OSCE - ELECTROPHYSIOLOGY BY DR. NARSIMHAN

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46M with ascites and portal hypertension

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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 is welcome. 46 year old Man, cook by occupation presented with cheif complaints of Abdominal distension, Shortness of breath, pedal edema since 15 days. Patient was apparently normal 20years back, when he started drinking with friends initially as a recreation, drinks 180ml of whiskey per day, eventually progressed to 360ml per day since 20years. History of smoking of 10 beedis per day since 20 years. 3 years back patient reported history of Alcohol binge following which he develo...
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20F severe headache, neckpains and vomitings.

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First admission discharge summary Age/Gender : 21 Years/Female Address : Discharge Type: Relieved Admission Date: 27/09/2022 04:57 PM Date of Operation MLC No DR.ADITYA [SR] DR.CHARAN[PGY3] DR.DEEPIKA[PGY1] Diagnosis SYSTEMIC LUPUS ERYTHEMATOSUS WITH GLOMERULONEPHRITIC FLARE UP OF LUPUS NEPHRITIS ?CATASTROPHIC APLA SECONDARY TO SLE [LIBMAN SACKS ENDOCARDITIS ,CNS THROMBO EMBOLISM, AND RENAL FAILURE] Case History and Clinical Findings 20 YR OLD FEMALE CAME ITH C/O B/L PEDAL EDEMA SINCE 15 DAYS HYPERPIGMENTED MACULES SINCE 15 DAYS FEVER SINCE 15 DAYS ABDOMINAL DISTENSION SINCE 8 DAYS DRY COUGH SINCE 7 DAYS SORE THROAT SINCE 7 DAYS DECREASED APPETITE SINCE 7 DAYS SOB SINCE 5 DAYS DECREASED URINE OUTPUT SINCE 3 DAYS CONSTIPATION SINCE 3 DAYS HOPI -20 YEAR OLD FEMALE CAME WITH C/O OF B/L PEDAL EDEMA EXTENDING TILL THE KNEES PITTING TYPE SINCE 15DAYS   FOR WHICH SHE GOT MEDICAL HEALTH CHECKUP AND PRESCRIBED SOME MEDICATION [UNKNOWN] THEN HER PEDAL EDEMA GOT RESOLVED ALNG WITH FEVER SHE D...
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Cutaneous Clues in Secondary Adrenal Insufficiency Associated with Mixed Connective Tissue Disease: A Case Report

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  Abstract Secondary adrenal insufficiency (SAI) is a rare but potentially life-threatening complication of autoimmune connective tissue disorders such as mixed connective tissue disease (MCTD). We present a case of a middle-aged woman with MCTD who developed SAI. She exhibited cutaneous hyperpigmentation, particularly over the face, palmar creases, and soles, but lacked oral mucosal pigmentation. These findings, supported by biochemical tests and imaging, were consistent with a diagnosis of SAI rather than primary adrenal insufficiency (PAI). This case emphasizes the value of cutaneous findings in early recognition and differentiation of adrenal insufficiency subtypes. Keywords Secondary adrenal insufficiency, mixed connective tissue disease, hyperpigmentation, oral mucosa, ACTH, autoimmune Introduction Adrenal insufficiency may be classified as primary (PAI), secondary (SAI), or tertiary, depending on the level of the hypothalamic-pituitary-adrenal (HPA) axis affected. SAI r...
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