74F UTI Metabolic Syn Stroke, Acute Scald Recent WB PaJR

 

03-02-2025

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.

[03-02-2025 09:02] PPM 1: [03/02, 08:48] Patient Advocate Diabetes 44F WB: Sir ekta kotha ,apnake bolechilam amr patient aer bes onk bochor dhorei urine infection hoche , antibiotic khay kichudin thik thake but abr hoy .r vison bad smell ...

[03/02, 08:49] Patient Advocate Diabetes 44F WB: Pressure r nerve r medicine nen .age 74 years.Apni ektu unar byapare bhabben?tahole ja bolben sei sob prescription apnake pathate pari ba jodi kono test korte bolen

[03/02, 08:53] Patient Advocate Diabetes 44F WB: Ekhon mone hoche abr o kono infection hoyeche ..

[03/02, 08:56] Patient Advocate Diabetes 44F WB: Pl bolben uni ei matro bathroom guzar jol gorom hoyeche  kina dekhte giye hate futonto jol pore jole jache...?

[03/02, 08:57] Patient Advocate Diabetes 44F WB: Paste lagieche ,ki korbo ice dichi?

[03-02-2025 09:04] PPM 1: [03/02, 08:57] pm: Prescription noi... detailed history ebong clinical examination dorkar

[03/02, 08:57] Patient Advocate Diabetes 44F WB: Acha ..pathabo .

[03/02, 08:58] pm: Unar PaJR group toiri kore dicchi

[03/02, 08:58] Patient Advocate Diabetes 44F WB: Clinical examination Mane?

[03/02, 09:00]pm: Daktar er chokh diye patient ke dekha

 [03-02-2025 09:05] PPM 1: @PPM3 amader team member. Uni Chinsurah te thaken. Unar chokh diye dekhte parle bhalo hoto

[03-02-2025 12:40] PPM 3: Ekdom

[03-02-2025 16:06] PPM 1: History:  @CR

At present rastay cholle mone hoy pa balance kom , stepping thik porena.Rater dike 3_4 ber toilet jay,prochur hoy .

[03-02-2025 16:09] PPM 1: @~PA রোগীর অ্যাডভোকেটের জন্য প্রশ্ন;অনুগ্রহ করে আপনার রোগীর ঘটনাগুলির ক্রম বর্ণনা করুন যা বর্তমান সমস্যার দিকে পরিচালিত করেছে। আপনার রোগীর একেবারে কোন সমস্যা না হওয়ার সময় থেকে ঘটনাগুলির ক্রম শুরু করুন। অনুগ্রহ করে আপনার রোগীর 24 ঘন্টা ধরে তার প্রতি ঘন্টার রুটিন বর্ণনা করুন যখন সে পুরোপুরি ঠিক ছিল এর পরে অনুগ্রহ করে বর্ণনা করুন যে একবার রোগটি তার জীবন ধরে নেওয়ার পরে তার প্রতি ঘন্টা 24 ঘন্টার রুটিনে কী ঘটেছিল রোগীর প্রতি ঘণ্টার রুটিনের কোন অংশটি ব্যাহত হয়েছে তা বিশেষভাবে উল্লেখ করুন আমাদের কাছ থেকে রোগীর বর্তমান প্রয়োজনীয়তাগুলি কী যেমন আমরা যদি তাকে একটি ওষুধ দিতে হয় তবে তারা কোন সমস্যাটি সমাধান করতে পছন্দ করবে? অনুগ্রহ করে রোগীর পেট এবং বাহুর পেশীর ক্লিনিকাল ফটো পোস্ট করুন যেমনটি নীচের ছবিতে দেখানো হয়েছে:

https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html?m=0

[03-02-2025 16:16] PPM 1: @CR will you be making this case report?

[03-02-2025 16:27] PA: 2015 sept. ekber stroke hoy.Left side weak hoy jay.Kotha jorie jay,Mri of brain nd CT scan report- grey brain.

[03-02-2025 16:29] PPM 1: Tar aage ekdom bhalo chilen?

[03-02-2025 16:29] PA: Long time bhugechen.

[03-02-2025 16:30] PA: Onk bochor dhorei kichu na kichu hotei thake

[03-02-2025 16:30] PPM 1: Ekdum prothom ta diye shuru kora jaak

[03-02-2025 16:30] PA: 1998 Mastoid bone operation hoy

[03-02-2025 16:31] PA: Kaner porda futo hoye gechilo,then operation hoy but bochor khaneker modhey I abr whole dekha jay

[03-02-2025 16:31] PPM 1: Tar aage ki koshto chilo jar jonye operation korte hoi

[03-02-2025 16:31] PPM 1: Unar tokhon prothom symptoms ki chilo?

[03-02-2025 16:32] PPM 1: 1998 er aage sompoorno shushtho chilen?

[03-02-2025 16:34] PA: That time1998 rate ghumonor somoy hathath i dekhe balis vije geche kan theke jol porche .terpor dr .dekhano hoy porda futo hoye jay .then operation hoy

[03-02-2025 16:35] PA: Ter age 1990 vison bleeding hoy, anemia hoy ,3 months bed ridden chilen Then Typhoid hoy.

[03-02-2025 16:39] PA: 1992 hathath i puja korte bose r darate paren na.duto knee lock hoye jay .then orthopedic, medicine dr.dekhanor por colonoscopy advice koren .colon e ulcer dhora pore.

[03-02-2025 16:39] PA: Long treatment choleche

[03-02-2025 16:40] PA: Er majhe gestric, indigestion hotoi.

[03-02-2025 16:41] PA: 1996 theke sanghatik mental pressure ase family te.

[03-02-2025 16:41] PPM 1: Knee lock theke colonoscopy?

[03-02-2025 16:42] PA: Ha

[03-02-2025 16:42] PA: Gastric issues chilo .

[03-02-2025 16:42] PA: Oh sorry miss kore gechi ..

[03-02-2025 16:42] PPM 1: Colonoscopy generally paikhanai kono problem hole korano hoi

[03-02-2025 16:44] PA: Ekdin hathath dupure electric shock khan just 2 din por thekei stool r sathe raw blood aste thake

[03-02-2025 16:44] PA: Terpor i lower abdomen pain hoy. then dr. colonoscopy advice koren

[03-02-2025 16:45] PA: Ebhabei cholchilo . constant treatment e chilo

[03-02-2025 16:46] PPM 1: 1992?

[03-02-2025 16:46] PPM 1: Bochore ek dur jor ba pet kharap ,ombol esob hoto otherwise serokom kono problem chilona

[03-02-2025 16:46] PPM 1: Ki medicines kheten? Aekhono khaan?

[03-02-2025 16:47] PPM 1: Ekhon pressure r nerve r medicine nen .uric acid high .

[03-02-2025 16:49] PA: Oi somoy antibiotic kheyechilo prochur r injection ,bes choto thakay oto details thik bola chaper

[03-02-2025 16:49] PPM 1: Raw blood er jonye ki oshudh kheten? Koto din khete hoyechilo?

[03-02-2025 16:50] PA: Na 1992 noy ,At the year of 2000

[03-02-2025 16:51] PA: 1992 e knee lock hoye jay ,uris acid vison high thake r gastric hoy.

[03-02-2025 16:52] PA: Otherwise kono problem chilona

[03-02-2025 16:54] PA: Ekdom bolte parbona, injection cholto r antibiotic,antacid kheten

[03-02-2025 16:54] PPM 1: Kotodin cholchilo?

[03-02-2025 16:54] PA: Gastro dr .dekhten seta jani

[03-02-2025 16:55] PA: Pray3 mas medicine kheyechilen pray 1bochor puro sustho hote time legechilo

[03-02-2025 16:58] PA: Ebhabei cholchilo.tuk tak kichu holeo samle jeten.

[03-02-2025 17:02] PA: 2004 train kolkata Jaber somoy bunk theke bhari suitcase pore jay mathar opor ..then porerdin thekei komore pain start hoy.Orthopedic dekhano hoy x-ray report e dekha jay komore nerve chepe geche .pray almost bed ridden hoye poren .soja hoye darate ,hatte parten na .

[03-02-2025 17:03] PA: Oi somoy vitamin injection ,D3 kheyechilen pray 3 months

[03-02-2025 17:04] PA: Terpor theke bhari kaj korte ba matite bosle uthte osubidha hoto

[03-02-2025 17:07] PA: Ebhabe pray 2005 obdhi bes kosto peyechilen

[03-02-2025 17:13] PA: Erpor 2010 hathath i rastay beriechilen , er kta bus aschilo side dite giye pa mochke jay but pore jan ni .pa soja korte perchilen na then ekjon help niye jokhon bari dhukte jan thik tokhon i r ekta pa mochke jay ..r soja darate perena .kono rokom e barir lokerder sahajye ghore ese sue poren .porer din Orthopedic dekhano hoy x_tay dekha jay 2 pa eksathe i goralir kache bhenge geche .ekekta pa plastering hoy r ekta crepe bandage chilo pray 2 weeks

[03-02-2025 17:14] PA: Normal hatachola y aste pray 1 bochor lege jay

[03-02-2025 17:16] PA: Erpor thekei dekha jay ektu jore dhakka lagle ,ba hochot kheleo kokhon o hater angul ,kokhon o ba payer angul ekadhik ber bhenge geche

[03-02-2025 17:16] PA: Ei somoy urine infection hoy ,uric acid high hoy abr o

[03-02-2025 17:17] PA: Vit D3, calcium, tab kheten

[03-02-2025 18:42] PA: Erpor thekei uni ber ber urine infection e bhogen .halka jor ,ga hat e byatha ,kash ,golar voice change hote thake .knee pain ,pa fola esob choltei thakto ..

[03-02-2025 18:45] PA: Abr 2015 sept. Stroke,left side weak hoye jay , vomiting tendency, vertigo,high pressure etc...

[03-02-2025 18:50] PA: Pray 6 months legechilo normal life aste ,but bhagyer porihase 2016 oct. Husband mara jan.vison bhabe imbalance life ..ojotha bhul bhal boka,bhule jaoa ,jed,khaberchure fele deya, etc berte thake ..

[03-02-2025 18:52] PA: 2017 march abr mild stroke with same symptoms.

[03-02-2025 18:52] PA: Erpor theke constant kichu na kichu legei thake

[03-02-2025 18:54] PA: Aste aste hatacholay goti komte thake ,pa fele daralei kanpte thake,hat mutho korte osubidha hoy ,jor payna r vison byatha

[03-02-2025 19:00] PA: 2019 r por sarir aste aste bhange thake .2020 Covid r somoy vison jor full symptoms high fever, tana 7 days for charena,sange kashi,gola  byatha,mathar jontrona,buke sordi,chest infection blood test report Typhoid ase but Covid report    not properly checked ase.

[03-02-2025 19:00] PA: Onkdin bhugte hoyechilo oi somoy.

[03-02-2025 19:06] PA: Then 2021 ,month of July middle hathath ekdin majh rat theke  loose motion start hoy more than 34 times, then hospital e admit kora hoy, saline r kichu antibiotic 2 din cholar por o kono improve na hoyay bond sign kore onno nurshing home admit kora hoy

[03-02-2025 19:07] PA: At a time oi period  e Md medicine,Gastro, Nephrology, neurology nd ent dr dekhen.

[03-02-2025 19:09] PA: Somosto reports oi somoy imbalance chilo . pancreatitis, urine infection, Enlarged liver, etc detect hoy ..total organ imbalance chilo

[03-02-2025 19:13] PA: Discharge r por onkdin catheter chilo,er por ,odbhut bhabe oi somoy continuous medication thaka soteyo urine stop hoye jay pray 4 hours por white ball typer kichu ber hoy urine r sathe

[03-02-2025 19:15] PA: Vison critical condition chilo

[03-02-2025 19:18] PA: Then urologist consult kora hoy ,abr hospital e admit korano hoy 10 days admit thake, high infection of urine, amylase, lipase level was so high. Then hystoscopy kora hoy 

[03-02-2025 19:50] PA: Terpor pray 1 year sustho hoye uthte time lage.kintu sei thekei kichudin por por urine infection hoche.

[03-02-2025 20:02] PPM 1: Last urine culture kabe koriyechen ebong last urine a asubidhe kabe feel korechen?

[03-02-2025 21:54] PA: 4-5months age hoyeche .

[03-02-2025 21:55] PA: Pus cell chilo 10-12.

[03-02-2025 21:55] PA: Ter 1 month age chilo 32-36

[03-02-2025 21:56] PA: Amikacin injection diyechilen tokhon

[03-02-2025 21:58] PPM 1: Urine culture sensitivity ki chilo ebong patient er koshto ki chilo

[03-02-2025 21:58] PA: Urine r osubidha pray 2019 theke bochore 1-2ber hoto ,kintu ekhon last 3-4years yearly pray 3-4mas ontor hoche . antibiotic cholche terpor hoyto 2_3months thik thake ..

[03-02-2025 22:00] PA: Ha sensitivity chilo (.32-36).clear hotona ,lower abdomen nd back pain hoto r sombhob bad smell

[03-02-2025 22:00] PA: Mild temperatures thakto

[03-02-2025 22:01] PPM 1: Urine culture sensitivity test korano hoini tokhon?

[03-02-2025 22:01] PA: Terpor jokhon pus cell 10-12chilo  tokhon kono sensitivity paoa jayni

[03-02-2025 22:02] PA: Ha hoyechilo r sensitivity chilo

[03-02-2025 22:02] PA: Amoxicillin

[03-02-2025 22:04] PA: Ekhon o sei ager moto smell hoche,hat pa kmn kanpche ,r vison payer cheto jala kore ,rater dike 3_4times bathroom jete hoche..

