OSCE - INTERVENTIONAL CARDIOLOGY BY DR. SREENIVAS KUMAR

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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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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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20F severe headache, neckpains and vomitings.

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