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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-IgE mediated food allergy Chr fatigue syndrome to r/o Addison's
Final Diagnosis-Chr fatigue syndrome IgE mediated food allergy
History and Findings-H/o Tiredness,lack of allergy,sleepiness during day time especially after food.Occasional feverishness,brachialgia,Gen.oedema picture,paroxysmal palpitation since 1yr DOE class II x 1month.H/o Lt Cervical rib on physiotherapy,TMT,Echo AIMS cardiology 03/06/10-N study,Chikun gunya July 2009.Ayurvedic Rx for all complaints for 5months from Jan-June 2010 O/e Wt-50kg,BP-100/80 lying,90/80 standing.
Investigation-Prior inv in AIMS;FT4-1.15,TSH-2.97(1/06/10) Dec 2009-RBS-97.2,urea-11.6,creat-0.8,LFT-n,Na-137,K-4.3,Ca-8.7,P-3.7,TSH-3.89,CRP-2.03,ESR-38,Hb-12.6,Cxr-N study Present inv:Hb-12.1,ESR-28,RP-1.79,ASO <200,RA-Neg,Corrected ca-9.09,Cortisol-7mcg,Post synacthen cortisol-23.7mcg,ANA-0.25,TG IgA- <0.2 neg,Stool fat ++,OB-Neg,stool chymotripsin-13.6,C1 esterase(C1-INH)-17mg N 11-26,OGD scopy 2/07/10-LA-A esophagitis,deep D2 biopsy,colonoscopy-Normal,ileal biopsy.Both HPR-N study,no e/o dysplasia,granuloma,malignancy,malabsorbtion.IgE-845.2 Pulmo food allergy done
Treatment-Diet chart avoiding knowm allergens Cap.Doxepin 25mg 0-0-1 x 3wks & then 1-0-1 x to ct Tab.Allegra 120mg 1-0-1,Tab.Rantac 150mg 1-0-1 Ensure 2 tsp bd x 3months R/w after 3 months
Follow Up-Pt improving well,no more sedation during day time,energetic,able to attend duties normally,no more angioedema,BP improved 130/80 both lying & standing 27/07/11-IgE-440.9,stool fat-Neg

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Provisional Diagnosis-Anemia (iron def) Vit D def state IgE mediated food allergy IBD (Crohn's) Neurasthenia
Final Diagnosis-Crohn's disease Iron & vit D def state Neurasthenia IgE mediated food allergy
History and Findings-Chief Nursing Officer Incharge AIMS H/o hypothyroidism 2006-2007 Off Rx after 2007 Anemia,Lack of energy,tiredness,plapitation-Chr low grade fever x 2yrs H/o Rx for enteric fever in 2008 Pain neck,brachialgia,eye strain,muscle spasm x 4yrs Wt-61k BP-130/80 Features of Neurasthenia ++
Investigation-Inv earlier-MDCT abd/Thorax/Pelvis 24/08/07-N study MRI Brain 24/08/07-N study,CT Neck 3/12/07-early spondylitis,multiple L.Nodes (Benign),MDCT Thorax 03/12/07-Small pleral tagging,postr basal segment Lt,USG abd-13/06/08-N study,MDCT abd 18/06/08-Bulky ovaru with follicular cyst,colonoscopy & rectal biopsy 12/07/08-Multiple aphthoid ulcers in rectum,biopsy unremarkable,BMFT study 18/07/08-N study,Echo-21/06/08-MVP with AML prolapse Present Inv:Hb-9.76,ESR-62,MCV & MCH low,stool fat +ve,OB NegS Iron-19.9,fe-7.44,ALP-84.3,Stool chymotripsin-14.1,25(OH)vit D-4.96,S PTH-109.7,Corrected ca-8.6,P-2.3,IgE-406.2,food allergy pulmo done,Urine CCR-0.03,CK-47.4,ASCA IgA-38.5 normal <20,CRP-7.73,ECG-WNl,CXr-increased BVm Rt base C.Spine-C.Spondylosis
Treatment-calcirol sachets,Citromacalvit,Dexorange, Tab.Mesacol,Folvite,Rantac,Cap.Doxepin,Tab.allegra+ Ensure
Follow Up-08/09/10-CRP-6.04,ESR-40,Hb-10g 15/11/10-Hb-10.6 14/5/11-Hb-10.1,ESR-40 07/1/11-CA-125-22.5(N),CRP-5.65,ESR-46,hb-11

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Provisional Diagnosis-Cystic lung Disease (from childhood) recurrent sinoBronchial Infection Fat Malabsorbtion ?cystic Fibrosis/CFTR mutation study pending Marfan syndrome
Final Diagnosis-Cystic Fibrosis(Recurrent URTI & LRTIs,Cystic Lung Disease & Exocrine pancreatic dysfn),CFTR pending
History and Findings-Final year MBBS student Karakkonam MCH TVM Recurrent fever,headache,sinus & throat infection,hyperactive airways,Br asthma,recurrent LRTIs,MVP,AF induced by terbutaline ,C4 cytoenia,Polymyalgia,Polyarthralgia since early childhood. Under wt-43kg,high arched ppalate,arm length-180cm Ht-169cm,Marfanoid features ++
Investigation-Hb-17g,ESR-2,Creat-1mg,A/g-4.9/3.2g,PT with INR-2.4,APTT-31.8,ACE-34.2,Cortisol-14.72,Stool fat +ve,OB Neg,Stool chymotripsin-11.5(N >13.2)TTg IgG(Tissue Transglutaminase IgG)-Neg,Quantiferon TB gold assay(Gamma Interferon)-Neg,Mantaeux-neg,BMFT-Normal,PFT-Mixed dysfn pattern with minimal reversibility,Cxr-Chest emphysematous,Pul conus prominent,PNS-Mucosal thickenning Max antra,TSH-1.8,FT4-1.9,Aspergilla IgG-Neg, CT Thorax-Minimal bronchiectatic changes B/l upper & loower lobes.IgG,IgM,IgA-Normal,Serum.Kappa,Lambda freE lite-N,ANA IFA-nEG,C-ANCA,P-ANCA-Neg,Rpt PT with INR(07/11/11)-1.05,APTT-31.9/32.2,S.Amylase-63.9,urine amylase-63.9,Serum Na-141,k-3.9,Cl-103,sweat Na-136.9(N <35)sweat Cl-112.2 (N <46),Vit A-22.9 (N 30-120),Vit D 23.18 (20-30 insufficiency),Echo-Normal chamber,trivial MR & TR
Treatment-Chest physiotherapy,steam inhalation Tab.Mucomix/Duolin & Budicorte Nebulization Cap.Eldervit ZC,Cap.Evion,Tab.Pancreon,Tab.Montelukast
Follow Up-With sputum culture both bacterial & fungal & CFTR mutation study

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