Online blended bimonthly assignment for the month of May 2021
Rithika.K
8th semester
Roll no: 69
I have been given the following cases to solve in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and coem up with a treatment plan.
This is the link of the questions asked regarding the cases
This is the link of the questions asked regarding the cases :
1. 20 years ago - first episode of SOB lasted for 1 week(Relieved on taking medication.)
Then every year lasting for 1 week for the next 8 years in the month of January
12 years ago - Another episode lasting for 20 days(Relieved on taking medication.)
Then every year lasting for 1 month for the last 12 years
30 days ago - SOB present on exertion(Relieved on rest)
Since 2 days - SOB on rest
Pedal edema since 15 days - level of ankle - pitting type
Facial puffiness since 15 days
Drowsiness - Since 2 days and low urine output
The anatomical location of the problem is bronchioles
The etiology may be due to the dust or may be due to paddy
2.Head end elevation had been shown to improve oxygenation and hemodynamic performance.
It also prevents ventilatior associated pneumonia.
BiPAP - To increase tidal volume by increase IPAP and increase oxygenation by increasing EPAP
Augumentin (Amoxicillin and clavulanic acid)
Azithromycin macrolid which acts against both gram positive and gram negative organisms is use to treat any superimposed infection
Furosemide - to treat the edema by increasing the renal outflow
Hydrocortisone(lasic) - used to decrease any inflammation due to COPD
NEB. with IPRAVENT, BUDECORT causes bronchodilation
Tab.pulmoclear acts as a mucolytic
Chest physiotherapy involves a number of physical techniques to help remove excess mucus from respiratory passages and improve breathing
I/O charting Maintenance of records of patients fluid intake and output has been considered an important aspect to assess them
3. The cause for acute exacerbation may be a superimposed infection
4 ATT might affected her symptoms as isoniazid and rifampicin are nephrotoxic
5 Respiratory acidosis with metabolic alkalosis can occur
Hypokalemia
NEUROLOGY
1.9 days ago falling and laughing to himself which is of sudden onset
Decreased food intake - 9 days
Short term memory loss since 9 days
One episode of seizures 1 year ago
And another episode if seizure 4 months ago following cessation of alcohol associated with sweating
The problem is with the neurotransmitters
Etiology being alcohol intake
Alcohol is generally known as a DEPRESSANT of the central nervous system; it INHIBITS brain activities, causing a range of physiological effects.
The pleasurable feeling associated with drinking, on the other hand, is linked to alcohol-induced dopamine release
Alcohol also increases levels of brain serotonin, a neurotransmitter implicated in mood regulation.
Short-term alcohol consumption DISRUPTS this balance, INCREASING INHIBITORY and DECREASING EXCITATORY functions.
It triggers GABA receptors, ligand-gated chloride channels, to open and allow chloride ions to flow into the neuron, making it more NEGATIVE and LESS likely to respond to new stimuli (keeping the channels open for a longer time and thus exaggerating this inhibitory effect)
long-term consumption of alcohol, however, produces an OPPOSITE effect on the brain. This is because SUSTAINED inhibition caused by PROLONGED alcohol exposure eventually ACTIVATES the brain's ADAPTATION
In attempts to restore the equilibrium, the brain DECREASES GABA inhibitory and INCREASES glutamate excitatory functions to compensate for the alcohol's effect. As the balance tilts toward EXCITATION, more and more alcohol is needed to achieve the same inhibitory effect. This leads to overdrinking and eventually addiction.
2.IVF NS and RL: Administer intravenous (IV) fluids for rehydration, as necessary. Most patients with severe alcohol withdrawal are significantly dehydrated, and their fluid requirements range from 4-10 L in the first 24 hours. Because hypoglycemia is common in these patients due to depleted glycogen stores, a 5% dextrose solution (in 0.90% or 0.45% saline) should be used to prevent hypoglycemia.
THIAMINE: chronic alcohol consumption can result in thiamine deficiency by causing inadequate nutritional thiamine intake, decreased absorption of thiamine from the gastrointestinal tract, and impaired thiamine utilization in the cells.
