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Bimonthly assessment January

a)  Problem representation : 26yr old female with k/c/o SLE Polyarthritis with head ache since 8 days and fever, vomtings since 4 days and altered sensorium since 2 days with Euvolemic hyponatremia under evaluation. Anatomical localization: Brain. b) etiology: CVA , TB Meningitis , SLE vasculitis ,SIADH secondary to infection.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357611/( Bisphosphonate prophylaxis). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970554/(proton pump for corticosteroid ulcers) https://pubmed.ncbi.nlm.nih.gov/10067053/ ( TB Meningitis in SLE pts) C) Bisphosphonates were given to prevent osteoporotic fracture risk associated with using long-term steroids. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357611/ Bisphosphonate prophylaxi s d) Probable cause of normal CSF count in patients of Chronic meningitis is probably due to the use of steroids which caused immunosuppression and decreased inflammatory   was the research question in the above thesis presentation
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26 m btech with complaints of vomitings

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  26/M btech,completed 3yrs back non alcoholic and a non smoker , developed vomitings 4-5episodes on23rd December: yellow colored,non bilious,non blood stained contained foodparticles/water. Thenafter patient used to have vomitings every day 2-3episodes or at times multiple episodes for  one &half month i.e till feb 11th    After 15days of onset of vomitings i.e in January patient went to Suryapet hospital and there for the first time he was said to have high bp-170mmhg and brain imaging was done .Used anti hypertensive drugs for 10days and stopped On February 12th he presented with : 1-multiple episodes of vomitings a day before,2-he noticed decreased urine output since January  3- intermittent shortness of breath on walking for long distance 4-spasm of both calves since 5-6yrs monthly twice/thrice only night times due to which he used to get up from his sleep His creatinine was 15mg/dl On February 13th he was referred to NIMS  i/v/o renal biopsy.There his shortness of breath was
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A 58 yr old male with pedal oedema

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This is the case i have seen  A 58 year old male daily wage labourer from vattikodu who is apparently asymptomatic 5 yrs back. Then he developed deafness secondary to (?Tympanic membrane perforation) and was fine with it until last year when he developed on & off episodes of giddiness & headache which was attributed to hypotension by a local RMP and was treated conservatively. (can it be ? Peripheral vertigo) 2 months back he had an episode of fever , generalized weakness & body pains for which he is using analgesics and has on and off pedal edema from then which subsided with treatment by a local RMP. 4 days back he developed pedal edema , burning micturition and SOB which gradually progressed to anasarca associated with abdominal distention ,  increased SOB and decreased urine output 1 day later for which he was taken to a local hospital where he was diagnosed with kidney failure and was referred to our hospital for further management. No h/o chestpain / palpitations / sy
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A 45 year old male with complaints of left side loin pain radiating to groin since 8 days

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This is the case i have seen   A 45 year old male farmer by occupation chronic alcoholic and smoker presented with c/o left side loin pain radiating to groin :since 8 days Fever for 1 day associated with chills : 1 week back Vomitings and loose stools for 2 days - 5 days back Decreased urine output :5 days Pedal edema :4 days Patient was apparently assymptomatic 8 days back and then he developed left loin pain radiating to groin which subsided with medication .Then he developed fever associated with chills. Vomitings :3-4 episodes and loose stools : 5-6 episodes for 2 days associated with pain abdomen subsided on medication .Decreased urine output :5days and pedal edema (non pitting , painful extending upto knees) for 4 days .No h/o chest pain/sob/palpitations. No other complaints. Not a k/c/o DM /HTN/asthma /epilepsy /CAD/TB General examination: Pedal edema + upto knees Multiple ecchymotic patches + over both lower limbs Subconjunctival hemorrhage present Dry gangrene of tip
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