04-02-2025
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.
The 77-year-old female is a homemaker with no previous illness. She is a hard working lady with four married daughters who are settled and leading their own life. The patient lives with her husband who is an 80yr old man suffering with diabetes, hypertension and CKD. They live in a village in Nalgonda District with meagre earnings and cannot afford a quality living. Because of concern for each other their health is being effected. Overall they maintain good health.
PA - The patient is having problem with her right hand fingers and swelling in the fist.
PPM 1 - We need to examine her clinically.
From what I can recall from our meeting her last time we had diagnosed OA due to her metabolic syn and none of the above
We can ask him to also share his wife's two hour post meal sugars if he can check them for a day.
Uric acid appeared slightly high which again suggests metabolic syn and her symptoms are likely OA as a result of that. Unnecessary testing spending their meager resources by the local caregiver they approached? @PPM2.
PPM 1 - @PA She appears to be having edema and we may need to investigate if it's due to heart failure or glomerular injury. Does she complain of shortness of breath?
PA - Her fasting sugar level is 123mg/dl.
The patient had one roti for breakfast.
Post breakfast sugar level is 199mg/dl.
Lunch rice with ladies finger curry.
Post lunch 145mg/dl.
PPM 2 - Will be looking forward to the x-rays of her hands.
PPM 1 - 👍
PPM 2 - Agree that this looks consistent with Inflammatory OA. Can start with topical gels perhaps but I'm sure Methotrexate has shown excellent efficacy in Inflammatory OA as well.
PPM 1 - Any lateral view of her arms and abdomen?
PPM 2 - Known diabetic?
Just confirming as I can see a glucometer.PA - Tomorrow they are coming to the hospital for consultation.
Has developed left knee OA with fixed flexion deformity since her last chikungunya
She is complaining of knee pains and left shoulder pain.
PPM 1 - 👍
PPM 2 - Alright.
PPM 1 - Her diabetes was discovered today with that glucometer.
Maybe I'll take her lateral view with arms and abdomen.
PPM 2 - Ah yes I see the same food plate!!
04-02-2025
PPM 1 - @PA one of the problems to their issue of not being able to grow vegetables they said were monkeys. I was thinking we too have the same monkey menace but we have two dogs to counter them. Can they too adopt 2 stray dogs to guard their vegetable patch?
PA - I suggested to put thorny bushes around.
Will ask about adoption of dogs.
PPM 1 -
PPM 1 - Her overall flare up of pain was recent? On examination appears to be enthesitis and myositis. Could be viral.
07-02-2025
PA - The patient is having severe joint pains since 2 days.
PPM 1 - Yes she appears to be having a viral enthesitis and partly myositis and the virus that is most commonly associated in Telangana that can do this is Chikungunya
How many times is she taking the Ultracet half? We had advised 6 hourly.
PA - She is taking 6 hrly.
PPM 1 - It's a very mild drug and weak pain reliever that works very slowly as the steady state levels of the drug keeps building up but she should have had some relief in two days.
We didn't want her to use stronger NSAIDs due to risk of renal failure but I guess we may not have much choice but to try one of those.
How much paracetamol was she taking? Was she taking that too 6 hourly? Is she still in her daughter's place or reached home?
PA - She is taking half tablet Ultracet and paracetamol 500 6 hrly. But not taking in the midnight. She is still at her daughter's place.
PPM 1- 👍
Is she sleeping well?
PA - Normal.
09-02-2025
PA - They are not getting Ultracet nearby their house. They are still with their daughter. Any alternative medicine can be used?
