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 PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[24-05-2025 16:13] PPM 1: @CR can we find out from her how is she now?
[24-05-2025 16:20] CR: Patient still having pains and is not well.
[24-05-2025 16:26] PPM 1: Did she take the Ultracet 1/2 tablet every 6 hours and P650 every 6 hours yesterday?
Can she share the picture of what medicines she is taking?
[24-05-2025 16:30] CR: According to PA, she is taking both the tabs. He will share the med pics asap.
[24-05-2025 16:37] PPM 1: 6 hourly?
[24-05-2025 16:37] CR: Yes, according to him.
[24-05-2025 16:46] PPM 1: If they take it regularly it should start reducing by third day and if not then we can add more drugs.
[24-05-2025 22:02] PA: Fingers are very painful doctor.
[25-05-2025 07:11] PPM 1: Does dipping it in cold water reduce the pain or increase it? @CR
[25-05-2025 12:03] CR: There will be some relief doctor but pain will not reduce completely. I would prefer hot water for relief.
[25-05-2025 14:16] PPM 1: How many times in a day does she dip her hands and feet in warm water?
[25-05-2025 14:17] PPM 1: She can try adding Tablet Naproxen 250 mg eight hourly today. She can stop the paracetamol but can continue the Ultracet half tablet six hourly
[25-05-2025 14:20] CR: Just now spoke to them and explained home remedies also. Asked them to try either hot bag or ice pack, which ever is comfortable to the patient.
[25-05-2025 14:24] PPM 1: Chikungunya is so very common in Telangana perhaps amongst all states in India! Wonder why? @Meta AI
[25-05-2025 14:24] Meta AI: @Meta AI here! 🤖 Chikungunya's indeed a major concern in Telangana, and you're right, it seems to be quite prevalent in the state. There could be a few reasons for this:
- Climate: Telangana's tropical climate with high temperatures and humidity creates an ideal environment for the Aedes mosquito, which spreads Chikungunya.
- Water logging: The state's monsoon season and poor drainage systems can lead to water logging, providing breeding grounds for these mosquitoes.
- Urbanization: Rapid urbanization and poor waste management can contribute to the spread of the disease.
- Lack of awareness: Maybe there's a need for more awareness campaigns and preventive measures in the region?
What do you think? Have you or someone you know been affected by Chikungunya? 🤔
[26-05-2025 11:28] CR: This patient is having trouble with severe pains on shoulders, calf muscles, fingers and is not able to sleep or eat anything. Asked her to add Naproxen 250mg 8 hourly. Please advise Doctor.
[26-05-2025 11:56] PPM 1: Yes let's see the effect of Naproxen 250 mg tid.
Also continue the tablet Ultracet half 6 hourly.
She's free to come and get admitted in our wards anytime as adviced even on that day when we first saw her in the OPD. I guess she was unable to as she has to look after her children at home.
[28-05-2025 09:20] PA: Very painful sir
[28-05-2025 09:28] CR: @PPM1 doctor this patient is not able to bear the pains and called me just now. PA was asking if he should consult Orthopaedic. I said better take the patient to Our hospital as the pains are normal for chikungunya.
[28-05-2025 09:40] PPM 1: Yes I too would have suggested the same.
If she can come and get admitted we can offer her some injections to take better care of her pain.
In this context if only we had an access to a peripheral health worker trained and certified in giving injections (nurse practitioner) near her home who we could guide here on which injections to give and how to capture data for monitoring her current symptoms, she need not have even visited our hospital
[08-06-2025 17:00] CR: Pains yemaina koncham thaggaya?
[08-06-2025 17:12] PA: Konchem
[08-06-2025 17:12] PA: Tagginavi
[09-06-2025 10.25] PA: 
[09-06-2025 11:36] PPM 3: Based on the two images you've uploaded, here's a detailed breakdown and interpretation:
---
### 📄 *Image 1: Handwritten Medical Notes (Likely a Prescription Sheet)*
This sheet appears to be a doctor's prescription. The handwriting is difficult to interpret precisely, but here are the decipherable parts:
#### ✅ Likely Medicines Prescribed:
1. *Haptenocalcin* (possibly a calcium or vitamin D supplement)
2. *Polyarticular Arthritis* (appears as a diagnosis)
3. *Tab Predmet* – likely *Predmet (Prednisolone)* for inflammation.
4. *Tab HCQS* – *Hydroxychloroquine*, commonly used for autoimmune arthritis (like RA/SLE).
5. *Tab Febuxor* – likely *Febuxostat, used in **gout*.
6. *Tab Brozole-CV* – an *antibiotic combination* (Cefuroxime + Clavulanic acid).
7. *Tab Dolo 650* – *Paracetamol*, for fever/pain.
8. *Tab Etirelease* or *Etirele SR* – possibly *Etodolac, a **NSAID* for pain.
9. *Tab Conzace* – a *multivitamin*.
