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doctor bhaskaaran

doctor bhaskaaran

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

Website URL: http://www.optuyeohdu.com/ E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Provisional Diagnosis-Seroneg RA+Sec OA knees SHTN RHD/Severe MS/MR/Mild AR/Normal RV & lv fn Cholelithiasis
Final Diagnosis-Seroneg RA+Sec OA knees SHTN RHD/Mod Severe MS/MR/Mild AR/Normal RV & lv fn Cholelithiasis
History and Findings-Chr Allergic Br/Br Asthma from age 14yrs Rheumatoid arthritis x 17yrs (1994) on Ayurvedic Rx,Allopathy Rx last 7yrs Mild MS (AML & PML thickenning-subvalvar pathology not on Rx).SHTN x 14yrs,Echo 14/10/11-mild pericardial effusion,cataract surgery BE (May 2010 & June 2011) DOE class III x 1yr.Pain,swelling,stiffness-knees,shoulders & IP joints ++,Bluish nails,BP-130/80,Gr 2/6 ESm at LCV,PA,P2 loud,TR murmur+ JVP++
Investigation-Hb-12.7,ESR-28,HBA1c-5.5%,BU-24.8,Creatinine-0.8,A/g-4.16/2.6g,LDH-350,CRP-3.8,RA& ASO Neg,ECG-Poor R V1 V2,P.Pulmonal,Cxr-Rt base pleural blunting,P.Smear-N,USG abd-N,Xray knees-advanced OA b/l,Podiatrics-Severe P.Neuropathy,Low ABIndex,PFT-Mixed pattern dysfn,Echo-7/12/11-RHD/Thickened AML & PML,Moderate-severe MS,MVA 1-1.1cm2,Calcified MV,Mild AR,CT chest HRCT-8/12/11-Rt sided minimal pleural effusion,Cholelithiasis,No ILD,No L.adenopathy,B/l Venous & arterial doppler lower limbs-normal,BNP-825.5pg/ml (high).Echo TEE cardiology on 16/12/11-Mod severe MS & MR,thickened AV,Mild AR,Biventricular function-good
Treatment-Lanoxin/Amifru/Predmet 2mg/Oncotrex 7.5mg/wkly/Folvite/Telma/Lefra/Renerve/Dilzem/Udiliv /Cartilamine & Glucosamine
Follow Up-Adv:Cardiology f/u & ortho consultation

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Provisional Diagnosis-Autoimmune Hepatitis AMA Neg,PBC Autoimmune Thyroiditis ?Reflux Nephropathy/early CRF
Final Diagnosis-Autoimmune Hepatitis/Cholangitis AMA Neg PBC/Vit D def Reflux Nephropathy/Early CRF Iron def anemia
History and Findings-Pain Rt Calf muscle & recurrent fever with chills x 1month One episode of UTI post partum 1 1/2 yrs back on 1/12/09 Culture E.coli USG abd 09/12/09-Contracted RK 5.8x 1,7cm size Compenastory hypertrophy LK 12.3x 3.4cm Multiple GB calculi 3-6mm(1/01/11) Arterial & venous doppler lower limbs 8/06/11-No DVT
Investigation-Hb-10.6,ESR-70,S.Creatinine-1.5 upto 1.9,Urine-10-15 WBCs,urine culture-No growth,uric acid-5-7mg upto 6mg,MP MF neg,CRP-79.20 upto 283.1,SGOT-82.6,SGPT-65.6,GGT-395.6,ALP-559.7,A/g-3.9/6.1,Na-135.4,K-4.3,urine Na-29.1,S.protein EP-No M Band,ANA +ve (1.64),AMA-Neg,C-ANCA,P-ANCA-Neg,ds-DNA-Neg(18),C-ANCA,P-ANCA-neg,Anti LKM-2.00 (Neg),C3-202,C4-51.86,iron-50.1,fe-148.06,EPO-16.3,IgG-2568.37(high),IgM-256.24,IgA-466,32,ANA profile-Neg,Cryoglobulins-Neg,25(OH)Vit D-10.95ng,stool OB x 3 -neg,Leptospira IgM-Neg,24hr urine protein-9mg,Echo-N study,Blood culture coagulase neg staph,whole body skeletal scintigram-31/10/11-No e/o Metabolin bone disease,DTPA renogram-6/07/11-Non functioning RK,LK GFR-37 ml/min,severe parenchymal disease RK,Moderate parenchymal dysfn LK,DMSA scan-6/-7/11-No DMSA uptake RK,loss of cortical volume in midcortex LK,size 13x5xcm,Lymphoscintigram B/l,no lymphatic obstruction,Micturating cysto urethrogram(MCV)10/07/11-no vascico-ureteric reflux could be observed.Urine AFB culture -no growth after 6wks Nephro opinion:reflux nephropathy with early CRF
Treatment-Inj.Linezolid for staph coagulase neg(Blood culture) along with montelukast/UDCA/LT4/Calcirol/Iron supplements with OD dose ofloxacin 200mg(from Nephro)
Follow Up-Repeat LKM1 antibody 09/12/11-borderline +ve.Pt improving on present line of Rx.Tissue diagnosis could not be done since pt is unwilling for liver biopsy

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Provisional Diagnosis-Hypothyroidism/Thyroiditis Polymyositis to r/o Multiple Myeloma
Final Diagnosis-Polymyositis(Biopsy proved) Lymphocytic thyroiditis Iron Def anemia
History and Findings-Polyarthritis x 4months,Pain back interscapular area Thyromegaly Rt lobe Wt-44k
Investigation-Hb-8.19,ESR-62,HBA1c-5.2%,creat-0.7,Uric acid-5,Ca-8.6Iron-33.7,Ferritin-162.29,A/g-3.47/4.66,CRP-22.74,TSH-5.23,TPO-30.28 & ATG-54.85(Both high),RAF-Neg,ECG-Normal,CXR-cardiomegaly,Echo-Normal study, FNAC thyroid-lymphocytic thyroiditis,Serum protein EP-No M Band,ANA IFA-+++ Anti Jo antibody +ve,Anti SEL 70 ,Anti RNP +++,Anti SM +ve,ds DNA-Neg,Ck-253,Muscle biopsy(NIMHANS)(No-X3382/11)24/10/11-Inflamatory myopathy with vasculitis(Delay in biopsy & Rx since pt went for ayurvedic trial at ottapalam in between)
Treatment-Thyronorm/Fefol Z/Pan D wef 15/6/11 Wysolone/Milical/Azoran wef 7/12/11(After pt returned leaving ayurvedic trial).
Follow Up-

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