Dr Raga Deepika Chakravarthula

25 year Old student ,resident of annareddy gudem is brought to the opd with cheif complaints of  Cough since 1 month Fever since 1 month Patient was apparently asymptomatic 1 month back then he developed  Cough  Duration 1month Onset insidious,  Occasional - 5-6 bouts /day Non productive Non barking type Non paroxysmal cough Associated with fever  No post tussive vomiting Fever- Low grade , intermittent, not associated with chills and rigors, No diurnal variation Not associated with burning micturition, loose stools,vomiting ,pain abdomen Past history-  2009-10‐->   Patient developed weakness of lower limbs, difficulty in walking  Was taken to private hospital for the same  Weakness of the limbs-- Insidious onset, gradually progressive, paresis Weakness begun in the lower limbs gradually progressed to upper limbs over 4- 5 months Weakness distal to proximal progression With tipping of tors, slippage of chappals Later patient developed diff...

55 year old male cattle rearer by occupation was brought to the casualty with complaints of Inability to move left sided upper and lower limb since 6 days Inability to speak since morning Patient was apparently asymptomatic 6 days back then he developed weakness of left upper and lowerlimb after waking up from sleep For which he was taken to hospital and diagnosed to have multiple infarcts in.......areas and was treated for the same  During the stay patient developed ? episodes of seizure Lasted for 10 min , ?focal , post ictal confusion for 15min  Later patient was discharged  Yesterday night patient had an episode of seizure , focal tonic clonic involving left upperlimb for 5minutes , gained consciousness after 10 minutes  Later patient was unable to speak Patient was brought to the hospital  Past- K/C/O Dm since 5 years (under irregular medication) Had left index finger amputated( ? Due to diabetes) Personal-

NOTE: THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 65/m farmer Dupalli Yadadri district farmer since 45 years was brought to the casualty with complaints of vomiting since 2 months, weakness of lower limb since 1week and difficulty in walking since 1 week 2012--> pain , deformity of right knee(? Chickungunya) 2019 --> episode of giddiness while working in the farm  Went to pvt practioner and diagnosed to have HTN and started the patient on Amlodipine 5mg  ( no loc,fall, syncope, chestpain, weakness of limbs, Involuntary movements) Similar episode an year later while working in the farm  ( Which attenders attributed to patient not having e...

Sometimes I didn't realise the value of appreciating the nature or natural phenomena that goes through be it our body or the universe I've always been fond of nervous system it's uncertainty and its beautiful feature of plasticity,the way it naturally tries to mold to adjust and make us the better ones  Could we really be any btr without its plasticity ?!! Few patient's have taught us how life happens and takes a sudden course of downhill , how some go uphill y is d life so uncertain. Could we as physicians bring any difference to their or so called our lives!!? When do we know if it's early or late ?! Who could decide this for?! I've had few cases not just academically but has taught me life worth lessons 1- A case of elderly male with diagnosis of multiple myeloma,  journey to the diagnosis made me realise how uncertain ones lives are and how unpredictable course could be  In the beginning we tried ruling out infective cause--- but then still q remained the sa...

68 year old female resident of vemulapalli housewife  Was brought to casualty with complaints of shortness of breath since 10days Decreased appetite and weakness since 4 days Decreased activity since 4 days Patient was apparently asymptomatic  5 years back--> then she developed sob and was taken to private hospital , was given Nebulisation (?unknown medication) relevied symptomatically Sob + seasonal variation ( every year during winters) 6months back-->Patient developed similar complaints with fever and was admitted in pvt hospital was treated as Bronchial asthma with Nebulisation  10days back -->  Sob- insidious onset gradually progressed from grade 3 (mmrc) Fever+ cough + wheeze- Not a/w chestpain , cold, Palpitations, sweating No h/o orthopnea , pnd  Wad given Nebulisation 5 days back which could relieve her symptoms temporarily  Cough - Non productive  3-4 days back--> patient developed increased sob (grade 3-4), weakness , increas...

  NOTE: THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT Thanks to Sanjana for her inputs - CHEIF COMPLAINTS: blog link -https://96sanjanapalakodeti.blogspot.com/2022/09/47m-with-uncontrolled-hand-movements.html HISTORY OF PRESENT ILLNESS: WEAKNESS OF LIMBS a.         Weakness of all 4 limbs present  b.       Onset -insidious c.        Duration from 2 years , gradually increased  d.       Severity – paresis e.        Progresion – simultaneous involvement of all 4 limbs f.       1.       Upper ...

http://drkulkarnimd.blogspot.com/2022/07/36m-with-decreased-appetite-nausea-and.html Patient came with complaints of  C/O weakness and fatigue since 3 days Unable to lift his rt upper limb since 3 days History of fever 2 days back Swelling of lower limbs from 2 days Fever : low grade  No diurnal variation Duration 1day Associated with chills  Subsided after taking medication Not associated with cough and cold  Not associated with loosestools. ? Burning micturation present Weakness of rt upperlimb Pain + @ right shoulder Inability to move since 4 days Able to move his fingers and forearm Not history of trauma or lifting heavy weights No radiation of pain to neck and chest Swelling of lower limbs Bilaterally present grade 1 [pitting type] History of pedal edema on and off present past 1 year Not associated with sob , pnd, chest pain, Palpitations, Patient is a known case of DM since 2 years , was on HAI and NPH given by her wife at lateral aspect of arm and on thighs...