K. Prem sai pavan kumar

    Case History and Clinical Findings C/O 1 EPISODE OF LOC ON 18/2/23 AFTERNOON AROUND 12 PM HOPI: PT WAS APPARENTLY NORMAL UNTIL AFTERNOON (18/2/23) THEN HE SUDDENLY HAD 1 EPISODE OF LOSS OF CONSCIOUSNESS FOR PERIOD OF 2 MINUTES AND THEN REGAINED CONCIOUSNESS. NO H/O NAUSEA,VOMITINGS,HEADACHE,TRAUMA,ENT BLEED, DIMMING OF VISION. NO H/O CONFUSION,SEIZURES,CHEST PAIN,SOB NO H/O INVOLUNTARY BOWEL AND BLADDER PASSAGE,TONGUE BITE PAST HISTORY: K/C/O TYPE 2 DM SINCE 20 YEARS (ON T.GLIMI M1 PO/OD) K/C/O HYPERTENSION SINCE 20 YEARS(ON T.MET-XL 50 MG PO/OD AND T.TELMA 40 MG PO/OD)   PT.SON GIVES H/O STOPPING MEDICATION FOR AROUND 20-30 DAYS 2 YEARS BACK K/C/O CKD SINCE 2 YEARS ON CONSERVATIVE MANAGEMENT N/K/C/O CAD,CVA,TB,EPILEPSY,ASTHMA,THYROID DISORDERS     ON EXAMINATION: PT IS C/C/C TEMP:97 F PR:74 BPM BP:170/100 MM HG RR-18 CPM   RS: BAE + NORMAL VESICULAR BREATH SOUNDS. CREPTS HEARD IN RIGHT IAA CVS: S1S2+,NO MURMURS P/A: SO

  Case History and Clinical Findings C/O ABDOMINAL DISTENSION SINCE 1WEEK C/O DECREASED APETTITE SINCE 1 WEEK C/O DECREASED URINE OUTPUT SINCE AFTERNOON PT WAS APPARENTLY ALRIGHT 1MONTH BACK THEN HE DEVELOPED PAIN ABDOMEN ON AND OFF , THEN HE DEVELOPED ABDOMINAL DISTENSION , WHICH WAS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE .   NO H/O FEVER , NAUSEA , VOMITING ,LOOSE STOOLOS , CONSTIPATION HE HAD LOSS OF APPETITE SINCE 1 WEEK AND DECREASE IN URINE OUTPUT SINCE AFTERNOON. NOT A K/C/O DM ,HTN , ASTHMA , TB , CAD , CVA , EPILEPSY OCCASIONAL ALCOHOL INTAKE , NO H/O SMOKING . GENERAL EXAMINATION : PT IS C/C/C, MODERATELY BUILT AND NOURISHED NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMHADENOPATHY , EDEMA AFEBRILE PR -120BPM BP - 130/80 MMHG RR - 20CPM SPO2 - 98% AT ROOM AIR GRBS - 108MG% CVS - S1S2 HEARD , NO MURMURS CNS-HMF INTACT . NFND RS -BAE PRESENT , NO ADDED SOUNDS P/A - ABDOMEN DISTENDED , UMBILICUS CENTRAL ,

    Case History and Clinical Findings DEATH SUMMARY 50 YEAR OLD MALE CAME WITH CHIEF COMPLAINTS OF SOB SINCE 10 DAYS AND EDEMA OF UPPER LIMB AND LOWER LIMB SINCE 6 DAYS. HE WAS MANAGED BY GIVING INJ LASIX 40 MG AND RATE CONTROLLING T. MET XL 25 MG GIVEN. HE WAS SHIFTED TO AMC. IN VIEW OF GLOBAL HYPOKINESIA HE WAS STARTED ON ANTI PLATELET. IN VIEW OF HIGH CREATININE LEVELS NEPHRO OPINION WAS TAKEN AND THEY SUGGESTED CONSERVATIVE MANAGEMENT   ON 16/03/2023 PATIENT SUDDENLY DEVELOPED SINUS TACHYCARDIA AND SHIFTED TO ICU AND GIVEN RATE CONTROLLING AGENTS WERE GIVEN. SINCE YESTERDAY MORNING HE IS COMPLAINING OF GIDDINESS AND CEREBELLAR SIGNS WERE NEGATIVE AND RULED OUT CENTRAL CAUSE. IN VIEW OF INCREASED CREATININE PATIENT IS ADVISED FOR DIALYSIS BUT PATIENT ATTENDERS WERE NOT WILLING FOR DIALYSIS. YESTERDAY NIGHT [18/03/2023] PATIENT WAS DROWSY BUT AROUSABLE. TO RULE OUT ANY INFARCT MRI WAS SUG