[03-02-2025 22:39] PPM 1: Tahole ekta urine for pus cells ebong urine culture sensitivity kore dekha jete pare kintu antibiotics start nao korte hote pare

[03-02-2025 22:40] PA: Acha

[03-02-2025 22:45] PA: Age tahole routine test kora hobe pus cell koto ache dekhe culture sensitivity test hobe?

[04-02-2025 16:22] PPM 1: Hain

[04-02-2025 16:24] PPM 1: Tahole urine problem bortomane shudhu smell ta? Baki shobi anyo problem? Blood sugar unar fasting ebong proti khawar du ghonta baade last kobe kora hoyechilo?

[04-02-2025 16:37] PA: Proti khaber 2 hours por hoyni konodin.Normal fasting r vat khaber 2 hours por hoyechilo .

[04-02-2025 16:37] PA: 3 months ago

[04-02-2025 16:44] PA: Na, urine pele r dhore rakhte paren na rate bes 4 ber jete hoy , bad smell achei. prochur jol khan r mukh dry hoye jay..pa mainly jala kore r kanpe daralei ...hater finger tips jor nei, gripping e problem.

[04-02-2025 16:44] PA: Saradin tuk tuk kore khide pay bole kichu na kichu kheye jan.

[04-02-2025 16:45] PA: kono blood test proyojon ache ki?uric acid high r constipation ..

[04-02-2025 17:01] PPM 1: Glucometer fasting and two hours after every meal for one day

[04-02-2025 18:43] PA: Ok

[05-02-2025 08:43] PA: Fasting blood sugar 107.

[05-02-2025 08:44] PA: BP 142/67, pulse  87

[05-02-2025 14:05] PA: After 2 hours of lunch sugar 138

[05-02-2025 14:28] PPM 1: Goto kaal shara dine koto liter jol kheyechen ebong koto liter urine beriyechhe.

Eta goto kaal na holeo kalke theke ektu mepe janaben

[05-02-2025 15:02] PA: Acha kal bolbo tahole

[05-02-2025 15:02] PA: Saradin prochur jol khan

[05-02-2025 16:23] PPM 1: Proti ta amount mepe 24 ghontai koto daracche sheta jana dorkar. Koto ta nicchen ebong koto ta beruchhe dutoi alhada bhabe mepe janaben

[05-02-2025 16:23] PA: Ha ,sure kal obossoi

[05-02-2025 16:24] PA: Urinal e measure korte bolbo ..

[05-02-2025 16:48] PPM 1: Ekta 1 liter er marking dewa measuring pot a urine ta dhele measure kora jete pare

[05-02-2025 17:10] PA: After 2hours later of taking breakfast sugar level is 143

[05-02-2025 17:11] PA: Acha

[05-02-2025 22:25] +91 91638 78286: After2 hours of dinner sugar level is 144

[06-02-2025 07:56] PPM 1: Pre diabetic range So not that bad

[06-02-2025 08:22] PA: Urine routine test aj hobe .,

[06-02-2025 08:23] PA: Sugar r jonno kono medicine nen na.just nerve , pressure r high uric acid r medicine khan

[06-02-2025 22:16] PA: The patient intake 2.5 lit water till now  nd urine korechen ekhono porjonto 1.7lit

[06-02-2025 22:17] PA: Hate o paye  vison byatha grip korte perchena na r vison mukh dry hoye jache o hat bes fuleche

[06-02-2025 22:37] PA: Ekhon r ekber toilet holo 400ml

[07-02-2025 09:03] PA: Pa o hat bes fuleche..

[07-02-2025 09:03] PA: Photote bojha jachena

[07-02-2025 09:04] PA: Pa fele darate bes lagche

[07-02-2025 09:05] PA: Kaal Sandher por theke urine r poriman kom hoyeche..

[07-02-2025 09:05] PA: Eta observe kore dekha geche urine clear hole abr pa hat fola kome jay ..long time ei symptoms cholche

[07-02-2025 09:07] PA: Ei somoy Mukh o fule jay r alkasol khele abr clear hoy ..ei ber obossoi r alkasol deya hoyni

[07-02-2025 09:07] PA: Wait for ur opinion

[07-02-2025 09:11] PA: Last few days she takes green peas, moong daal, cabbage, palak, beetroot, carrot, potato, chana, nuts ektu besi porimanei.

[07-02-2025 16:55] PPM 1: It needs to be measured from 8:00AM to 8:00AM. Is 2.5 liters since today 8:00AM?

[07-02-2025 16:56] PPM 1: The food plates need to be shared at those times

[07-02-2025 16:56] PPM 1: Does she have any difficulty in breathing?

[07-02-2025 16:57] PPM 1: 1.7 liters ta kota theke kota obdhi?

Normal 24 hours urine is supposed to be 1-2 liters

[07-02-2025 17:55] PA: Tomorrow I will measure from 8Am to 8Am

[07-02-2025 18:00] PA: Na serokom kichu noy ,tobe ektu kaj korlei gheme jan r hanpie jay

[07-02-2025 18:01] PA: Sokal 7 ta theke rat 8 ta obdhi

[07-02-2025 18:02] PA: Regular ja jokhon khan ter photo pathabo tai to?

[07-02-2025 21:02] PPM 1: Hain

[08-02-2025 09:26] PA: Morning Tea with chocolate biscuit.

[08-02-2025 09:28] Rakesh Biswas Sir: Avoid biscuits! Nuts are healthier

[08-02-2025 09:29] PA: Ha

[08-02-2025 09:30] PPM 1: Check out how this other PaJR patient changed from tea biscuits to healthier nuts 👇

https://pajrcasereporter.blogspot.com/2025/01/33f-with-post-traumatic-headache.html?m=1

[08-02-2025 09:31] PA: This is not black tea ,she has started to take  nutrition drinks since last 3 months

[08-02-2025 09:34] PA: Absolutely right sir ..100 percent right i already nije experience korchi...feeling very light..

[08-02-2025 09:48] PPM 1: Nutrition drinks can be even more dangerous!

Most of them are full of sugar

[08-02-2025 21:56] PA: She took rice with butter, veg sabji..

[08-02-2025 21:56] PA: Sweet dohi

[09-02-2025 08:02] PA: Morning 8 am to 8 am Urine hoyeche [800+450+250+400+500+1700]=Total 4100 ml.

[09-02-2025 08:07] PA: Water intake from 8am to 8am. almost 4.5lit.

[09-02-2025 08:09] PA: Ber ber gola sukie jache ,bes onkta kore jol khete hoche at a time

[09-02-2025 08:32] PA: Morning Tea with puffed rice.

[09-02-2025 08:34] PA: She takes it every day in 3 times

[09-02-2025 10.10] PA: 164/86 PR 74

[09-02-2025 12.04] PA: At 11.30 am.

[09-02-2025 13.17] PPM 1: Has her increased water intakeand urination started after taking this?

Since when?

[09-02-2025 13.21] PPM 1: Need to see the details written on top here.

[09-02-2025 13.22] PPM 1: Had she ever had any fever?

[09-02-2025 13:25] PPM 1: Please share a picture of all the medicines she is currently taking

[09-02-2025 13:25] PPM 1: Does she have any problem during passing urine?

[09-02-2025 13:32] PA: Her current prescription

[09-02-2025 14:23] PPM 1: What is the date of this prescription?

Please share the medicine pictures that the patient has been taking ever since she was experiencing her current priority symptoms of dry mouth and excessive water drinking.

[09-02-2025 14:24] PPM 1: 👆 since when is she taking this?

[09-02-2025 15:13] PA: No, she has no problem during passing urine but can't hold.

[09-02-2025 15:16] PA: From last 3 months she takes this syrup. In the morning  and  evening.

[09-02-2025 15:19] PPM 1: She is drinking too much water! That's the reason it's difficult for her to hold. She needs to reduce her intake from 4 liters to 1-2 liters max

[09-02-2025 15:19] ppm 1: Please ask her to stop taking this

[09-02-2025 15:20] PA: After passing Urine she feels very tired

[09-02-2025 15:21] PA: Ok sir ,i will tell.

[09-02-2025 15:21] PPM 1: Anyone who has to pass 4 liters of urine will feel tired

[09-02-2025 15:22] PA: Yes.

[09-02-2025 15.24] PA: once in a week.

[09-02-2025 15:26] PA: Shen takes loxof when she had urine infection.

[09-02-2025 15:28] PA: 1/2tab at night. Amlodipine

[09-02-2025 15:46] PA: Any advice in this case?

[09-02-2025 15:47] PA: Ebhabe 2_3months difference kno ber ber urine infection hoche?

[09-02-2025 15:48] PA: Ei medicine gulo cholbe na kichu change korben?

[09-02-2025 15:55] PA: 2times daily

[09-02-2025 15:58] PPM 1: When was this last taken? Since when has she started taking it?

How many times did she start taking it and took it for how many days?

[09-02-2025 16:00] PPM 1: She may not be having any urine infection this time

[09-02-2025 16:03] PA: 5-6days ago dr.prescribe this medicine

[09-02-2025 16:05] PA: Tahole ki oner urine infection hoyni? loxof off kore deben?

[09-02-2025 16:05] PA: R baki medicine gulo?

[09-02-2025 18:15] PA: Ekhon koronio ki?kno emn hoche ?

[09-02-2025 22:20] PPM 1: Then it's possible that the urine bacterial count may have subsided because of the loxoff (levofloxacin) taken since then. Her count from whatever is visible in the report shared appears to be insignificant in teams of numbers but then to call a patient UTI it's the clinical findings including symptoms that are equally important in terms of overall evaluation.

From what is being shared here about the patient she appears to be clinically not having an active UTI but her current priority issues are different such as dryness of mouth causing more water intake and urination (4.5 litres), which in turn is causing inability to hold the urine

[10-02-2025 09:02] PA: Morning Tea

[11-02-2025 11:43] PPM 1: Hourly activities?

[11-02-2025 11:49] PA: Very weak almost rest tuktak kaj korchen

[11-02-2025 11:53] PPM 1: Please let us know exactly hourly

[11-02-2025 12:10] PA: But how? pl guide me

[11-02-2025 13.14] PPM 1: Every hour just let us know what the patient is doing. As illustrated here👇

আপনি কি আপনার রোগীর প্রতিদিনের ঘন্টার ক্রিয়াকলাপগুলি নীচের স্লটের মতো করে ভাগ করতে পারেন? 👇 

08.02.2024 আপডেট 

8.30 AM - ঘুম থেকে ওঠার সময় 

8.30-9 AM - ফ্রেশআপ 

9.30 AM - প্রাতঃরাশ (6 ভাদা + চাটনি) + এক কাপ কফি 

10 AM - 1 PM - ক্লায়েন্ট কল 

1.45 PM- দুপুরের খাবার (3 কাপ ভাত + চিকেন কারি প্রায় 300 গ্রাম) 

2.15-5.30 PM - ক্লায়েন্টের কাজ চলতে থাকে 

6 PM - 2 মাফিন + এক কাপ চা

 6. PM- 9PM- সিস্টেমে ক্লায়েন্টের কাজ 

9.30 PM - রাতের খাবার (2 কাপ ভাত + চিকেন কারি প্রায় 200 গ্রাম)

https://userdrivenhealthcare.blogspot.com/2024/02/pajr-telugu-guidelines-for-sharing.html?m=1

[11-02-2025 15:27] PA: Acha..

[11-02-2025 20:03] PA: She had dinner with roti and sabji

[11-02-2025 20:03] PA: She completed dinner at 8 pm

[12-02-2025 00:02] PA: She went to bed at 12 o clock at night

[12-02-2025 08:57] PA: Morning 6.30 ghum bhengeche .

[12-02-2025 09:11] PA: Motamuti pray ghum theke uthte 1 chinter opor time lege jay sokale bichana theke uthte

[12-02-2025 09:11] PA: 8am fresh hoy

[12-02-2025 09:12] PA: 8.30 drinks with chola vaja nen

[12-02-2025 11:56] PA: Patient took her lunch with this plate at 11.30 am

[12-02-2025 14:00] PA: Vat khaber 1ghonta r modhei ghumie poren o pray 20 25 mint deep ghum hoyeche..

[12-02-2025 19:26] PA: Patient took her dinner with 3pic roti nd 1 bowl ghugni

[13-02-2025 11:26] PA: She took lunch at 11.15 am with this plate

[14-02-2025 10:21] PA: She wake up in 7.30am.

[14-02-2025 10:22] PA: After 1 hours later she takes black tea nd chola vaja

[14-02-2025 10:33] PPM 1: 👆 other than sleeping what are her hourly activities?

[14-02-2025 13:08] PA: She took her lunch at 12.30pm with this

[14-02-2025 13:30] PA: 12.30 pm

[15-02-2025 07:58] PA: Morning Tea

[15-02-2025 15:21] PA: She took her tiffin at 3.15pm

[29-03-2025 13:03] PPM 1: @PPM 4 @PPM 5 this patient is the mother of our current patient admitted from WB in special ward. 2021 she had severe strangury and discharged two hard fleshy particles from her urethra and was consequently cystoscoped. The only finding was a large volume bladder and incidentally at the same time she also was found to have pancreatitis with high lipase etc. Can both of you prepare her case report after further collecting the images etc from @~PA

[29-03-2025 13:17] PPM 4: Okay sir!

[29-03-2025 13:18] PPM 5: Yes, sir

[29-03-2025 14:41] PPM 1: 👍

[08-04-2025 06:31] PA: Fasting blood sugar level is 129

[08-04-2025 06:32] PA: 1st time BP  135/65

[08-04-2025 07:13] PPM 1: 👍

[08-04-2025 09:34] PPM 1: @~PPM 6 need your inputs on this patient's ideal footwear to cure her corn! Will share the updates below

[08-04-2025 09:37] PPM 6: P&O nearby?

[08-04-2025 09:37] PPM 6: Which town?

