12-03-2026
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[11:25 pm, 12/03/2026] PPM 3: Good day sir ma patient ki 3years back b12 problem vacchindhi sir valu appudu 30 vunde hyd yashoda hospital lo Rajashekar reddy sir ni consult ayyamu sir thanu inapur 5mg tablets b ta forced tablets iccharu sir after 1 year back sugar attack ayyindhi sir sugar chala uncontrolled vuntundhi sir ippudu e tablets vesukunna thala thippadam naralu chala lagadam avuthunnai sir thinna thinakunna 400above sugar chupisthundhi ma patient problem ki solutions cheppandi sir
[11:25 pm, 12/03/2026] PPM 3: @PA edey na Meru cheppalanukunnadi.
[11:32 pm, 12/03/2026] PPM 3: As this patient advocate (hu2) I saw her first time with non healing ulcers with poorly controlled sugars on OHA.
She underwent debridement and insulin optimisation with actrapid and Lantus.
She also been diagnosed with hypertension few months back, since then she is using Telmisartan + hydrochlorthiazide and metaprolol.
She had palpitations, persistent tachycardia and occasional episodes of weakness followed by giddiness. At such episodes her sugars and BP normal.
[11:33 pm, 12/03/2026] PA: E koncham ekkuva dose tablets or insulin kuda ameki padatam ledu sir bp kuda ekkuvagavundhi bp ki tablets vaduthundhi sir
[11:34 pm, 12/03/2026] PPM 3: Recently she was added with prazopress XL 2.5mg night by her primary physician at her village.
[11:35 pm, 12/03/2026] PPM 3: @PA Ippudu bp inka sugar Ela undi..?
[11:36 pm, 12/03/2026] PA: Bp 150 or160 sugar 310
[11:36 pm, 12/03/2026] PPM 2: 3 years back anni bagane undey na? B12 problem appudu em symptoms vocchai patient ki?
[11:37 pm, 12/03/2026] PA: Bp ekkuvaga ayyindhi sir thalathippdam
[11:38 pm, 12/03/2026] PPM 2: Okay. Appudu BP entha undey?
Mee patient em chestharu? Roju em panulu cheskuntaro every hour describe cheyyandi. Problems modalaina taravatha ee panulu cheskontam lo ibbandi ela ayindi
[11:40 pm, 12/03/2026] PA: Appudu bp 180 vunde sir aproblem vacchindu ontariga koncham dhuramkuda nadavaledu eppudu thalathipputhuvundhi ani cheppevaru
[11:41 pm, 12/03/2026] PA: Thodulenide ekkada vellaledu
[11:42 pm, 12/03/2026] PPM 2: Acha okay. @PPM3 can you ask the advocate to share AP and lateral views of the patient and also all previous medical records in a strictly deidentified manner.
[11:42 pm, 12/03/2026] PPM 2: Dhuramga nadavekapovadam, antey dammu kuda vosthundey na?
[11:43 pm, 12/03/2026] PA: Ledu sir dammu ledu heart ki sambandhinchi anni testlu kuda normal vunnai sir
[11:44 pm, 12/03/2026] PA: Yashoda hospital chepincharu anni ok vunnai annaru
[11:45 pm, 12/03/2026] PA: But thanaku nadi vyavastha koncham week ga vundhi annaru
[11:46 pm, 12/03/2026] PA: Andhuke bp ki metxl 50mg tablets iccharu
[9:24 am, 13/03/2026] PPM 1: Please ask him not to share any names of doctors or hospitals to protect the privacy confidentiality of his patient and also to represent his patient in a way that her privacy is always protected.
[9:24 am, 13/03/2026] PPM 1: But thanaku nadi vyavastha koncham week ga vundhi annaru
@CR I'm unable to get the exact translation of this.
[9:25 am, 13/03/2026] PPM 1; @CR can we ask the patient's advocate to share her current BP recordings and four point sugar profile along with the timing and names of the medicines similar to how the other PaJR patients are sharing?
[9:28 am, 13/03/2026] CR: Pulse rate was weak.
[9:29 am, 13/03/2026] PPM 1: How did they come to know it was weak?
[9:30 am, 13/03/2026] CR: When they consulted the doctor at Yashoda hospital
[9:30 am, 13/03/2026] PA: Pulse 80 or 90 sir
[9:37 am, 13/03/2026] PPM 1: The problem is we want to know what the patient felt at that time to understand the event properly and the patient's advocate puts more emphasis on what the doctors told them (which we don't want to hear)!