PPM 1 - Ultracet is a combination of Tramadol and paracetamol and there's a long list of substitute brands for the same pasted below 👇
Ultracet Tablet
by Janssen Pharmaceuticals
₹ 20.4/tablet
Substitute Brands for Ultracet Tablet
Calpol T Tablet
by Glaxo SmithKline Pharmaceuticals Ltd
₹ 7.27/tablet
64% cheaper
Kinedol-EF Effervescent Tablet
by Kinedex Healthcare Pvt Ltd
₹ 11.79/tablet
42% cheaper
Trabest 37.5mg/325mg Tablet
by Lupin Ltd
₹ 13.5/tablet
34% cheaper
Trabest 37.5mg/325mg Tablet
PT 37.5mg/325mg Tablet
by Apex Laboratories Pvt Ltd
₹ 6.51/tablet
68% cheaper
PT 37.5mg/325mg Tablet
Tolydol Tablet
by Ipca Laboratories Ltd
₹ 4.9/tablet
76% cheaper
Tolydol Tablet
Trazodac P 37.5mg/325mg Tablet
by Cadila Pharmaceuticals Ltd
₹ 14.2/tablet
30% cheaper
Trazodac P 37.5mg/325mg Tablet
Dolonat Tablet
by Pfizer Ltd
₹ 6.92/tablet
66% cheaper
Dolonat Tablet
Gudril Tablet
by Intas Pharmaceuticals Ltd
₹ 13.3/tablet
35% cheaper
Gudril Tablet
Ultramol 37.5mg/325mg Tablet
by Aristo Pharmaceuticals Pvt Ltd
₹ 7.07/tablet
65% cheaper
Ultramol 37.5mg/325mg Tablet
Ramcet Tablet
by Sundyota Numandis Probioceuticals Pvt Ltd
₹ 9.6/tablet
53% cheaper
Ramcet Tablet
Ultram Tablet
by Micro Labs Ltd
₹ 13/tablet
36% cheaper
Ultram Tablet
Zyrotram P 37.5mg/325mg Tablet
by Troikaa Pharmaceuticals Ltd
₹ 8.79/tablet
57% cheaper
Zyrotram P 37.5mg/325mg Tablet
Domadol Plus 37.5mg/325mg Tablet
by Torrent Pharmaceuticals Ltd
₹ 13.5/tablet
34% cheaper
Domadol Plus 37.5mg/325mg Tablet
Urgendol P 37.5mg/325mg Tablet
by Win-Medicare Pvt Ltd
₹ 14.8/tablet
27% cheaper
Urgendol P 37.5mg/325mg Tablet
Ultramed Tablet
by Pharmed Ltd
₹ 10.6/tablet
48% cheaper
Ultramed Tablet
Ultra Plus Tablet
by Icon Pharma & Surgicals Pvt Ltd
₹ 11.1/tablet
46% cheaper
Ultra Plus Tablet
Tramadin Plus 37.5mg/325mg Tablet
by Mankind Pharma Ltd
₹ 8.46/tablet
59% cheaper
Tramadin Plus 37.5mg/325mg Tablet
Ultrazac Tablet
by Zydus Cadila
₹ 7.83/tablet
62% cheaper
Ultrazac Tablet
Vorth TM 37.5mg/325mg Tablet
by Integrace Pvt Ltd
₹ 14.5/tablet
29% cheaper
Vorth TM 37.5mg/325mg Tablet
Mega Flexon Tablet
by Aristo Pharmaceuticals Pvt Ltd
₹ 11/tablet
46% cheaper
Mega Flexon Tablet
Trson P 37.5mg/325mg Tablet
by Unison Pharmaceuticals Pvt Ltd
₹ 2.7/tablet
87% cheaper
Trson P 37.5mg/325mg Tablet
Nicodol Plus 37.5mg/325mg Tablet
by Abbott
₹ 6.39/tablet
69% cheaper
Nicodol Plus 37.5mg/325mg Tablet
Trampol Tablet
by Shankus Acme Pharma Pvt Ltd
₹ 4.07/tablet
80% cheaper
Trampol Tablet
Tramasure-Plus RF Tablet
by Mankind Pharma Ltd
₹ 8.45/tablet
59% cheaper
Tramasure-Plus RF Tablet
Fladol P 37.5mg/325mg Tablet
by Lupin Ltd
₹ 6.06/tablet
70% cheaper
Fladol P 37.5mg/325mg Tablet
Safrodol P 37.5mg/325mg Tablet
by Saffron Therapeutics Pvt Ltd
₹ 5.33/tablet
74% cheaper
Safrodol P 37.5mg/325mg Tablet
Bestodol Tablet
by BestoChem Formulations India Ltd
₹ 6.64/tablet
67% cheaper
Bestodol Tablet
Parasafe-T Tablet
by Strassenburg Pharmaceuticals.Ltd
₹ 7.45/tablet
63% cheaper
Parasafe-T Tablet
Dolosafe D Tablet
by Tidal Healthcare Pvt Ltd
₹ 11.1/tablet
46% cheaper
Dolosafe D Tablet
Kamadol P 37.5mg/325mg Tablet
by Karnataka Antibiotics & Pharmaceuticals Ltd
₹ 3.37/tablet
83% cheaper
Kamadol P 37.5mg/325mg Tablet
Tramacad P 37.5mg/325mg Tablet
by Cadila Pharmaceuticals Ltd
₹ 6.56/tablet
68% cheaper
Tramacad P 37.5mg/325mg Tablet
Supergin Fast 37.5mg/325mg Tablet
by Medopharm Wellness Pvt Ltd
₹ 7.54/tablet
63% cheaper
Supergin Fast 37.5mg/325mg Tablet
Tremsol Tablet
by Medsol India Overseas Pvt Ltd
₹ 8.32/tablet
59% cheaper
Tremsol Tablet
Xdol 37.5mg/325mg Tablet
by Maxamus Pharma Pvt Ltd
₹ 8.24/tablet
60% cheaper
Xdol 37.5mg/325mg Tablet
Nexdol P 37.5mg/325mg Tablet
by Zuventus Healthcare Ltd
₹ 4.39/tablet
78% cheaper
Nexdol P 37.5mg/325mg Tablet
Dolosafe 37.5mg/325mg Tablet
by Tidal Laboratories Pvt Ltd
₹ 6.28/tablet
69% cheaper
Dolosafe 37.5mg/325mg Tablet
