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53M WITH SOB AND PEDAL EDEMA

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Case History and Clinical Findings  C/O PEDAL EDEMA SINCE 2 MONTHS C/O SOB SINCE 3 DAYS C/O DECREASED URINE OPUTPUT SINCE 1 WEEK  HISTORY OF PRESENTING ILLNESS:  PT WAS APPARENTLY ALRIGHT 1 YEAR BACK THEN HE WAS DIAGNOSED WITH CKD AND WAS ON CONSERVATIVE MANAGMENT . PATIENT HAD DECREASED URINARY OUTPU SINCE 1 WEEK NO HESITANCY, DRIBBLING OF URINE PEDAL EDEMA SINCE 2 MONTHS, PITING TYPE UPTO KNEE SOB SINCE 3 DAYS GRADE IV, ORTHOPNEA+ NO PND , NO CHEST PAIN, PALPITATIONS  PAST HISTORY:   K/C/O DM II SINCE 7 YRS ON INSULIN K/CO HTN 1 YEAR ON CLINIDIPINE 10MG   PERSONAL HISTORY :   DIET MIXED APPETITE DECREASED SLEEP ADEQUATE BOWEL REGULAR ADDICTIONS NONE  GENERAL PHYSICAL EXAMINATION PATIENT IS CONCIOUS COHARENAT COOPERATIVE  VITALS  PR 90 BPM  BP 130/80 MM HG  RR 17 CPM  TEMP 98.7 F  GRBS : 102 MG/DL  SPO2 99 @ RA  CVS : S1 S2 +  RS : BAE +, TRACHEA CENTRAL , NVBS HEARD, B/L BASAL CREPTS PRESENT CNS : HMF INTACT , NO NEUROLOGICAL DEFICITS  P/A : SOFT , NT. COURSE IN THE HOSPITAL 53 YEAR
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61M WITH FEVER AND PAIN ABDOMEN

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Case History and Clinical Findings  C/O FEVER SINCE 10 DAYS C/O PAIN ABDOEN 10 DAYS  HOPI PT WAS APPARANTLY ALRIGHT 10 DAYS BACK THEN HE HAD HIGH GRADE ASSOCIATED WITH CHILLS,INTERMITTENT , RELIEVED BY TAKING MEDICATION PAIN ABDOMEN SINCE 10 DAYS , DRAGGING TYPE OF PAIN , NON RADIATING , ASSOCIATED WITH VOMITING ONE EPISODE ,BILIOUS , NON BLOOD TINGED , NON PROJECTILE , NON FOUL SMELLING BINGE OF ALCOHOL 10 DAYS BACK NO PEDAL EDEMA NOP COUGH , COLD  PAST H/O  N/K/C/O DM II , HTN , CVA , CAD , EPILEPSY ,  K/C/CO B/L RENAL CALCULI S/P L URTSL + DJ STENTING 4 MONTHS BACK VARICOSE VEINS PRESENT PERSONAL HISTORY :  DIET :MIXED APPETITE : GOOD SLEEP : ADEQUATE BOWEL:REGULAR  GENERAL EXAMINATION :   PATIENT IS CONSCIOUS , COHERENT , COOPERATIVE PALOR PEDAL EDEMA NO SIGNS OF CLUBBING , ICTERUS , CYANOSIS , LYMPHEDNOPATHY VITALS : TEMP : 98.3 F PR : 76 BPM BP : 110/70 MMHG GRBS : 118 MG / DL SPO2 : 94% RR : 15 CPM SYSTEMIC EXAMINATION :  CVS : S1 , S2 HEARD , NO MURMURS  RS : BAE + , NVBSHEARD 
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19YR OLD PRIMI (36wks gestational age) with proteinuria

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Case History and Clinical Findings  19 YEAR OLD PRIMIGRAVIDA WITH 9 MONTHS OF AMENORRHEA CAME FOR SAFE CONFINEMENT. C/O SWELLNG OF BOTH LOWER LIMBS SINCE 10 DAYS LMP 19/5/22 EDD 26/02/23 POG 36 W 1D SEDD 25/2/23  HOPI:  PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK, THEN SHE GRADUALLY DEVELOPED SWELLING OF BOTH LOWER LIMBS PROGRESSING TILL KNEES. RELEIVED ON TAKING REST AND INCREASED ON PROLONGED SITTING. NO H/O FACIAL PUFFINESS, DECREASED URINE OUTPUT NO H/O PAIN ABDOMEN, BLEEDING OR LEAKING PV, BURNING MICTURATION H/O FROTHY URINE SINCE 5 DAYS NO H/O FOUL SMELL INCREASED FREQUEMCY, URGENCY, POST VOIDAL PAIN NO H/O GENERALISED WEAKNESS, DYSPNEA, EASY FATIGUIBILITY H/O FACIAL PUFFINESS AND PEDAL EDEMA 3 MONTHS BACK, FOR WHICH SHE WAS ADMITTED AT KIMS AND TREATED.  H/O SIMILAR COMPLAINTS 1 YEAR BACK, FOR WHICH SHE WAS ADMITTED IN KIMS AND DIAGNOSED WITH NEPHROTIC SYNDROME AND USED T.WYSOLONE 60MG, INJ LASIX 40 MG, T. RAMIPRIL 2.5 MG AND SYMPTOMS SUBSIDED FOR 1 YEAR(USED FOR 6 MONTHS)
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23F with Nephrotic syndrome

