30-01-2025
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.
Reviewing the other long distance patient in OPD now and sharing in real time toward team based learning of this endocrine disorder @PPM2.
PPM 1 - We are starting to take the patient's history now.
PA - The patient is 31 years old Female
Having obessity issues since childhood with Asthema since childhood.
The recent basic issue is relating to acute gastic problem along with nausea.
31F
Jotting down her notes below in the OPD:
Was reportedly obese since birth
And had thrombophlebitis of right foot for which they even contemplated amputation.
Used to love shiuli flowers as a toddler but they precipitated her first bronchial asthma attack and then annually at around the same date! Autumn.
First inhalers in 9th standard
Till then was largely controlled on Ayurveda and Homeopathy!
In 2009 when she was 15 and focusing on her 9th exams, her Ayurvedic physician died and she had no option but to turn to mainstream medicine and started salbutamol inhalers since then every year twice during the spring and autumn exacerbations.
During the same time she also noticed her asthma attacks coming few days just before the menstrual cycles 50% of the year.
Following 12 years of age she gained further weight other than the congenital obesity noticed during birth.
Used to consume Amway products due to their door to door sales marketing for her dysmenorrhoea and obesity 2013-14.
Next life events
10th, 12th, BA English, 2011 LLB, 2014 LLM 2017 PhD admission in 2020
Worked as Asst Professor since 2019-2022 in NBU in parallel
PhD submitted December 2024 waiting
Married in 2021
Mother died in 2023. Mother had a movement disorder suggestive of hemiballismus with uncontrolled sugars (diabetic striatopathy) and stroke in April 2021 and then developed COVID and suffered from pulmonary long covid and died during 2023.
Patient also developed anosmia and COVID positivity at the same time.
Also had a major UTI December 2022 and suffered for two weeks.
Developed epigastric discomfort since last 6 months
Along with irregular meals in a vicious cycle.
2016-17 developed intermittent headache.
Says she's a sugar addict who used to get headaches if she tried to give up sugar and attributes those headaches to her sugar de-addiction trials!
Has developed a corn since two months.
She also mentioned that she had a breast fibroadenoma in November 2024 diagnosed only through breast ultrasound
@PPM3 please send her to Professor Surgery for evaluation and let's get her repeat breast ultrasound too.
PPM 2 - Steroids you mean?
I mean I'm all in for narrative based medicine but I still can't make out what her current problems are?
PPM 1 - 👍
She could recall the name salbutamol for her inhaler. Would expect that she would have received steroid inhalers too.
It's clinical complexity that can only be expressed through unstructured narrative!
So to reduce (as in reductionist) clinical complexity we can use a structured problem list:
1) Obesity since birth with add on obesity since teens @PPM3 can you please ask someone to check her height and weight and share here?
2) Corn
3) Dyspepsia Constipation suggestive of NUD IBS
4) Seasonal Bronchial asthma (currently quiescent)
PPM 2 - No sir I meant the ayurvedic drugs covertly mix steroids anyway.
PPM 1 - 😲
Also send her CBC, Chest X-ray, LFT, RFT, urine cue, ECG
Send her to psy for sugar de-addiction. Send her fasting, post breakfast, post lunch, post dinner for next three days @PPM3.
PA -
PA - All the tests report given for the patient except the Sugar test have been received today. Please be kind enough to find the attached files.
PPM 1 - Looks good
@PPM4 please share surgery OPD notes for breast fibroadenoma and psy notes on sugar de-addiction.
@PPM5 can you please check what all consults were done for this patient today?
She was planned for
Surgery OPD for breast fibroadenoma and
psy consult for sugar de-addiction.
6 Hourly BP monitoring today, tomorrow and day after.
PA - 1. The psych consult could not be done today it is said that' it will be done tomorrow morning.
2. The breast USG is done today and the report is attached above.
PPM 1 - Yes saw the report but needed to see the surgery consultant's notes.
PA - Nothing as such done. Till now.
PPM 1 - @PPM5 @PPM4
PA - The ECG report of the patient.
PPM 1 - Yes all tests look normal 👍.
01-02-2025
PPM 1 - @PPM5 please plan her ultrasound abdomen for Monday morning.
PPM 5 - Okay sir.
PA - The patient went to the OPD Surgery for consultation.
PA - And the followings are the report of fasting, pp and glycated hemoglobin.
PPM 1 - Good. All tests are good👏👏
02-02-2025
PA - Sir, Should the patient remain on an empty stomach for the said ultrasound of the abdomen?
And from where to collect the requisition slip for the same?
PPM 1 - @PPM5 can you provide an ultrasound abdomen requisition for this patient for tomorrow morning empty stomach?
PPM 5 - Yes sir, I’ll give it tomorrow morning at 8am
PA - Abdominal USG Report
PPM 1 - Good everything is normal 👍.
12-02-2025
PA - Today our patient has come to her daily routine. Patient had lunch with Rice, methi shaag, moong daal, salad and chicken.
PPM 1 - 👍
August AI
Thanks for sharing this file. Let me process this. This usually takes 1-2 minutes. I'll let you know when it's done.
📸In this image, there is a hearty lunch consisting of white rice, mixed vegetable curry (with visible carrots, peas, potatoes), cooked greens (possibly spinach), meat curry (possibly chicken or mutton), and radish salad.
Nutritional Breakdown
- 🔥 Total Calories: 530 kcal
- 💪 Proteins: 20g 🍗
- 🍞 Carbs: 80g
- 🍬 Sugars: 5g
- 🥑 Fat: 20g
- 🌾 Fibers: 10g
Disclaimer: This might not be accurate as it doesn't contain the cooking process.
Well, this meal looks quite balanced! You've got a good mix of carbs, proteins, and veggies. The meat curry adds a nice protein boost, which is great for energy.
If you're looking to manage your weight or reduce acidity, you might consider slightly reducing the rice portion and increasing the greens or salad. But overall, this is a satisfying meal! Enjoy your lunch! 🍽✨
PPM 1 - Good also share this patient's hourly activities so that we can gauge her energy outputs to balance it with her energy Inputs (food plates)
Every hour just let us know what the patient is doing
As illustrated here👇
"Can you share your patient's daily hourly activities like the slots below? 👇
08. 02.2024 Update
8. 30 AM - Time to wake up
8. 30-9 AM - Freshen up
9. 30 AM - Breakfast (6 vada + chutney) + a cup of coffee
10 AM - 1 PM - Client calls
1. 45 PM - Lunch (3 cups of rice + chicken curry about 300 grams)
2. 15-5.30 PM - Client work continues
6 PM - 2 muffins + a cup of tea
6 PM-9 PM - Client work on the system
9. 30 PM - Dinner (2 cups of rice + chicken curry about 200 grams)"
14-02-2025
PA - Our patient woke up today at 5.30 am
Went on for walking
Took 5k steps in the morning for an hour
Came back at 7 am
Having a blue pea green tea (অপরাজিতা ফুল) (Aparajita flower) at 8 am.
