23-07-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED ATER TAKING HIS 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.
[23-07-2025 21.44] PPM 1: OPD 27M first seen on Monday OPD but couldn't log at that time. Reviewed him again today at OPD.
Unexplained pedal edema since one year with no hypoalbuminemia ruling out liver and glomerular origin of his pedal edema.
He does have mild shortness of breath and is highly suspect for heart failure due to metabolic syn from visceral fat phenotype.
History of VP shunt since 8 months of age and revised again three years ago.
On examination prominent striae over abdomen and functional VP shunt.
[24-07-2025 07.57] PA: Good morning sir.
The patient woke up at 6amHad Idly at 7am
Going to school at 8am.
[24-07-2025 08.44] PPM 1: 👍
[28-07-2025 21.17] PA: Hi sir
[24-07-2025 19.44] PA: The patient went for a walk at 6 pm for half an hour, had tea and relaxed for some time.
[24-07-2025 20.08] PA: The patient had lunch at 12.45pm and took tuition for his students.
[24-07-2025 21.45] PPM 1: What subjects does the patient teach? 6 am walking?
[24-07-2025 22.09] PA: All subjects. Main Mathematics.
[25-07-2025 07:17] PPM 1: That's very interesting 👍
[25-07-2025 19:17] PA: Good evening everyone same time table
[25-07-2025 20:44] PA: Today ate fish curry
[25-07-2025 21:18] PPM 1: @CR what would be the best PaJR links for this patient's advocate to read and realise how best to share his hourly activities?
[25-07-2025 21:27] PPM 1: Here's a sample:
7. AM - wakeup time
7 -7.40 AM - freshup
8 AM - breakfast (3 Vada + chutney + one cup tea)
8.15- 9 AM - watching news
9-9.35 AM - journey to work place
10 AM- 4 PM- client work on system
4.30 PM - lunch (3 cups rice + 2 cups tomato dal + grilled chicken approximately 200 grams)
5-6 PM - journey back home
6.30 PM- had a cup of coffee
7-9.30 pm- watching OTT
10.00 PM - dinner (2 cups vegetable fried rice + 2 chocolate muffins - gluten free made of ragi+jowar )
Note - the pain he complained in the lower back was almost negligible by evening/night. Only some 5-10 % discomfort was there.
[25-07-2025 23:28] PA: It's not my time table
6am- wakeup time
6-6:30 am- freshup
7:00 am breakfast
7:10 am Going to my school by bus
Reached- 9 Am
9am -12 pm teach the lessons
12 pm to 1 pm lunch
Rice and curry
4-6 pm journey back home
5 pm cup of tea
6pm to 9 pm waching tv, Personal works
9: 30 pm dinner rice and egg curry
[25-07-2025 23:28] PA: Curry is changed every day vegitable or nonveg
[25-07-2025 23:28] PA: Anything
[26-07-2025 07:35] PPM 1: 👆This is his patient's @CR
[26-07-2025 07:35] PPM 1: The patient's bus takes two hours?! From which place to which place?
[26-07-2025 07:38] PPM 1: @Meta AI @PPM can you analyse the brief report of this patient's daily activities below and deduce how much calories he could be burning?
It's not my time table
6am- wakeup time
6-6:30 am- freshup
7:00 am breakfast
7:10 am Going to my school by bus
Reached- 9 Am
9am -12 pm teach the lessons
12 pm to 1 pm lunch
Rice and curry
4-6 pm journey back home
5 pm cup of tea
6pm to 9 pm waching tv , Personal works
9: 30 pm dinner rice and egg curry
[26-07-2025 07:38] Meta AI: Let's break down the patient's daily activities and estimate the calories burned. We'll use approximate MET (Metabolic Equivalent of Task) values for each activity.
1. Sleeping (6am wake-up): assume 8 hours sleep, calories burned ~400-500 kcal (basal metabolic rate)
2. Freshup (6-6:30 am): light physical activity, ~50-100 kcal
3. Sitting during:
- Bus journey (7:10-9:00 am & 4-6 pm): ~200-300 kcal (total for both journeys)
4. Teaching lessons (9am-12 pm): moderate physical activity, ~300-400 kcal
5. Sitting during:
- Lunch (12-1 pm): ~50-100 kcal
- Watching TV (6-9 pm): ~150-300 kcal
6. Personal works (6-9 pm): assume light physical activity, ~100-200 kcal
7. Dinner (9:30 pm): sitting, ~50-100 kcal
Total estimated calories burned from activities: ~1300-2200 kcal
Add basal metabolic rate (BMR) for 24 hours: ~1600-2000 kcal (depending on age, weight, height, sex)
Total daily energy expenditure: ~2900-4200 kcal
Keep in mind that this is a rough estimate and actual calorie burn may vary depending on individual factors like weight, age, sex, and physical condition. To get a more accurate estimate, consider using a fitness tracker or calorie calculator.
