Chandana vishwanatham

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box" 55year female patient, Patient was admitted for ACTH stimulation test on May 24 th 2022 15 years ago,she went for routine check up and diagnosed with HTN and started on medication. 9 years ago -she has h/o cough and diagnosed with pulmonary kochs used ATT for 6 months associated with joints pains . 8 years ago- she has h/o increased joint pains - polyarthritis - prescribed with steroids by local doctor and was adviced to taper and stop .But as she stopped using steroids ,the...

  Ascites blog links https://chandanavishwanatham19.blogspot.com/2022/04/56year-male-with-nephrotic-syndrome.html https://navyamallempalli.blogspot.com/2021/02/dr_6.html http://abdulraheem7168.blogspot.com/2021/01/41year-old-male-with-portal.html https://swathibogari158.blogspot.com/2020/09/chronic-decompensated-liver-disease.html?m=1 https://06akhil.blogspot.com/2021/11/general-medicine-case-4.html?m=1 https://sushma29.blogspot.com/2020/09/ascites-secondary-to-nephrotic-syndrome.html?m=1 https://harikachindam7.blogspot.com/2020/12/55m-with-abdominal-distention-since-15.html?m=1 https://jayanth1802.blogspot.com/2021/02/55-year-old-farmer-with-sob-abdominal.html?m=1 https://chandanavishwanatham19.blogspot.com/2021/03/52year-old-male-with-ascites.html https://drkulkarnimd.blogspot.com/2021/04/46m-with-ascites-and-portal-hypertension.html https://pravalikachithanuri.blogspot.com/2020/10/45-year-old-male-with-decompensated.html http://sairaghuver.blogspot.com/2020/10/is-online-e-log-bo...

 Spotter 1 What are your differentials for the distended vein seen over the abdomen?Is any way to find out the cause based on the direction of flow of blood in the vein? https://harikachindam7.blogspot.com/2020/12/55m-with-abdominal-distention-since-15.html?m=1 Spotter 2 What is the striking feature in this picture in a patient of anemia?What is the cause of his anemia? https://priyanka176.blogspot.com/2022/02/pancytopenia-under-evaluation.html?m=1 Spotter 4 What is the interpretation of peripheral blood smear shown above in a patient of anemia and what are your differentials? https://lekhanakeetha64.blogspot.com/2022/02/case-of-anemia.html?m=1 Spotter 4 What is the procedure that is being done in the above picture and what are the indications? https://chandanavishwanatham19.blogspot.com/2022/06/procedural-competencies.html   Spotter 5 What is the test that is being done in a patient of dengue in the above picture? What is the procedure and interpretation of the test? https://...

 IJV-Central venous catheterisation  https://youtu.be/PgI1vbxat5Q Pleural tap https://youtube.com/shorts/JO35HK3WkeY?feature=share

It was a fine morning on 10th may 2022,it’s my duty day.Reaching college with lots of enthusiasm and the fear of missing my biometry.However managed to reach college by 8:02am in the morning. There was one case in my unit of Stable angina and Haemorrhoids which I reviewed and wrote my repeat. I went to OPD  by 9am as i usually do on my duty days and started seeing various Op cases of Diabetes, hypertension, hypothyroidism,Anemia, Gastritis, headaches,giddiness etc...everything was going fine and Got a call from Emergency room (ER) at around 1 30pm when I was planning to go for my lunch after clearing the OPD cases of almost about 30-35cases,that a 60year male is brought in a unresponsive state. I rushed to the ER from OPD.On my way to ER got a call from ENT OPD that a POD- 3 case of sub mandibular excision had a syncopal attack followed by one episode of ?Generalised tonic clinic seizures.So I took my junior along with me, informed my faculty and rushed to ENT OPD which is anyway o...

 May 1st-Sunday https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437371/ Efficacy and safety of Rituximab in SLE Shared and discussed Dr.Hari Priya pg1 ************* May 2nd Online https://ashpublications.org/blood/article/117/16/4190/20799/The-American-Society-of-Hematology-2011-evidence Dexamethasone+Rituximab vs Dexamethasone alone in newly diagnosed ITP Shared and discussed by Dr Hari priya http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435674/ Pathological significance and prognostic role of indirect bilirubin in hepatic encephalopathy Shared and discussed by Dr Sai charan https://manasaalasani.blogspot.com/2022/04/65-year-old-female-labourer-by.html Removal of phenytoin by Hemodialysis Discussed by shailesh https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398619/#:~:text=Diffuse%20blackish%20hyperpigmentation%20was%20seen%20in%2040%25%2C%20which%20was%20relatively,as%20well%20as%20superficial%20dermis http://1601006027.blogspot.com/2022/04/60-yr-old-male-with-crf-flash-pulmonary.html...

 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.  24/4/21 19 Year old female came with cheif complaints of generalised swelling with decreased urine output since 10 days  complaints of multiple joint pains since 2 years  HOPI :-patient was apparently asymptomatic 2 years ago  Patient had complaints of fever with bilateral ankle ,knee  joint pain with swelling and difficulty in walking due to pain  Later within 1 week after the onset of these symptoms patient had bilateral interphalyngeal joint pains , elbow , shoulder wiyth restriction of movement  , swellings  Patient with these complaints visited a local doctor and was tol...

 Case reference: https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html SOAP NOTES  D WARD 25/2/22 S:  C/O sob and abdominal distension since last dialysis O: Patient was C/C/C No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema Vitals at admission: PR- 80 bpm BP- 140/80 mmHg RR- 21 cpm SpO2- 98% CVS: S1 S2 +, RS: B/L AE + P/A: soft nontender . Ascitic tap was done on 23/2/22 showing high SAAG high protein SAAG value - 1.8 Ascitic protein - 3.0 A: ? NSAIDS induced nephropathy (H/o HTN since 2 months)  High SAAG high protein secondary to heart failure Recent hemodialysis: 23/2/22 Hemodialysis since 1 month 2 sessions per week P : 1. INJ. LASIX 40 mg IV BD 2. INJ PAN 40 mg IV OD  3. INJ ZOFER 4 mg IV OD 4. INJ erythropoietin 4000 IU SC once weekly 5. MONITOR VITALS 6. Tab OROFER XT PO  OD 7. Tab SHELCAL PO OD 8 T AMLONG 5 mg PO BD 9. T NICARDIA 20 mg PO OD

 History taken in August 18 2021 56 year old man, owns a restaurant at choutuppal presented with the complaints of Bilateral lower limb swelling since 1 month Reduced urine out since 20 days Abdominal distension since 7 days Scrotal swelling since 4 days Patient used to previously work as a farmer and later in 2004 he and his wife started running their local bandi for breakfast at Choutuppal. He even serves breakfast on cycle. He is a father of 2 children.   22 years back: He got diagnosed with pulmonary kochas for which he used ATT for 6 months   1 month back :  He first developed left lower limb swelling extending upto his ankle and he later gradually developed swelling of his right lower limb and the swelling in both his lower limbs extended upto his thighs He even had difficulty in passing stools for which he received enema outside  Since 20 days - he has been experiencing reduced urine output  10 days back - When he paid a visit to a hospit...