[08-04-2025 09:38] PPM 1: West Bengal, Chuchura

[08-04-2025 09:39] PPM 1: @PPM 4 @~PA need a Bengali volunteer to translate the conversation to English. AI is also welcome

[08-04-2025 09:40] PPM 6: I will understand🙏🏻

[08-04-2025 09:41] PPM 6: Small dig in the insole and put MCR pad

[08-04-2025 09:55] PPM 1: Can you share an image to illustrate?

[08-04-2025 10:04] PA: Chinsurah, West Bengal.         Pin 712101

[08-04-2025 10:13] PA: Ok. Will try.

[08-04-2025 10:14] PA: What is MCR pad nd how to use?

[08-04-2025 10:20] PA: Which type of shoes will be best for her mom's? Her foots r very highly sensitive for stepping. Most of the time she feels something has fallen on the floor like sand. She can't walk steadily. In the year 2012 her both feet were broken and after that's why she feels discomfort.

[08-04-2025 10:23] PA: In the year of 2015 the patient had a stroke after that the balance of leg decreased.

[08-04-2025 10:25] PA: She can't walk with sandles, and never wore thick sole shoes.

[08-04-2025 10:27] PA: Most of the time she walks with bare foot. Now due to corn in her foot she can't walk and feels pain

[08-04-2025 10:28] PA: Pl suggest which type of shoes she can wear?

[08-04-2025 10:30] PPM 3: Pincode looks like mine

[08-04-2025 10.30] PA: Is it right to walk in bare foot inside the house? Most of the time when she walks she feels burning sensation and redness.

[08-04-2025 11:56] PPM 3: That is lost proprioceptive feedback. Physiotherapist will demonstrate PNF exercise for that

[08-04-2025 11:56] PPM 6: Better physiotherapy techniques are required

[08-04-2025 11:56] PPM 6: Chappal/Sandal whatever convenient

[08-04-2025 11:58] PPM 6: Ni. Use slippers- MCR

[08-04-2025 11:59] PPM 6: Didn't find after trial on G

[08-04-2025 12:08] PPM 1: You are their local doctor!

@~PA you can also meet our best student PPM3 who lives nearby and visits his house once a week!

[08-04-2025 12:09] PA: Ok.

[08-04-2025 12:09] PPM 1: Erythromelalgia!

@Meta AI what are the possible causes of erythromelalgia in a 74 year old woman with metabolic syndrome?

[08-04-2025 12:10] Meta AI: Erythromelalgia in a 74-year-old woman with metabolic syndrome could be triggered by several factors. Metabolic syndrome, characterized by abdominal obesity, dyslipidemia, glucose intolerance, and hypertension, increases the risk of developing conditions that may contribute to erythromelalgia.

Possible Causes:

- Medications: Certain medications, such as vasodilators and calcium channel blockers, used to manage hypertension and other cardiovascular conditions, may cause erythromelalgia as a side effect.

- Neuropathy: Diabetic neuropathy, a common complication of diabetes, can cause nerve damage, leading to erythromelalgia symptoms.

- Vascular Issues: Poor blood circulation and vascular problems, more common in people with metabolic syndrome, may contribute to erythromelalgia.

- Hormonal Changes: Hormonal fluctuations during menopause, which often coincide with metabolic syndrome, may also play a role in developing erythromelalgia.

- Underlying Conditions: Certain conditions, such as polycystic ovary syndrome (PCOS), can increase the risk of developing metabolic syndrome and potentially erythromelalgia.¹

What to Do:

To manage erythromelalgia symptoms, consider the following:

-Consult with a healthcare provider to review medications and adjust as needed.

- Practice good blood sugar control and manage diabetes, if applicable.

- Engage in regular exercise and maintain a healthy weight to improve circulation.

- Avoid triggers like heat, stress, and certain foods that may exacerbate symptoms.

It's essential to consult a healthcare professional for personalized guidance and treatment. They can help determine the underlying cause of erythromelalgia and develop a plan to manage symptoms and address related health issues.

[08-04-2025 12:20] PPM 3: I am not the best but I can try to help her

[08-04-2025 12:21] PA: Just few minutes ago,i spoke with Aadipta Ghosh. He told that he will talk to me at night.

[08-04-2025 PA: BP 124/55, PR 101   124/54, PR 104

[08-04-2025 12:54] PA: Yesterday she took BP medicine Amlodipine 5mg in 1/2 tab

[08-04-2025 15:05] PA: After 2 hours of lunch sugar level is 202mg/dl

[08-04-2025 15:08] PA: Same menu +extra quantity of boiled rice nd farmented rice with water

[08-04-2025 15:10] PA: (Fermented rice nd water means_ In Bengali called panta vat)

[08-04-2025 15:11] PA: Forgot the pic of the food plate

[08-04-2025 15:13] PA: She doesn't take any sugar medicine

[08-04-2025 16:10] PA: BP 153/63 PR 122, 3 mints after standing BP is 131/63

[08-04-2025 18:33] PA: 2 hours after tiffin sugar level is 254mg/dl

[08-04-2025 23:45] PA: BP is 147/67 Sugar level is 91mg/dl post dinner

[12-04-2025 09:26] PPM 1: Sharing the meticulous details of the PaJR informed consent process above because @~PA is going to need it when she connects to more and more patients

[12-04-2025 15:01] PA: Patient has chronic UTI problem. She has to go toilet 3-4times at night, mouth dryness and muscle cramp in legs

[12-04-2025 15:08] PA: Every 2_3months alternate she takes antibiotic medicine for urine infection. Now she takes BP medicine and pregabilin 75 at night.

[12-04-2025 15:30] PA: At present she has a severe foot pain due to corn ,most of the times she feels burning sensation under the foot and when she walks on the floor feels that sand r spearding on the floor ..she likes to walk in bare foot.she can't hold any sandle nd can't grip with hand.

[12-04-2025 15:41] PA: Now she has high uric acid, Hba1c more than 7.5, cough and cold

[12-04-2025 15:48] PA: Activities:  Wakes up around 7.am. after gets up she needs to take time for daily work because that time she feels dizziness in hand and leg both,   7.30 am Taking black tea with biscuit/nuts. after that she needs rest for sometime.

[12-04-2025 15:52] PA: 8.30 9am drinks chatur sorbot then she Cleans her bed room. 9.30 am she take bath. after that doing puja meditation .11.30 _complete her lunch

[12-04-2025 15:53] PA: Then she takes rest for 1hour .1pm _ She attend Online Gita class.

[12-04-2025 15:59] PA: 2.30 pm _she makes roti for tiffin ..3.30 pm taking rest or works depends on her energy

[12-04-2025 16:01] PA: 5.30 pm _Goes to temple within walking 5 mints distance. 7 pm  She  returns back her home. then she takes tea or anything ..8.30_9.30 pm   Dinner Time

[12-04-2025 16:13] PA: Most of the time she keeps doing some works or others as long as her health permits.

[12-04-2025 16:40] PPM 1: Do we have any recent urine culture report? Also how much urine volume does she pass each time at night? Is it small volume or normal volume? What is her 24 hour intake of water and 24 hour output of urine. Please share if possible by measuring these on a holiday. 

Also on a given day can you share the last fasting and two hour post meal sugar after breakfast, lunch and dinner?

[12-04-2025 16:50] PPM 1: @Meta AI is there an association between erythromelalgia in this 74 year old woman with recent exacerbation of Diabetes and sensation of sand beneath her feet?

[12-04-2025 16:50] Meta AI: An interesting combination of symptoms. Considering the recent exacerbation of diabetes and erythromelalgia, the sensation of sand beneath her feet could be related to several factors:

- Diabetic neuropathy: High blood sugar levels can damage nerve endings, leading to abnormal sensations like burning, tingling, or feeling like there's sand beneath her feet.

- Peripheral neuropathy: This condition, often associated with diabetes, can cause numbness, tingling, and pain in the feet, which might be described as feeling like sand.

- Dry skin or skin conditions: Certain skin conditions, like eczema or dry skin (xerosis), can cause sensations of roughness or grittiness on the skin, similar to feeling sand beneath her feet.

- Medication side effects: Some medications used to manage diabetes or other related conditions might cause sensations like numbness, tingling, or paresthesia (abnormal sensations like pins and needles).

Given the complexity of her symptoms, it's crucial to consult a healthcare professional for a thorough evaluation. They can assess her diabetes management plan, examine her feet for any signs of skin conditions or neuropathy, and review her medications to determine the best course of action.

[12-04-2025 16:55] PPM 1: Low colony count. What was the date of this test?

[12-04-2025 16:57] PA: Now she intakes 2-3lit water per day.nd out put of urine is 2 lit .

[12-04-2025 16:58] PA: 8th of  Feb

[12-04-2025 16:58] PA: Mostly 8 th of Feb

[12-04-2025 17:00] PPM 2: Incredible history taking 👍🏼

[12-04-2025 17:01] PPM 2: For how many years has the patient been a diabetic?

[12-04-2025 17:03] PPM 2: All her features are consistent with small fiber neuropathy (damage to the small nerves) which are supplying the heart, bladder and bowels and also the nerves in the hands and legs (which is why she feels like walking in sand)

[12-04-2025 17:06] PA: In the year 2023 her fasting nd PP was just crossed the border line, but Hba1c was 6.5 that's why she didn't take any sugar medicine

[12-04-2025 17:07] PPM 2: Okay. Can we go back to 2023? When was she absolutely well in herself and when did she start having any symptoms at all

[12-04-2025 17:08] PA: But 2015 when she had brain stroke after that she feels imbalance when she walks and feels sand beneath her feet

[12-04-2025 17:09] PPM 2: So before 2015, she was fairly well in herself?

[12-04-2025 17:09] PPM 2: What symptoms did the stroke cause in her?

[12-04-2025 17:10] PA: Yes, almost 2015 she was fairly well

[12-04-2025 17:10] PA: Sorry before 2015

[12-04-2025 17:13] PPM 2: Yes got it. And what symptoms did she have in 2015?

[12-04-2025 17:13] PA: That time suddenly she felt giddiness in the night.

[12-04-2025 17:17] PA: Then she tried to go to bathroom but couldn't. But 1-2hours after she went to toilet and then she felt same. after that she realised due to vertigo she felt giddiness.

[12-04-2025 17:18] PA: Then reported to local doctor,. checked BP that time it was 170.

[12-04-2025 17:19] PA: Normally her BP is low.

[12-04-2025 17:23] PA: That time she couldn't stand properly, leg sensation (key ringtesting) redness of tongue and slightly her mouth was unshaped.

[12-04-2025 17:23] PPM 2: Which side was she unable to stand properly?

[12-04-2025 17:24] PA: Left side.

[12-04-2025 17:24] Aditya: Okay

[12-04-2025 17:24] Aditya: Did she have any speech disturbance at the time?

[12-04-2025 17:27] +91 91638 78286: One more thing that I forgot to mention that is in the year her left ears mastoid bone operation done

[12-04-2025 17:27] PA: Yes,sir

[12-04-2025 17:52] PPM 2: Okay. What was the problem?

[12-04-2025 17:52] PPM 2: Please can you describe it further.

[12-04-2025 18:23] PA: After operation she was absolutely fine.

[12-04-2025 18:35] PA: Year of 2001 she found that her stool was full of raw fresh blood. That time she felt uneasiness in her lower abdomen but no pain or any other symptoms

[12-04-2025 18:37] PA: 2 -3 days was continued with her stool ,no other time .

[12-04-2025 18:39] PA: Before that time she was very irregular to her taking food.most of the time she skipped her breakfast.

[12-04-2025 18:44] PA: After that dr. advised to do colonoscopy and then ulcer in colon detection detected.Then she was under treatment. she has a gastric problem. Suddenly she felt that she was unable to stand nd bend her knee.

[12-04-2025 17:24] PPM 2: Okay

[12-04-2025 17:24] PPM 2: Did she have any speech disturbance at the time?

[12-04-2025 17:27] PA: One more thing that I forgot to mention that is in the year her left ears mastoid bone operation done

[12-04-2025 17:27] PA: Yes,sir

[12-04-2025 17:52] PPM 2: Okay. What was the problem?

[12-04-2025 17:52] PPM 2: Please can you describe it further.

[12-04-2025 18:23] PA: After operation she was absolutely fine.

[12-04-2025 18:35] PA: Year of 2001 she found that her stool was full blood. That time she felt uneasiness in her lower abdomen but no pain or any other symptoms

[12-04-2025 18:37] PA: 2 -3 days was continued with her stool no other time.

[12-04-2025 18:39] PA: Before that time she was very irregular in taking food. Most of the time she skipped her breakfast.

[12-04-2025 18:44] PA: After that dr.adviced to do colonoscopy and then ulcer in colon detected. Then she was under treatment. she has a gastric problem. Suddenly she felt that she was unable to stand and bend her knee.

[12-04-2025 18:44] PA: X-ray was taken.

[12-04-2025 18:59] PA: That time she was more healthy about 70 kg. She had severe knee pain almost  bed ridden. Doctor told that it was due to gastric, ulcer and defficiency of D3 and low Hb. But sir if u want any prescription regarding this she cannot submit because patient's daughter was unable to take responsibility. she was only 20 years old.

[12-04-2025 19:02] PA: Medication continued for long time and 2 months she was bed ridden.

[12-04-2025 19:04] PA: That time she was on strict diet which was prescribed by the doctor.

[12-04-2025 20:39] PPM 2: Absolutely no worries. As long as she is able to share the narrative that is good enough

[12-04-2025 20:39] PPM 2: And how did she start moving and stop becoming bedridden?