[26-07-2025 08:58] +964 750 136 1306: Based on the provided daily schedule, here's a breakdown of the estimated calorie burn, *keeping in mind significant limitations*:
1. *Basal Metabolic Rate (BMR):* This is the calories burned just to stay alive (breathing, circulation, etc.). Assuming this is an *average adult male (e.g., 30-50 years old, ~70kg / 154 lbs)*:
* *Estimated BMR:* ~1,600 - 1,800 kcal per day.
* This is the largest component of daily calorie burn.
2. *Activity Analysis:*
* *Wakeup & Freshen Up (6:00-6:30 AM):* Light activity. *~20-40 kcal.*
* *Breakfast & Commute Prep (7:00-7:10 AM):* Very light/sedentary. *~10-20 kcal.*
* *Bus Commute to School (7:10 AM - 9:00 AM):* Mostly sitting, possibly some walking to/from stops. *~80-150 kcal.*
* *Teaching Lessons (9:00 AM - 12:00 PM):* Standing/walking lightly in a classroom. Light activity. *~150-250 kcal.*
* *Lunch (12:00 - 1:00 PM):* Sedentary (sitting/eating). *~15-30 kcal.*
* *Afternoon (1:00 PM - 4:00 PM):* Activity not specified. Assuming light activity (prep, admin, some walking) or sedentary (desk work). *~100-200 kcal (if light activity) or ~50-100 kcal (if sedentary).*
* *Bus Commute Home (4:00 PM - 6:00 PM):* Mostly sitting. *~80-150 kcal.*
* *Tea & Evening (5:00 PM - 9:00 PM):* Sitting (TV, personal work). Very light/sedentary. *~50-100 kcal.*
* *Dinner (9:30 PM):* Sedentary (sitting/eating). *~15-30 kcal.*
* *Sleep (10:00/10:30 PM - 6:00 AM):* ~7.5-8 hours. BMR rate during sleep is slightly lower. *~400-500 kcal.*
*Estimated Total Daily Calorie Burn:*
* *BMR:* 1,600 - 1,800 kcal
* *Activity:* 500 - 1,000 kcal (Highly dependent on the unspecified afternoon activity and teaching intensity)
* *TOTAL ESTIMATE:* *2,100 - 2,800 kcal*
*Most Likely Range:* Given the described activities are predominantly *sedentary or light intensity, a more probable range is **2,200 - 2,500 kcal* for an average adult male.
*Crucial Limitations & Assumptions:*
1. *No Personal Details:* Age, sex, weight, height, and muscle mass are HUGE factors. A smaller/older person burns less; a larger/younger/more muscular person burns more. This estimate assumes an average adult male (~70kg).
2. *Activity Intensity Unknown:* "Teaching lessons" could range from sitting at a desk to actively moving around a classroom. "Personal works" could be desk work or light chores. The afternoon (1-4 PM) is completely unspecified. *This is the biggest source of uncertainty.*
3. *Commute Details:* Walking distance to/from bus stops? Standing on the bus? These details matter but aren't provided.
4. *Metabolic Variability:* Individual metabolism varies.
5. *NEAT Missing:* Non-Exercise Activity Thermogenesis (fidgeting, posture) isn't captured but contributes.
*Conclusion:*
Based only on this limited schedule and assuming an *average adult male profile, the estimated total daily energy expenditure (calories burned) is likely between **2,200 and 2,500 calories.* This is a *very rough estimate* due to the lack of critical personal details and the unspecified intensity of key activities (especially teaching and the afternoon period). For a more accurate assessment, details like weight, age, sex, and specifics on activity intensity/duration are essential.
[26-07-2025 09:17] PPM 1: Thanks! This is a much better input 👏👏
Now the difficult Web 2.0 question here who will call the patient to get the answers to the queries posed by deepseek? @PPM4 @CR
[26-07-2025 09:33] PPM 3: Based on the provided daily activity report, an estimation of the patient's calorie expenditure can be made by considering the energy cost associated with each activity. To calculate an approximate calorie expenditure, details such as the individual's weight, age, gender, metabolic rate, and the intensity levels of activities are needed. Without this information, I will provide a general estimation based on typical values.