Lorazepam : Benzodiazepines are the mainstay of treatment in alcohol withdrawal. Benzodiazepines are cross-tolerant with alcohol and modulate anxiolysis by stimulating GABA-A receptors.During withdrawal from one agent, the other may serve as a substitute. They are proven to reduce withdrawal severity and incidence of both seizures.
Pregabalin:Pregabalin is a structural analogue of GABA approved by FDA for partial epilepsy, neuropathic pain and recently generalized anxiety disorder.
Syp Potchlor:it helps to maintain potassium balance in the body by restoring normal potassium levels
3.
4.Thiamine is required for carbohydrate metabolism
It acts as a coenzyme.
Thymine pyrophosphate is required in:
Pyruvate dehydrogenase ketoglutarate dehydrogenase.
Branched chain ketoacid dehydrogenase.
Transketolase
Thiamine deficiency may lead to wernikes encephalopathy
In order to prevent it we give thiamine supplements
5. Alcohol induced kidney injury
6.Chronic excessive alcohol ingestion reduces the number of blood cell precursors in the bone marrow and causes characteristic structural abnormalities in these cells, resulting in fewer-than-normal or non functional mature blood cells. As a result, alcoholics may suffer from moderate anemia, characterized by enlarged, structurally abnormal RBC's
Or it may be due to
Hypersplenism, a condition charac terized by an enlarged spleen and can induce premature RBC destruction
7.Drinking high amounts of alcohol may be linked to increased risk of stroke or peripheral artery disease - the narrowing of arteries in the legs
This is thought to preven t adequate blood flow to the tissue in the leg. As a result, this tissue will die, and ulcers will begin to form or fail to heal
1.Slurring of speech deviation of month since 2 days
- giddiness 7 days back associated with vomiting
- after 3 days he consumed small amounts of alcohol after which he developed giddiness(sudden onset and gradually progressive)
associated with B/L hearing loss , aural fullness and presence of tinnitus
associated vomiting 2-3 episodes per day
Non Projectile Non bilious
2.Tab Veratin:Betahistine,is an anti-vertigo medication. It is used to alleviate vertigo symptoms associated with Ménière's disease
Inj Zofer :Ondansetron is used to prevent nausea and vomiting
Tab.Escosprin is also an anti platelet drug
Tab Atorvostatin is used to help lower LDL, triglycerides and raise HDL in the blood.
Tab Clopidogrel : the active metabolite of clopidogrel selectively inhibits the binding of ADP to its platelet P2Y12 receptor and the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.
3.The increased stress on the endothelium can cause endothelial damage and altered blood cell endothelium interaction can lead to local thrombi formation and ischaemic lesions. Fibrinoid necrosis can cause lacunar infarcts through focal stenosis and occlusions.Furthermore, hypertension accelerates the arteriosclerotic process, thus increasing the likelihood for cerebral lesions related to stenosis and embolism originating from large extracranial vessels
Hypertension sure has a positive association
4. Yes in chronic alcoholics they are more susceptible to ischaemic or haemorrhagic type of stroke
1.she could feel her own heartbeat Palpitations since 5 days(sudden in onset more during night time and aggregated by lifting weights n speaking continuously and it is relieved by medication)
Pain along her left upper limb associated with tingling and numbness since 6 days
Chestpain since 5 days
Difficulty in breathing since5 days
B/L Swelling over the legs since 8 months
Chest pain associated with chest heaviness
Cervical vertebrae is the pathological location
2. Increase of recurrent hypokalemia may be due to the usage of diuretics in this case
3.ECG changes include
flattening and inversion of T waves
Q T interval prolongation
visible U wave and mild
ST depression in more severe hypokalemia. Severe hypokalemia can also result in arrhythmias such as Torsades de points and ventricular tachycardia.
1.Early poststroke seizures are thought to result from cellular biochemical dysfunction leading to electrically irritable tissue.Acute ischemia leads to increased extracellular concentrations of glutamate, an excitatory neurotransmitter that has been associated with secondary neuronal injury.
late-onset seizures are thought to be caused by gliosis and the development of a meningocerebral cicatrix Changes in membrane properties, deafferentation, selective neuronal loss, and collateral sprouting may result in hyperexcitability and neuronal synchrony sufficient to cause seizures
2. Because of the seizures which occurred over a period of time there might be an increased severity of the post stroke seizure over time leading to loss of consciousness
1. Alcohol-induced cerebellar degeneration is the commonest type of acquired toxic ataxia with a significant history of chronic alcohol abuse. Permanent cerebellar deficits are observed among alcoholics, and they persist even with alcoholic abstinence.
