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doctor bhaskaaran

doctor bhaskaaran

wkfvcepdupscibtlbsbo, http://www.lmyhjkaety.com iaroburchp

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Provisional Diagnosis - Iatrogenic thyrotoxicosis IGT Spondyloarthritis/Osteopenia
Final Diagnosis - Granulomatous Cervical L.adenitis On ATT wef 16/11/11 Iatrogenic thyrotoxicosis Spondyloarthritis/Osteopenia IGT
History and Findings - Hypothyroidism on Rx LT4 150mcg od last 3yrs.wt loss 72 -62kg,tiredness,body aches,bone pains since 3yrs O/e BP-130/80,Bipedal edema,tachycardia,C.L nodes + non tender,Gr 1/6 ESM at LBA,varicose veins ++,Joints-OA knees shoulders
Investigation - Hb-11.3,CRP-1.06,ESR-60,HBA1c-6.7%,FBS-122.7,TSH-0.01,FT3-1.69,TPO-58.96,Blood urea-25.2,creat-0.8,uric-5.3,ca-9.3,P-3.5,A/g-3.59/3.7g,RA-neg,25(OH)vit D-14.73,BMD-Osteopenia,P.Smear-Normocytic normochromic,Skeletal scintigraphy-Hot spots dorsal & lumbar vertebrae-degenerative,L node biopsy AC-2451/11-Granulomatous L.adenitis
Treatment - Cap.Rcinex 600 1-0-0,Ethambutol 1000mg 1-0-0,Tab.Benadon 40mg 1/2-0-0,Tab.Risophos 35mg wkly once,Calcirol sachets 1gm in milk wkly once,Tab.Shelcal 0.5g 1-0-1,Tab.Razo 20mg od cm ,Tab.Durajoint GM 0-0-1,Cap.Fefol 0-0-1 x 2months
Follow Up - R/a 2 months with LFT/GGT/uric acid/TSH

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Provisional Diagnosis-Basilar Migraine ?Hyperviscosity syndrome Neuromyasthenia Vit D def state
Final Diagnosis-Basilar Migraine/Hyperviscosity syndrome Neuromyasthenia Vit D def state
History and Findings-Referred from Adm office AIMS Recurrent syncopal episodes >30yrs H/o headache along with diziness Previous units ENT 10/12/10 Rt ear SNHL-minimal,Lt ear-SNHL Mod severe cardiology-CAG 29/07/05-normal coronaries Bronchial asthma from age 24 on inhalers from Pulmo Neurology 12/3/10-NCV normal,3 hr video EEG 4/12/10-N study GE Med 1/4/04-OGD Normal
Investigation-Previous Inv:MRI brain with MRA 03/12/10-N study Electrolytes/LFT/ANA/ACLA(Anti cardiolipine ab),TSH,Hb all normal Present Inv:Hb-12.6,ESR-36.CRP-1.23,Ca-8.8,P-3.9,TSH-0.46,TPO-2.70,ATg-23.19,HBSAg,anti HCV-Neg,Cryoglobulins-Neg,A/g-4.25/4g,ALP-89.9 ECG-WNl,Echo-25/04/11-N study,25(OH)vit D -9.16,Beta 2 microglobulin-2.93,IgE-1373.72 Other immunoglobulins-N(0.24-1.98)
Treatment-Tab.Sibelium 5mg 0-0-1,calcirol sachets + oral Milical,Tab.Fiona 60mg 0-0-1,Tab.Nortryptillin 25mg 0-0-1 increased to 0-0-2 wef 08/08/11,Tab.Montelukast Ct inhalers as before.
Follow Up-No further episodes of syncope

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Provisional Diagnosis-Nonocaseating Cervical L.adenopathy ?Toxoplasmosis?Sarcoidosis
Final Diagnosis-Toxoplasmosis(Cervical L.adenitis-Biopsy)
History and Findings-Case referred by Dr.Pavithran Prof.Medical oncology H/o recurrent throat pain,sputum+,voice change frequently since last 12yrs.H/o Lt sided postr C.L.adenopathy x 1month.Pain Lt shoulder x 1month Family h/o Sisterx 1-Tuberculosis O/e Pharyngitis++,Post nasal secretion +,Halitosis+
Investigation-CRP-1.95,Hb-13.7,ESR-10,WBC,Plat-N,ca-8.7,A/g-4.7/3.5,LFT-N,LDH-198.5,Tox IgM 16/03/11+ve (2.362),Brucella IgM Neg,ACE-44 (N),pre op serology(HIV,anti HCV,HBSAg)-neg,Cxr-Rt basal cystic changes,Xray PNS-Max sinusitis B/l,C-ANCA-neg,Mx-Neg,Histopathology C.L Node S11-2290-No Caseating microgranulomas possibility of toxoplasmosis,ENT consultation for nasal endoscopy
Treatment-Tab.Rovamycin forte x 6weeks (spiramycin)
Follow Up-R/w 03/06/11-Pt asymptomatic HadENT Rx for sinusitis

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