[12-04-2025 20:50] PPM 1: The entire narrative was shared in 3/2/25 and is available here 👇

https://pajrcasereporter.blogspot.com/2025/04/74f-uti-metabolic-syn-stroke-acute.html?m=1

[16-04-2025 08:19] PA: Ma r 3 din age rastay honchot lege vison pain hochilo .Amr nijer o sei somoy sarir thik na thakay r x-ray korate parini .sange sange pray ghonta khanek ice pack r mukhe Arnica 10 drops kore diyechilam .1st angul narte perchilona , onkkhon borof deber por pain komechilo .

[16-04-2025 08:19] PA: Ma r ektutei samanno honchot I bhenge jay r kal shite pore jay .

[16-04-2025 08:19] PA: Hatte gele lagche olpo.

[16-04-2025 08:19] PA: Aj ki tahole duto angular majhe stick diye bendhe debo?

[16-04-2025 08:23] PA: Aj ki tahole duto angular majhe stick diye bendhe debo?

[16-04-2025 08:23] PA: Saturday jaoa ,thik bujhte perchina..ki korbo?pl ektu bole din

[16-04-2025 08:23] PA: Ei jaygay to plaster  o hobena ,naki crepe bandage ?

[16-04-2025 08:23] PA: Fola khub ekta nei

[16-04-2025 08:23] PA: Olpo anguler dogata fola

[16-04-2025 08:23] PPM 1: Basic principle of orthopaedic is

Reduction

Splintage

Physiotherapy

Ideally an x-ray of foot to rule out fracture followed by splintage as planned above or with a professionally made splint for the purpose

[16-04-2025 08:36] PPM 1: [16/04, 08:23] Patient Advocate Diabetes 44F WB: Aj tahole xray korie nbo?

[16/04, 08:23] Patient Advocate Diabetes 44F WB: Erokom bohuber hoyeche ,

[16/04, 08:24] Patient Advocate Diabetes 44F WB: Ma r jonno j form r link diyechilen download kore print kora jachena ..tai sign korteo perchina

[16/04, 08:24]cm: Last x-ray kabe korano hoyechilo?

[16/04, 08:24] Patient Advocate Diabetes 44F WB: 2 bochor age

[16/04, 08:25] Patient Advocate Diabetes 44F WB: Ektu thokkor laglei emn chir ba bhenge jay hat ba payer angul

[16/04, 08:27]cm: Ota share korte parben?

[16/04, 08:27] Patient Advocate Diabetes 44F WB: Khub kom kore holeo ma 8 theke 10 ber erokom hat pa bhenge geche

[16/04, 08:27] Patient Advocate Diabetes 44F WB: Mainly angul gulo

[16/04, 08:30] cm: Bhenge jawar evidence hishebe X ray dekha dorkar

[16/04, 08:34] Patient Advocate Diabetes 44F WB: Dekhchi kothay rekhechi xray plate .

[16-04-2025 09:28] PPM 1: [16/04, 09:26] Patient Advocate Diabetes 44F WB: Ki x_ray korbo ektu prescribed kore din na ..meye jabe ma kiye .barir kachei clinic

[16/04, 09:27] Patient Advocate Diabetes 44F WB: Plate niye aslei apnak photo pathachi

[16/04, 09:28]cm: Xray of the feet ap view with the focus on 1st metatarsal web space

[16/04, 09:28] Patient Advocate Diabetes 44F WB: Acha

[16-04-2025 10:46] PA: What should we do?

[16-04-2025 16:31] PPM 1: Show her to a local Orthopaedic doctor

[16-04-2025 16.53] PA: Yes sir. She went to orthopedic doctor this afternoon. The patient has sent her prescription. The leg is quite swollen and painful. Doctor will see her again day after tomorrow. If swelling reduces he will do strapping. Hope for the best.

[16-04-2025 18:50] PPM 1: @~ would this splint be better for the patient?👇

https://www.amazon.com/Metatarsal-fixation-Orthosis-Fracture-Stabilizer/dp/B0D78CKPS9

[16-04-2025 19:00] PA: This item can't be delivered in our location

[16-04-2025 19:06] PPM 6: No

[18-04-2025 13.05] PPM 1: 👏

[18-07-2025 08:23] PA: Since Monday morning patient had 3-4times loose motion, started muscle cramp, severe weakness, sweating, vertigo. Then went to local doctor..

[18-07-2025 08:24] PPM 1: Today's update.

[18/07, 07:01] Patient Advocate Diabetes 75F WB: 

Sir, Ma r sarir ta thik bhalo lagche na dekhe. Ektu age dekhchi full speed fan chaliechen. jol khache .. bristir weather, fan chalanor moto ekdom I noy, dekhe kmn jno laglo.ektu darie lathi diye ghor munchen osubidha ektu hatlei hanpie jache,ghamche, kotha bolte osubidha hoche. kal obdhi uthe daralei matha ghurche ,jor pachena ei kdin e bes roga hoye gechen.

[18/07, 07:04]pm: Shune mone hocche unar heart ta thik moton kaaj korchena

[18/07, 07:05] Patient Advocate Diabetes 75F WB: Amr o tai mone hoche. last jokhon amr sathe rag kore berie gechilen ashram e okhan theke phone kore Amy bolechilen bes kdin dhorei naki buke byatha hochilo, amdr kichu janayni

[18/07, 07:11] Patient Advocate Diabetes 75F WB: Last monday amr meye k niye jokhon jadavpur university entrance exam r jonno jachilam jachilam terpor i phone bolen homeopathy dr. Kache jaben othochoter 30 min age bari theke beriechilam, kichui bolen ni, emn tao noy j ami ma r  sathe kono kotha bolina ba ragaragi hoyni,  normal beronor somoy ma k pronam korei berolam

[18/07, 07:12] Patient Advocate Diabetes 75F WB: Sedin sokale homeopathy dr. chilen na .sandheybela ferar somoy ma didi k niye amder family physicians r kache gechilen .bollen khub weak lagchilo .

[18/07, 07:24] Patient Advocate Diabetes 75F WB: Monday vor rat theke loose motion hoyechilo.2_3ber. pa tene dhorchilo then didi dr. kache niye gechilo .urine e abr prochondo smell tai phone doctor k bolte bolechilam ..ma r previous history te 4_5mas ontor urine infection hoy. tai bhablam abr hoyto erokom kichu hoyeche . Ma k dekhe kintu amr ektuo bhalo lagchena .others kono test o denni .ekhon ki ekber p r blood sugar test korbo barite?Ma r sugar ache border line kichui manen na, tahole ki Hba1c check korte bolbo? ba others kono test?

[18/07, 07:28] Patient Advocate Diabetes 75F WB: Aj urine test hobe tahole ekber test korie nitam?

[18/07, 07:30] Patient Advocate Diabetes 75F WB: Ba ECG?

[18/07, 07:52]pm: Hain eta oboshyoi. Chest X-ray ta aer aage kora hoyeche kina ekbar unar PaJR case report a check kore dekhchi

[18/07, 07:53] Patient Advocate Diabetes 75F WB: Ha bochor 4 age Covid r somoy kora hoyechilo ,sei report khunje paoa muskil

[18/07, 07:53]pm: Unar PaJR group a aeguno post korben?

Unar PaJR group tai khuje pacchina

[18/07, 07:54] Patient Advocate Diabetes 75F WB: Ei matro jigasa korlam ki osubidha?bollen chokh buje thakte ichey korche ,vison weak lagche ,gheme jachen

[18/07, 07:55]pm: PaJR group ta pelam.

Okhane ki ami hi shob share kore debo?

[18/07, 07:55] Patient Advocate Diabetes 75F WB: Apni bolle dite pari but ma kichuto timely mene chilen na ,r amio kichu r jor korina ekhon tai ..apni ja bolben..

[18/07, 07:57]pm: Ami update kore dicchi ekkhuni. Information ta sequentially archive na korle puro Roger anumanik bhitti tai gondogol hoye jete pare

[18/07, 07:58] Patient Advocate Diabetes 75F WB: Ma Hb ,TSH ,fasting and pp bolechi check kore dite

[18/07, 08:00] Patient Advocate Diabetes 75F WB: Sir apnake ami sobtai bolechi .amr ma khub satty kono kichui niyom mene cholte pochondo korena ,jokhon osustho hon tokhon ja bolbo sob sunben r ektu sustho holei rajyer oniyom suru kore den ..amr kono jor nei .. apni Amy jeta bolben ami korbo .

[18/07, 08:01] Patient Advocate Diabetes 75F WB: Jotoi hok Ma to sustho thakuk ,amder mathar opor thakuk setai chai ..amr r kono demand nei .apni jeta bolben ami sunbo

[18/07, 08:02]pm: Prithibir shob maa rai erokom hoi

[18-07-2025 08:27] PA: Fasting 157

[18-07-2025 08:27] PA: This morning Fasting blood sugar is 157

[18-07-2025 10.35] PA: BP 144/95, PR 85, 

[18-07-2025 12.19] PA: BP 139/80, PR 94

[18-07-2025 12:25] PA: The patient had breakfast with 2 roti and veggies then she took Metrogyl 600 ,Hyocimax s.

[18-07-2025 12:27] PA: After 2 hours of breakfast her sugar level is 104

[18-07-2025 13:16] PPM 1: Why is she taking metrogyl and Hyoscimax?

[18-07-2025 13:17] PA: Patient feeling very uneasy. SPo2 98

[18-07-2025 13:17] PPM 1 Could be the side effects of medicine

[18-07-2025 13:17] PA: For loose motion na muscle cramps

[18-07-2025 13:18] PPM 1: Not necessary.

You could have just shared her stools images and we would have advised

[18-07-2025 14:15] PA: It is not happening now, it occurred Sunday and Monday morning 3 times. After that she went to local dr and then she took  Metrogyl 600 3times for 4 days and Hyocimax 3 times for 4 days.Now she is fine.

[18-07-2025 14:15] PA: With Stomach.

[18-07-2025 14:18] PA: Now the patient can't eat rice and has constant vomiting sensation had her lunch at 1.20.

[18-07-2025 15:18] PA: 2 hours after lunch 163mg/dl

[18-07-2025 16:20] PPM 1: Please stop those medicines now

[18-07-2025 16:20] PPM 1: It's the side effects of the unnecessary medicine.

[18-07-2025 19:23] PA: Ok sir.

[18-07-2025 19:29] PA: Will continue Inj Methycobalamin 500 alternate day? The patient took only the  injection 

[18-07-2025 19:53] PA: Feeling better

[18-07-2025 20:15] PPM 1: You mean the patient feels better after the injection?

Is there any recent hemogram report available?

[18-07-2025 21:40] PA: This morning she checked her Hba1c,hb,TSH and ECG but she hasn't received the reports till now, will get tomorrow except ECG

[18-07-2025 21:50] PA: When she feels her saturation was 99

[18-07-2025 21:50] PA: Better.

[19-07-2025 08:23] PPM 1: Update:

[18/07, 08:04] Patient Advocate Diabetes 75F WB: 

Baba neito ,chokher samne ma k chokher samne sustho thaklei bhalo .last amdr samner bari pichoner barir dujon mara gechen ,setao ekta moner modhey kharap lagar ache...

[18/07, 09:59] Patient Advocate Diabetes 75F WB: 

Buke byatha hoche ,hata cholay hapie jache .amdr local dr. K bollam uni bollen heart r problem mone hoche ,kolkata r kothao admit kore heart r thoroughly check up korate , Ecg te kichu pabena ,nahole sorbitrate diye dekhte hobe ,matha ghurte pare ..onk problem arise korte pare ..mathato ekhon i ghurche ..ki korbo ?ebr boddo helpless lagche...

[18/07, 10:00] Patient Advocate Diabetes 75F WB: Tao ekta ECg kore dite bolechi ..bekelay asbe .ki korbo ekhon?ma k jata chola korte baron korbo?

[18/07, 10:02] Patient Advocate Diabetes 75F WB: Ma r ektutei vison barabari hoye Jaber tendency tai dr. bollen olpo osubidha thakte rogta diagnosis kora dorkar

[18/07, 10:02] Patient Advocate Diabetes 75F WB: Pl Amy bolun ki korbo?

[18/07, 10:21]cm: Local doctor thik bolechen. Kachakachi kothao observation er jonye admit korte parle bhalo hoi.

Aei shober jonyei amra chaichilam jaate ekta home health care system training er dwara gothon kora jaate roogider aei dhoroner observation er jonye baritei monitor kora jete pare thik jemon amra hospital a roj kore thaki

[18/07, 10:38] Patient Advocate Diabetes 75F WB: Ekdom bolechen sir...amder satty khub dorkar ei dhoroner training r ..Ami o amr meye dujonei nite chai training ..apni ekdom amdr moner kotha bolechen..vison joruree ajker dine ...

[18/07, 10:47] Patient Advocate Diabetes 75F WB: 2004 theke ber ber feel korechi ,bivinno somoy .etao thik nana difficult situation face koray onkta egie jete pari kintu proper training na thakay vison hotas lage .jdin start korben health care system training Amy obossoi bolben ..amdr kintu arts background.Bhebechilam hospitality management ba trauma care niye j sob course hoy meye koranor arts background bole r bhabini..

[18/07, 10:49]cm: Amra eta dewa start korechi prai 20-30 bochor dhore kintu ekta dhaaper por aegiye jawa mushkil hocche

[18/07, 10:53] Patient Advocate Diabetes 75F WB: Kibhabe sir?amder moto non medical person ra ki perbe?jototuku para jay setai ba kom kiser ?ekdom hatre beranor cheye to prathomik support deya jabe..

[18/07, 13:08]cm: Exactly. Amar dharona khub bhaloi parben jodi icche thake ebong jodi apnar moton kormotho ebong sincere hon

[18/07, 21:31] Patient Advocate Diabetes 75F WB: Eta ki share kor jabe group e? roadside bari amder prochondo sound..dekhe bolben thik ache kina ECG ?