2.Chronic heavy alcohol ingestion evidently exerts an inhibitory effect on platelet function even in the absence of alcohol in the blood, and this phenomenon is reversible on abstaining. The impaired platelet function, together with the reduced platelet count, may contribute to the bleeding diathesis associated with chronic alcoholism
1.the patient's history of road traffic accident might not have any role in cva
2.warning signs of CVA
3.Injection Mannitol
Used for the promotion of diuresis before irreversible renal failure becomes established, the reduction of intracranial pressure, the treatment of cerebral edema, and the promotion of urinary excretion of toxic substances.
Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water
from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma. As a result, cerebral edema, elevated intracranial pressure, and cerebrospinal fluid volume and pressure may be reduced. As a diurectic mannitol induces diuresis because it is not reabsorbed in the renal tubule, thereby increasing the osmolality of the glomerular filtrate, facilitating excretion of water, and inhibiting the renal tubular reabsorption of sodium, chloride, and other solutes.
Mannitol promotes the urinary excretion of toxic materials and protects against nephrotoxicity by preventing the concentration of toxic substances in the tubular fluid.
TAB Ecospirin
Aspirin is indicated for various other purposes, due to its ability to inhibit platelet aggregation. These include:
Reducing the risk of cardiovascular death in suspected cases of myocardial infarction (MI)
Reducing the risk of a first non-fatal myocardial infarction in patients, and for reducing the risk of morbidity and mortality in cases of unstable angina and in those who have had a prior myocardial infarction
For reducing the risk of transient ischemic attacks (TIA) and to prevent atherothrombotic cerebral infarction
TAB ATORVAS 40mg po/HS
Atorvastatin is used to help lower LDL, triglycerides and raise HDL
4. Alcohol may have a role maily because it causes reduction in cerebral blood flow by stimulation of cerebral vascular smooth muscle contraction or by altering cerebral metabolism
But not in this case cause he's an occasional alcohol consumer
5.increased cholesterol and LDL levels are associated with higher risk of developing ischemic stroke
But in this case it may not be that evident but since the HDL levels are below the optimum it may be possible
1.There is loss of power of adduction and extension of the ulnar two or three fingers and an inability to grip and release rapidly with these fingers.
2. Finger Escape test or Wartenberg's sign
It is the inability to adduct the little finger
3.
1. It may be due to iron definitely Anemia?
Serum iron is an important regulator of thrombopoiesis.Normal iron levels are required to prevent thrombocytosis by acting as an inhibitor. Iron deficiency can increase the number of platelets in blood, which is linked with a hypercoagulable state.Erythropoietin which stimulates megakaryocytes is also increased during the iron deficiency.
Iron deficiency itself can lead to a hypercoagulable state. It has been found that microcytosis decreases the cell deformability and increase the viscosity, causing abnormal flow patterns.Under conditions of stress or infections, the metabolic demand at the tissue level rises which can create anemic hypoxia and can predispose to venous thrombosis
Or may be due acute cortical vein thrombosis leading to infarction?
If hemorrhage occurs focal cortical irritation caused by blood metabolites could also cause seizures?
2. Risk factors for children and infants include:
Sickle cell anemia
Chronic hemolytic anemia
Beta-thalassemia major
Iron deficiency
Certain infections
Dehydration
Head injury
Risk factors for adults include:
Pregnancy and the first few weeks after delivery
antiphospholipid syndrome,
protein C and S deficiency,
antithrombin III deficiency,
factor V Leiden mutation
Cancer
Collagen vascular diseases like lupus, Wegener’s granulomatosis, and Behcet syndrome
Obesity
Low blood pressure in the brain (intracranial hypotension)
Inflammatory bowel disease like Crohn’s disease or ulcerative colitis
3.Stopping Midazolam immediately results in seizures. It should be done gradually by tapering the dose.
Antiepileptics should not be withdrawn immediately. It should be done only if the minimum seizure free period is 2 years.