10. *Tab Comyflam* – might be *Combiflam* (Ibuprofen + Paracetamol).
---
### 📋 *Image 2: Outpatient Record from SAI SRINIVASA MULTISPECIALITY HOSPITAL*
#### 👤 *Patient Info:*
* Name:
* Age/Gender: 26Y / Female
* Date: 28-05-2025
* Doctor: Dr. Srinivas DS (General Medicine)
#### 📌 *Clinical Summary:*
* *Complaints:*
* Polyarthritis & swelling (self-reported)
* Fever, chills, rigors, nausea
* Loss of appetite and sleep
* Early morning stiffness (suggestive of *Rheumatoid Arthritis or SLE*)
* Night-time worsening of pain
* *Vitals:*
* Weight: 55 kg
* Pulse: 65/min
* BP: 100/60 mmHg
* SPO₂: 97%
* Temp: afebrile at time of check
* *Investigations/Findings:*
* Renal calculi (4 mm stone), scanned on 16-05-25
* Anti-CCP: 60.5 (✅ *positive, supports **RA diagnosis*)
* ESR: 37 (✅ *elevated*, suggests inflammation)
* RA Factor: *Negative*
* Other tests: *Typhoid, Chikungunya – Negative*
#### 💡 *Impression:*
* Likely *early rheumatoid arthritis or another autoimmune polyarthritis*, given:
* Polyarthritis
* Early morning stiffness
* Positive Anti-CCP
* Elevated ESR
* Also has a small *renal stone*.
---
### ✅ Suggested Next Steps:
1. *Rheumatology referral*: Confirm autoimmune cause (RA/SLE).
2. *Continue anti-inflammatory medications* as prescribed.
3. *Hydration and renal stone management* (small 4 mm stones usually pass on their own).
4. *Regular monitoring* of Anti-CCP, ESR, CRP, and renal function.
Would you like a typed copy of the prescription or a simplified medication schedule?
---
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[09-06-2025 11:37] PPM 3: Here’s a *simplified medication schedule* based on the handwritten prescription and medical note you shared. This schedule assumes *standard dosing* based on the likely identity of the medications, but *please confirm all dosages and timings with the prescribing doctor or pharmacist*, as handwriting and abbreviations can sometimes be misinterpreted.
---
## 🕒 *Simplified Medication Schedule for Mrs. Uma Maheshwari Perika*
| *Medication* | *Likely Purpose* | *Dose* | *Time of Day* | *Notes* |
| ----------------------------- | ------------------------------------- | -------- | ---------------------- | ------------------------------------------ |
| *Predmet* (Prednisolone) | Anti-inflammatory / Immunosuppressant | 1 tablet | Morning (after food) | Do not stop suddenly. Taper if prescribed. |
| *HCQS* (Hydroxychloroquine) | Autoimmune (RA, SLE) treatment | 1 tablet | After lunch | Regular eye checkups needed. |
| *Febuxor* (Febuxostat) | Gout prevention / uric acid reducer | 1 tablet | Night (after dinner) | Avoid in acute gout attacks. |
| *Brozole-CV* (Antibiotic) | Possible infection treatment | 1 tablet | Morning & Night | Complete full course. Take after food. |
| *Dolo 650* (Paracetamol) | Fever / Pain relief | 1 tablet | Up to 3x/day as needed | Max 4 tablets/day. |
| *Etirelease / Etodolac* | Pain & inflammation | 1 tablet | Morning or Night | Take with food. Can cause acidity. |
| *Conzace* (Multivitamin) | General health / supplement | 1 tablet | After breakfast | Drink plenty of water. |
| *Combiflam / Comyflam* | Pain relief | 1 tablet | As needed (max 2/day) | Avoid combining with Etodolac or Dolo. |
| *Haptenocalcin / Calcium* | Bone & joint health | 1 tablet | After dinner | Avoid with iron or thyroid meds. |
| *Eldervit / Etirel SR?* | Possibly a vitamin supplement | 1 tablet | After food | Clarify exact name with pharmacy. |
---
## ⚠ Important Notes:
* *Double-check medicine names and doses* with the pharmacy (some brand names are unclear).
* If *symptoms worsen (e.g., severe joint pain, fever)*, contact your doctor immediately.
* *Hydrate well* – especially for kidney stone prevention.
* Keep follow-up visits as scheduled, especially to monitor:
* RA disease activity (Anti-CCP, ESR, CRP)
* Kidney health
Would you like this schedule in a downloadable printable table (PDF or Excel)?