[18/07, 22:27] Patient Advocate Diabetes 75F WB: ECG report dekhie esechi ,ei medicine gulo diyechen r Eco korie nite bolechen .

[18/07, 22:27] Patient Advocate Diabetes 75F WB: Ki korbo?

[19/07, 06:21] Patient Advocate Diabetes 75F WB: Buke byatha ache .

[19/07, 06:21] Patient Advocate Diabetes 75F WB: Majh rate besir bhag din buke byatha hoy

[19/07, 07:16]cm: ECG ta dekhe temon kharap mone hocche na tabe ekjon manusher heart er somosya ache na nei sheta jaante hole shob theke important holo serial clinical observation jetar training apnar somewhow nijer patient diye hoye choleche.

ECG poribeshon ta video te na kore (odhikansho somoi video dekhte anek somoi laage othocho ekta sompoorno ECG r just chobi dekhte bujhte tar fraction of a second laage) ecg ta ekta kagoj a bibhinno lead jemon 1,2,3, avf, avl, v1, v2 etc kete kete saajale ekta patai puro chobi ta chole aasto

[19/07, 07:17] cm: Besir bhag din kabe theke?

[19/07, 07:20]cm: Tar aage chest X-ray ta joruri ebong film ta oboshyoi share korben

[19/07, 07:21]cm: Hospital observation a hole amra koyek din roj ekta kore ECG kore dekhtam kono change hocche kina

[19/07, 07:24] Patient Advocate Diabetes 75F WB: Ei buke byatha ta ma bollen sikkim theke ghure asar por theke hoche .pray 1.5 mas dhore .rate ghumer modhey buker thik majhe khane ei byatha hoy, pray 2 _2.30nagad.10 theke 15 mint moto hoy., r byathar karonei ghum bhenge jay .

[19/07, 07:29] Patient Advocate Diabetes 75F WB: Amr mone hoy ma r thanda legeo hote pare bcz j prochondo gorom e pray dekhechi freeze r jol khete , direct doi ba misti ber kore khete.majhe majhei gola o kane byatha hoy.ma r left ear  porda futo,  operation kora hoyechilo but kichudin por abr futo hoye jay. prochondo gorom feel koren ,rate full speed e fan chole, r nahole dekhi khub gheme jan .

[19/07, 07:33] Patient Advocate Diabetes 75F WB: Edaning dekhchi roj sokale onk somoy bathroom e thaken .prochur jol dhale gaye ,,r last month e jokhon ashram chole gechilen tokhon theke thanda jole snan korche ,othocho bathroom geyser ache..jani na ..tobe eta thik bes kichudin dhorei dekhchi ma ektu hata chola ba kaj korle ,ektu ranna korle  khub gheme jay.

[19/07, 07:33] Patient Advocate Diabetes 75F WB: R ekta kotha bolte bhule gechi ta holo rate jokhon buke byatha hoy tokhon bes gheme jay bollen .

[19/07, 07:34] Patient Advocate Diabetes 75F WB: R ei bythata kmn chap dhora typer ,jno mone hoy dom atke jabe ..

[19/07, 07:40] Patient Advocate Diabetes 75F WB: Acha thik ache , jodi arrange korte pari ekber chesta kore dekhbo?ek i time ki ECG korte hobe ?Amy details bolben tahole obossoi try korte pari...Ma sustho thakle onk jor pabo ..boddo mukhta fyakase lagche .bhalo lagchena dekhte ..ei kdin e kmn roga hoye gechen ..

[19/07, 07:57] Patient Advocate Diabetes 75F WB: Han, sir kotha bolechi j dada ECG koren oner sathe ,Amy pl bole din ...

[19/07, 08:11] Patient Advocate Diabetes 75F WB: Last year pujar nurshing home theke ferar por amr o ma r moto symptoms hoto roj rate 12.30 theke 2.30 r modhye vison buke chap dhorto ,gheme jetam ,hat  jhin jhin korto ,kmn ekta uneasiness chilo .ghum bhenge jeto ..oi somoy At -pro BPn vison high chilo ..Amr meye dekhtam roj jege bose thakto r oi somoy saturation check korto ..bes kom thakto ..pray din 85-92 modhey thakto r heart rate 120 _145..oi period e saturation on an average 90 theke 93 thakto ..ektutei hapie jetam ...koto medicine cholto ..Odbhut bhabe sir apner treatment e aj r satty esob problem amr nei ..khub tension korle ektu hoyto hoy but ekdom thik achi ..Ma o thik hoye jaben nischoy ..Tobe amder mama ,masi r torofer sokoler heart ,kidney ,high BP o diabetes ache ...even COPD o..

[19/07, 08:12] Patient Advocate Diabetes 75F WB: Natun medicine gulo start korechen Ma Kal rat theke

[19/07, 08:16]cm: 👆 notun aeguno?

Roj aeki time a ECG korleo habe

Ecg ta video na kore ekta patae kete kete ekta chobi pathale bhalo hoi

[19-07-2025 15:55] PA: Please explain the difference between lab test report and home monitoring sugar level report which is collected with same blood and same timings but reports r not same.which one is countable?

[19-07-2025 16:45] PPM 1: Please mention the home monitoring sugar values alongside the lab values with time sample taken.

[19-07-2025 16.56] PA: At home fasting sugar is 157, At lab it is 105

[19-07-2025 16:59] PA: In home monitor 2 hours after lunch sugar level _163. Lab test report  121

[19-07-2025 16:59] PPM 1: So both are nearly normal

What time? Two hours after food?

Before that what meal or medicine was taken?

[19-07-2025 17:00] PA: Fasting, Empty stomach

[19-07-2025 17:01] PPM 1: 👆Fasting, Empty stomach?

[19-07-2025 17:01] PA: Yes sir. BP 139/80, PR 94

[19-07-2025 17:02] PA:  For breakfast she had 2 roti and veggies then she took Metrogyl600, Hyocimax _s.

[19-07-2025 17:05] PA: For lunch she took small quantity of rice (5-6spoon) curd and sabji 2-3spoon

[19-07-2025 17:05] PA: She couldn't take solid food.

[19-07-2025 17.15] PPM 1: We asked it to be stopped.

[19-07-2025 20:42] PPM 1: Looks good 👍

[19-07-2025 20:44] PA: Report?

[19-07-2025 20:44] PA: Is it normal?

[19-07-2025 20:54] PPM 1: Looks good

[20-07-2025 06.57] PA: BP 132/68, 93

[20-07-2025 07:03] PA: Respiratory rate 9 per mint

[20-07-2025 09:39] PA: Respiratory rate 10/mint SPo2 98, 102

[20-07-2025 11:07] PPM 1: So far so good. Nice to see the patient's objective parameters are doing so well

[20-07-2025 13:55] PA: Respiratory rate 10/mint. 97, 96. BP 122/64, 94

[20-07-2025 14:01] PPM 1: 👍

[20-07-2025 20:10] PA: Respiratory rate 8-9/mint. BP 119/66, 91

[20-07-2025 20:31] PPM 1: 👆Yes the ecchymosis are likely because of the clopidogrel here

[20-07-2025 20:31] PPM 1: 👆how many times a day?

[20-07-2025 20:33] PPM 1: [20/07, 20:14] Patient Advocate Diabetes 75F WB: 

Ebela khub aste swas nichen . ECG korar por jekhane jekhane chest lid lagano hoyeche erokom kalshinte pore jache.

[20/07, 20:15] Patient Advocate Diabetes 75F WB: Kno emn hoche?

[20/07, 20:20] Patient Advocate Diabetes 75F WB: Ektu hatlei mane ek ghor theke paser ghore jete giyei hanpie jachen r gheme jache ..aj sandheybela sank bajate giye vison kosto hoyeche

[20/07, 20:27]pm: Heart failure

[20/07, 20:27] Patient Advocate Diabetes 75F WB: Ki hobe?

[20/07, 20:28] Patient Advocate Diabetes 75F WB: Ekhon ki korbo tahole?

[20/07, 20:28]pm: Ecchymosis

Uni ki heart er jonye aspirin kimba clopidogrel jatiyo oshudh khaan?

[20/07, 20:28]pm: Rest and medical monitoring

[20/07, 20:28] Patient Advocate Diabetes 75F WB: Wait pathichi ja ja medicine khachen

[20/07, 20:29]pm: Group a pathan jaate archive kora jai

[20-07-2025 20:33] PA: All those are continuing from Friday

[20-07-2025 20:34] PPM 1: 👆 This is more of a chest pain killer. Please share at what times she had the heaviness in her chest yesterday and today mentioning the approximate time

[20-07-2025 20:39] PA: There is no chest pain' and heaviness if she lies down

[20-07-2025 20:42] PPM 1: That is suggestive of a probable coronary pain that is responding to rest although it could even be an esophageal pain

[20-07-2025 20:46] PA: In the evening while she was making conch there was little pain, uneasiness even with little movement she is gasping and sweating.

[20-07-2025 20:48] PA: Please advise.

[20-07-2025 20:50] PPM 1: In this condition she shouldn't attempt to strain either while trying to blow into wind instruments like conch neither strain while passing stools both of which are known to aggravate heart failure

[20-07-2025 20:52] PPM 9: Is she a known case of heart failure?

[20-07-2025 20:55] PPM 1: Metabolic syndrome with clinically suspected heart failure from PaJR described symptoms

[20-07-2025 20:57] PPM 1: @PPM9 Can you ask an LLM to go through this and summarise her problems after doing a thematic analysis of the narrative data here 👇

https://pajrcasereporter.blogspot.com/2025/04/74f-uti-metabolic-syn-stroke-acute.html?m=1

[20-07-2025 21.02] PPM 9: Yes Sir. Sure

[20-07-2025 22:08] PA: Can all the medicines be continued?Ist time she takes sugar medicine Glyciphage 250 after dinner.

[20-07-2025 22:12] PA: How should the patient monitor it? Is there anything to worry about? Does she need to see a cardiologist?

[20-07-2025 22:16] PPM 1: Once a day

[20-07-2025 22:17] PA: Yes sir..

[20-07-2025 22:17] PPM 1: As she's currently monitoring it. Nothing has been achieved in this world through worry! Yes local cardiac evaluation is useful

[20-07-2025 22:19] PA: Other medicines to be continued as usual?

[20-07-2025 22:27] PA: Today's ECG

[20-07-2025 22:38] PPM 1: Let's layout the current medicines this patient is consuming here again one by one (with time consumed) and discuss each medicine's usefulness to this patient so that the patient advocate here is well versed with why the patient needs or doesn't need each of those medicines.

[20-07-2025 22:39] PPM 1: Good to see no changes suggesting that no further serious damage has happened since she started getting monitored with the daily ECGs among other things

[20-07-2025 22:41] PPM 1: Before echo have we seen the chest X-ray film here?

Also we would need to see the echocardiography video ourselves to decide. Please ask the local cardiologist to share that video

[20-07-2025 23:30] PA: Before the 26th July cardiologist is not available here.

[20-07-2025 23:40] PA: Tomorrow she will try to do chest xray.

[20-07-2025 23:49] PA: Please write down for chest x-ray

[21-07-2025 07:22] PPM 1: Chest X-ray pa view

[21-07-2025 08:54] PA: She doesn't take this food

[21-07-2025 08:56] PA: She takes black tea with puffed rice then takes Monit GTN 2.6 at 8 pm

[21-07-2025 08:56] PA: Sorry 8 Am

[21-07-2025 09:00] PPM 1: Monit GTN is a pain killer for her heaviness in heart with the idea that it may transiently improve coronary blood flow and provide symptomatic relief.

It may not be necessary if she doesn't have the chest heaviness.

She should also note if her chest heaviness is subsiding within 5 minutes of taking the medicine below her tongue

[21-07-2025 09:03] PPM 9: I think this GTN 2.6 mg is not immediate release sublingual tab sir?

[21-07-2025 09:11] PPM 1: Yes that adds to the complexity

[21-07-2025 09:13] PPM 1: A daily event sharing of each episodes of her chest heaviness with mention of onset time and duration can provide better clarity on her chest pain progression and outcomes other than daily ECG which so far suggests non progression and hence presumably stable angina at best

[21-07-2025 09:19] PPM 9: Like vital monitoring through RPG technologies that detect blood flow patterns. Similar technology might also detect coronary blood flow changes with clinical symptoms to correlate.

[21-07-2025 09:20] PPM 13: @Meta AI can we see if such technologies are existing Like vital monitoring through RPG technologies that detect blood flow patterns. Similar technology might also detect coronary blood flow changes with clinical symptoms to correlate.

[21-07-2025 09:20] Meta AI: Vital monitoring through technologies that detect blood flow patterns is indeed possible with various existing methods. Here are some examples:

- Remote Photoplethysmography (rPPG): This non-invasive technique uses cameras to detect blood flow and oxygen levels in the skin. It can measure vital signs such as heart rate, respiratory rate, heart rate variability, stress levels, blood pressure, and blood oxygen saturation. rPPG has been tested for accuracy and can be used in various settings, including remote monitoring.

- Speckle Plethysmography: This technology uses laser speckle analysis to provide real-time measurements of volumetric blood flow rates in the digits. It's been used in devices like FlowMet to assess blood flow in patients with Peripheral Artery Disease (PAD).

- Blood Pressure Transducers: Modern disposable blood pressure transducers use advanced sensor technology and improved biocompatibility to provide accurate and reliable blood pressure monitoring. These devices can enhance diagnostic accuracy and reduce maintenance costs.

- Wearable Sensors: Various wearable devices can monitor respiratory rate, heart rate, and other vital signs. These include:

    - Chest belts: Equipped with sensors like capacitive stretch sensors, IMU, and piezoelectric respiratory belts to track breathing patterns and vital signs.

    - Smart rings: Some smart rings can monitor blood pressure and other vital signs continuously.