PPM 1 - 👍
15-02-2025
PA - Well,
Yesterday again our patient could not keep up with her sugar cravings and had chocolate. Hence, did not share any update.
Today, our patient took boiled blanched carrots, omlet and vegetable soup as breakfast.
Fingers crossed for the rest of the day to stay away from sugar.
PPM 1 - At what time?
It may be good for you to follow your patient and post her updates more regularly at least hourly if not
half hourly as long as she's fine with sharing because only then our team could intervene at the right
time and formulate a better craving busting strategy.
Keep sharing! Fingers can't be crossed for ever else we'll have to stop work!
PA - Yes
Today onwards I shall post it on hourly basis
Got it
After the daily chores
Sitting for study
And having a cup of blue pea geen tea with a local fruit (kul)
PPM 1 - 👍
Perhaps the study insights could be shared too.
For example here's some insights from my morning readings:
I dug into this 👇
for insights from Microsoft's AI driven work in India and managed to find one insight with the first random paper i picked and I'm just sharing this to see if others here would like to also give the other papers a shot.
The insight from the paper I picked is summarised manually after the customary Tête-à-tête" with meta AI:
Doctors can be left to focus on their surgeries while AI chatbots could field user driven queries from patients and attendants with perhaps 84.5% accuracy in it's responses as per expert verified ratings.
Rest of the tete-a-tete if anyone cares to read it although it's humanly likely to be tldr 👇
[15/02, 09:40] cm to meta AI: Please list the insights from the work below as bullet points:
CataractBot, its first implementation, provides expert-verified responses to cataract surgery questions. A pilot evaluation showed its potential; however the study had a small sample size and was primarily qualitative. In this work, we conducted a large-scale 24-week deployment of CataractBot involving 318 patients and attendants who sent 1,992 messages, with 91.71% of responses verified by seven experts. Analysis of interaction logs revealed that medical questions significantly outnumbered logistical ones, hallucinations were negligible, and experts rated 84.52% of medical answers as accurate. As the knowledge base expanded with expert corrections, system performance improved by 19.02%, reducing expert workload. These insights guide the design of future LLM-powered chatbots.
Unquote
[15/02, 09:40] Meta AI: Here are the insights from the work as bullet points:
Insights from CataractBot Deployment
- Large-scale deployment success: 318 patients and attendants interacted with CataractBot, sending 1,992 messages over 24 weeks.
- High expert verification rate: 91.71% of responses were verified by seven experts.
- Medical questions dominated: Medical questions outnumbered logistical ones, highlighting the chatbot's potential for clinical support.
- Low hallucination rate: Hallucinations (unfounded or inaccurate responses) were negligible, ensuring reliable information.
- High accuracy rating: Experts rated 84.52% of medical answers as accurate.
- Improved performance over time: As the knowledge base expanded with expert corrections, system performance improved by 19.02%.
- Reduced expert workload: Improved system performance reduced expert workload, making the chatbot more efficient.
- Guidance for future LLM-powered chatbots: These insights inform the design of future LLM-powered chatbots, particularly in healthcare applications.
[15/02, 09:41] cm: Reduce the insights to a single most important insight
[15/02, 09:41] Meta AI: Here is the single most important insight:
- Improved performance over time: As the knowledge base expanded with expert corrections, system performance improved by 19.02%, reducing expert workload and increasing the chatbot's reliability and effectiveness.
[15/02, 09:46] cm: Disagree with your AI driven insight.
The single most important insight from this work as per this human here writing manually is:
Doctors can be left to focus on their surgeries while AI chatbots could field user driven queries from patients and attendants with perhaps 84.5% accuracy in it's responses as per expert verified ratings.
[15/02, 09:46] Meta AI: I love it when humans correct me!
You're absolutely right! I was too focused on the technical aspect of the chatbot's performance improvement. Your insight highlights the practical and impactful application of the research findings.
By leveraging AI chatbots to handle patient and attendant queries, doctors can indeed focus on their core expertise, like surgeries, while ensuring that patients receive accurate and reliable information. The 84.5% accuracy rating verified by experts is a testament to the chatbot's potential in this context.
Thank you for providing a more nuanced and human-centered perspective on the research findings!
PA - The patient had daal kichidi with cucumber for lunch.
Had an orange at 2pm.
Our patient is having a bowl of stirred veggies with cucumber for evening snack.
Our patient took 5km evening walk.
She is having a cup of green tea.
This is mainly evening when the patient is having craving for sweets.
Mainly around this time at 7pm.
PPM 1 - How long did the craving last?
The patient can have dinner around this time.
Most of us have dinner even earlier than that.
PA - Yes
The patient is having her dinner.
As long as not the sugar is taken.
PPM 1 - Hopefully dinner will reduce it.
Can ask her to take more fruits and vegetables and fill up her stomach.
PA - Yes..post dinner its feeling better.
PPM 1 - 👍
Can eat dry fruits when hungry.
PA - Okay.
16-02-2025
PA - Left bed at 8 am.
Having break fast with black coffee and nuts.
PPM 1 - 👍
17-02-2025
PA - the patient woke up at 8 am and now having a cup of black coffee.
PPM 1 - 👍
PA - The patient is having beet carrot soup some nuts and 2 dates as break fast.
While doing daily chores, the patient took one bowl of sour curd with half pomegranate.
At 12.30pm
PPM 1 - Patient appears to be taking very less food.
She can take more fruits and vegetables ad lib and also increase her rice quantity a bit more.
PA - Okay
Patient took 5 km walk this evening.
As the patient was craving for sweet... Hence, having some scrambled egg with two fruits.
PPM 1 - Very good for the patient 👏👏
And hopefully followed by dinner.
PA - No
It was supper
The patient will have dinner around 8. Is that okay?
PPM 1 - Fine
Many of us finish it by 6-7PM here.
PA - Okay
The patient shall try the same onwards.
PPM 1 - 👍
17-02-2025
PA - Vegetable rice for dinner.
PPM 1 - 👍
18-02-2025
PA - The patient woke up at 8.30 am (late). Now having a cup of lavender tea.
The patient is having a bowl of sour curd with a pomogranate and Methi roti with methi saag and a bowl of kheer with minimal gur cashew and raisins for lunch.
PPM 1 - 👍
PA - The patient took 5km walk in the evening... On returning she took 6 cashews... She is going to take her dinner at 7 pm with Chicken with veggies, methi saag and 2 rotis with cucumber.
The patient is having a cup of lavender tea at 20.48
19-02-2025
PA - Woke up at 7.30am
The patient taking a cup of Ginger blue pea green tea 6 soaked almonds and some nuts for breakfast.
PPM 1 - 👍
PA - Millet with saag and cabbage and pumpkin with moringa and a bowl of curd with pomegranate.