---
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[09-06-2025 11:39] +964 750 136 1306: Yes, based on the *handwritten prescription image* you uploaded earlier, there are *potential drug interactions and safety concerns* to be aware of. Here's a breakdown based on the *likely medications identified* from the note:
---
## 🔍 *Key Medications Likely in the Prescription:*
| *Medication* | *Drug Class* |
| ---------------------------- | ----------------------------------------- |
| *Predmet* | Corticosteroid (Prednisolone) |
| *HCQS* | DMARD (Hydroxychloroquine) |
| *Febuxor* | Xanthine oxidase inhibitor |
| *Brozole-CV* | Antibiotic (Cefuroxime + Clavulanic acid) |
| *Dolo 650* | Analgesic/Antipyretic (Paracetamol) |
| *Etirelease* | NSAID (Etodolac or similar) |
| *Conzace* | Multivitamin |
| *Combiflam / Comyflam* | NSAID + Paracetamol combo |
| *Calcium (Haptenocalcin?)* | Calcium supplement |
| *Eldervit / Etirel SR* | Likely Vitamin B12 or multivitamin |
---
## ⚠ *Potential Interactions & Concerns:*
### 1. *NSAIDs + Steroids (Etirelease + Predmet)*
* *Risk: Increased risk of **gastric ulcers, GI bleeding*.
* *Mitigation*: Use gastroprotective agents (e.g., pantoprazole), avoid prolonged combination use.
### 2. *NSAIDs + NSAIDs (Etirelease + Combiflam)*
* *Risk: **Double NSAID* → raises risk of *kidney injury, bleeding, and GI toxicity*.
* *Mitigation: Choose **only one NSAID*, avoid overlapping.
### 3. *HCQS + Antibiotics (Brozole-CV)*
* *Risk: Generally safe, but **monitor for QT prolongation* in high-risk cardiac patients.
* *Mitigation*: Watch ECG if patient has arrhythmias or cardiac history.
### 4. *Predmet + Febuxor*
* *Risk: No direct interaction, but both can mask **gout flare* responses.
* *Mitigation*: Predmet might relieve symptoms while Febuxor starts acting – be cautious interpreting symptom resolution.
### 5. *Multivitamins (Conzace, Eldervit) + Calcium*
* *Risk: **Over-supplementation* → Hypervitaminosis (esp. Vitamin A/D), calcium imbalance.
* *Mitigation*: Ensure daily total intake doesn't exceed recommended limits.
### 6. *Dolo 650 + Combiflam*
* *Risk: **Paracetamol overdose* (both contain it).
* *Mitigation: Limit combined use to avoid exceeding **4g/day of paracetamol*.
---
## ✅ *Safe Practices Suggested:*
* *Limit NSAID use: Prefer **Etirelease* OR *Combiflam*, not both.
* *Avoid overlapping paracetamol doses*.
* *Add a PPI* (e.g., pantoprazole) for stomach protection if using steroids + NSAIDs.
* *Hydration*: Important to reduce renal load from NSAIDs, antibiotics, and for kidney stone management.
* *Routine labs: Monitor **LFT, RFT*, especially if prolonged medication use is expected.
---
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[09-06-2025 19:44] PPM 1: Was her pain reduced before she met these doctors or after she met them and took their medicines? Which date did she show them?
[09-06-2025 19:49] CR: @PA Paina prescription mandulu vadaka thaggaya
[09-06-2025 19:51] PPM 1: 👆idi teeskunte tagginda?
[09-06-2025 20:00] CR: She consulted the doctor 0n 28th May and had good relief with the medication. She was prescribed meds only for 10 days and after stopping the medication her problem is back to normal. So now she wants to know whether she can continue further. She went to a nearby doctor as she couldn't come so far to our hospital was her explanation.
[09-06-2025 21:11] PPM 1: 👆@CR are these the medications she took on 28th May?
[09-06-2025 21:39] CR: Yes Doctor
[09-06-2025 21:41] PPM 1: Perhaps providing SAIDs along with NSAIDs regardless of the diagnosis is a better strategy.
[10-06-2025 15:19] PPM 1: What are these images of orange discoloration of her fingers? Has she applied some ointment?
[10-06-2025 15:46] CR: It's mehendi
[10-06-2025 16:11] PA: Ha sar
[10-06-2025 16:14] PPM 1: Medicinal?
[10-06-2025 16:14] CR: No
[10-06-2025 17:36] CR: Patient is experiencing severe pains again so can she continue the medicine prescribed by the local doctor. Please advise.@PPM1 doctor.
[10-06-2025 20:31] PPM 1: Please ask her to share the picture of each medicine so that the names and dose are visible
[10-06-2025 20:45] CR: Okay
[10-06-2025 20:45] CR: Ivi rendu vesukondi
[10-06-2025 20:48] CR: She is asking whether she can eat non veg without any restrictions@@Rakesh Biswas Sir doctor
[10-06-2025 20:55] PPM 1: As in Harvard plate
[10-06-2025 20:57] CR: Dosage can be according to the previous prescription?
[10-06-2025 20:58] CR: 👆Linklo vunna Dani batti thinachu @PA
[10-06-2025 20:59] PA: Ha ok sar
[10-06-2025 20:59] PA: Tq sar
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