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doctor bhaskaaran

doctor bhaskaaran

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Provisional Diagnosis-SHTN/Amlo induced edema Rt Hemicrania (Trigeminal Neuralgia) ?Temporal arteritis Osteopenia
Final Diagnosis-Trigeminal Neuralgia(Inadequate Rx) SHTN Vit D Def state GERD
History and Findings-Referred by Dr.Rahul Laxman (Pain & Paliative AIMS) H/o Rt Hemicrania,bone pains,bipedal edema of long duration.K/c/o SHTN on Rx,trigeminal neuralgia x 30yrs no relief on Rx
Investigation-Previous inv:MRI Brain 15/1/04-N study,pre op serology-neg,CAG 06/06/06-N study,CT Brain 27/10/07-N study,MRI c spine 03/05/08-Diffuse disc bulge C5,C6,Pap smear Dec 2009-Neg for malignancy,CT Brain Oct 2010-N study,A/g-3.9/2.7,TFT-Normal,RBS-179,Hb-12.5,ESR-30. present Inv:Hb-11.6,ESR-36,uric-5.5,HBA1c-6%,Ca-9.1,P-3.9,Ck-138,25(OH)vit D-10.92,S.B12-1161,Alb-4.22,Glob-3.26,Total chol-231,Tg-213,LDL-148,HDL-39,urine RE-Blood 1+,8-10 RBCs/HPF,HBSAg Neg,Doppler study temporal arteries-N study,OGD scopy 17/0/11-LA-A esophagitis,Pangastritis
Treatment-Rx before present consultation Tab.Ultracet,Imipramine,Evion,Dom DT,Amlong,Gabapentin,artificial saliva Present Rx:stop Amlodipine & Gabapentin Tab.Telma 20mg od,Tab.Pregabalin 75mg 0-0-1 increased to 1-0-1,carbamazepine (Mezetol)added subsequently increased to 200mg 1/2-1/2-1,Calcirol sachets 1gm in milk wkly once for 3months & then once monthly,Milical 1000mg 0-0-1,Tab,Pan 40mg od before food
Follow Up-Pt V.neuralgia & RT hemicrania improved remarkably with normal sleep & bone pains responded to calcirol & oral calcium



Provisional Diagnosis - Ac Pyelonephritis Lt ?Ac choletcystitis To r/o Renal Tuberculosis
Final Diagnosis - Ac Pyelonephritis Lt Urine AFB culture automated-Pending
History and Findings - Case worked up at GVR Sat clinic on 12/11/11 & later investigated in AIMS H/o Fever around 101*F since 4months,one episode of hematuria.LUTS+,h/o br asthma since 7yrs on inhalers,K/c/o SHTN on Amlodipine 5mg od. past PTB 1988 fully Rxd. Exam revealed tenderness Lt kidney on ballotable test
Investigation - ESR-120,Hb-11.6,CRP-23,Urine ACR-1816mg/g,BU-25mg,S.creat-1.27,LFT/GGT-N,Urine Alb +,Gr cast + Dengue IgM & Brucella IgM neg,ANA-Neg,C-ANCA,P-ANCA Neg,PSA-1.1,S.Protein EP-Neg,IgG-1650,IgA-516,IgM-101,Urine BJ protein Neg,IVU study-consistent spasm upper pole calyx Lt kidney clubbed calyx,DMSA scan on 12/12/11-No e/o any cortical scar B/l kidneys to suggest chronic Pylelonephritis,HIDA scan 13/12/11-Preserved hepatobiliary function,no e/o acute/chronic cholecystitis.ECG-Wnl,Cxr-Increased BVm Rt base,urine culture no growth,blood culture-no growth,widal-Neg,MP MF Neg,USG abd-Cholelithiasis,multiple stones largest 6.4mm,fatty liver,Mantoux-Neg,urine AFB culture-pending,urine cytology-Neg,Xray L S spine-spondylitis
Treatment - .Zanocin OD 400mg 0-0-1 x 6wks,Tab.Dolo 650mg 1sos,Ct Foracort Inh & Amlodipine as before
Follow Up - Pt afebrile 2 wks after starting antibiotics 12/12/11 ESR-60 started attending daily office work R/w with urine AFB culture


Provisional Diagnosis-Congenital Rubella syndrome Post Viral Demyelination Hypothyroidism/Thyroiditis T2DM Iron def anemia/Vit D def state
Final Diagnosis-Post viral demyelination/Hashimottos Encephalopathy Hypothyroidism/Thyroiditis T2DM Iron & Vit D Def state
History and Findings-Photocopy machine work with amma in Vallikavu H/o Chr cough,scanty sputum DOE class II last 6months snoring ++ Day sleepiness ++ for yrs Deaf & dumb from birth(congenital rubella syndrome), Speech improved on therapy.H/o PDA closure at 9yrs of age.Organic psychosis Nov/Dec 2008.H/o Hypothyroidism off Rx
Investigation-Previous Inv:09/07/04-CT Brain-Demyelinating disease ?Glyomatous cerebral/SSPE.MRI Brain 12/07/04-Viral induced demyelination ?Rubella encephalitis,MRI brain 20/2/07-Viral demyelination,MRI Brain Nov 2009- lesions status quo,B/L symetric white matter hyperintensities.13/09/04 TSH-7.98,20/03/07-TSH-4.60,25/11/08-TSH-6.88,ATg-45.92,ESR-16,Hb-12.2 Present inv:Hb-10.3,MCV MCH low.ESR-22,P.Smear-Microcytic hypochromic anemia,FBS-118,GRBS-196,HBA1c-8.6%,Blood urea-18.2,S.creat-0.7mg,uric-6.1,A/g-4.27/3.3g,ALP-103,GGT-65,Ca-8.5,P-3.6,LFT-N,Ck-81.5,CK MB-8.5,LDH-293,IgE-60.67,CRP-5.01,TSH-14.86,FT4-0.95,TPO-1656.7,25(OH)vit D-5.66ng,C1 INH-17mg (N-11-26),Na-136,K-4.4,S.Iron-24.4,Fe-8.17,TIBC-432.3,ANA-Neg (0.27),ds DNA-22.1,stool fat +ve,OB Neg,ECG-Sinus tachycardia,Cxr-Cardiomegaly,Echo-No RWMA,mild MR/TR,EF-55%,urine RE-Nil
Treatment-Diabetic diet. Tab.Thyronorm 75mcg 1-0-0,Cap.Fefol z 0-0-1,Tab.Rantac 150mg 1-0-1,Cap.GLA 120mg 1-0-0, Cap.Neuracetam 800mg 1/2-0-1/2,Glycomet SR 0.5g 1-0-0,Cap.Evion 400mg od
Follow Up-Pt improving steadily with more mental alertness & able to work without break.Intellectual works better,attention & speech better,day time sleepiness markedly improved 23/06/11-TPO-769.92,Hb-15.3 15/10/11-HBA1c-7.1,TSH-3.62


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