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79 yr old female with Acute exacerbation of COPD with type 2 respiratory failure with cor pulmonale with post tuberculosis sequelae with left bronchiectasis with refractory hypotension secondary to septic shock with ventilator associated pneumonia with multi organ dysfunction syndrome on mechanical ventilation day 18 and tracheostomy tube day 8

79 yr old female came with complaints of shortness of breath, cough since 10 days HOPI: Patient was apparently asymptomatic 10 days ago then she developed loss of appetite and sob which was insidious in onset (MMRC GRADE 2 TO 3), increased in supine position, not associated with wheeze, sweating and palpitations. Orthopnea PND -negative C/o cough with expectoration since 10 days which is insidious in onset, progressive, mucopurulent, yellow in colour,non blood stained and non foul smelling No c/o fever, chest pain, pedal edema, burning micturition, PND, wheeze. PAST HISTORY:     H/O COPD SINCE 5 YEARS (ON NEB SOS)    H/O PULMONARY TUBERCULOSIS 40 YEARS BACK (TOOK ATT FOR 6 MONTHS)    K/C/O DIABETES MELLITUS SINCE 2 YEARS (ON REGULAR HYPOGLYCEMIC DRUGS)    H/O BIOMASS EXPOSURE FOR 40 YEARS    NOT A K/C/O HYPERTENSION, ISCHEMIC HEART DISEASE FAMILY HISTORY: NO SIGNIFICANT FAMILY HISTORY PERSONAL HISTORY:  OCCUPATION: HOUSE WIFE D...
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69 yr old male with Bilateral Hydroureteronephrosis

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A 60 yr old male came to OPD with c/o pedal edema since 10 days H/o poor stream urine + H/o nocturia + 5-6 times H/o increased frequency +  10-15 times H/o urgency + Patient was apparently asymptomatic 1 and half year back then he developed spontaneous pain and swelling in the right leg for which he was operated for the same ; no history of trauma to leg Patient has history of NSAID abuse for 1 year due to severe leg pain Past history :       N/k/c/o DM,HTN,ASTHMA,CAD, EPILEPSY Family history :     No significant family history General examination :    No pallor icterus cyanosis clubbing, lymphadenopathy VITALS AT ADMISSION : Temperature : AFEBRILE PR: 82 SPO2:92 RR: 16 B.P. : 110/80 C.v.s: s1 s2 heard no murmurs RS: BAE present CNS: NAD Diagnosis: NSAID induced nephropathy PLAN of treatment : 1. Fluid restriction (<2lit/day), salt restriction (...
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44 yr old male with renal failure

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44 year old Toddy climber, climbing around 40 trees per day , from the age of 20, at 23 he was diagnosed with dm2 started on oha,due to symptoms of polyuria, was on regular followup of his dm2 , had complaints of leg pain for which he used nsaid's frequently ,3-4times per week, diagnosed with renal failure with initial creatinine 2.5 in 2019, but was on same medication, followed up every 6 months ,in January 2020 ,in a follow up his creatinine was rising , which didn't subside after consulting ?physician so he was on follow up with an ayurvedic doctor,he also developed symptoms of pedal edema which reduced with that treatment,he didn't report any symptoms of decreased output ,in March 2020 he was admitted for loc in miriyalguda ,told to have high sugars with increased creatinine and was started on insulin, he lost follow up with ayurvedic doctor and pedal edema didn't subside with medication so he went to nims where biospy was done , and he was started on hd , that poin...
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45 yr old female with B/L groin hydroureteronephrosis,B/L ureteric calculi ,Post right sided DJ stenting

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45 year old female patient came to OPD with c/o reduced urine output since 1 week,easy fatigabiility from 1 week and sob since 3 days and facial puffiness since 1 week. She is a daily wage labourer and she stopped working 3 years back because she would easily get tired.  1 year back she experienced severe right loin pain along with reduced urine output and generalized anasarca.  She underwent right DJ stenting and also 3 sessions of hemodialysis She didn't undergo hemodialysis or wasn't on any treatment for 1 year due to the COVID pandemic.  1 week back, patient started experiencing reduced urine output and would easily get tired. She also told us that she noticed facial puffiness 1 week back. She also started feeling dyspneic after walking a few steps since 5 days, though it wasn't associated with any orthopnea, PND, chest pain, palpitations. Also no complaints of cough, wheeze. General Examination: Patient was a moderately built individual, with pallor  and facial ...
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20 yr old male with adrenal crisis with secondary adrenal insufficiency with iatrogenic cushings syndrome

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CC -20 year old male came to casuality with c/o Giddiness since 1week, SOB on exertion since 2days with nausea and vomiting HOPI- patient was apparently asymptomatic 1week ago then he doveloped giddiness which was sudden in onset no aggravating factors relieved on consumption of food. Later he doveloped SOB 2 days ago with no aggravating and reliving factors along with nausea and vomiting with consumption of food as aggravating factor. PAST HISTORY- K/C/O cushings syndrome PERSONAL HISTORY- occupation -student Mixed diet appetite -normal  bowel and bladder - Normal no addiction  FAMILY HISTORY - not significant  PHYSICAL EXAMINATION- no pallor, icterus, cyanosis, clubbing, dehydration  VITALS- temperature - afebrile  pulse rate - 80 bpm  RR - 12 cpm  BP - 80/50 mm hg  SPO2 - 98 on RA  GRBS - 117.mg % SYSTEMIC EXAMINATION- CVS-S1 ,S2 heard ,no murmurs  RS -BAE +  P/A - soft ,non tender  CNS - speech - normal   power...
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