4.Low molecular weight heparin was given to treat the cortical vein thrombosis
Cardiology
1. Preserved ejection fraction (HFPEF) – also referred to as diastolic heart failure.
Reduced ejection fraction (HFrEF) - also referred to as systolic heart failure.
2.Pericardiocentesis is not done here may be because the effusion was resolving itself?
resolving : 2.07cms effusion at the time of admission -1,4mm at the time of discharge.
3.The risk factors for heart failure in him are: Hypertension, Diabetes ,Smoking , Alcoholism.
and his age too.
4.maybe because of the pressure exerted by the extra fluid around the heart, it is unable to pump the blood to its optimum which is contributing to hypotension?
1. The patient's 2D-ECHO showed diastolic dysfunction and also LVH, MR and TR with PAH. Heart failure with preserved ejection fraction (HFPEF) happens when the left ventricle is not filling with blood as well as normal. The ventricle can pump well. But it may be stiff so it cannot relax and fill with blood as well as normal. The ejection fraction is 50% or more. HFPEF may also be diagnosed if the ejection fraction is 40% to 49%. HFPEF happens because the left ventricle's muscle becomes too stiff or thickened. To compensate for stiff heart muscle, your heart has to increase the pressure inside the ventricle to properly fill the ventricle. Over time, this increased filling causes blood to build up inside the left atrium and eventually into the lungs, which leads to fluid congestion and the symptoms of heart failure
2.The patient has diabetic triopathy which means he showed, first, clinical evidence of neuropathy; then, diabetic retinitis, and, finally, the nephropathy of diabetes. Anemia can be due to decrease in erythropoietin production by the kidneys due to nephropathy which is usually common in patients with heart failure or it could be Anemia of chronic disease
3.Diabetic bullae, also known as bullosis diabeticorum, is a spontaneous, distinct, noninflammatory, blistering condition of the skin predominantly seen in patients with diabetes mellitus. Circulation of blood at the wound site is critical for wound healing. As a result of narrowed blood vessels, diabetic wound healing is impaired because less oxygen can reach the wound and the tissues do not heal as quickly.
4. The patient showed sequence of neuropathy followed by retinopathy and nephropathy It is termed as DIABETIC TRIOPATHY.
1.Surgery for Inguinal hernia 10yrs ago.Patient was fine after the surgery, but had On and Off pain at surgical site which aggravated since 3yrs.
Facial puffiness On and Off since 2-3yrs.
Shortness of breath (Grade II) 1yr ago for which he visited the local hospital and was diagnosed to be Hypertensive
Shortness of breath Grade II (on exertion) 2 days ago which progressed to Grade IV (at rest)
decreased urine output since 2 days and Anuria since morning.
2.Carvedilol is used in the treatment of Hypertension Angina and Heart failure.
It is an alpha and beta-blocker
Carvedilol inhibits exercise induce tachycardia through its inhibition of beta adrenoceptors. Carvedilol's action on alpha-1 adrenergic receptors relaxes smooth muscle in vasculature, leading to reduced peripheral vascular resistance and an overall reduction in blood pressure.
Digoxin induces an increase in intracellular sodium that will drive an influx of calcium in the heart and cause an increase in contractility. Cardiac output increases with a subsequent decrease in ventricular filling pressures.
Digoxin also stimulates the parasympathetic nervous system via the vagus nerve leading to SA and AV node effects, decreasing the heart rate.
Dobutamine (Dytor)directly stimulates beta-1 receptors
of the heart to increase myocardial contractility and stroke volume, resulting in increased cardiac output.
Torasemide is used in the treatment of Hypertension and fluid overload associated with heart, liver, kidney or lung disease.Torasemide is a diuretic.
Acitrom (Acenocoumarol) is an oral anticoagulant. It acts by preventing the formation of harmful blood clots. Although it does not dissolve the existing blood clots
Heparin The antithrombotic effect of heparin is well correlated to the inhibition of factor Xa.
3 pathogenesis of cardiorenal syndrome
The patient has type 4 CRS
4. Hypertension may be a risk factor for atherosclerosis in this patient
5 since the patient is being given heparin and acenocoumarol his APTT must be reviewed from time to time
1.shortness of breath (SOB) since 1/2 hour.
heartburn like episodes since a year. They were relived without use of any medication.