And one egg.
The patient took 4km walk this evening.
The patient had 2 KFC burger with KFC chicken popcorn as Dinner ...
PPM 1 - 😮
Not recommended for dinner.
20-02-2025
PA - Yes sir.
The patient woke up at 8 am.
PPM 1 - It's nice to note that people have that luxury of waking up at 8:00AM particularly for some of us who wake up at 5:30-6:00 AM forced by their dogs who literally pull them out of their beds in time for their early morning walk! 😅
PA - For a few days the patient and family have become late risers. Trying to change the same.
However, she is having a cup of green tea with some nuts in the hope to remain rest of the week on routine.
PPM 1 - 👍
PA - The patient took lunch at 12.30 today with millet salad vegitables and egg.
For evening snack the patient took 2 pieces of dhokla.
PPM 1 - 👍
PA - The patient took 4 km evening walk today.
The patient has taken 2 kools post evening walk.
Dinner with salad, shallow fried kofta, roti, salad and urad daal
PPM 1 - 👍
21-02-2025
PA - The patient woke at 7.30 am and having a cup of lavender tea at 8.30 am.
After the daily chores, the patient is taking her breakfast with two bananas, one orange and one boiled egg.
August AI -
📸In this image, there are:
- 🍌 Banana 2 medium - approx 210 kcal
- 🍊 Orange 1 medium - approx 62 kcal
- 🥚 Boiled egg 1 large - approx 78 kcal
- Total Calories: 350 kcal 🔥
- Proteins: 7 g 🥚
- Carbs: 75 g 🍌
- Sugars: 45 g 🍊
- Fat: 5 g 🥚
- Fibers: 8 g 🍌
This breakfast looks quite refreshing and nutritious! The combination of fruits and a boiled egg provides a good balance of carbohydrates, vitamins, and protein.
Just a small note: if you're looking to increase your protein intake, you might consider adding another boiled egg or some yogurt to your meal. But overall, this is a great start to your day! Keep it up! 🌟
PA - Til bata, kopta daal and rice with salad for lunch.
In the evening the patient is having a cup of lavender tea with some nuts.
PPM 1 - 👍
PA - The patient took 3 km walk today.
And took one boiled egg post evening walk.
PPM 1 - 👍
PA - Daal, kopta, moringa with pumpkin and roasted brinjal and rice for dinner.
PPM 1 - 👍
22-02-2025
PA - Woke up at 7.30 am.
PPM 1 - I started walking to the bus stop 1km from my house at exactly the same time and I'm still waiting at the bus stop!
PA - 🎕
The patient had 3 kul and 1 banana as breakfast at 10 am
Boiled rice and masoor daal with roasted brinjal and moringa with pumpkin.
She is taking two dates and one kul post walking.
PPM 1 - 👍
PA - The patient is having dinner... Oats chila, omlet of an egg and with veggies, some nuts, smashed & roasted sesame and chilly
For the omlet minimal chaddar cheese has been used.
PPM 1 - 👍
PA - The patient woke up at 7.30 am
For breakfast the patient is having a cup of blue pea green tea, cucumber salad with curd and 2 kul
PPM 1 - 👍
PA - Vegetable daal, papad and sauted cauliflower with rice for lunch.
The patient Had one banana post lunch.
The patient had one cup of blue pea green tea and 2 kul before evening walk.
PPM 1 - 👍
PA - The patient is taking dinner... Multigrain roti, omelette, sauted cauliflower, salad and beetroot & tomato soup.
She took 4km walk this evening
PPM 1 - 👏
25-02-2025
PA - The patient woke up at 7.30 am.
As break fast she had one cup beet root soup, 2 kul and one bowl of cucumber salad
PPM 1 - 👍
PA -
Lunch
She had a banana post lunch.
The patient had an omelette and some nuts as she was feeling hungry at 15.35.
The patient took 3km walk today as her corns in her left feet was paining today.
Usually it pains while taking walk
However, today it was a bit higher.
The patient took her dinner at 7 and forgot to take picture of the same. She took rice chicken and one boiled egg. Along with salad.
PPM 1 - What shoes does she use for walking? Please share the image.
PA -
Again unfortunately the market forces prevail here and also I'm not sure if anyone has scientifically studied the outcomes of various shoes on the corns.
PA - The patient had lunch with pomegranate, sweet potato and veggies.
PPM 1 - 👍
28-02-2025
PA - The patient woke up at 6 am.
The patient took 3km walk in the morning
PPM 1 - 👏
PA - Breakfast, later had one banana.
Lunch along with 4 pieces of chicken.
PA - Egg noodles with vegetables and salad for dinner.
01-03-2025
PA - The patient woke up at 5 am. For half an hour she cut vegetables for her breakfast. Next, at 6 am she will head for her morning walk.
PPM 1 - 👍
PA - She took 4.5 km walk in the morning.
PPM 1 - 👏
PA - Breakfast with veg chilla salad and 1 boiled egg.
The patient had a plain dosa with sambar and chutney for Lunch.
PPM 1 - Chutney was sweet?
PA - No..
Coconut and garlic-tomato chutney
PPM 1 - 👍
PA - The patient is having a glass of banana smoothie with chia and some nuts.
PPM 1 - 👍
PA - The patient is having some nuts for evening craving ... Planning to have dinner soon.
Patient had dinner with kichidi, omlette and pomegranate.
02-03-2025
PA - The patient woke up at 7.15 am today.
The patient had a cup of lavender tea.
And she has entered the kitchen for preparing lunch as one friend is invited at home.
PPM 1 - 👍
PA - Vegetable chila and 1 boiled egg for breakfast.
Lunch with rice, vegetable curry, dal and raitha.
In between had few pea nuts.
PA - The patient took her dinner at 6 pm but forgot to take the picture. However, she had same menu for dinner as well.
PPM 1 - 👍
03-03-2025
PA - Breakfast with vegetable chila with rava, egg and some nuts.
Lunch
PPM 1: 👍
04-03-2025
[04-03-2025 06:08] PA: The patient woke up at 6 am.
[04-03-2025 08:33] PPM 1: Morning asynchronous PaJR session: Diabetes reversal and individual
patient inquiry answered by AI
Summary:
PaJR patient on regular follow up for diabetes reversal is intrigued by a social media reel of a celebrity general physician of Kolkata and asks the PaJR physician about it for an explanation for reason why the celebrity physician is asking protein to be consumed first before carbohydrates. The PaJR physician is unable to answer because even he would need to look into the scientific data behind the statements and in the meantime the patient asks an AI LLM!
Patient's PaJR case report: https://pajrcasereporter.blogspot.com/2024/12/44f-diabetes-nud-ccf-wb-pajr.html?m=1
Conversational Transcripts:
[03/03, 16:49] Patient Advocate Diabetes 44F WB: Sir kdin age reels dekchilam amra j khabar age khai
seta naki age poripak hoy ,tai jonno 1st protein,then fat or sabji ekdom ses e carb diye olpo veggies
khaoa bhalo ..er mane thik bujhte parlamna kno?jodi sombhob hoy tahole ektu bolben er reason ta ki?
