Dr Raga Deepika Chakravarthula

75 year old male shopkeeper by occupation presented to the casuality with Altered sensorium History of 4 episodes of seizures since morning 4 am  Each episode lasting for a period of 5 minutes  Seizures- involving left upper limb and lower limb tonic clonic type associated with facial deviation and frothing not associated with urinary incontinence and tongue bite Patient was apparently asymptomatic 6 months back  Then patient developed tingling sensations of left upper and lower limb and was taken to local practioner and given unknown medications  Later patient was unable to move his left lowerlimb ,was Intitally able to move lt ul which then progressed to Inability to move lt ul and was taken to neurologist and was diagnosed as CVA  Ct brain done showing acute infarct in Rt frontal cortex Patient found to have GRBS 480 mg/dl and started on GlimiM2 twice daily During hospital stay patient developed frequent eye twitches  and was started on ? Anti epileptic for 6 weeks  Patient is start

 Patient came to casuality with , c/o generalised body pains since 4 months  A/w pedal edema since 1month A/w fever ( on and off ) HOPI:  Patient was apparently asymptomatic 4 months back then she developed severe joint pains involving toes and fingers not a/w swelling , this then was slowly progressing to involve other joints , wrist, elbow, shoulder,knee, and ankle - pain a/w restriction of movement since 3 months - stiffness of joints present since 3 months , aggrevated with increased activity  -stiffness and pain are more in the morning ( after waking up ) and decreasing as the day progressed ( increased again at the night after 7.30pm ) disturbing her sleep quality  -swelling joints present at the knee and MCP joints since 4 days ( on and off) resolves spontaneously  -swelling at ankle : Non pitting type , increased when standing and working and decreased at rest - pt c/o decreased capacity to work due to pain since 4 months  -No similar complaints in past -N/K/C/O  DM,HTN,CAD,Ast