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An Interesting case of chronic diarrhoea

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 New admission - casualty 73/ M presented with hypoglycemia and LOC . Corrected with 25 D .Bp- 130/90 ,pr-92 ,spo2-97 Ra. Pt now C/c/c . C/o Loose stools since 6 months intially 4-5 episodes per day . Liquid to semi solid consistency .Since 2 months frequency increased to 8-10 episodes of loose stools per day ,small quantity and yellow colour No malena , bleeding PR , vomitings. H/o intermittent pain abdomen and low grade fever present. H/o 16 kgs weight loss since months . Pt k/c/o Old CVA , CAD,HTN ,DM . no addictions  Past h/o henioplasty and hydrocele surgery P/a - soft , distended Bs+ Tenderness in left iliac fossa . Diagnosis -Chronic diarrhoea under evaluation ( Large bowel diarrhoea) Plan - all routine investigations and CECT abdomen , Endo,colon .  Endoscopy and colon done in aug 2023 - normal Cect abdomen done showing HCC  Afp- 242.1 Tb-0.3 ,db-0.2 , ast /alt - 163,181 Alp-203 ,alb -3.5  S creat -0.6 Serology negative Hb-11.3 ,tlc - 4840 ,plt - 4lakhs Micu  Deepaksingh takur
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35 F with nephrotic syndrome

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  35 year old female P2L2A1 presented to casualty with complaints of : Pedal edema since 6 months  Sob since 6 months- grade 1 initially progressed to grade 4 . Loss of appetite since 6 months  Fatigue since 6 months  Generalized anasarca since 3 months . Timeline of events  :  Past history - Not a k/c/o  CAD ,CVA ,TB , Epilepsy . On presentation her vitals :  Bp -160/100 mmhg Pulse rate - 108 bpm,regular normal volume ,no radio radial delay . RR - 28/min.      Spo2- 88% On RA and with 6 lit oxygen 94%  Grbs -125 mg/dl  Temp -99.4 F  GENERAL EXAMINATION :  Pt C/C/C Pallor - present No icterus , clubbing, cyanosis,koilonychia , lymphadenopathy . B/L pedal edema - pitting type present.  Generalized anasarca noted Jvp - elevated Skin - Dry ,scaly , itching present . Hyperpigmented skin lesions noted on hands ,over chest wall and over knee and shin of both legs . SYSTEMIC EXAMINATION :  Cvs - S1S2 present RS - B/L diffuse crepitations heard in all areas . CNS - No FND . INVESTIGATIONS: PER
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Interesting cases of valvular heart disease

  These are few elogs of valvular heart disease, i witnessed during my residency . 1)  https://karnativaishnavi.blogspot.com/2021/09/severe-ms-and-heart-failure-acute-pe.html 2)  https://karnativaishnavi.blogspot.com/2021/09/dr-k-vaishnavi-pgy3-dr-nikhitha-pgy3-dr.html   3)  https://karnativaishnavi.blogspot.com/2022/06/30-year-old-male-with-palpitations.html 4) https://karnativaishnavi.blogspot.com/2020/08/35-m-with-severe-ms-and-cva.html
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Evidence based medicine

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  Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction . RCT - placebo control trial . https://www.nejm.org/doi/full/10.1056/NEJMoa1911303. P- Total 4744 patients with HFref . 2373- Dapagliflozin 10mg od . 2371 - placebo I- Dapagliflozin vs placebo C- Placebo  O - The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death. 1) 237 - In dapaglifozin grp had worsening heart failure and 227- Died. 2) 326- placebo had worsening HF 273- DIED . CONCLUSION :  Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes. But pts who were included , dapagliflozon had more patients with NYHA class 2 and placebo had more pts with NYHA class 3,4 HF .
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SHORT CASE 2

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  This is an 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 inputs on the comment box . 65 year old male patient r/o Nakrekal presented to casualty with complaints of  C/O Shortness of breath grade 3 since 4 months . C/O B/L pedal edema since 4 months . C/O abdominal distension since 5 days C/O Oliguria since 2 days HISTORY OF PRESENTING ILLNESS :  Patient is toddy climber by occupation , was apparently asymptomatic 4 months ago .  -Intially he noticed b/l swelling of lower limbs , gradual onset and progressive . Pitting type and extending upto knees . Associated
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LONG CASE - 19100006004

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  This is an 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 inputs on the comment box .   CASE PRESENTATION : CHEIF COMPLAINTS :   29/F came to OPD with C/o Loss of appetite , weight since 2 years Generalised weakness and easy fatiguability since 2 years . C/o Fever since 6 months C/o Multiple joint pains and swelling since 6 months  Difficulty in movements and walking since 6 months. C/o Hyper-pigmented leisons over cheeck bones and chin ,ears , b/l fore arm  since 4 months . C/o Severe hair loss since 4 months  . HOPI AND PAST HISTORY : NO H/o decreased urine outp
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