[03/03, 16:54] pm: Reel a link ta share korben
[03/03, 16:55] Patient Advocate Diabetes 44F WB: Ei re .dekhchi jodi pai pathachi
[03/03, 17:17] Patient Advocate Diabetes 44F WB: https://www.facebook.com/share/v/1BhD9vo4aJ/
[03/03, 20:06]pm: Khub bhalo bolechen
👏👏
[03/03, 20:06] Patient Advocate Diabetes 44F WB: Kintu karon ta bujhte parini r tahole ki eibhabei khabo?
[03/03, 23:17] Patient Advocate Diabetes 44F WB:
[03/03, 23:19] Patient Advocate Diabetes 44F WB: Yes, sir .I have received this answer from chatgpt..
ChatGPT
This is a copy of a conversation between ChatGPT & Anonymous.
You said:
What is the actual reason of eating protein 1st then have to eat others...
ChatGPT said:
The idea of eating protein first before other foods is based on how it affects digestion, metabolism, and blood sugar levels. Here are the key reasons:
Better Blood Sugar Control – Protein slows down the digestion and absorption of carbohydrates, preventing sudden spikes and crashes in blood sugar levels. This helps in maintaining steady energy levels.
Increased Satiety (Fullness) – Protein keeps you fuller for longer by reducing hunger hormones like ghrelin and increasing satiety hormones like peptide YY. This helps in controlling overall food intake.
Improved Digestion and Nutrient Absorption – When protein is eaten first, it activates digestive enzymes and stomach acids, which help in breaking down food more effectively.
Muscle Maintenance and Growth – Eating protein early in the meal ensures that the body gets enough essential amino acids to repair and build muscles, especially for those who are physically active.
Weight Management – Since protein helps control appetite and reduces cravings, eating it first may lead to consuming fewer calories overall.
So, starting your meal with protein (like dal, tofu, paneer, or beans in a vegetarian diet) before moving to carbs and fats can have multiple health benefits.
You said:
Pl translate in Bengali
ChatGPT said:
প্রথমে প্রোটিন খাওয়ার পিছনে মূল কারণগুলি হল:
রক্তে শর্করার নিয়ন্ত্রণ উন্নত হয় – প্রোটিন ধীরে হজম হয় এবং কার্বোহাইড্রেটের শোষণকে কমিয়ে দেয়, ফলে রক্তে শর্করার মাত্রা হঠাৎ বেড়ে যাওয়া বা কমে যাওয়া থেকে রক্ষা করে। এটি শক্তি স্থিতিশীল রাখতে সাহায্য করে।
তৃপ্তি বেশি থাকে – প্রোটিন ক্ষুধার হরমোন (ঘ্রেলিন) কমিয়ে দেয় এবং পেট ভরানোর হরমোন (পেপটাইড ওয়াইওয়াই) বাড়ায়, যার ফলে দীর্ঘ সময় ক্ষুধা লাগে না।
হজম ও পুষ্টি শোষণ ভালো হয় – প্রথমে প্রোটিন খেলে হজমকারী এনজাইম ও পাকস্থলীর অ্যাসিড সক্রিয় হয়, যা খাবার ভাঙতে সাহায্য করে।
পেশি গঠনে সহায়তা করে – শরীরের পেশি গঠনের জন্য প্রয়োজনীয় অ্যামিনো অ্যাসিড প্রোটিন থেকে পাওয়া যায়, তাই প্রথমে প্রোটিন খেলে পেশির যত্ন ভালোভাবে হয়।
ওজন নিয়ন্ত্রণে সাহায্য করে – প্রোটিন বেশি সময় পর্যন্ত পেট ভরা রাখে এবং অতিরিক্ত ক্যালোরি গ্রহণ কমাতে সাহায্য করে, ফলে ওজন নিয়ন্ত্রণ করা সহজ হয়।
তাই খাবারের শুরুতে প্রোটিন (যেমন ডাল, সোয়া, পনির বা বিন্স) খেলে তা স্বাস্থ্যের জন্য উপকারী হতে পারে।
[04-03-2025 08:54] PA: The patient took 5.5 km walk this morning
[04-03-2025 09:57] PA: For breakfast apple, cucmber, boiled vegetables and one boiled egg.
PA - Lunch with rice and vegetable curries.
Dinner rice with veg curries and having 2 amitti as desert.
PPM 1 - 😮
05-03-2025
PA - Breakfast at 10 am 👆
The patient woke up at 6 am however did not go for morning walk as she was not feeling well. She will
go for an evening walk.
PPM 1 - 👍
[05-03-2025 14:05] PA: Lunch... Oats chila with chuttney salad and daal
[05-03-2025 14:17] PPM 1: 👍
[05-03-2025 18:19] PA: The patient took 3.5 km walk in the evening.
Oats chila, burnt brinjal, coconut chutney and daal for dinner
PPM 1 - 👍
[05-03-2025 21:23] PA: The patient took more 2.5 km walk post dinner.
However, she also took 2 amittis at night 🥺
And she is guilty for that.
[05-03-2025 21:38] PPM 1: 😮Was it lying at home? Who bought it?
[05-03-2025 21:41] PA: No ... Outside... A fair is going on and he offered...
PPM 1 - In such situations ask for healthy food 👇
[06-03-2025 08:36] PA: The patient woke up today at 8 am. Post which, she went to her roof for
watering her plants. After daily chores she will have her breakfast.
[06-03-2025 10:03] PA: Besan chila, omelette, coconut chutney, daal and fruits for breakfast.
[06-03-2025 13.46] PA - Lunch with rice and fish curry
[06-03-2025 17.36] PA - Had a bowl of sour curd as evening snack
[06-03-2025 21.03] PA: Dinner
[06-03-2025 09.55] PPM 1: 👍
[07-03-2025 05:36] PA: The patient woke up at 5.30 am this morning
[07-03-2025 07:26] PA: The patient walked 4.36 km in the morning.
[07-03-2025 07.54] PPM 1: 👍
[07-03-2025 07:54] PPM 1: 👆 hopefully the walk compensated for the above rice!
[07-03-2025 07:54] PA: 😬
[07-03-2025 09.45] PA: Breakfast oats dosa with dal
[07-03-2025 09.50] PPM 1: 👍
[07-03-2025 19.43] PA: Qnd fish curry.
[08-03-2025 10.09] PA: The patient left bed at 7.30 am and had breakfast with dosa, paneer and
pomegranate seeds.
[08-03-2025 11.57] PPM 1: 👍
[09-03-2025 09.52] PA: Breakfast mixed salad.
[09-03-2025 20.43] PA: Dinner with vegetables.