[9:42 am, 13/03/2026] CR: Spoke to her and she will update by afternoon
[9.45 am, 13/03/2026] PPM 1: Can use this template?👇
రోగి న్యాయవాది కోసం ప్రశ్నలు;
దయచేసి మీ రోగి యొక్క ప్రస్తుత సమస్యలకు దారితీసిన సంఘటనల క్రమాన్ని వివరించండి. దయచేసి మీ పేషెంట్కు ఎటువంటి సమస్యలు లేకపోయినా సంఘటనల క్రమాన్ని ప్రారంభించండి.
దయచేసి 24 గంటల పాటు మీ రోగి సరిగ్గా ఉన్నప్పుడు అతని గంటా దినచర్యను వివరించండి
తర్వాత, వ్యాధి అతని జీవితాన్ని పట్టుకున్న తర్వాత, అతని గంటా 24 గంటల దినచర్యకు ఏమి జరిగిందో దయచేసి వివరించండి
దయచేసి రోగి యొక్క గంట దినచర్యలో ఏ భాగం అంతరాయం కలిగిందో ప్రత్యేకంగా పేర్కొనండి
రోగికి మన నుండి ప్రస్తుత అవసరాలు ఎలా ఉన్నాయి, మనం అతనికి ఒకే ఔషధం ఇవ్వవలసి వస్తే, వారు ఏ సమస్యను పరిష్కరించడానికి ఇష్టపడతారు?
దయచేసి ఇక్కడ చిత్రంలో క్రింద ప్రదర్శించిన విధంగా ఉదరం మరియు చేయి కండరాల రోగి యొక్క క్లినికల్ ఫోటోను పోస్ట్ చేయండి:
[10:02 am, 13/03/2026] PPM 3: @PA ikkada me patients personal details leda doctors / hospital names em pettakandi. Meku emina ala doubt untey nak personal message pettandi.
[10:02 am, 13/03/2026] PPM 3: Ela unnaru..? Eppudu BP and sugar entha undi..?
[10:19 am, 13/03/2026] PA: Fasting 306, Bp140 pulse 96
[10:22 am, 13/03/2026] PPM 2: Tablets inka insulin vadthunnavi photo pettandi clear ga kanapadey laga
[10:37 am, 13/03/2026] PPM 1: Yes we need to know what was her night dose that led to this high fasting
[10:38 am, 13/03/2026] PA: Memu intiki vacche sariki 10pm aindhi sir
[10:40 am, 13/03/2026] PA: Late nt aindhi sir
[10:41 am, 13/03/2026] PA: Nt needura ledu tension ki
[10:43 am, 13/03/2026] PA: Food kuda ekkuva thinadu kani fasting ekkuva chupisthundhi but time neglect bagavundhi
[10:48 am, 13/03/2026] PA: Thanaku 7months back surgery ainde kalu velu ki gaju mukka thegi velu infection aindhe koncham velu thisaru sir
[10:53 am, 13/03/2026] PA: Appudu insulin padindhi sir ippudu ade insulin padatam leduu g
[11:10 am, 13/03/2026] PPM 2: Okay got it.
[11:10 am, 13/03/2026] PPM 2: Adey em em teeskuntunaro, time and dose tho saha pettandi
[11:39 am, 13/03/2026] PPM 3: T. Glimiperide 2mg twice daily
T. Sitagliptin 50mg twice daily
T. Pioglitazone 15mg once daily
T. Met xl 50 mg twice daily
T. Telma H once daily morning
T. Prazopress XL 2.5mg night.
Currently not taking Lantus since 1 week to 10 days
[11:39 am, 13/03/2026] PPM 3: @PA inka me patient emina vadthunnara..?
[11:40 am, 13/03/2026] PPM 2: Thanks. Isn't she type 1? Why not taking insulin?
[1:57 pm, 13/03/2026] PPM 3: Yes she was earlier on insulin actrapid and Lantus.
She developed giddiness and weakness (her sugars at event was 302)
Physcian near her village advised to stop insulin and started on OHAs.
@PA me patient insulin enduku stop chesaru..?