TB diagnosed 7 months ago for which she completed the course of medication a month ago.
DM2 since 12 years
hypertension since 6 months
The pathology is within the coronary circulation
2. Metoprolol is a beta-blocker that works on the heart and blood vessels. It is used to treat high blood pressure and chest pain. It slows down the activity of your heart allowing your heart to beat slower and less forcefully
3. Percutaneous coronary intervention (PCI)
INDICATIONS
Acute ST-elevation myocardial infarction (STEMI)
Non–ST-elevation acute coronary syndrome (NSTE-ACS)
Unstable angina.
Stable angina.
Anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope)
High risk stress test findings.
CONTRAINDICATIONS:
Intolerance for oral antiplatelets long-term.
Absence of cardiac surgery backup.
Hypercoagulable state.
High-grade chronic kidney disease.
Chronic total occlusion of SVG.
An artery with a diameter of <1.5 mm.
4.Complications of angioplasty:
Injury to the heart arteries, including tears or rupture
Infection, bleeding, or bruising at the catheter site
Allergic reaction to the dye or contrast used
Kidney damage from the dye or contrast
Blood clots that can lead to stroke or heart attack
Bleeding into the abdomen (retroperitoneal bleeding)
1.chest pain since 3 days and giddiness and profuse sweating since morning.
Pathology is in the coronary circulation
2.TAB.ASPIRIN inhibits platelet function through irreversible inhibition of cyclooxygenase activity
TAB ATROVAS
Atorvastatin is used to help lower LDL, triglycerides and raise HDL in the blood
TAB CLOPBIB
Clopidogrel is used for prevention of heart attack and stroke .It decreases the chances of having another heart attack or stroke in people at high risk of heart disease.
Clopidogrel is an antiplatelet medication.
3.PCI performed from 3 to 28 days after MI does not decrease the incidence of death, reinfarction or New York Heart Association (NYHA) class IV heart failure but it is associated with higher rates of both procedure-related and true ST elevation reinfarction. Late PCI leads to the increased risks of periprocedural complications, long-term bleeding, and stent thrombosis.
The high incidence of CAD and the increasing need for PCI provides an opportunity to evaluate its appropriate use and highlight potential overuse. PCI is frequently reported to be overused and inappropriately recommended.
1.Administration of i.v fluids in the early stages of cardiogenic shock can restore circulation by compensating for the decreased volume and perfusion. But this compensation is transient.
The patient's SOB is a compensatory mechanism for the metabolic acidosis brought on by cardiogenic shock. IV bicarbonate infusion can help reverse this metabolic acidosis and temporarily alleviate SOB.
However, this is not the definitive treatment as IV fluids alone can cause volume overload states resulting in edema. They need to be coupled with suitable diuretics, inotropes, ACE inhibitors/ARBs
2.Torsemide causes excretion of sodium chloride and water by inhibiting sodium and chloride reabsorption in the ascending loop of Henle
Torsemide is used alone or in combination with other medications to treat high blood pressure.
It decreases the symptoms such as shortness of breath
3. Using ceftriaxone may be prophylactic in this patient in order to prevent the UTI associated with Foley's catheterization
GASTROENTEROLOGY
1. pain abdomen & vomiting since 1 week and constipation, burning micturition, fever since 4 days
painabdomen & vomitings for which he was taken to a local hospital and treated conservatively 5 years back
constipation since 4 days and passing flatus.
burning micturition since 4 days
The etiology of this is most probably alcohol binge
2. ING. MEROPENAM
Meropenem (broad spectrum Carbepenem ) an antibiotic.
ING. METROGYL METRONIDAZOLE
(Nitroimidazole drug ) an antibiotic
ING. AMIKACIN 500 mg IV BD for 5days
It is an Aminoglycoside antibiotic
All these are used to control infection and ; to prevent septic complications of acute pancreatitis.
TPN ( Total Parenteral Nutrition )
Method of feeding that bypasses gastrointestinal tract
Fluids are given to vein , it provides most of the nutrients body needs.
IV NS / RL
Given for fluid replacement ie., treat dehydration
ING. OCTREOTIDE
It is a Somatostatin long acting analogue.
It is used here to decrease exocrine secretion of pancreas and it also has anti-inflammatory & cytoprotective effects.