    - Wearable patches: These can track vital signs like heart rate, respiratory rate, and blood oxygen saturation.

- Radar Vital Sign Monitoring: This technology uses radar signals to detect breathing patterns and heartbeats. It can be used for remote monitoring and has shown promising results in feasibility studies ¹ ² ³.

These technologies have the potential to revolutionize healthcare by providing more accessible and convenient monitoring options. Researchers continue to develop and refine these methods to improve accuracy and usability ⁴.

[21-07-2025 09:20] Meta AI: https://www.vastmindz.com/remote-photoplethysmography-rppg-is-a-non-invasive-method-of-measuring-blood-flow-and-oxygen-levels-in-the-skin/

[21-07-2025 09:20] Meta AI: https://pmc.ncbi.nlm.nih.gov/articles/PMC10886711/

[21-07-2025 09:20] Meta AI: https://www.jvir.org/article/S1051-0443(20)30772-7/fulltext

[21-07-2025 09:20] Meta AI: https://timetotreat.co.uk/the-evolution-of-blood-pressure-transducers-transforming-patient-monitoring-and-care/

[21-07-2025 09:51] PA: At 9.45 in the morning. Respiratory rate 10. BP 119/62, 96. SPo2 98

[21-07-2025 09:55] PPM 1: 👍

[21-07-2025 09:56] PPM 9: What’s the heart rate? Is it 54?

[21-07-2025 09:57] PPM 1: 98

[21-07-2025 09:58] PPM 9: I think we should target for a lower HR?

[21-07-2025 10:09] PPM 1: Good point! You recommend a beta blocker for her suspected heart failure?

@Meta AI please share one RCT where beta blockers have been compared to placebo in heart failure with endpoints such as improvement in shortness of breath as well as heart rate reduction achieved.

Please share the perplexity styled link to the article and share it's findings in a PICO format taking care not to share any relative percentages but only absolute numbers

[21-07-2025 10:09] Meta AI: Here's an example of a relevant RCT:

## RCT Details

- Study: MERIT-HF (Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure)

- Publication: Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA. 2000;283(10):1295-1302.

## PICO Format

- P (Population): 3,991 patients with heart failure (NYHA class II-IV) and reduced ejection fraction (mean EF 28%)

- I (Intervention): Metoprolol CR/XL (beta blocker) 25-200 mg/day

- C (Comparison): Placebo

- O (Outcome):

    - Mortality: 145 deaths in the metoprolol group vs 217 deaths in the placebo group

    - Hospitalizations: 641 hospitalizations in the metoprolol group vs 795 hospitalizations in the placebo group

    - NYHA Class Improvement: Not directly reported in the primary paper, but the study noted improvements in patient well-being and reduced symptoms

## Findings

The MERIT-HF trial demonstrated that metoprolol CR/XL reduces mortality and hospitalizations in patients with heart failure. While the primary paper doesn't directly report on shortness of breath or NYHA class improvement in a way that fits the exact request, the study does mention an improvement in patient well-being and reduced symptoms.

## Perplexity Styled Link

You can find the article on PubMed or through a DOI search: (link unavailable)

## Heart Rate Reduction

The study reported a significant reduction in heart rate in the metoprolol group compared to the placebo group, with a mean difference of approximately 10-15 beats per minute.

## Additional Context

For more detailed information on symptom improvement, such as shortness of breath, you might need to look into subgroup analyses or secondary publications from the MERIT-HF trial.

[21-07-2025 10:13] PPM 1: @Meta AI thanks. In terms of the trials heart rate reduction result it means that if we start her on metoprolol we may be able to make her current heart rate from 98 to 83-88. 

However I need you to share more evidence from that trial that draws better correlation between the improved absolute mortality in metoprolol group vs placebo group. I mean how can we be sure that the lesser mortality in the metoprolol group was due to heart rate reduction alone when an individual heart failure patient's outcomes could be driven by so many other factors!?

[21-07-2025 10:13] Meta AI: The MERIT-HF trial indeed showed a significant reduction in mortality and hospitalizations with metoprolol CR/XL, but attributing the benefit solely to heart rate reduction oversimplifies the complex pathophysiology of heart failure.

## Potential Mechanisms

The benefits of beta blockers in heart failure are multifactorial and may include:

1. Heart rate reduction: Decreased heart rate can reduce myocardial oxygen demand, improve diastolic filling, and enhance cardiac output.

2. Neurohormonal modulation: Beta blockers can decrease sympathetic tone, reducing the adverse effects of chronic adrenergic stimulation on the heart.

3. Improved cardiac function: Long-term use of beta blockers can lead to improved left ventricular ejection fraction (LVEF) and reduced remodeling.

## Correlation Between Heart Rate Reduction and Outcomes

While the MERIT-HF trial didn't provide a direct correlation between heart rate reduction and mortality benefit, subgroup analyses have explored this relationship. A post-hoc analysis of the MERIT-HF trial found that the benefit of metoprolol CR/XL was consistent across various subgroups, including those with different baseline heart rates.

## Additional Evidence

Other studies have investigated the relationship between heart rate reduction and outcomes in heart failure. For example:

- SHIFT trial: This trial investigated the effect of ivabradine, a pure heart rate reducer, in patients with heart failure and a heart rate ≥70 bpm. The trial showed that ivabradine reduced the composite endpoint of cardiovascular death or heart failure hospitalization.

## Complexity of Heart Failure

As you mentioned, heart failure is a complex condition, and outcomes can be influenced by multiple factors, including:

- Comorbidities: Presence of conditions like hypertension, diabetes, or chronic kidney disease.

- Medications: Interactions with other medications, such as ACE inhibitors, ARBs, or diuretics.

- LVEF: Baseline left ventricular function and changes over time.

- NYHA class: Severity of symptoms and functional capacity.

## Conclusion

While heart rate reduction is likely an important mechanism of beta blockers in heart failure, it's challenging to attribute the mortality benefit solely to this effect. The benefits of beta blockers in heart failure are likely due to a combination of mechanisms, including heart rate reduction, neurohormonal modulation, and improved cardiac function.

[21-07-2025 10:22] PPM 9: “Beta blocker — We recommend treatment with metoprolol succinate, carvedilol, sustained release carvedilol, or bisoprolol rather than with other beta blockers. The initial doses are described in a table (table 2).

Beta blockers are commonly initiated after optimal treatment for volume overload and soon after the patient has started an ARNI, ACE inhibitor, or ARB monotherapy.

Certain groups of patients may be more likely than others to tolerate specific beta blockers:

●Hypertension and hypotension – Carvedilol may have more effect on blood pressure than the other preferred beta blockers because of its alpha-1 antagonist properties. Conversely, metoprolol succinate and bisoprolol may have less blood pressure effect compared with carvedilol.

●Asthma – In patients with HFrEF and asthma, it is important to formally assess the patient for asthma; the symptoms of HF are similar to the symptoms of asthma. (See "Asthma in adolescents and adults: Evaluation and diagnosis".)

In patients with moderate to severe asthma who have HFrEF, we typically initiate treatment with a low dose of either metoprolol succinate or bisoprolol. We do not use carvedilol in patients with asthma who have mild persistent or worse symptoms.

Cautions — Relative contraindications to beta blocker therapy include the following:

●Bradycardia or second- or third-degree atrioventricular (AV) block – If the patient has second- or third-degree AV block and does not have a pacemaker, beta blocker therapy is relatively contraindicated. However, the patient should be evaluated for appropriate placement of pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization device. If a pacemaker is appropriate, a beta blocker may be started after the pacemaker is placed.

The indications for pacemaker, resynchronization, and defibrillator device implantation are discussed separately. (See "Overview of pacemakers in heart failure" and "Cardiac resynchronization therapy in systolic heart failure: Indications and choice of system" and "Primary prevention of sudden cardiac death in patients with cardiomyopathy and heart failure with reduced LVEF".)

●Severe heart failure – In patients with persistent NYHA class IV HF symptoms (table 1) or Stage D HF (table 5), beta blockers should be rarely used and only by experienced heart failure specialists; these patients are at risk of decompensation caused by the negative inotropic effect of beta blockers [2]. Though a small fraction of patients enrolled in trials of beta blockers had class IV HF symptoms, the favorable results of these trials are most applicable to patients with class II or III HF symptoms who comprised most of these trials (table 2). (See 'Evidence' below.)”

[21-07-2025 10:23] +1 (305) 539-8941: “Evidence — In patients with HFrEF who have NYHA functional class II to III HF, randomized trials of specific beta blockers (carvedilol, sustained-release carvedilol, sustained-release metoprolol succinate, and bisoprolol) have demonstrated that these agents reduce the risks of mortality and hospitalization and decrease the severity of HF symptoms:

●Reduction of mortality and readmission – These benefits were illustrated by a meta-analysis that included 22 trials involving more than 10,000 patients with an LVEF <35 to 45 percent, almost all of whom had NYHA functional class II or III HF and treatment with an ACE inhibitor [40]. The following findings were noted:

•Beta blockers significantly reduced total mortality at one year (OR 0.65, 95% CI 0.53-0.80) and two years (OR 0.72, 95% CI 0.61-0.84) compared with placebo. Beta blocker therapy saved 3.8 lives in the first year per 100 patients treated.

•Beta blockers also reduced hospitalization for HF (OR 0.64, 95% CI 0.53-0.79), with an absolute benefit of four fewer hospitalizations in the first year per 100 patients treated.

•Similar findings were noted in a meta-analysis limited to large randomized trials [41].”

[21-07-2025 10:23] PPM 9: @Meta AI can you summarize it clearly? 

“Beta blocker — We recommend treatment with metoprolol succinate, carvedilol, sustained release carvedilol, or bisoprolol rather than with other beta blockers. The initial doses are described in a table (table 2).

Beta blockers are commonly initiated after optimal treatment for volume overload and soon after the patient has started an ARNI, ACE inhibitor, or ARB monotherapy.

Certain groups of patients may be more likely than others to tolerate specific beta blockers:

●Hypertension and hypotension – Carvedilol may have more effect on blood pressure than the other preferred beta blockers because of its alpha-1 antagonist properties. Conversely, metoprolol succinate and bisoprolol may have less blood pressure effect compared with carvedilol.

●Asthma – In patients with HFrEF and asthma, it is important to formally assess the patient for asthma; the symptoms of HF are similar to the symptoms of asthma. (See "Asthma in adolescents and adults: Evaluation and diagnosis".)

In patients with moderate to severe asthma who have HFrEF, we typically initiate treatment with a low dose of either metoprolol succinate or bisoprolol. We do not use carvedilol in patients with asthma who have mild persistent or worse symptoms.

Cautions — Relative contraindications to beta blocker therapy include the following:

●Bradycardia or second- or third-degree atrioventricular (AV) block – If the patient has second- or third-degree AV block and does not have a pacemaker, beta blocker therapy is relatively contraindicated. However, the patient should be evaluated for appropriate placement of pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization device. If a pacemaker is appropriate, a beta blocker may be started after the pacemaker is placed.

The indications for pacemaker, resynchronization, and defibrillator device implantation are discussed separately. (See "Overview of pacemakers in heart failure" and "Cardiac resynchronization therapy in systolic heart failure: Indications and choice of system" and "Primary prevention of sudden cardiac death in patients with cardiomyopathy and heart failure with reduced LVEF".)

●Severe heart failure – In patients with persistent NYHA class IV HF symptoms (table 1) or Stage D HF (table 5), beta blockers should be rarely used and only by experienced heart failure specialists; these patients are at risk of decompensation caused by the negative inotropic effect of beta blockers [2]. Though a small fraction of patients enrolled in trials of beta blockers had class IV HF symptoms, the favorable results of these trials are most applicable to patients with class II or III HF symptoms who comprised most of these trials (table 2). (See 'Evidence' below.)”

“Evidence — In patients with HFrEF who have NYHA functional class II to III HF, randomized trials of specific beta blockers (carvedilol, sustained-release carvedilol, sustained-release metoprolol succinate, and bisoprolol) have demonstrated that these agents reduce the risks of mortality and hospitalization and decrease the severity of HF symptoms:

●Reduction of mortality and readmission – These benefits were illustrated by a meta-analysis that included 22 trials involving more than 10,000 patients with an LVEF <35 to 45 percent, almost all of whom had NYHA functional class II or III HF and treatment with an ACE inhibitor [40]. The following findings were noted:

•Beta blockers significantly reduced total mortality at one year (OR 0.65, 95% CI 0.53-0.80) and two years (OR 0.72, 95% CI 0.61-0.84) compared with placebo. Beta blocker therapy saved 3.8 lives in the first year per 100 patients treated.

•Beta blockers also reduced hospitalization for HF (OR 0.64, 95% CI 0.53-0.79), with an absolute benefit of four fewer hospitalizations in the first year per 100 patients treated.

•Similar findings were noted in a meta-analysis limited to large randomized trials [41].”

[21-07-2025 10:23] Meta AI: Here's a clear summary:

Beta Blocker Recommendations for Heart Failure

- Preferred beta blockers: Metoprolol succinate, carvedilol, sustained-release carvedilol, or bisoprolol.

- Initiation: Start beta blockers after optimal treatment for volume overload and soon after starting an ARNI, ACE inhibitor, or ARB monotherapy.

- Patient considerations:

    - Hypertension/hypotension: Carvedilol may have more blood pressure effect, while metoprolol succinate and bisoprolol may have less.

    - Asthma: Use metoprolol succinate or bisoprolol in patients with moderate to severe asthma; avoid carvedilol in patients with mild persistent or worse asthma symptoms.

- Cautions:

    - Bradycardia or AV block: Relative contraindication; consider pacemaker placement before starting beta blockers.

    - Severe heart failure: Use beta blockers rarely and only with experienced heart failure specialists in patients with persistent NYHA class IV symptoms.