First, the Basal Metabolic Rate (BMR) needs to be estimated. The Mifflin-St Jeor equation is commonly used:
* For men: BMR = (10 x weight in kg) + (6.25 x height in cm) - (5 x age in years) + 5
* For women: BMR = (10 x weight in kg) + (6.25 x height in cm) - (5 x age in years) - 161
Since the gender, weight, height and age of the patient are unknown, I will assume some average values. Let's assume the patient is male, weighs 70 kg, is 175 cm tall, and is 30 years old.
BMR = (10 x 70) + (6.25 x 175) - (5 x 30) + 5 = 700 + 1093.75 - 150 + 5 = 1648.75 calories per day
Next, estimate the calories burned during each activity. MET (Metabolic Equivalent of Task) values can be used to estimate energy expenditure for various activities (Sanchez-Lastra et al., 2024). One MET is approximately the energy expended while sitting at rest (Sanchez-Lastra et al., 2024).
Here's an estimation of the patient's daily activities and calorie expenditure:
1. *Wake up and fresh up (6:00 am - 6:30 am):* Light activity like washing and dressing might expend around 2 METs. Assuming this takes 30 minutes (0.5 hours):
* Calories burned = 2 METs x 70 kg x 0.5 hours = 70 calories
2. *Breakfast (7:00 am - 7:10 am):* Eating is a low-intensity activity. The thermic effect of feeding (TEF) refers to the increase in energy expenditure after consuming a meal (Shiroma et al., 2012)(Chung et al., 2018). This effect is included in the total daily energy expenditure (Shiroma et al., 2012). Assuming 1 MET:
* Calories burned = 1 MET x 70 kg x 0.17 hours ≈ 12 calories
3. *Commuting by bus (7:10 am - 9:00 am):* Sitting on a bus is considered sedentary behavior (WEXLER & GOLDNER, 2021). Assuming 1.5 hours of sitting (1.0 MET):
* Calories burned = 1 MET x 70 kg x 1.83 hours ≈ 128 calories
4. *Teaching (9:00 am - 12:00 pm):* Teaching involves standing and some physical activity. This can be considered light to moderate activity (2.0-3.0 METs). Assuming an average of 2.5 METs for 3 hours:
* Calories burned = 2.5 METs x 70 kg x 3 hours = 525 calories
5. *Lunch (12:00 pm - 1:00 pm):* Similar to breakfast, this involves eating and some light activity (1.5 METs). Assuming 1 hour:
* Calories burned = 1.5 METs x 70 kg x 1 hour = 105 calories
6. *Journey back home (4:00 pm - 6:00 pm):* Traveling by bus (1.0 MET). Assuming 2 hours:
* Calories burned = 1 MET x 70 kg x 2 hours = 140 calories
7. *Tea break (5:00 pm):* Similar to the breakfast activity (1.0 MET). Assuming 15 minutes (0.25 hours):
* Calories burned = 1 MET x 70 kg x 0.25 hours = 18 calories
8. *Watching TV and personal work (6:00 pm - 9:00 pm):* Sedentary behavior (1.0-1.5 METs). Assuming an average of 1.25 METs for 3 hours:
* Calories burned = 1.25 METs x 70 kg x 3 hours = 263 calories
9. *Dinner (9:30 pm):* Similar to breakfast and lunch (1.0 MET). Assuming 20 minutes (0.33 hours):
* Calories burned = 1 MET x 70 kg x 0.33 hours ≈ 23 calories
*Total estimated calories burned:* 70 + 12 + 128 + 525 + 105 + 140 + 18 + 263 + 23 = 1284 calories
*Total Daily Energy Expenditure (TDEE):*
TDEE = BMR + Calories burned from activities
TDEE = 1648.75 + 1284 = 2932.75 calories
Therefore, based on these assumed values, the patient could be burning approximately 2933 calories per day.
