Alava Ramya Tulasi Tejasri 11

 45 F at 16 years female child nvd at 20 years female childnvd at 23 years female child nvd husband died 28 years ago ,cirrhosis of liver. 10 years ago  diagnosed as diabetic( 240mg/dl )checked due to  increased frequency  of urine on metformin. 2 years ago , typhoid fever 3 days fever high grade fever with chills and rigors , weight loss started then she noticed prominence of veins on right leg then on left leg upto knee, itching sensation present from buttocks to feet . she used to sell fruilts at this time After 5 months bilateral dragging type of pain in lowerlimbs aggravated on walking for 200 meters and relieved on standing for few minutes.  she quit selling fruits due to this pain and started working in hostel ,after 4 months patient started having burning sensation of both lowerlimbs proximal to distal from knee to feet . then after 3months then she complains bilateral upper limb pains burning sensation from shoulder to fingers , this burning sensation aggravated on full bladde

  A 60 year old female came to casuality with chief complaints of fever with chills , nausea, vomitings , pain abdomen since 4 days  Patient was apparantly asymptomatic 4 days ago then she developed fever which is high grade associated with chills , intermittent in nature relieved by medication associated with pain abdomen , with nausea and vomitings vomitings are non bilious , nonprojectile contains food particles h/o burning micturition since 4days with no increased frequency in urine 9i patient complains of chest pain , non radiating type  COURSE OF EVENTS IN HER LIFE: patient ,  agricultural labourer works in jowar fields and in poultry , married at a age of 16  at 18 she attained menarche  first child birth at 20 year second child birth at 22 years She usually eats jowar instead of rice till 40 years , she shifted to rice from 40 years ,  At 42 years patient has excessive bleeding for which hysterectomy has done at 48 years she had an episode of fever with chills admitted into a h

  As keen learner, i want to share some insights of me and my medicine journey, theres a patient , who came to medicine department with a bruise that doesn't heal , her bt ct was prolonged and her platelet count is 6000,  i was  stunned by seeing her counts, and she was admitted,immediate platelet transfusion was planned, and she had idiopathic thrombocytopenic purpura, tried steroids got pedal edema and many more side effects, she used to do weekly hemogram counts are maintained at 60,000, one fine day , she started have nleeding,menorrhagia,melena,her platelet counts fallen rapidly,SHE is on azathioprine,eletrombopag, iv ig  and high dose steroid injections to get the platelet count higher, no use ,she suffered from side effects, there comess the RITUXIMAB, the wonder drug, after she tried it, her platelet count, drastically improved without any relapse. I observed a complete medical case and monitored the entire treatment process until the patient was cured. I learned a lot in h

 Final diagnosis : CHRONIC PLAQUE PSORIASIS with Left  INGUINAL HERNIAand hydrocele 61 year old male,civil engineer from west Bengal, came to medicine department with chief complaints of itchy skin lesions on buttocks,legs,hands,thigh since 40 years. patient was apparantly asymptomatic 40 years ago then he developed a   a itchy, red lesion at the base of the penis, which gradually spread through out the body associated with burning type of pain and itching, constant in nature aggravated on exposure to sun , relieved by blowdrier. PAST HISTORY : k/c/o psoriatic arthritis since 43 years ( relieved from  k/c/o chronic bronchitis since 42 years k/c/o BPH also have kidney stones of 4mm size. k/c/o DM and Hypertension since 4 months  PERSONAL HISTORY: Water intake:- normal (2L max.) Appetite:-normal Diet:- mixed Bowel movement:- Constipation. not able to pass stools , only passes after medication.  bladder movement:-Polyuria Addictions:- Consumes supari. Alcohol:- none Smoking:- doesn't

This is 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 comments on comment box is welcome A 60 yM , previously a autodrive came with chief complaints of b/l lowerlimb swelling B/l lower limb weakness and  decreased speech output since 4 days bowel and bladder incontinence since 4 days Hopi: patient was apparantly asymptomatic 4 days ago then on tuesday morning when he developed bilateral lower limb swelling which is insidious in onset, intermitten ,not pitying type H/o dragging type of pain from proximal to distal , continuous aggravated on walking(impairing him to