Dr Saicharan Kulkarni MD

36 year old male, daily waged labourer by occupation presented with cheif complaints of  Fever since 1 week Pain abdomen since 4-5 days Burning micturation since 4-5 days Yellowish red coloured urine since 4-5 days Patient was apparently normal 14 years back, when he used to smoke 1 pack of beedies per day during his daily works like farming, then one day he developed shortness of breath on exertion which gradually progressive over days to limit his daily routine works. Then he visited near by hospital and told that he had fluid in Rt side of the lung ( nimmu : in patient words) no fluid was removed and told it is beacuse of smoking and treated conservatively after few days symptoms resolved. 4 years back he had a snake bite at right leg. 2 years back he had head injury in a fight with relatives due to financial issues and 6 sutures was placed.  1 week back he developed Fever which is high grade associated with chills mostly in nights with sweating,. Continous type , relived with medic

63 year old male farmer  ON EXAMINATION:- Pallor+ No icterus, cyanosis, clubbing edema , lymphadenopathy. VITALS ON ADMISSION:-  Temp:- 101F  PR:- 92 BPM RR:-14 cpm BP: 90/60 MMHG Spo2:- 83 % at RA GRBS:- 195 MG% CVS:- S1 S2+ ,NO MURMUR RS:- BAE+ , NVBS+ P/A SOFT ,NT CNS:- Eye opening to pain  No verbal response No meningeal signs GCS:- E2 V1 M5. 8/15 PUPILS--B/L mid dilated unequal(Rt>Lft) Plantars-- B/l Flexion  Power- --. RT. LT  Upper limb - 5/5. 5/5  Lower limb- plegia plegia(0/5) Tone --  Upper limb- Increased.Increase  Lower limb- Decreased.decreased. Reflexes:- RT. LFT             B- absent. 2+             T-. 3+. 3+             S-. 2+. 2+             K-. Absent. Absent             A-. Absent. Absent.

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box 45M came to casuality now with  C/O fever since 5 days   Burning micturation since 3 days slurring of speech since 1 day.   Patient was an elite farmer who used to work in feilds daily from 8am to 6pm with few breaks for lunch and short naps  Pt was apparently alright 2 years back where he was first time hospitalised for the complaints of fever which is high grade associated with chills associated with burning micturation but not associated with vomitings and pain abdomen where diagn