PPM 1 - 👍
[09-03-2025 20:58] PA: As the patient had a guest at home she forgot to update about the Lunch.
[10-03-2025 07:47] PA: The patient woke up at 7.30 am.
[10-03-2025 09.54] PA: And with 2 eggs the patient is having her Breakfast.
PPM 1 - 👍
[10-03-2025 13.56] PA: Lunch
[10-03-2025 14:02] CR: @PA can you please name the items when you share the patient 's food plates?
[10-03-2025 14:29] PPM 1: 👍, 👆This could be a goby fried with besan but will wait for @PA to
clarify
[10-03-2025 14:32] PA: Yes, the patient took fried cauliflower and salad and rice
Along with some spinach which is not shown in the plate.
[11-03-2025 07.49] PA: The patient woke up at 6 am
And she took 4 km walk in the morning
PPM 1 - 👍
[11-03-2025 13.46] PA: Lunch . shukto, methi saag, salad, matar paneer,
[15-03-2025 09:18] PA: The patient was out of station for 2 days because of which she could not update
her daily things..
Today she woke up at 7 am post which she is doing her daily chores.
[15-03-2025 09:20] PPM 1: Out of station updates are also welcome
[15-03-2025 10.01] PA: 1 Roti, Chickpeas, 1 boiled egg and Salad for breakfast
[17-03-2025 08.37] PA: The patient woke up at 7 am.
[17-03-2025 09:59] PA: Ragi roti with salad and fruits breakfast.
[17-03-2025 10:10] PPM 1: 👍
[17-03-2025 13:49] PA: Concern:
One of the several corns in her left foot is itching (severely) since a few days and no clue regarding how
to reduce this sensation of itching in the surrounding area of one of her corns.
[17-03-2025 16:28] PPM 1: Share an image of that area
[17-03-2025 16:41] PPM 1: Is her footwear new?
How long does she wear it?
[17-03-2025 16:41] PA: She is wearing it since 2 months
[17-03-2025 16:42] PA: As a change of footwear was recommended
[17-03-2025 16:42] PA: And this itching issue has rose since past 4 to 5 days
[17-03-2025 16:50] PPM1: How long every day?
[17-03-2025 16:51] PPM 1: Well we wish the heel thickness was greater
[17-03-2025 16:51] PPM 1: In the last 5 days has the usage of footwear increased?
[17-03-2025 16:52] PA: 2 hrs to 3 hrs when going out
At home also the patient is using rubbery shoes as walking bare foot is difficult at home
[17-03-2025 16:52] PA: No
[17-03-2025 16:53] PPM1: Are the rubber shoes new?
[17-03-2025 16:53] PA: No
[17-03-2025 16:53] PA: They are being used since long
[17-03-2025 16:55] PPM 1: There could be an underlying inflammation causing it but she
could try tablet avil 25 mg 1/2 thrice daily to reduce the itching
[17-03-2025 17:00] PA: Ok
[17-03-2025 22.34] PA: Poha as dinner... Today the patient is late to have her dinner ... In the evening
she had one spinach & corn sandwitch with coffee with one sachet of sugar
[18-03-2025 07:29] PPM 1: One sachet of sugar!
[18-03-2025 10.11] PA: Fruits for breakfast.
[18-03-2025 10:18] PPM 1: This breakfast can be captioned as:
"Prayoschitto for yesterday's sandwich, sugar, sachet!"
[18-03-2025 13.11] PA: After 1 and half hour of kitchen time having a glass of vegetable soup.
[18-03-2025 14.38] PA: Lunch with roti, dal, aloo sabji, vegetable salad and one egg.
[19-03-2025 14.35] PA: For lunch the patient had rice mixed daal salad and vegetables
PPM 1 - 👍
[20-03-2025 10.15] PA: The patient woke up at 7 am... For breakfast she is having 2 homemade idlys
coconut chutney & watermelon
[21-03-2025 10.20] PA: The patient woke up today at 7 am.
She could not take picture of her breakfast today due to unavailability of internet. She took a glass of
fruit smoothie as breakfast in the morning.
[21-03-2025 13.20] PA: Homemade dosa with peanuts chutney having for lunch.
[21-03-2025 16.15] PPM 1: 👍
[21-03-2025 23:06] PA 2: The patient's diet is deficient in protein and healthy fat, which
likely contributes to her sugar cravings.
- opinion of a patient who was previously overweight and is now maintaining her weight.
@PPM 1 Sir please correct if wrong.
[22-03-2025 06:27] PPM 1: Yes. Would you also like to share all her images available in her case report
in the description with a multi modal AI LLM and check out what it is opines on the protein and fat
content of her diet similar to how this patient of ours👇
used August AI helped by @SE to ascertain his dietary protein and fat.
Also was just now reviewing these other interesting studies here: one of them, from AIIMS Delhi,
which evaluated the circulating levels of omega-6/omega-3 ratio and affected cardiovascular risk
markers in India.
Prior to this in another study "Percent subjects having intakes above the desirable level were 72% in
Kolkata, 36% in Ghaziabad, U.P. and only 10% in Goa."
[22-03-2025 09:53] PA: Okay
The patient will do that
[22-03-2025 09:55] PA: However, for breakfast she took one cup of black coffee without any sugar,
some roasted soya nuts and a few pieces of watermelon.
PPM 1 - 👍
[22-03-2025 13:02] PA: Prior to the lunch the patient had one boiled egg with a cup of vegetable soup
[22-03-2025 13:02] PA: At 12
[23-03-2025 12.42] PA: The patient woke up at 7 am today and could not update due to some issues.
As breakfast at 10 am she had some jowar puffs along with some roasted soya nuts and watermelon
with basil seeds water and gond katira
[23-03-2025 14.14] PA: Lunch Baingan barta and vegetables with ragi roti.
[23-03-2025 17.50] PPM 1: 👍
[24-03-2025 10.04] PA: Beetroot soup with soya nuts for breakfast.
[22-04-2025 10:10] PA: Past one month, the family of the patient was out of town and had an irregular life. Since yesterday, she is back to her home. As she is having cough and cold, so in the morning she is having a cup of Kadha as morning drink.
[22-04-2025 10:11] PPM 1 We are interested in the irregularities and eliminating that information would skew our interpretations
[22-04-2025 10:12] PA: Shall Keep in mind
[22-04-2025 12:34] PA: For breakfast she had 1 aloo paratha with some roasted makhana
[22-04-2025 13:41] PA: For lunch she had millet khichdi with 2 papad and garlic achar And one egg poach
[22-04-2025 16:59] PPM 1: 👍
[22-04-2025 19:52] PA: In the evening the patient went for marketing... There as evening snack she had a bowl of steamed corn with some veggies and minimal spices
[22-04-2025 22:00] PA: As dinner
The patient had the same menu which she had for her lunch.