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Case History and Clinical Findings  A 22 YR OLD FEMALE FARMER BY OCCUPATION, RESIDENT OF NADIKUDU CAME TO HOSPITAL WITH CHEIF COMPLAINTS OF B/L LOWERLIMB SWELLING , FACIAL PUFFINESS , DECREASED URINARY OUTPUT , SOB, LOWER BACK PAIN, PT NOW ADMITTED FOR RENAL BIOPSY   HOPI :  PT WAS APPARENTLY ASYMPTOMATIC 5 MONTHS BACK AND THEN SHE DEVELOPED FACIAL PUFFINESS &PERIORBITAL SWELLING PRECEDED BY B/L LOWER LIMB SWELLINGS, DECREASED URINE OUTPUT &SOBGRADE 2 TO GRADE 3 TOOK TREATMENT AT NALGONDAPRIVATE HOSPITAL FOR SAME SHE WAS ADMITTED FOR SAME OMPLAINTS AT OUR HOSPITAL AND NOW SYMPTOMS SUBSIDED AND DIAGNOSED AS NEPHROTIC SYNDROME; ADMITTED FOR RENAL BIOPSY  PAST HISTORY : NOT A K/C/O DM,HTN,ASTHA,CAD,EPILEPSY  ON EXAMINATION :  PT IS C/C/C  TEMP : AFEBRILE  BP : 120/80 MM HG  PR : 82 BPM  GRBS : 83 MG/DL  I/O : 1100 ML/1300 ML CVS : S1,S2 +  P/A : SOFT , NT,  BS +  CNS : NAD Treatment Given    TAB. RAMIPRIL 2.5
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41F with Facial puffiness and B/L pedal edema since 1week

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Case History and Clinical Findings  40yr F came with chief complaints of- Fever since 1 week,subsided 3 days ago- Pedal oedema since 1 week-Facial puffiness since 1 week-Burning micturition 1 week ago ,subsided 3 days ago-Head ache,neck pain - 1 day HOPI :Patient was apparently asymptomatic 1 week ago then she developed fever which was for 3 days which is high grade , intermittent, relieved on medication.Then she developed pedal oedema 3 days ago extending upto knee,pitting type Past history:Denovo HTNN/K/C/O DM, Asthma, TB, Epilepsy, CVA, CAD Personal history:Appetite -NornalDiet-MixedBowel and bladder habits -Burning micturition from 3 daysNo Addictions General Examination:Patient is conscious, coherent, co-operative,well oriented to time, place and person, moderately built and nourishedNo pallor, icterus, cyanosis, clubbing, pedal oedema, lymphadenopathy Vitals: PR:99bpm BP:170/100 RR:25 Temp:98.4F Systemic Examination: CVS:S1S2 Present RS:BAE Present,NVBS P/A:Soft,non tender CNS: N
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JUNE 2023 WARD

1/6/2023   10am Visit to  O.P. 11am - 1pm visit to SS ward 25F ANEMIA DM HEADACHE. https://chat.whatsapp.com/CzfYvReOitzHRo6E0w5xKS 63M METABOLIC SYNDROME https://chat.whatsapp.com/CqJ7L86neFV7gE2PUXVxjF 45F HYPOTHYOID  https://chat.whatsapp.com/CZGM43suU3E7FSqilpyQ5Q Questions around the patients 1.Inheritance pattern of HbE thalassemia. 2.How obesity cause DM. 3.effectiveness of bone marrow transplantation in thalasemia 4.New treatment plan (gene therapy) for thalassemia. 2:30 to 4 PM  BED SIDE DISCUSSION IN ICU  45F ITCHY LESIONS AND ORAL ULCERS https://chat.whatsapp.com/JCd1k78fadDEKGIFDR0TLH Findings Suggestive of DLE . what type of skin lesions ( ?scaly? plaques? ANA negative SLE? CARPET TACK SIGN ( 35M SKIN LESIONS AND ARTHRITIS https://159rohithreddy.blogspot.com/2023/04/35-yrs-old-male.html ) Pt c/o throat pain - added mucain gel and advised for endoscopy. ONLINE DISCUSSION ON 1/6/23 [6/1, 10:25 PM] +91 91216 35470 (BY AKHIL CHOWDHURY): In obese individuals, the amount of non
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THESIS

Draft thesis plan: OUTCOMES OF MONITORING ACUTE AND CHRONIC GLOMERULAR INJURIES WITH SPOT AND 24 HOUR URINARY PROTEIN CREATININE RATIO ESTIMATION: PROBLEM STATEMENT / BACKGROUND  "In most patients with evidence of glomerular disease there is no single measure that provides a specific diagnosis, not even kidney biopsy. To achieve a specific diagnosis, and all that this implies for appropriate management, it is often necessary to test broadly and use a systematic approach." However in many patients the glomerular disease may progress and an  important factor that is linked to patient survival is residual renal function, clinically assessed as the amount of daily urinary output. Many factors conspire against this important variable: aging, the etiologies of renal failure and time on dialysis.  AIM : To study outcomes of monitoring  acute and chronic glomerular injuries with random and 24 hour urinary protein creatinine estimation.  OBJECTIVES 1.To assess spot urine protein creat
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