Evidence:

- Benefits: Beta blockers reduce mortality, hospitalization, and symptom severity in patients with HFrEF and NYHA class II-III heart failure.

- Meta-analysis findings: Beta blockers saved 3.8 lives and reduced 4 hospitalizations per 100 patients treated in the first year.

[21-07-2025 11:17] PA: 10 bar

[21-07-2025 11:17] PA: Just now.

[21-07-2025 13:09] PPM 1: Nice illustration of how recommendations are not the same as actual outcomes and why GBM is not the same as EBM

[21-07-2025 13:10] PPM 1: Thanks

Looks more like emphysema.

An echocardiography video will be the next step if feasible

[21-07-2025 20:50] PPM 1: Can you describe her hourly activities since morning today?

[21-07-2025 21:30] PA: Yes, sir

Woke up at 6.30am, took bath at 7 am. At 7.30 am performed puja and meditation for about 30 mins. Had breakfast at 8 am. After that took complete rest. Went for an X-ray at 11.30am and was back after an hour. After relaxing for some time, had lunch at 1 pm and took rest till 4.30pm. Then had 2 roti with ladies finger curry and followed by tea. Sat for a while. Occasionally spent time on phone. Had dinner at 9 pm with 3 roti and sambar dal. Did not do any work the entire day. However even while going to the bathroom, felt breathless and sweating. Feels the urge to go to the bathroom repeatedly but unable to clear the bowels completely (incomplete defecation)

[21-07-2025 22:20] PPM 1: Thanks

This explains a lot.

Can you share it in a text file instead of image file.

[21-07-2025 22:22] PPM 1: Please give her stool softeners like liquid paraffin as the straining at stools appears to be worsening her heart failure symptoms.

She also has an underlying lung problem

[21-07-2025 22:50] PA: Sorry sir.. Her stool is normal. I made a mistake while the bathroom isn't getting cleared I mean the feeling of a strong urge to go, like a lot will come out, but little amount is passing and then she feels uneasiness.

[21-07-2025 22:50] PA: *While writing

[21-07-2025 22:51] PA: *I mean toilet

[21-07-2025 22:54] PA: What is emphysema? Is it the cause of sweating and gasping?

[21-07-2025 23:57] PA: She feels the urge to go to the toilet but passes 2- 3drops only. feeling pain in the lower abdomen giving ice pack in lower abdomen

[21-07-2025 23:58] PA: With burning sensation

[22-07-2025 00:00] PPM 9: Does she have a difficult urinating or passing toilet?

[22-07-2025 00:01] PA: Yes sir

[22-07-2025 00:02] PA: She feels it from this evening

[22-07-2025 00:02] PPM 13: Feel difficulty with urinating?

[22-07-2025 00:03] PA: Yes

[22-07-2025 00:04] PA: Giving ice pack in lower abdomen

[22-07-2025 00:04] PA: Takes lots of water also

[22-07-2025 00:06] PPM 9: Any leg swelling or fever?

[22-07-2025 00:06] PA: I will check it.

[22-07-2025 00:15] PA: Slightly swelling is there.

[22-07-2025 00:15] PA: Temparature 99.2 F

[22-07-2025 09:35] PPM 1: Update with advocate dyadic narrative:

Looks like her UTI precipitated her heart failure in the background of her metabolic syndrome and unrelated emphysema comorbidities.

Please start her on Tablet Nitrofurantoin 200 mg twice a day before we obtain her urine culture results. Please check similar situation in the other 75F with Diabetes Telangana patient which @Sailaja has archived as a case report and everyone here is added to her PaJR group too.

Dyadic conversational data:

[22/07, 08:59] Patient Advocate Diabetes 75F WB: Ma kal sararat prochondo kosto peyechen .toilet pache kintu hochilona , sandhya bela x_ray dite giye dr.k bolechilam uni bolle Glevo 500 dite but ekdom chailena, bollen  urine infection ache RBC ache antibiotic dite hobe kintu uni nite perbena sure .. hesitate korlen bole r ami kini ni .bhablam apnake age jigasa kore terpor debo .

[22/07, 09:01] Patient Advocate Diabetes 75F WB: Sara rat chotfot koreche ,halka jor chilo but ekhon nei..urinary passage, payer cheto o tolpet naki lonka batar moto jala koreche.bhor bela onkta toilet hober por relief pan

[22/07, 09:03] Patient Advocate Diabetes 75F WB: Ki korbo ekhon ?Alkasol chilona tai dite parini .aj ki debo .Ej Echohober kotha, r 26 th July cardiologist Dr.R S Joshi appointment confirm

[22/07, 09:03] Patient Advocate Diabetes 75F WB: Antibiotic ki deben ?

[22/07, 09:04] Patient Advocate Diabetes 75F WB: Glyciphage 250 half kore dite bolechen sugar medicine @PPM9 @PPM10 @PPM7 @PPM5 can you check if her prior four point sugar profile shared here last week merits anything more than low dose metformin, which I guess is not doing much to her sugars and her UTI could be due to uncontrolled sugars although again from what I recall from her sugar data shared last week it was under reasonable control or perhaps the data was inadequate to conclude well

[22-07-2025 10:22] PA: What is four point sugar?

[22-07-2025 10:23] PPM 1: Fasting

Two hours after breakfast

Two hours after lunch

Two hours after dinner

[22-07-2025 10:23] PA: Oh.

[22-07-2025 10:41] PA: Firstly, she has to do urine culture then have to start Nitrofurantoin 200mg?

[22-07-2025 11:31] PA: Can urine be collected anytime for culture?

[22-07-2025 11.50] PA: BP 129/76, 93

[22-07-2025 13:15] PA: Respiratory rate 11

[22-07-2025 13:19] PPM 1: Can but @Meta AI please guide how to collect a clean catch mid stream urine for culture

[22-07-2025 13:19] Meta AI: Collecting a clean catch midstream urine (CCMSU) sample is crucial for accurate urine culture results. Here's a step-by-step guide:

## Preparation

1. Wash your hands: Thoroughly wash your hands with soap and water before starting the collection process.

2. Clean the genital area: Use soap and water to clean the genital area. For women, it's essential to clean from front to back to prevent contamination from the anal region.

## Collection

1. Begin urinating: Start urinating into the toilet.

2. Collect midstream urine: After 1-2 seconds of urination, place the collection container under the urine stream. Collect about 1-2 ounces (30-60 mL) of urine.

3. Avoid touching the container: Make sure the container doesn't touch your genital area to minimize contamination.

4. Finish urinating: Once you've collected the required amount of urine, you can finish urinating into the toilet.

## Handling the Sample

1. Secure the container: Close the container tightly to prevent leakage or contamination.

2. Label the container: Label the container with your name, date, and time of collection.

3. Store the sample: If you can't deliver the sample to the laboratory immediately, store it in the refrigerator at a temperature of 4°C (39°F) or lower.

## Important Tips

- Avoid contamination: Try to minimize contamination by following the steps above.

- Use a sterile container: Ensure the collection container is sterile and provided by the laboratory or healthcare provider.

- Follow laboratory instructions: If you have specific instructions from the laboratory or healthcare provider, follow them carefully.

By following these steps, you can collect a clean catch midstream urine sample for culture. If you have any questions or concerns, consult with your healthcare provider.

[22-07-2025 13:20] PPM 1: Also monitor four-point blood sugars

[22-07-2025 13:42] PA: Daily updates needed to four-point blood sugar?

[22-07-2025 16:48] PPM 1: Daily updates are needed daily for all our PaJR patients

[22-07-2025 16:49] PPM 1: Four point blood sugars can be done once weekly in all our diabetes patients.

[22-07-2025 20:36] PPM 1: Good. No fresh ischemic change in the ECG since one week inspite of chest heaviness.

Heart failure can't be ruled out on the echocardiography report unless we see the video but it's alright, you tried your best to obtain all the necessary data. 

Let's continuity to monitor her symptoms and signs and sugars and hope for her speedy recovery.

Currently looks like a UTI possibly precipitated by uncontrolled sugars and further precipitating heart failure.

[22-07-2025 20:52] PPM 9: But no reporting of whether calcifications and thickening led to stenosis or not?

[23-07-2025 11:39] PA: Today she feels better . respiratory rate 10-11

[23-07-2025 11:39] PA: She feels discomfort when she passes urine.

[23-07-2025 13:20] PA: Please tell what medecine is needed for the patient. She feels the urge to pass urine but unable. Feels also strong pressure and uneasiness in the passage since morning

[23-07-2025 13:24] PPM 1: Syrup alkasol deene teen bar

Beshi kore jol grohon

Pelvic Strengthening exercises

Tablet pyridium 100 mg deene dubar for immediate relief 

https://www.amazon.com/AZO-Urinary-Phenazopyridine-Hydrochloride-Relieves/dp/B001G7QT3S

[26-07-2025 16.01] PA: Compared to earlier problems the patient feels healthy. Went to take bath and cleaned the rest room. After coming out she felt weak and dryness in her face, tongue, lips. After taking medicine Azotel 10 and Monit GTN for several days she feels better. The patient is not cooperating with family to take rest and thus could not update her issues.

Patient's BP from the Cardiologist chamber 155/76, 99, weight 60.5kg

[27-07-2025 21:53] PA: Respiratory rate 15, BP 153/76, 93

[27-07-2025 21:54] PA: Tomorrow she will check her sugar level.

[27-07-2025 21:54] PA: Feeling good

[28-07-2025 11.11] PA: BP 122/59, 86, Sugar level 151mg/dl

[28-07-2025 15:27] PA: Two hours after sugar level is 113, BP 133/58, 93

[28-07-2025 16:26] PA: Urine culture report

[28-07-2025 17:08] PPM 1: Is she currently on Tablet Nitrofurantoin?

[28-07-2025 17:19] PA: Yes sir.

[28-07-2025 18:23] PPM 1: How many days?

How are her urinary symptoms now?

[28-07-2025 18:41] PA: Slightly reduced compared to before,but still  pain is there while passing urine .also feeling  uneasiness nd fatigue

[28-07-2025 18:43] PA: She takes Nitrofurantoin from 3 days

PPM 1: 👍

[28-07-2025 20:50] PA: How long should she take Nitrofurantoin?

[28-07-2025 21:03] PPM 1: 7 days

If symptoms stop she stops

Or else repeats the urine culture

[28-07-2025 22.21] PA: BP 148/72, 92

[28-07-2025 23.04] PA: 2 hours after dinner sugar level is 165, BP 159/80, 79

[29-07-2025 08.47] PPM 1: 👍

[29-07-2025 18:44] PA: This morning the patient slept for a long time almost till 9 am.

[29-07-2025 18:46] PPM 1: She needs rest as it will also rest her heart

[29-07-2025 18:54] PA: After that she suffered a lot over 3 hours, even after going to the toilet but she didn't pass it altough there was a strong urge she felt severe pain in the abdomen like bursting sensation with cramps in both leg hands and legs turning cold and toes were turning blue.

[29-07-2025 18:55] PA: After that at last, drinking lot of water, she was able to pass urine

[29-07-2025 18:56] PA: After that she felt exhausted..

[29-07-2025 19:08] PPM 1: Yes any kind of straining is likely to affect her heart too.

Please share her current medicines again to let us check if she's on any anticholinergic medications by any chance that can also cause this sluggish bladder or bowel

[29-07-2025 19:15] PA: Still now her legs are turning cold with tingling sensation

[29-07-2025 19:17] PPM 1: Can rub them gently and keep checking her vitals.

[29-07-2025 20:09] PA: The patient hasn't taken Rivotril yet..

[29-07-2025 20:18] PPM 1: @Meta AI what are the side effects of trimetazidine on urinary bladder motility and contraction

[29-07-2025 20:18] Meta AI: Trimetazidine's effects on urinary bladder motility and contraction aren't well-documented in my search results. However, I can provide some general insights on how certain medications influence bladder function, which might be helpful.

Medications that affect bladder contraction typically work by interacting with the detrusor muscle or the nervous system's control over bladder function. For instance¹ ² ³:

- Anticholinergic medications can reduce bladder contractions by blocking acetylcholine, a neurotransmitter involved in detrusor muscle contraction. This can lead to decreased bladder motility.

- Muscarinic agonists, on the other hand, can stimulate bladder contractions and facilitate urination.

- Opioids can impair bladder contraction and lead to urinary retention by activating opioid receptors in the central nervous system, reducing bladder contractility and urine output.

Some potential side effects of medications on urinary bladder motility and contraction include⁴:

- Urinary retention: Caused by decreased bladder contractility or increased urethral resistance.

- Incomplete bladder emptying: Resulting from weakened detrusor muscle contractions.

- Changes in urination frequency: Some medications can increase or decrease the urge to urinate.

To better understand trimetazidine's specific effects on urinary bladder motility and contraction, consulting a healthcare professional or reviewing clinical studies focused on this medication would be beneficial.

[29-07-2025 20:18] Meta AI: https://pharmacologymentor.com/cholinomimetic-drugs-cholinergic-agonists-parasympathomimetics/

[29-07-2025 20:18] Meta AI: https://aspireatlas.com/which-antidepressants-cause-urinary-retention

[29-07-2025 20:18] Meta AI: https://medshun.com/article/do-pain-killers-give-frequent-urination

[29-07-2025 20:18] Meta AI: https://www.urologyworks.com.au/pdf/Medications-for-Overactive-bladder.pdf

[29-07-2025 20:19] PPM 1: Since when is she having the urinary bladder problem and since when is she taking these medicines?

[29-07-2025 21:30] PA: Almost 6-7 years she has been suffering from urinary bladder problem. From 2021 the patient was admitted twice with a serious UTI that time catheter had to be used three times since then she has been experiencing serious uti 2-3times in a year

[29-07-2025 21:32] PA: From the last few days before

[29-07-2025 21:35] PA: She just takes only 1 trimetazidine tab

[29-07-2025 21:35] PPM 1: Duration of her diabetes?

