the basis of clinical symptoms. Tests may be done to exclude secondary causes of RLS. </span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<b><span style="color: #cc0000;">What is the long-term outcome in patients with RLS?</span></b></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: blue;">The symptoms of RLS get worse over time and most have significant problems after age 50. Sleep impairment is common. There is increased risk of getting hypertension and headaches (including migraines). </span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<b><span style="color: #cc0000;">How is RLS treated?</span></b></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: blue;">There are effective medications available to treat RLS:</span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: blue;">1. Dopamine agonists: ropinirole, pramipexole, rotigotine, cabergoline.</span></div>
<div>
<span style="color: blue;">2. Levodopa,</span></div>
<div>
<span style="color: blue;">3. Gabapentin or pregabalin,</span></div>
<div>
<span style="color: blue;">4. Opioids in severe cases. </span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: #660000;"><b>DR SUDHIR KUMAR MD DM (Neurology)</b></span></div>
<div>
<span style="color: #660000;"><b>Senior Consultant Neurologist</b></span></div>
<div>
<span style="color: #660000;"><b>Apollo Hospitals, Jubilee Hills, Hyderabad</b></span></div>
<div>
<span style="color: #660000;"><b>Phone- 040-23607777/60601066</b></span></div>
<div>
<span style="color: #660000;"><b>drsudhirkumar@yahoo.com </b></span></div>
<div>
<span style="color: blue;"><br /></span></div>
<div>
<span style="color: blue;"><br /></span></div>
</div>
Dr. Sudhir Kumarhttp://www.blogger.com/profile/10020497539556640868noreply@blogger.com4