[22-04-2025 22:00] PA: At 8.30 pm
[23-04-2025 09.15] PA: The patient woke up at 7 am. For breakfast she js having a bowl of salad with jowar puffs and soya nutts...
[23-04-2025 09:18] PA: And a cup of Kadha with methi jeera and saunf boiled water with haldi
[23-04-2025 14:00] PA: At 12.30 pm the patient had a cup of lassi with salt. Along with this the patient is having a bowl of chicken stew with veggies.
[23-04-2025 17.23] PA: Some papaya as evening snack
[23-04-2025 19:34] PA: Dinner at 7 pm
Millet Khichuri, Oats-Ragi Chila, Chicken Stew with quash and carrot, cucumber and raw onion
[24-04-2025 10:47] PA: The patient woke up at 9 am and had breakfast
[24-04-2025 10:48] PA: Breakfast oats-ragi chila, scrambled eggs, Salad (tomato, cucumber, onion with yogurt) with a cup of whey water.
[24-04-2025 13:12] PPM 1: 👍
[24-04-2025 13:48] PA2: আপনার রোগীর বিগত দিনের শর্দি-কাশি এবং তজ্জনিত ইনহেলার ব্যবহারের কোন বিবরণ ? নাকের ফোড়া? কি অবস্থা ??
[24-04-2025 13.54] PA: Dessert The patient is having a pastry
[24-04-2025 16:59] PPM 1: Once a year?
[24-04-2025 19.46] PA: Dinner ragi roti, omlette and curry
[25-04-2025 09.44] PA: The patient is having luke warm water along with some roasted chana and soya nuts.
[25-04-2025 10.01] PA: The patient has happened to carry this blister kind of thing on the tip of her nose and carrying this since almost 2 months. Initially, she thought that it is a simple blister and will go away along with time, however, it has made its way permanent on the nose.
[25-04-2025 10:01] PA: And seeking help regarding how to get rid of it...
[25-04-2025 10:03] PPM 1: Share a better macro picture. This one is blurred
[25-04-2025 13:22] PA: The patient forgot to take picture of her lunch palate... She had some pieces of ripped papaya, rice roasted neem leaves with sauted brinjal, raita, salad and one boiled egg.
[25-04-2025 16:53] PPM 1: 👍
[25-04-2025 16:55] PA: Because of feeling hungry the patient popped some popcorn and having it
[25-04-2025 18:06] PPM 1: 👍
[26-04-2025 12.16] PA: Shakshuka with cucumber for lunch
[26-04-2025 12.30] PPM 1: 👏
[26-04-2025 15:44] PA: The patient had one bowl of ripped papaya.
[26-04-2025 18.56] PA: Dinner
[26-04-2025 20.58] PA: The patient was craving for something salty So shallow fried one potato
[27-04-2025 09.52] PA: Black coffee without sugar and roasted makhana and jowar puffs
[27-04-2025 11:49] PPM 1: @PPM2 @Meta AI any pointers toward psychoendo neuroimmune internal medicine mechanisms of salt and sugar cravings and no craving for the best bitters!
[27-04-2025 11:49] Meta AI: Research suggests that cravings for salt and sugar are influenced by complex interactions between neuroendocrine and immune systems. Here are some key mechanisms:
- Salt cravings:
1. Aldosterone and vasopressin regulation: These hormones play a crucial role in maintaining electrolyte balance and fluid homeostasis. Imbalances can trigger salt cravings.
2. Dopamine release: Consuming salt activates dopamine release in the brain, which can lead to cravings.
3. Stress response: Stress triggers the release of cortisol, which can increase salt cravings.
- Sugar cravings:
1. Insulin and leptin signaling: Imbalances in insulin and leptin signaling can lead to increased sugar cravings.
2. Dopamine release: Like salt, sugar consumption activates dopamine release, contributing to cravings.
3. Gut microbiome: An imbalance in gut microbiota can influence sugar cravings.
- Bitter taste perception:
1. Genetic variations: Some people are more sensitive to bitter tastes due to genetic variations in bitter taste receptors.
2. TAS2R38 gene: This gene is associated with bitter taste perception, and variations can affect preferences for bitter foods.
The lack of craving for bitter tastes might be related to individual differences in taste perception or genetic predispositions.
Some key references for further exploration:
- "The Role of Dopamine in Reward and Motivation" (Kringelbach, 2009)
- "The Neurobiology of Salt Appetite" (Geerling & Loewy, 2008)
- "Sugar Addiction: The Role of Dopamine" (Avena, 2010)
Would you like more information on these topics or specific references?
[27-04-2025 12:00] PA: The patient eats bitter foods as well... However, not aware of these terms.... So what does it indicate?
[27-04-2025 12:01] PA: The patient likes bitter gourd, neem leaves etc. As well
[27-04-2025 12:51] PPM 1: It was a general query about humans. No one has heard about craving for bitter, why?
[27-04-2025 13:39] PPM 1: Will the neem bitter instigate more sugar cravings? Remains to be seen
[27-04-2025 17:01] PPM 2: The current rave is in 'hedonic hunger' patterns. Need a thorough daily activity log and when and what the patient watches on TV and at what times (among others)
[27-04-2025 18:34] PA: For dinner Rice, brinjal barta, mixed veg and one boiled egg
[27-04-2025 20:01] PA2: এই cravings শব্দটার অর্থ বা ভাবার্থ জানা নেই, কিন্তু, আমাদের খাদ্যসংস্কৃতিতে তিতা (bitter) এবং টক বা অম্ল (sour) অঙ্গাঙ্গিভাবে সংযুক্ত। বিশেষত গ্ৰীষ্ম কালে নানারকম তিৎকুটে উপাদান দৈনন্দিন খাদ্যাভ্যাসের অন্তর্ভুক্ত। নানা জিনিশ দিয়ে নানারকম পদের অবস্থান এতদঞ্চলের রন্ধন প্রক্রিয়ায় পরম্পরাগত! ফলতঃ এতদঞ্চলের জল হাওয়ায় বেড়ে ওঠা মানুষের প্রায়শই তিতা খাওয়ার ইচ্ছা (জানিনা সেটাই cravings কি না) হয় ! অনেকসময়ই "পাগলের মতই" ইচ্ছেটা হয়।
কিন্তু এই তিৎকুটে ইচ্ছেটা, মিষ্টি বা লবনাক্তর মতো, একক ভাবে পরিপূরণ করা সম্ভব হয়না! সাধারণভাবে দিনের বেলার প্রধান খাদ্যের অনুসঙ্গী হিসাবে এক বা একাধিক পদ হিসেবে পরিবেশিত হয়ে থাকে।
বাৎসরিক কিছু বিশেষ বিশেষ দিনে এতদঞ্চলে তিতা খাওয়াটা পরম্পরাগত "প্রথা" হিসাবে প্রায় বাধ্যতামূলক।
এইরকম বিশেষ দিনগুলোতে বাজারে যে শুধু প্রচুর পরিমাণে আমদানিকৃত হয় তাই নয়, সেগুলো অন্যান্য দিনের তুলনায় চড়াদামে বিক্রিও হয়।
[28-04-2025 11:39] PA: The patient woke up at 8 am because of disrupted sleep at night... She took her breakfast at 11 am with some chicken fries, rava chilla (made with curd and rava)
[28-04-2025 13:14] PPM 1: 👏👏@PA2
[28-04-2025 15.20] PA: Lunch... Millet, and veggies
[28-04-2025 19.50] PA: This is the photo as was requested by you Sir
[28-04-2025 20.14] PPM 1: Looks like a Chondroid syringoma, a rare cutaneous or subcutaneous tumor that presents as a painless, slow-growing lesion. A biopsy would be diagnostic.