[29-07-2025 21:37] PA: Almost 1-2years but not prescribed the medicine. Hardly 10days.

[29-07-2025 21:41] PPM 1: Diabetes 2 years

Bladder problems 6 years

[29-07-2025 21:42] PA: In 2015 she had a stroke, then she was paralysed on left side.

[29-07-2025 21:43] PA: Due to various complications dr.did not prescribe any sugar medicine .

[29-07-2025 21:43] PA: Yes

[29-07-2025 21:51] PPM 1: How long did the paralysis take to recover?

[29-07-2025 22:39] PA: Almost 6 months but still now she cannot walk steadily.

[30-07-2025 09:30] PA: Please tell how the patient needs to be monitored daily?

[30-07-2025 09:45] PPM 1: This is how all our PaJR patients need to be monitored daily and the most important data that needs to be shared is her hourly account of activities (including sleep)👇

[29/07, 15:05]: Patient er ghontai ghontai kaaj kommo tao janaben jemon ekhane dekhano hoyeche 👇

https://medicinedepartment.blogspot.com/2023/12/pajr-daily-activities-energy-outputs.html?m=1

[29/07, 15:08]: রোগীর প্রতি ঘণ্টায় ঘণ্টায় কাজ জানাবেন, যেমন এখানে দেখানো হয়েছে 👇

https://userdrivenhealthcare.blogspot.com/2023/12/pajr-daily-activities-energy-outputs.html?m=1

[30-07-2025 09:46] PPM 1: Once we have her hourly descriptions of activity and status we can guide better.

[30-07-2025 13:18] PA: Morning 7.30 Woke up. Then household activities like bed and floor cleaning for 15 min. 7.45 am taking bath and wash her regular dress..still now she believes in self-service.  8.15 Doing  pranayam and meditation for 20 min. 9Am taking breakfast and medicine Monit GTN 1 tab.   9.30 am doing puja for 15 min after that goes to the bathroom but is not able to pass urine. Then starts uneasiness pain with burning sensation in lower abdomen and urinary passage. Still now she feels pain she tries to take rest but cannot

[30-07-2025 13:24] PA: Pl tell how she relief this types of discomfort.

[30-07-2025 13:25] PA: Does she take flavocip 200?

[30-07-2025 13:42] PA: She has a strong urge but cannot pass...since 2-3hours.

[30-07-2025 14:29] PPM 1: Yes

[30-07-2025 14:30] PPM 1: Also syrup alkasol

[30-07-2025 14:33] PPM 1: [23/07, 13:17]: Tablet pyridium 100 mg deene dubar for immediate relief 

https://www.amazon.com/AZO-Urinary-Phenazopyridine-Hydrochloride-Relieves/dp/B001G7QT3S

[23/07, 16:40] Patient Advocate Diabetes 75F WB: Amder location paoa jabena

[23/07, 16:45]: Kaacher shob dokanei pawa jabe. Composition pyridium bollei habe

[23/07, 16:45] Patient Advocate Diabetes 75F WB: Acha

[30-07-2025 14:35] PPM 1: @Meta AI is there a head to head comparison between the two urinary bladder analgesics, Tablet Falvoxate vs Tablet Pyridium? Please share any single RCT data if available in a PICO format taking care to share absolute numbers and avoid sharing percentages

[30-07-2025 14:35] Meta AI: Comparing flavoxate and phenazopyridine (Pyridium) directly in a head-to-head RCT is challenging due to limited availability of such studies. However, here's a summary of what we know about these medications:

Mechanism and Use

- Flavoxate: Works as an antispasmodic to relax bladder muscles, treating symptoms like painful urination, frequent urination, and incontinence. It's used for muscle spasms of the urinary tract.

- Phenazopyridine (Pyridium): Acts as a local analgesic to soothe the urinary tract lining, providing quick relief from pain and discomfort. It's often used for urinary tract infections, interstitial cystitis, and dysuria.

Side Effects

- Flavoxate:

    - Common side effects: headache, dizziness, drowsiness, nausea, vomiting, dry mouth, blurred vision, nervousness.

    - May cause interactions with other medications, and caution is advised in patients with kidney disease.

- Phenazopyridine (Pyridium):

    - Common side effects: nausea, upset stomach, vomiting, itching, pain, burning, dizziness.

    - May cause methemoglobinemia, hemolytic anemia, and skin pigmentation in rare cases.

Comparison Points

- Both medications are used to treat urinary tract symptoms, but flavoxate is more focused on antispasmodic effects, while phenazopyridine provides analgesic relief.

- Flavoxate may be more suitable for patients with overactive bladder or urge incontinence, while phenazopyridine is often used for short-term relief of urinary pain and discomfort.¹ ²

Unfortunately, without a direct head-to-head RCT, it's challenging to provide a definitive comparison in PICO format. If you're looking for more specific guidance, consulting a healthcare professional would be beneficial.³

[30-07-2025 14:35] Meta AI: https://www.drugs.com/mtm/flavoxate.html

[30-07-2025 14:35] Meta AI: https://www.rxlist.com/how_do_urinary_analgesics_work/drug-class.htm

[30-07-2025 14:35] Meta AI: https://www.drugs.com/compare/urinary-analgesic

[30-07-2025 14:37] PPM 1: 👆Phenazopyridine tablet tai better habe @PA. Jekono kacher dokane peye jaben

[30-07-2025 14:39] PA: Thik ache,edike bes bristi hoche komlei niye asbo

[30-07-2025 17:38] PA: Phenazopyridine not available in our lacal market

[30-07-2025 22.40] PA: 2pm she completes her lunch. Then she takes rest. Most of the time she takes rest after lunch. she feels very tired. At 8.30 pm she takes dinner and takes medicine.

[31-07-2025 09:59] PPM 1: Yesterday's hourly activities and symptoms chart 👇

[30/07, 13:18] Patient Advocate Diabetes 75F WB: 

Morning 7.30 Woke up. Then household activities like bed and floor cleaning for 15 min    

7.45 Taking bath and wash own regular dres..still now she believes in self service. 

8.15 Doing  pranayam and meditation for 20 min.      

9Am taking breakfast and medicine Monit GTN  1 tab.  

 9.30 Am Doing puja for 15 min after that goes to the bathroom but is not able to pass urine then starts uneasiness, pain with burning sensation in lower abdomen and urinary passage still now she feels pain she tries to take rest but cannot.

9:30AM to 2:00 PM hourly log is missing 

2pm she completes her lunch then she takes rest. Most of the time she takes rest after lunch. she feels very tired.

2:00PM to 8:30PM hourly log is missing 

At 8.30 pm she takes dinner and takes medicine.

After that it's missing.

9:30AM to 2:00 PM is missing

2:00PM to 8:30PM hourly log is missing

[31-07-2025 09:59] PPM 1: 9:30AM to 2:00 PM is missing

2:00PM to 8:30PM hourly log is missing

After that hourly log before sleep is missing

[31-07-2025 11:02] PA: Even after visiting 4-5 times the medical shop,  Pyridium was not available in our local market, so she took flavoxate 200. 40 min after taking this medicine there was lot of urination and relieved.

[31-07-2025 11:03]PA: She takes rest in the above mentioned missing time.

[31-07-2025 11:04] PA: At that time she felt very discomfort..

[31-07-2025 11:18] PPM 1: Can you reshare the above timeline by filling in yesterday's hourly details?

[31-07-2025 11:24] PA: Yes sir.

[31-07-2025 14:53] CR: Beetroot and peanut?

[31-07-2025 14:54] PA: Yes

[31-07-2025 14:54] PPM 1: Thanks. @PPM8 can these be converted from image to text using an LLM?

[31-07-2025 14:56] PA: Should we avoid to take beetroot?

[31-07-2025 14:57] PA: Is it harmful for sugar patient?

[31-07-2025 15:03] PPM 1: No can take

[31-07-2025 15:03] PPM 1: Not at all

[31-07-2025 15:55] PPM 8: I will try when time allows me as I am in an ENT event.

[31-07-2025 20.50] PA: Dinner

[01-08-2025 14.03] PA: After cutting and eating pineapple she is experiencing itching and tongue has become red and swollen.

[01-08-2025 21.21] PPM 1: Can sometimes happen with eating pine apple but doesn't look very bad. Perhaps can share another image after sometime.

What has been her hourly symptoms today?

[01-08-2025 23:46] PA: No other photo

[02-08-2025 07:33] PA: Actually mobile photo is not very clear, difficult to understand how much redness is there, that's why she deleted other photo.

[02-08-2025 07:52] PPM 1: Other than redness, how much pain she feels on touching is also an important finding to share

[02-08-2025 09:08] PA: 1. Tab. Monit GTN 8 Am. &4pm.

[02-08-2025 09:10] PA: 2. Tab..Flavocip 200mg 3 times after meals.

[02-08-2025 09:23] PA: 3. Tab .Aztolet 10 2 pm.

[02-08-2025 09:26] PPM 1: Is this being taken at night one hour before dinner so that she can sleep well?

[02-08-2025 09:26] PPM 1: This can be stopped. Doesn't have sufficient evidence of usefulness

[02-08-2025 09:27] PPM 1: This is a preventive medicine to prevent another stroke and can be continued once daily

[02-08-2025 09:28] PPM 1: This is for her urinary pain. How many is she taking every day and at what time? How is her pain in her hourly activities?

[02-08-2025 09:28] PA: 4. Tab Flavedon OD 80mg after lunch

[02-08-2025 09:29] PPM 1: This is for her cardiac pain manifested as chest heaviness.

Please mention how many times during her hourly activities is she experiencing the chest pain

[02-08-2025 09:30] PA: 5.Tab.Rivotril Bedtime

[02-08-2025 09:31] PA: 6.Tab. Glyciphage 250mg After dinner

[02-08-2025 09:32] PA: Yes, sir After taking this she feels better with deep sleep.

[02-08-2025 09:35] PA: She takes Monit GTN in 2 times that is 8am nd 4 pm. After taking this there is heaviness and chest pain during her activities.

[02-08-2025 09:39] PA: Ok she will stop it.

[02-08-2025 09:45] PA: Flavocip 200 she takes it 3 times after meals from last Tuesday and feels good after using it. There is no pain and burning sensation during urination.

[02-08-2025 09:46] PA: She can stop only Flavedon OD 80mg and others r continuing..right?

[02-08-2025 09:48] PPM 1: You mean there's no heaviness after taking this?

[02-08-2025 09:49] PA: Yes.

[02-08-2025 09:50] PA: Now she has no chest pain .

[02-08-2025 09:51] PPM 1: Yes it's always better to stop one by one

[02-08-2025 09:52] PA: Ok.

[02-08-2025 10:01] PA: I think the patient has a really Heart problem. From her paternal sides everyone has diabetes,Heart problem and kidney problem. She lost her nephew recently he was just 59 years.

[02-08-2025 10:05] PPM 1: Yes very likely considering her trunkal obesity and the fact that she also had a brain attack (stroke) and took months to recover from that paralysis

[02-08-2025 10:09] PPM 1: Transcribed by @PPM4 👇

Timing Activity

7.30am Get Up then household activity like bed & floor cleaning for 15 mins

7.45am Taking Bath & washed own regular dress ... still now she believes in self service.

8.15am Doing pranayam & meditation for 20 mins.

9am Taking breakfast & medicine Monit GTN 1 tab.

9.30am Doing puja for 15 mins after that went to bathroom but was not able to pass Urine, then started uneasiness, pain with burning sensation in lower abdomen & urinary passage. Almost 2-3 hours it continued. She tried to take rest but failed.

10.30am She took a glass of water.

11.30am She couldn't lie down or sit comfortably. There was uneasiness.

12.30pm She couldn't lie down or sit comfortably. There was uneasiness.

1.30pm Took Musambi (fruit 1pic)

2pm She completed her lunch then took rest. She felt very tired.

3pm Attend 1-hour online Gita class.

4pm Uneasiness continue.

5pm Took medicine Flavoxate 200 (1tablet).

5.40pm Relived after lot of Urination.

6pm Took rest.

7pm Watch TV sat on the bed.

8pm Watch TV sat on the bed.

8.30pm Completed dinner & took medicine.

9.30pm Started discomfort.

10.30pm Playing Ludo with her grand daughter.

11.30pm She took Revotril half tablet, went to toilet & passed little bit urine.

                                                                  Lunch at 13.50

[03-08-2025 07:14] PA: Fasting blood sugar level is 104. BP 149/81, 89

[03-08-2025 10:55] PA: 2 hours after breakfast her sugar level is 115. BP 126/67, 96

[03-08-2025 11:21] PPM 1: Thanks. Please also mention the medications at the same time she's taking them

[03-08-2025 12:34] PA: After breakfast she takes Flavocip 200 nd Monit GTN

[03-08-2025 12:35] PA: Also Neftus 100

[03-08-2025 16:15] PA: 2 hours after lunch sugar level is 114. BP 137/68, 96.

[03-08-2025 23.27] PA: 164mg/dl, BP 130/60, 91

[03-08-2025 23:29] PA: 2 hours after lunch sugar level is 164

[04-08-2025 07:12] PPM 1: 👍

[04-08-2025 07:38] PA: The patient's urine is normal now, and there are no obstacles and pain. still need to take more flavocip 200, already taken 10 tablets.

[04-08-2025 07:45] PA: Yesterday she did light work, was sweating excessively even with a little effort but there was no breathing difficulty.

[04-08-2025 08:04] PPM 1: Can stop because it's just a pain killer and will not improve anything else. Can be taken again if pain recurs

[04-08-2025 08:40] PA: Now she couldn't take sabji only with salad

                                                             

[04-08-2025 14.43] PA: Lunch 👆