Tralocet 37.5mg/325mg Tablet
by Tas Med India Pvt Ltd
₹ 3.88/tablet
81% cheaper
Tralocet 37.5mg/325mg Tablet
Stradol P 37.5mg/325mg Tablet
by Lupin Ltd
₹ 5.82/tablet
71% cheaper
Stradol P 37.5mg/325mg Tablet
Tramacet 37.5mg/325mg Tablet
by Psycormedies
₹ 7.27/tablet
64% cheaper
Tramacet 37.5mg/325mg Tablet
Dolinsta P Tablet
by Indoco Remedies Ltd
₹ 5.91/tablet
71% cheaper
Dolinsta P Tablet
Traceta 37.5mg/325mg Tablet
by Wanbury Ltd
₹ 5.53/tablet
73% cheaper
Traceta 37.5mg/325mg Tablet
Tramot Plus 37.5mg/325mg Tablet
by Bennet Pharmaceuticals Limited
₹ 4.46/tablet
78% cheaper
Tramot Plus 37.5mg/325mg Tablet
Tramspin Tablet
by Cerspin Healthcare Pvt Ltd
₹ 5.13/tablet
75% cheaper
Tramspin Tablet
Orthodex-TR Tablet
by Psychotropics India Ltd
₹ 6.4/tablet
69% cheaper
Orthodex-TR Tablet
Paintrol 37.5mg/325mg Tablet
by Mapra Laboratories Pvt Ltd
₹ 4.07/tablet
80% cheaper
Paintrol 37.5mg/325mg Tablet
Anbrol SP 37.5mg/325mg Tablet
by Ramose Laboratories Pvt Ltd
₹ 5.33/tablet
74% cheaper
Anbrol SP 37.5mg/325mg Tablet
Penover 37.5mg/325mg Tablet
by Syncom Formulations India Limited
₹ 4.46/tablet
78% cheaper
Penover 37.5mg/325mg Tablet
Centra P 37.5mg/325mg Tablet
by Bsp Pharmaceuticals
₹ 5.89/tablet
71% cheaper
Centra P 37.5mg/325mg Tablet
Precidol 37.5mg/325mg Tablet
by Precia Pharma
₹ 5.82/tablet
71% cheaper
Precidol 37.5mg/325mg Tablet
Freze 37.5mg/325mg Tablet
by Crescent Therapeutics Ltd
₹ 6.37/tablet
69% cheaper
Freze 37.5mg/325mg Tablet
Delpodol Tablet
by Delcure Life Sciences
₹ 6.25/tablet
69% cheaper
Delpodol Tablet
Tranzat Plus 37.5mg/325mg Tablet
by Wockhardt Ltd
₹ 0.97/tablet
17-02-2025
PPM 1 - Who's prescription is this? @PA
PA - They visited some local doctor for her pains.
PPM 1 - Yes I meant who was the local doctor?
PA - He is from your hospital
PPM 1 - Not sure if I know him.
PA - That's what he told me.
Can they use the above medicine @PPM1 sir.
19-02-2025
PA - After taking the medication prescribed by local doctor, the patient had much relief from edema and joint pains.
PPM 1 - The relief is because of the aceclofenac but needs to be stopped now else it will damage her kidney similar to how her husband's kidneys have been damaged.
This also may have given relief and can be stopped now. The medicines may not have been useful.
👆just noticed a texting error. I meant the 'other' medicines may not have been useful except for the two pointed out in the above texts.
[14-04-2025 11:00] CR: This patient is now fine and continuing ultracet. She says her pains are normal when she is stopping ultracet. She is also continuing prednisolone tab. They need your advise.
[14-04-2025 19:00] PPM 1: We are not supposed to take the Ultracet tablet for more than 1-2 days! It's scary to think that she's continuing it! Also prednisolone! What dose? How long now!
[14-04-2025 19:02] PPM 1 : Aceclofenac👆this is the only drug that may have worked for her symptomatic relief and the rest were all unnecessary including most of the irrational tests! We tried to save their money and they went and blew it on another doctor largely because we were unable to communicate the issues and educate them
[14-04-2025 19:03] PPM 1: We had avoided giving this in view of it's side effects
[14-04-2025 19:04] PPM 1: They didn't follow our advice to stop Prednisolone?
[14-04-2025 19:12] CR: Told him several times doctor, he was saying his wife was in much pain and couldn't avoid Ultracet. I will talk to him now.
[14-04-2025 19:26] CR: Informed him to stop Ultracet and Prednisolone.
[14-04-2025 19:35] PPM 1: He was supposed to let us know here everyday about his patient's pain
[14-04-2025 19:42] CR: Communication problem
[14-04-2025 20:07] PPM 1: He is communicating daily about his other 82M patient
[01-05-2025 15:52] PPM 1: Reviewed today in ICU
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