[28-04-2025 21:20] PA: Biopsy ?
[28-04-2025 21:21] PA: How to proceed for that ?
[28-04-2025 21:21] PA: The patient would be needing a prescription for that as well
[28-04-2025 21:26] PA: It would be helpful if you kindly provide a prescription for the patient
[28-04-2025 21:28] PPM 1: The patient needs to meet a local Dermatologist who will himself/herself do the biopsy
[28-04-2025 21:28] PA: Okay
[28-04-2025 21:28] PA: Thank you
[29-04-2025 17:05] PA: The patient had veg (corn & onion) grilled sandwich and a cup of masala tea at 2 PM
[29-04-2025 17:05] PA: The patient is having chia pudding (no added sugar) with coconut and papaya and black coffee (without sugar)
[29-04-2025 19.53] PA: Dinner... Khichdi with loads of veggies and sauted veggies with lal saag
The patient is having a meetha paan after dinner.
[29-04-2025 20.29] PA: Today the patient went to the Dermatologist as was suggested by you... Then the following remarks were made...
[29-04-2025 20:34] PPM 1: So he has asked to show another surgeon to excise it?
[29-04-2025 20:35] PA: After discussing the family history of the patient she referred her to an Onco-Surgeon for excision. Dinner at 20.45
PPM 1: 👍
[30-04-2025 10.22] PA: The patient woke up at 9:00 AM Breakfast Roasted Makhana and Jowar puffs with salad (cucumber, raw onion, beet root)
[30-04-2025 13.44] PA: Lunch Khichdi with peanuts-carrot-cabbage, laal saag, pointed gourd with paneer.
[30-04-2025 13:57] PA: Had a piece of paan with saunf, coconut, coco powder and gulkand
[30-04-2025 17:12] PPM 1: Hopefully not sweet
[30-04-2025 21.02] PA: Now the patient is having dinner. Rice and moong dal khichdi with carrots and cabbage. Parwal-quash gravy, laal shaak and egg bhurji.
PPM 1: 👍
[01-05-2025 14.02] PA: Chia pudding with dry fruits and papaya and egg ragi upma taken for breakfast at 10.30 am. 2 sandwiches and chicken stew taken as Lunch at 2 pm.
[01-05-2025 14:03] PA: Feeling of the sandwich hung curd, cucumber & onion were taken
[01-05-2025 14:10] PA: Post lunch had half home made meetha pan
[01-05-2025 16:39] PPM 1: Hopefully without the meetha?
[01-05-2025 16:45] PA: Yes
[04-05-2025 10.24] PA: The patient woke up at 8 am... Having breakfast at 10.23 am... Homemade idly with peanut and gram daal chuttney.
[04-05-2025 10:24] PA: Idly is made with moong daal, urad daal and some joha rice (atop chal)
[04-05-2025 20:56] PA: The patient took a small walk of 3KM.
[04-05-2025 20:57] PA: Millets with vegetables Dinner finished at 8.28 pm
[04-05-2025 21:11] PPM 1: 👍
[05-05-2025 07.35] PA: The patient woke up at 7.15 in the morning
[05-05-2025 20.07] PA: Lunch at 1:00 PM 2 roti, dhokar dalna with parwal, chicken stew with carrot and potato, cucumber and raw onion salad with curd. The patient took 4 km walk in the evening.
[05-05-2025 20.10] PA: Dinner at 7:30 PM. The patient had some idli chaat made with urad dal - moong dal, with beet root, curd, pomegranate, roasted peanuts, grapes and some bhujia.
Also home made watermelon drink made with watermelon, lime, pudina with some salt.
[05-05-2025 21.48] PPM 1: 👍
[06-05-2025 13.43] PA: Lunch ... Vegetables with khichdi
[07-05-2025 09.17] PA: The patient woke up at 6.30 am... Post daily chores she had some roasted makhana and cashews as break fast...
[09-05-2025 20:12] PA: Today the patient went for this check up to an Onco Surgeon... Where she was suggested excision of the growth that took on the nose tip and directed her for certain tests.
[09-05-2025 20:19] PA: And then the game started...
For the tests he suggested her a specific diagnostic centre... When she went there, found out it was the place owned by him...
There the attendant told her the total cost of the procedure which was exceeding 20k rupees. When she argued about the high price and said she will take the test somewhere else, then the attendant said that the Doctor does not accept the reports of somewhere else.
Hearing this she realized the trap and got out of there.
[09-05-2025 20:21] PA: Eventually found out another place, who is a general surgeon and went for the check up the doctor had prescribed the tests and fixed the date of the OT for tomorrow. In the following prescription is attached.
[09-05-2025 20:24] PA: The reason behind writing this whole this is that ...
1. For this consultation the patient had to travel 45 to 5p kms.
2. Which took the whole day of the patient
3. These business centric giants are handling the patients in such a way as if "we the people" are just a commodity for them.
[09-05-2025 20:26] PA: Its certainly an appalling situation and the medical fraternity along with the people beed to bring changes within this... Otherwise doomsday is near...
[09-05-2025 20:43] PPM 1: He hasn't mentioned if he's going to send it for biopsy!
Please ensure that the biopsy is done.
[09-05-2025 21:00] PPM 2: Why does the patient think it's a trap? Why does she not think that the machinery used for tests there are vetted and trusted by the doctor?
[09-05-2025 21:05] PPM 2: An example - HbA1c test from where @PPM1 Sir practices is low quality and never aligns with the clinical picture of the patient.
Although me and him have raised it with management, it has fallen on deaf ears (which is a separate issue). But the point is that a doctor develops his or her reputation for good clinical practice because they want to be meticulous? And having specific lab equipment, which is tried and tested is one way of doing reaching it.
Comments welcome.
[09-05-2025 21:06] PA: Yes Sir It will be done
[09-05-2025 21:11] PA: As the patient has seen that it was not a lab... It was a collection centre where he collects the samples and send it to lab which he has tied up...
Now you may ask the patient how does she know ? Tha answer is that by the name of that centre there is no lab in the entire city...