    Case History and Clinical Findings SUDDEN UNRESPOSIVNESS SINCE 6PM ON 27/03/23 HISTORY OF PRSESNTING ILLNESS PATIENT WAS APPARENTLY ASYMPTOMATIC 10 YEARS BACK THEN DEVELOPED GIDDINESS FOR WHICH HE WENT TO LOCAL HOSPITAL AN D WAS DIAGNOSED AS HAVING DIABETES AND HYPERTENSION ON MEDICATION SINCE THEN HISTORY OF WEAKNESS OF LEFT UL AND LL 3 YEARS AGO DIAGNOSED AS CVA   15 DAYS AGO DEVELOPED COUGH WITH EXPECTORATION WHITE IN COLOR AND BILATERAL LOWER LIMB SWELLING INSIDIOUS ONSET GRADUALLY PROGRESSIVE AND FEVER LOW GRADE ON AND OFF SINCE 15 DAYS AND DEVELOPED SHORTNESS OF BREATH EVEN AT REST FOR WHICH HE WENT TO LOCAL HOSPITAL AND GOT AND TREATED WITH ANTIBIOTICS FOR 6 DAYS AND GOT DISCHARGED ON LAMA AND PATIENT SYMPTOMATICALLY IMPROVED AND SINCE EVENING 6 PM DEVELOPED SUDDEN ONSET UNRESPOSIVNESS PAST HISTORY : KNOWN CASE OF TYPE 2 DM AND ON TAB GLIMI M2 2MG/500MG AND HYPERTENSION SINCE 10 YEARS AND ON T MET-XL 25mg/P

    Case History and Clinical Findings A 45 YEARS OLD MALE CAME WITH -C/O ANURIA SINCE 1 DAY -RIGHT LOWERLIMB SWELLING SINCE 3 DAYS -EPISODES OF FEVER WITH CHILLS (INTERMITTENT) SINCE 2DAYS   HISTORY OF PRESENTING ILLNESS- PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK THEN HE DEVELOPED SWELLING OVER RIGHT LOWER LIMB WITH BLISTERS OVER IT ,INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE AND PRESENTLY UPTO RIGHT MID THIGH REGION. ASSOCIATED WITH DULL ACHING PAIN. PATIENT WENT TO A LOCAL HOSPITAL AND FASCIOTOMY WAS DONE UNDER LA - SATURDAY (I.E 18/3/23) H/O FEVER , HIGH GRADE, INTERMITTENT SINCE 3 DAYS ASSOCIATED WITH CHILLS . RELIEVED ON MEDICATION. NO SOB H/O ANURIA SINCE 1 DAY.     PAST HISTORY K/C/O TYPE 2 DM SINCE 5 YEARS AND ON MEDICATIONS •TAB GLIMEPIRIDE 1MG •TAB METFORMIN 500MG K/C/O HTN SINCE PAST 3 YEARS AND ON MEDICATIONS •TAB OLMESARTAN 20MG •TAB CILNIDIPINE 40MG N/K/C/0 CAD, EPILEPSY, ASTHMA, TB , CVA ,THYROID DISORDERS

    Case History and Clinical Findings COMPLAINTS OF GIDDINESS SINCE 1 DAY COMPLAINTS OF DOUBLE VISION SINCE MORNING COMPLAINTS OF DIFFICULTY IN SWALLOWING SINCE MORNING COMPLAINTS OF WEAKNESS OF LEFT LOWER LIMB AND INABILITY TO WALK   HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC TILL YESTERDAY THEN HE HAD 1 EPISODE OF VOMITING - FOOD PARTICLES AS CONTENT, NON PROJECTILE, NON BILIOUS, NON BLOOD STAINED IN THE EVENING HE DEVELOPED GIDDINESS WHICH HE THOUGHT WAS HYPOGLYCEMIC EPISODE AND HAD A COOL DRINK.   THE GIDDINESS DIDN'T SUBSIDE SO HE WENT TO A LOCAL RMP AND FOUND TO BE HAVING SBP OF 90 MMHG AND HENCE FLUIDS WERE GIVEN AND SENT HOME. AT AROUND 5 AM HE COULDN'T GET UP AND HE NOTICED WEAKNESS OF LEFT LOWER LIMB AND EXPERIENCED SEVERE GIDDINESS AND WAS TAKEN TO A LOCAL HOSPITAL WHERE MRI WAS DONE. IT WAS FOUND THAT HE HAD ACUTE INFARCTS IN LEFT MEDULLA AND INFERIOR CEREEBLLAR HEMISPHERES. HE ALSO DEVELOPED DIFFICULTY I