ING. PANTOP PANTOPRAZOLE ( Proton Pump Inhibitor) used for its anti pancreatic secretory effect.
THIAMINE
It is B1 supplement.
It is given here because; due to long fasting & TPN usage, body may develop B1 deficiency
Wernicke encephalopathy secondary to B1 deficiency may be caused... so a prophylactic B1 supplemention is necessary.
TRAMADOL
It is an opioid analgesic, given to releive pain
1. The cause of dyspnea may be due to pleural effusion
2The development of diabetes is a complication of pancreatitis
It damages the cells that produce insulin and glucagon, which are the hormones that control the amount of sugar in your blood. This can lead to an increase in blood sugar levels. About 45 percent of people with chronic pancreatitis will get diabetes.
3. fatty liver disease is diagnosed after blood tests show elevated liver enzymes
Like aminotransferase test (ALT) and aspartate aminotransferase test (AST)
Elevated liver enzymes are a sign of liver inflammation. Fatty liver disease is one potential cause of liver inflammation, but it’s not the only one.
4.Plan of action and Treatment:
Investigations:
24 hour urinary protein
Fasting and Post prandial Blood glucose
HbA1c
USG guided pleural tapping
Treatment:
IVF: 125 mL/hr
Inj PAN 40mg i.v OD
Inj ZOFER 4mg i.v sos
Inj Tramadol 1 amp in 100 mL NS, I.V sos
Tab Dolo 650mg sos
GRBS charting 6th hourly
BP charting 8th hourly
1.Ruptured liver abcess may be the most probable diagnosis
2 .Her cause of death might be due to sepsis
3 . analgesic nephropathy
she had grade-3 RPD changes in right kidney
She may be having underlying CKD which is secondary to her NSAID abuse
NEPHROLOGY
1.His sob was due to Acidosis which may be caused by Diuretics
2. Intermittent Episodes of drowsinessmay be due to hyponatremia
3.The patient was secreting excess pus cells in his urine which the patient might have confused to be a fleshy mass in the urine. However this may also be due to peripapillary necrosis and papilla sloughing off in the urine giving a mass like passage in the urine
4 complications of TURP
Electrolyte abnormalities (hyponatremia and creatinine imbalance)
Urinary bladder infections and injury
post TURP syndrom
(hyponatremia,coma,blindness,cardio respiratory depression)
1. Attention-deficit/hyperactivity disorder (ADHD)
includes difficulty sustaining attention, hyperactivity and impulsive behavior.
2. Because ADHA is a psychosomatic disorder?
3.Behavior therapy, including training for parents; and
Medications.
For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried.
For children 6 years of age and older, the recommendations include medication and behavior therapy together
Stimulant drugs
Amphetamines.
These include dextroamphetamine dextroamphetamine-amphetamine and lisdexamfetamine
Methylphenidates.
These include methylphenidate and dexmethylphenidate
Other medications that may be effective in treating ADHD include:
Atomoxetine
Antidepressants such as bupropion
Guanfacine
Clonidine
INFECTIOUS DISEASE ( HIV, MTB, GASTROENTEROLOGY)
1. Difficult in swallowing and cough since 2 months combined with the findings of the barium swallow points towards the diagnosis of tracheo esophageal fistula
2.Estimates for the prevalence of IRIS in asymptomatic HIV patients initiating ART vary from 3% to 38%. The wide range is likely due to a number of factors including the lack of a consensus case-definition for IRIS, the degree of immunosuppression prior to initiation of ART, and the burden of opportunistic infections in the population studied
Complications of IRIS can be prevented by careful monitoring the patients with low CD4+ cell count and a thorough history of co-infections. Clinicians should be aware of the fact that in spite of the initial restoration of CD4+ counts the patient has high chances to develop IRIS in a course of time.
Patients with low CD4+ counts at the start of therapy have suspicion for ophthalmologic manifestations of IRIS, which could further result in CMV retinitis after initiation of ART. Thereby the patient is advised to receive a dilated ophthalmologic examination every 3 months
Transaminase levels should be monitored prior to initiation and monthly monitoring for first 3 months after ART
INFECTIOUS DISEASE AND HEPATOLOGY
1.alcoholism, mainly consuming locally prepared alcohol plays a major role as a predisposing factor for the formation of liver abscesses that is both amoebic as well as pyogenic liver abscess because of the adverse effects of alcohol over the Liver.