[09-05-2025 21.19] PA: The surgery which will be done at the clinic of the doctor which only costs 15k whereas, the same surgery in a reputed hospital is costing the patient less than half.
Here, in defence, it might be stated in defence on behalf of the doctor that that he runs a small clinic privately hence he is charging this huge amount for a small excision. However, if the same procedure is costing way less in a good hospital with better amenities and service then it is the logical reasoning that he is here to earn the big chunk of profit from the helpless patients (provided irrespective of whatever social status you belong, at the time of health crisis "the general people" are helpless).
[09-05-2025 21:53] PPM 2: Thanks for clarifying, why was he chosen in the first place? And why was the other good hospital not consulted in the first place?
I'm not sure how the patient is helpless here - she has the choice of picking and choosing her doctor, she also has been getting plenty of robust medical inputs from a WhatsApp group with several reasonably experienced doctors.
I'm also unsure why the doctor should not seek profits? The patient for whatever reasons did not go with the first doctor but surely that's not a "trap" he laid out?
[09-05-2025 21:55] PA: This is the exact point ...
You exactly cleared the point of view of the patient that ultimately it is a business. That what the patient was trying to say. Thank you.
[09-05-2025 21:56] PA: And the patient was referred by her first doctor to the second one.
[09-05-2025 21:56] PA: Thats another clarification the patient wanted to add.
[09-05-2025 21:56] PA: Thank you
[09-05-2025 21:56] PA: Have a great night.
[19-05-2025 18.52] PA: This is the biopsy report of the blister kind of thing on the tip of the nose.
[19-05-2025 20.07] PPM 1: Nothing to worry about.
Now that it's been removed one doesn't need to worry about it further.
More about it here: https://dermnetnz.org/topics/pilomatricoma
[19-05-2025 20:48] PA: Sir
The patient read the link provided... However she is unable to understand why this things occur? She will be grateful if explained!
[19-05-2025 21:03] PPM 1: @Meta AI @~PPM3 why does pilomatricoma happen? How did it happen in this patient's nose?
[19-05-2025 21:03] Meta AI: Pilomatricoma, also known as pilomatrixoma or calcifying epithelioma of Malherbe, is a rare, harmless tumor that originates from hair matrix cells in hair follicles. It typically appears as a single, firm, skin-colored or purplish lump, often on the head or neck, and can occur at any age, although it's most common in children and teenagers.
Causes of Pilomatricoma:
- Localized mutation in a hair matrix cell, leading to uncontrolled cell growth
- Mutations in the CTNNB1 gene, which codes for the beta-catenin protein, causing loss of regulation in cell growth and division
- Overactive proto-oncogene BCL-2, suppressing normal cell death processes
- In some cases, external factors like trauma, insect bites, or surgery may trigger pilomatricoma development (about 3.9% of cases)¹ ²
How it Happened in This Patient's Nose:
While there's no specific information about this patient's case, pilomatricomas can occur in various locations, including the head and neck region. Given the tumor's origin from hair matrix cells, it's possible that the pilomatricoma in the patient's nose developed from a mutated hair follicle cell in the nasal area. The exact cause of pilomatricoma in this patient's nose would require a medical professional's evaluation.
Key Facts:
- Demographics: More common in females than males, and slightly more common in whites
- Age: Bimodal distribution, with peaks between 0-20 years and 50-65 years old
- Symptoms: Usually asymptomatic, but may be tender or uncomfortable
- Treatment: Surgical excision is the recommended treatment, and recurrence is rare if completely removed³
[19-05-2025 21:03] Meta AI: https://dermnetnz.org/topics/pilomatricoma
[19-05-2025 21:03] Meta AI: https://healthjade.com/pilomatricoma/
[19-05-2025 21:03] Meta AI: https://healthjade.net/pilomatrixoma/
[19-05-2025 21:43] PPM 3: Theoretically speaking, it can occur in any hair containing skin, including the nasal vestibule, containing these vibrissae hairs.
[19-05-2025 21:46] PPM 3: Pilomatricoma (also known as pilomatrixoma) is a benign skin tumor originating from hair follicle matrix cells. Its occurrence is primarily linked to *genetic mutations* and localized cellular changes. Below is a detailed explanation of its causes and how it might develop in specific locations like the nose:
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### *Why Does Pilomatricoma Happen?*
1. *Genetic Mutations*:
- The majority of pilomatricomas are caused by *somatic mutations* in the *CTNNB1 gene*, which encodes the beta-catenin protein.
- Beta-catenin plays a critical role in the Wnt signaling pathway, regulating cell proliferation and differentiation. Mutations in CTNNB1 lead to *overactivation of beta-catenin*, disrupting normal hair follicle cell regulation and causing uncontrolled growth of matrix cells.
- These mutations are not inherited but occur spontaneously in hair follicle cells during a person’s lifetime.
2. *Association with Genetic Syndromes*:
- Rarely, multiple pilomatricomas are linked to inherited conditions like *myotonic dystrophy, **Gardner syndrome, or **Rubinstein-Taybi syndrome*. In these cases, additional systemic symptoms are usually present.
3. *External Triggers*:
- In about 3.9% of cases, trauma (e.g., insect bites, surgery, or skin injury) may trigger tumor formation. However, this is not the primary cause.
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### *How Did It Occur in the Patient’s Nose?*
1. *Anatomical Origin*:
- Pilomatricomas arise from *hair follicle matrix cells*, which are present in hair-bearing areas. The nose contains small hair follicles (e.g., in the nasal vestibule), making it a potential site for tumor development.
2. *Growth Process*:
- A mutation in the CTNNB1 gene within a nasal hair follicle matrix cell leads to abnormal proliferation. Over time, these cells form a hard, calcified nodule under the skin.
- Calcification is common in pilomatricomas, giving the tumor its characteristic "rock-hard" texture. This may explain the palpable lump in the nose.
3. *Clinical Presentation*:
- Nasal pilomatricomas often present as a *painless, firm nodule* beneath the skin. The overlying skin may appear normal, bluish, or reddish.
- While most nasal cases are asymptomatic, larger tumors might cause discomfort or cosmetic concerns.
4. *Diagnosis*:
- Imaging (e.g., ultrasound or CT scan) may reveal calcifications and help differentiate it from other nasal masses.
- Definitive diagnosis requires a *biopsy* or surgical excision, showing hallmark histologic features like "shadow cells" and basophilic cells.
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### *Key Takeaways*
- *Primary Cause*: Somatic CTNNB1 mutations drive uncontrolled hair matrix cell growth.
- *Nasal Location*: Hair follicles in the nose provide the cellular origin for the tumor.
- *Treatment*: Surgical excision is curative, with low recurrence rates if fully removed.
For this patient, the tumor likely developed spontaneously due to a CTNNB1 mutation in a nasal hair follicle, leading to the characteristic calcified nodule. Genetic testing or evaluation for associated syndromes may be considered if multiple tumors are present.
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