35F ?allergic dermatitis METHOTREXATE TOXICITY

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Here we discuss our individual patient problems through series of inputs from available Global online community of experts with n aim to solve those patient clinical problem with collect current best evidence based input

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I have been given this case to solve in an attempt to understand the topic of " Patient clinical data analysis" to develop my competancy in reading and comprehending clinical data including history, clinical finding, investigations and come up with a diagnosis and treatment plan

35 year old female, farmer by occupation resident of aakaram. wakes up at 5 am does household chores till 9am goes to farm and comes back by evening 5pm, cooks food, have dinner and go to bed by 9pm.

The patient is apparently asymptomatic until 5 days ago then she had sudden onset of low grade fever without chills at night time . Not associated with sweating, dizziness, fatigue and body pains.

Second day after onset of fever she went to farm for work and injured her left toe with ?sand while spraying fertilizers. From third day she noticed progressive painful lesions appearing on both lower limbs and upper limbs chest and neck associated with local rise in temperature and swelling . Not associated with loss of sensation, itching, joint pains.

No complaints of headache, burning micturition, giddiness, chest pain, shortness of breath, palpitations, cough ,insomnia, loose stools, loss of appetite.

History of usage of semecarpus anacardium for one day. Tab deflazocort 6mg for five days itraconazole tofloxacin, orividazole, clobetalol propionate, and megaheal ointment for five days

History of psoriasis vulgaris? From 2 years for which she used tab methotrexate 7.5mg OD for one month and capsule itraconazole 100mg OD for one month which she stopped 15 days back

Day 1

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MEDIASTINAL SHIFT USING 2D ECHO PROBE

Case history 40 year male autodriver by occupation resident of Narketpally came to General medicine opd with complains of Pain abdomen since 3 days, Cough since three days and Difficulty breathing since 3 days Patient is apparently alright until 3 days ago then had complains of Epigastric pain and abdominal bloating sensation , insidious onset, intermittent , No aggravating and relieving factors. Patient consumed soda water, eno, jeera soda to alleviate symptoms Complains of Non productive cough insidious onset associated with shortness of breath progressive from grade 1 to grade 4 aggreviated on supine position and lying on right side. History of low grade fever not associated with chills and rigor, no diurnal variations relieved with Tab PCM650 mg No complains of loss of appetite, weight loss, insomnia No complains of Orthopnea, PND, Palpitations, profuse sweating No complaints of burning micturition, increased or decreased urine output No complains of nausea, vomiting, loose stoo

70M ALTERED SENSORIUM ET TUBE INSITU

70 year male was bought to Casuality in an intubated state HOPI: Pt is apparently asymptomatic until 2 days ago then he developed sudden onset of abdominal discomfort and SOB after dinner. Patient was taken to nearby hospital in altered sensorium and was found Grbs-30 mg/dl . patient was intubated i/v/o poor GCS-5/15 and was bought to our hospital for further management with ET tube in situ PAST HISTORY: H/O Right inguinal surgery on 15/09/23 K/c/o hypertension since 12 yrs( on unknown medication) K/c/o Pulmonary Tuberculosis 30 years back( used ATT for 6 months) PERSONAL HISTORY: DIET :mixed APPETITE : Normal SLEEP: adequate BOWEL AND BLADDER :Regular Addictions : Patient was an Alcoholic and smoker 30 years ; stopped after diagnosed with Tuberculosis. FAMILY HISTORY: N/K/C/O DM, Hypertension,Epilepsy, Asthma, Thyroid disorders. GENERAL EXAMINATION: Patient is on Mechanical ventilation. Dilated neck veins present. No Pallor,Icterus,clubbing,cynosis. VITALS: TEMP: 97.2 F BP: 160

PROJECT

TITLE:- BIOPSYCHOSOCIAL FACTORS INFLUENCING OUTCOMES IN PATIENTS WITH ABDOMINAL OBESITY AND MULTISYSTEM COMORBIDITIES By Dr. VEMULAPALLI HIMAJA (General Medicine PG) Team Members- Dr. Rakesh Biswas(MD General Medicine), Dr.Vishwak (MD PSYCHIATRY) INTRODUCTION Abdominal obesity may be defined as excess deposits of fat in the abdominal region. It is a common health condition seen in South Asians and is positively related to non-communicable diseases (NCDs). It is independent of body mass index and measured by raised waist circumference for men≥90 cm and women≥80 cm1 Waist circumference (WC) and waist-to-hip ratio (WHR) are widely used as indirect measures of abdominal or central adiposity in epidemiological studies. Although the definition of abdominal obesity remains in dispute, the cutoffs for WC (102 cm for men, 88 cm for women) and WHR (0.95 for men, 0.88 for women) were recommended by the American Heart Association and the US Department of Agriculture2 Abdominal obesity was deter

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