2Chronic alcohol use can impede the normal liver physiology and histology by bringing about cirrhotic changes in the liver and cirrhosis which may have a postive association with liver abscess?
3.The right hepatic lobe is affected more often than the left hepatic lobe by a factor of 2:1. Bilateral involvement is seen in 5% of cases. The predilection for the right hepatic lobe can be attributed to anatomic considerations. The right hepatic lobe receives blood from both the superior mesenteric and portal veins, whereas the left hepatic lobe receives inferior mesenteric and splenic drainage. It also contains a denser network of biliary canaliculi and, overall, accounts for more hepatic mass. Studies have suggested that a streaming effect in the portal circulation is causative.
4.The indications for drainage of amebic liver abscess include the following:
Presence of a left-lobe abscess more than 10 cm in diameter
Impending rupture and abscess that does not respond to medical therapy within 3-5 days
1.Based on right hypochondriac and epigastric pain and fever
USG finding of hyperechoic mass in right lobe of liver along with other supportive investigations like leucocytosis ( suggestive of infection/inflammation) and ALP ( Alkaline phosphatase ) rise in LFT is a suggestive diagnosis of LIVER ABCESS.
2.The mainstay of treatment for ALA is either metronidazole or tinidazole orally for a period of 10 days or 5 days, respectively.
This is followed by treatment with a luminal agent such as paromomycin for a period of 5 to10 days to eradicate any remaining cysts in the intestinal tract. Most cases of ALA respond to medical treatment while patients not responding to medical treatment should undergo drainage
3.As treatment is often administered prior to collection of appropriate specimens, the causative pathogen and prevalence of either disease remain unclear.
Hence we treat both amoebic liver abscess and pyogenic liver abscess
4. Antigen testing may be useful to confirm the definitive diagnosis
E histolytica Antigen Detection test detects the presence of Gal/GalNos antigen in serum and is both sensitive (295%) and specific (100%, n=70 controls including nine PLA). Sensitivity decreases significantly in patients who have been pre-treated with metronidazole prior to testing.
Molecular testing of liver abscess contents is reliable for the diagnosis of ALA
INFECTIOUS DISEASE (MUCORMYCOSIS)
1.18/04/21 He went to local PHC for COVID 19 vaccination.. Since that night patient is complaining of Fever associated with chills and rigors, high grade fever, no diurnal variation which was relieved on medication
Similar complaints after 3 days
On 28/04/21, c/o Generalized weakness and facial puffiness and periorbital edema and also patient is in drowsy state
On 04/05/21, patient presented to casualty In altered state with facial puffiness and periorbital edema and weakness of right upper limb and lower limb
It affects the nasal passage,the sinuses, oral cavity and the brain
The most likely risk factor in this patient is diabetes
2.Lipid formulations of amphotericin are currently the preferred first-line treatment for mucormycosis, with a possible preference for liposomal amphotericin for CNS infection. The possibility of combination therapy with lipid amphotericin B and an echinocandins or iron-blocking strategy merits additional investigation. Salvage therapy options are numerous, including posaconazole, deferasirox, adjunctive cytokine therapy, and hyperbaric oxygen
Blood vessel thrombosis and resulting tissue necrosis during mucormycosis can result in poor penetration of antifungal agents to the site of infection. Therefore, debridement of necrotic tissues may be critical for complete eradication of mucormycosis.
3.the current surge of cases has been attributed to the improper use of steroids to treat Covid-19 patients, coupled with poorly managed diabetes.
Another likely cause could be the improper use of oxygen cylinders—with unclean masks or without purified water in the apparatus—which became a norm in most cities grappling with a hospital bed shortage
INFECTIOUS DISEASE (COVID-19)
https://docs.google.com/spreadsheets/d/1fmfvuLhFvD-wC3ES9wuF5HHUo-A0rlXIa-aAjbbNtR0/edit?usp=sharing
MEDICAL DISCUSSION
This assessment has been really helpful to me pushing myself to new horizons by researching a lot about the literature related to the concepts and learning about various cases
It definitely aided me a lot through this whole learning process
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