58M ERECTILE DYSFUNCTION 1yr with ?UTI

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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

Chief complains

Lower back pain since one month

PRESENT HISTORY

Patient was apparently alright 15 years ago then had non healing ulcers in right medial thigh went to local hospital and diagnosed with diabetes, started on OHAs

Since one year patient had complains of Burning Micturition Intermittent accompanied with Dark yellow coloured urine.

Patient also complains of erectile dysfunction

Since two months patient complains of white discharge, non-foul smelling , non-itching.

Since one month patient complains of lower back pain insidious onset, intermittent, prickling type of patient radiating to loin. No aggreviating and relieving factors

Since two days patient had complains of cold associated with Dry cough. No sore throat

Occasional low grade fever not associated with chills and rigor , on and off.

Occasional flatus- foul smelling

PAST HISTORY

Known case of DM-2 since 15years

On tab Glimi M1 po/od

On Tab metformin 500mg po/Od

Not a known case of HTN/thyroid/cad/Cva/TB

PERSONAL HISTORY

Married

Daily wage labourer, truck driver

Appetite- normal

Diet- non vegetarian

Bowels- regular

Micturition- abnormal

Allergies- no

Addictions

No alcoholic history

Started smoking 2 beedi/day since two months due to health anxiety

FAMILY HISTORY

mother is a known case of diabetic and had history of stroke

GENERAL EXAMINATION

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema

BP-110/70mmhg

PR - 70bpm

GRBS

Spo2-98% at RA

CVS- s1s2 heard, no murmur

R/S- BAE present, NVBS

P/A- Soft,NT

CNS- NFND

PROVISIONAL DIAGNOSIS

Erectile Dysfunction with ?UTI

Lower Back pain under evaluation- ?Renal calculi

DM2 since 10 years

INVESTIGATION

ECG

UROLOGY Referal in view of erectile dysfunction

Comments

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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