Medicine E Log

  Infective spondylodiscitis is a rare disease.  Infective spondylodiscitis should be considered in hemodialysis patients who present with prolonged back pain with or without fever. Non-contrast MRI is an appropriate diagnostic tool for this condition. Vascular access infection increases the risk for infective spondylodiscitis in hemodialysis patients.  A review of the literature indicated that the common risk factors for infective spondylodiscitis are intravenous drug use, uncontrolled or poorly controlled DM, complications from catheter-associated infections, infective endocarditis, prior spinal surgery, and immunocompromised status. Patients on maintenance HD are exposed to additional risks due to the need for repetitive puncture of the arteriovenous shunt, long-term indwelling of a central venous catheter or Gore-Tex graft, and contamination of the dialysate storage or distribution system . We report 2  cases of infective spondylodiscitis in chronic kidney disease patients who are

  Clinico-Etiological profile and outcomes of patients presenting with Acute Altered Sensorium in a Tertiary care center : ABSTRACT: INTRODUCTION: Altered sensorium is a very common emergency case, but the exact etiology of many altered sensorium patients is unknown 1,2. Patients often present with vague symptoms, thus altered sensorium diagnosis and treatment are highly challenging for treating physician. The aim of this study is to assess the various etiology and clinical presentation of altered sensorium patients.2 This assessment should allow providers to better understand the etiology of altered sensorium and therefore improve diagnostic skills and management. MATERIALS AND METHODS: This is a prospective cohort study conducted at Kamineni  Institute of medical Sciences, Narketpally from May 2021  to July, 2021. The study involved 70 patients of altered  Sensorium accounting for 23.3% of all emergency patients.  RESULTS: Among 70 patients with altered sensorium patients above 14 ye

  45 year old male patient resident of miryalguda having 3 children, married at the age of 20 years, daily wage labourer( weight lifting). Patient is chronic alcholic consumes 180ml- 1 full bottle of whiskey since 20 years, and chronic smoker- beedis 20/ day 4 years ago patient had history of trauma to right nail and in view of delayed healing they got tests done and was diagnosed with Diabetes Mellitus and was started on OHA's. But sugars were not controlled and were high in previous reports. Patient's wife c/o patient taking large quantities of food and is always hungry (1/4-1/2 kgs rice intake daily) ? Polyphagia On further asking he gives even history of polydypsia and polyuria. Gets up approximately 5-6 times in the night for micturition. In v/o uncontrolled sugars patient was shifted to H.Mixtared 24U-16U. But patient takes it irregularly and takes alcohol in between  Attender even gives history of weight loss but no h/o fever, cough Since 8 months patient c/o increased f

Link to above data : http://patelsrighanashyam113.blogspot.com/2021/11/39m-with-altered-sensorium-and-bl-lower.html A 39 Yr old male , electrician by occupation, with no significant medical history since childhood. Chief complaints:- **C/o decreased responsiveness since 2 days **Not eating since 2 days  **Decreased speech since 2 days--completely not talking since today morning. Past illness:- **8 months ago -- c/o low back ache , pain abdomen -- was told to have renal stones , meatal stenosis--underwent urethral dilatation in July 2021. ** August last week , 2021 -- c/o left lower limb weakness, slow gradually progressed to right LL -- B/L Paraplegia -- MRI was done --? Potts spine Used ATT for 15 days and stopped , due to nausea and loss of appetite, patient was bedridden since, then , used unani medication. **H.D was adviced 2 months ago - but didn't get it done due to fear of death ( among relatives deaths on H.D+) ** Since September 2021--Bed sores developed, 1 daily dressing

 

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 60 yr old female came with  c/o Fever since one month and  c/o pain abdomen since 15 days. c/o Loose stools since 15 days. Pt was apparently asymptomatic 1 month ago ,then she developed fever since 1 month associated with chills and rigors, intermittent type and evening rise of temp present . Subsided with medications. Loose stools since 15 days ,mucoid and watery . Daily 5-6 episodes. Not blood stained and associated with pain abdomen . H/o Vomitings since 10 days , containing food particles . non projectile . h/o bloody stiols 40 days ago. c/o pedal edema since 2 years. Not a k/c/o htn,dm,cad,asthma. o/e :  pt c/c/c. temp- 100 F bp- 80/60mmhg pr- 105 bpm grbs -101  spo2- 97% on ra. HB - 4.8 g/dl Wbc - 25,300  RFT : UREA - 126 ; S.creatt - 4.4 mg/dl ; Na -134 meq/l ; k-3.6 meq/l ; cl- 104 meq/l . ABG :  PH- 7.29 ,PCO2 - 16.4 ; po2-116 ; hco3- 7.6  st hco3 - 10.4  spo2- 97% Serology - negative . USG ABDOMEN :  B/L Grade 2 RPD . b/l kidneys normal size increased echotexture. MODERATE A

  October 30, 2021  34 YEAR OLD MALE MASON BY OCCUPATION CAME TO THE OPD WITH  C/O Blurring of vision RE greater than LE since 3 yrs not associated with headache ,nausea , vomiting Patient was apparently assymptomatic 3 yrs back ,while he was doing his work complained of giddiness and fell( black outs)non postural,not associated with nausea, vomitings,vertigo,tinnitus,earfull ness ,he was taken to a local hospital and was diagnosed with HIGH BLOOD PRESSURE ( used medication , unknown) for over 2 1/2 yrs  C/O slurring of speech since 1 year ( progressive)  C/O body pains since 1 year  H/O giddiness 1 week back taken to local hospital ,was on medication ( unknown)  No C/O chest pain , palpitations, shortness of breath ,pedal edema  K/C/O HTN since 3 yrs (on past atenolol 50mg ,nicardia 10 mg,telma 40 mg) Not a K/C/O DM,ASTHMA, EPILEPSY,TB He is alcoholic (90ml /day)and smoker ( 2 per day)since 10 yrs  No significant family history  Vitals on admission: BP: 270/140 mm hg   given Nicard