[2:11 pm, 13/03/2026] PPM 2: Her not having a DKA (I presume) and having poor diabetes should make us consider non Type 1 causes. Particularly FCPD induced Type 3C and Type 5 are first contenders.
[2:12 pm, 13/03/2026] PPM 2: @PA @PPM3 please ask them to share AP and lateral views of the patient habitus, without identifiers obviously
@PaJR Health can you help translate the message to telugu
[2:12 pm, 13/03/2026] PaJR Health: *TELUGU TRANSLATION*
దయచేసి రోగి యొక్క శరీరాకృతి (habitus) కనిపించేలా ముందు నుండి (AP view) మరియు పక్క నుండి (Lateral view) తీసిన ఫోటోలను పంపండి. ఫోటోలలో రోగి ముఖం లేదా ఇతర గుర్తింపు వివరాలు (identifiers) లేకుండా జాగ్రత్త వహించండి.
*CLINICAL NOTE*
The absence of DKA despite poor glycemic control suggests we should investigate non-Type 1 etiologies. Fibrocalculous Pancreatic Diabetes (FCPD) leading to Type 3c or Type 5 diabetes are primary considerations. The habitus views will help assess for clinical markers of these conditions.
[2:15 pm, 13/03/2026] PPM 2: Which chronic pancreatitis etiologies first present with endocrine abnormalities over exocrine abnormalities?
[2:15 pm, 13/03/2026] PaJR Health: *ETIOLOGICAL DIFFERENTIATION*
While exocrine insufficiency (steatorrhea, malabsorption) typically precedes endocrine dysfunction in most forms of chronic pancreatitis (CP), specific etiologies can present with diabetes as the sentinel or dominant feature:
1. *Fibrocalculous Pancreatic Diabetes (FCPD):*
- A unique form of tropical CP where *diabetes (endocrine)* is often the presenting symptom, frequently occurring in young, lean individuals.
- Unlike alcoholic CP, exocrine symptoms like steatorrhea are often mild or clinically silent initially, despite extensive pancreatic calcification.
2. *Type 3c Diabetes (Pancreatogenic):*
- In cases of *Early-stage Chronic Pancreatitis* or *Autoimmune Pancreatitis (AIP)*, glucose intolerance can manifest before overt exocrine failure. AIP, in particular, may present with sudden-onset diabetes or obstructive jaundice rather than malabsorption.
3. *Genetic/Hereditary Pancreatitis (PRSS1, SPINK1):*
- While these usually present with recurrent acute pain, the progression to endocrine failure can sometimes outpace clinically apparent exocrine insufficiency, depending on the specific mutation and environmental triggers.
4. *Idiopathic Senile Chronic Pancreatitis:*
- In elderly patients, "painless" pancreatitis may present primarily with new-onset diabetes due to progressive atrophy and fibrosis, with exocrine symptoms being less prominent.
*CLINICAL NOTE*
In the current patient (30F, lean, poorly controlled sugars >400 mg/dL, history of "weak pulse" and giddiness), the presentation of severe diabetes without a history of chronic diarrhea or steatorrhea strongly points toward *FCPD* or *Type 3c diabetes*. The requested AP/Lateral habitus photos are critical to look for the "lean" phenotype and abdominal distension typical of FCPD.
[2:26 pm, 13/03/2026] PPM 3: She has urine ketones 1 positive.
Added Lantus yesterday again
Added PaJR yesterday to track her.
[2:54 pm, 13/03/2026] PPM 1: We need to know her four point (at least) sugars with or without insulin
[2:57 pm, 13/03/2026] PPM 2: Wouldn't really consider that as significant here
[3:39 pm, 13/03/2026] PPM 2: Do you have a ketone meter at the place you work? If yes can check
[6:06 pm, 13/03/2026] PPM 3: Yes but patient has to travel 60 kms. This ketones was done 2 days earlier
[6:06 pm, 13/03/2026] PPM 3: I can ask her to get urine ketones done near her home.
[6:49 pm, 13/03/2026] PPM 2: Not needed. Body morphology more important
[6:49 pm, 13/03/2026] PPM 2: History of weight loss? Osmotic symptoms?
[8:08 pm, 13/03/2026] PPM 3: History of weight loss? Osmotic symptoms?
@PA me patient weight loss emina iyyara..?
[10:06 am, 14/03/2026] PPM 3: @PA me patient ela unnaru..?
[12:24 pm, 14/03/2026] PPM 1: @PA Meru me patient gurinchi ilkada cheppandi
me patient ki eppati nundi em problem undi, anni oka serial events laga cheppandi.
Didn't realise this but as per new DPDP rules we gather this DPDP compliant signed informed consent before we can even create a PaJR group for any patient.
Please ask them to take the next step ASAP 👇
: తదుపరి దశ, ఈ ఫారమ్ను డౌన్లోడ్ చేసి:https://userdrivenhealthcare.blogspot.com/2025/11/pajr-telugu-consent-form-dpdp-compliant.html?m=1, దానిని చదివి, సంతకం చేయండి.
ఫారమ్లో ఈ క్రింది వివరాలను పూరించండి:
వయస్సు
లింగం
పూర్తి చిరునామా
సమస్య యొక్క సంక్షిప్త వివరణ
ఈ రోజు తేదీ
వాట్సాప్ (WhatsApp) మొబైల్ నంబర్
సంతకం చేసే వ్యక్తి అన్ని పేరాగ్రాఫ్లను చదివారని ధృవీకరిస్తూ అన్ని బాక్సులపై టిక్ (Tick) చేయండి.
ఆ తర్వాత, ఫారమ్ను స్కాన్ చేసి మా టీమ్ కోఆర్డినేటర్ మరియు ఆర్కైవిస్ట్ గారికి పంపండి.
అనంతరం, ఆమె రోగి కోసం ఒక PaJR గ్రూప్ను క్రియేట్ చేస్తారు. అప్పుడు రోగి సమస్యలకు సంబంధించి సాధ్యమైనంత ఉత్తమమైన సాక్ష్యాధారిత (evidence-based) పరిష్కారాన్ని కనుగొనడానికి మేము ఇతర బృంద సభ్యులతో చర్చలు ప్రారంభిస్తాము. అలాగే, రోగి యొక్క వ్యక్తిగత వివరాలను వెల్లడించకుండా (deidentified data), సమాచారాన్ని ఈ ఓపెన్ యాక్సెస్ కేస్ రిపోజిటరీలో భద్రపరుస్తాము:
గోప్యత కోసం ముఖ్య సూచనలు:
రోగి లేదా వారి బంధువులు తమ గుర్తింపును ఎవరికీ వెల్లడించవద్దని కోరడమైనది.
రోగి యొక్క గోప్యతను మరియు రహస్యాలను కాపాడటం కోసం, వారు కేవలం తమను తాము 'రోగి యొక్క ప్రతినిధి' (Patient’s Representative) గా మాత్రమే పరిచయం చేసుకోవాలని కోరండి.
Tadupari dasha, ee form-nu download chesi:
Form-lo ee krindi vivaralanu poorinchandi:
Vayassu (Age)
Lingam (Gender)
Poorti chirunama (Full address)
Samasya yokka sankshipta vivarana (Brief description of the problem)
Ee roju tedi (Today’s date)
WhatsApp mobile number
Santakam chese vyakti anni paragraph-lanu chadivayani dhruveekaristu anni box-lapai tick cheyandi.
Aa taruvata, form-nu scan chesi maa team coordinator mariyu archivist gariki pampandi.
Anantaram, aame rogi kosam oka PaJR group-nu create chestaru. Appudu rogi samasyalaku sambandhinchi sadhyamainanta uttamamaina sakshya-dharita (evidence-based) parishkaranni kanugonadaniki memu itara brunda sabhyulato charchalu prarambhistaamu. Alage, rogi yokka vyaktigata vivaralanu velladinchakunda (deidentified data), samacharanni ee open access case repository-lo bhadraparustamu: https://pajrcasereporter.blogspot.com/?m=1
Gopyata kosam mukhya suchanalu:
Rogi leda vaari bandhuvulu tama gurtimpunu evariki velladinchavaddani koradamainadi.
Rogi yokka gopyatanu mariyu rahasyalanu kapadatam kosam, vaaru kevalam tamanu taamu 'Rogi yokka pratinidhi' (Patient’s Representative) ga matrame parichayam chesukovalani korandi.
[9.59 am, 15/03/2026] PPM 3: Gud mrng sir today fasting sugar120 bp112/70 pulse 77 sir
[12.52 pm, 15/03/2026] PPM 1: And post prandial after breakfast, after lunch, after dinner with what dose of medications would be very useful to know