It's important to note that this is a rough estimate. Several factors can influence energy expenditure, including age, sex, body composition, genetics, and the intensity of physical activities (Spady, 1980)(Shiroma et al., 2012). Also, the accuracy of estimating energy expenditure through questionnaires can be limited (Shiroma et al., 2012). For instance, studies show that even among individuals with similar activity levels, BMR can vary (Spady, 1980). Equations for predicting BMR may overestimate BEE in certain populations (Hugli et al., 1996). Furthermore, people's perceptions of calorie expenditures can be inaccurate (Hills et al., 2014). More precise measurements, such as those obtained through indirect calorimetry or wearable activity monitors, would provide a more accurate assessment (Shiroma et al., 2012). The use of heart rate and physical activity monitors can help quantify energy expenditure (Allan et al., 2019).[ScienceNavigator(new LLM)]
[26-07-2025 09:34] PA: It's not my timetable
6am- wakeup time
6-6:30 am- freshup
7:00 am Two puri, chicken curry
7:10 am Going to my school by bus
Reached- 9 Am
9am -12 pm teach the lessons
12 pm to 1 pm lunch
Rice and curry
4-6 pm journey back home
5 pm cup of tea
6pm to 9 pm waching tv, Personal works
9: 30 pm dinner rice and egg curry
[26-07-2025 09:38] PPM 1: 👆 yes this is your patient's timetable?
[26-07-2025 12:36] CR: @PPM 4 please you talk to the patient.
[26-07-2025 18:37] PA: Today
7am- wakeup time
7-7:30 am- freshup
8:00 am Two puri, chicken curry
8:00 am Going to my school by bike
Reached- 9 Am
9am -12 pm teach the lessons
12 pm to 1 pm lunch
Rice and Egg curry
4-6 pm journey back home
6 pm cup of tea
6pm to 9 pm using mobile &, waching tv, down the bed
9: 30-10 pm dinner rice and egg curry
[26-07-2025 18:40] PA: My high is 161 cm
Weight is 72
Age is 27
[26-07-2025 18:41] PPM 1: The patient's bus takes two hours?! From which place to which place?
[26-07-2025 18:42] PA: Suryapet to Thirumalagiri and going to velisha
[26-07-2025 18:42] PA: 50 km
[27-07-2025 13:49] PA: Today
9am- wakeup time
9:30 am- freshup
10:00 Am upma,
1 pm to 2 pm lunch
Rice and chicken curry
[27-07-2025 14:08] PPM 1: What hourly physical activities?
[27-07-2025 16:17] PA: Good
[27-07-2025 16:17] PA: 1 hour
Today
woke up at 6 am
6-6:30 am- freshup
7:00 am Two chapathi , curry alu kurma
7:10 am Going to school by bus
Reached- 9 Am
9am -12 pm teach the lessons sometimes sitting and teaching lessons
12 pm to 1 pm lunch
Rice and curry ladies finger
4:30-6 pm journey back to home
5 pm cup of tea
6pm to 9 pm watching tv, Personal works
9: 30 pm dinner rice and ladies finger curry
PPM 1: 👍
[30-07-2025 22:47] PA: Hi sir
Today
Wake up 6 am
6-6:30 am- freshup
9:00 am Two chapathi , curry cabage
7:10 am Going to school by bus
Reached- 9 Am 9:00 am Two chapathi , curry cabage
9am -12 pm teach the lessons some times sitting and teaching lessons
12 pm to 1 pm lunch
Rice and curry ledies finger
4:30-6 pm journey back to home
6 pm cup of tea
6pm to 9 pm waching tv , Personal works
9: 30 pm dinner Biryani rice mutton curry
[31-07-2025 09:52] PPM 1: Please elaborate about his activities from 9:00 AM to 12:00 PM how many times was he sitting and standing and every time for how much time (duration of sitting and standing).
Can also elaborate about the teaching delivered as it's likely to be entwined in the hourly workflow
[31-07-2025 11:51] PA: Ok
[31-07-2025 18:17] PA: Most of the time sitting on chair or sitting on the ground.
[01-08-2025 08:48] PPM 1: Can you share the total time the patient sits on the chair vs sitting on the ground?
[01-08-2025 17:53] PA: 1.30 hour sitting in the bus traveling
3hour sitting on the chair,1 hour sitting on the ground
[01-08-2025 20:57] PA: Hi sir
Today
Wake up 6 am
6-6:30 am- freshup
9:00 am Two chapathi, Broadbeans curry
7:10 am Going to my school by bus
Reached- 9 Am
9am -12 pm teach the lessons some times sitting and teaching lessons
12 pm to 1 pm lunch
Rice and curry tamata
4:00pm-5:30 pm journey back to home
6 pm cup of tea
6pm to 9 pm watching tv, Personal works
9: 30 pm dinner rice and dal
[01-08-2025 20:58] PA: Evening 1hour walking
[01-08-2025 21:04] PPM 1: Best to finish dinner by 7PM
[01-08-2025 21:05] PA: I will try
[02-08-2025 04:58] PPM 2: What are his activities between 1PM to 4PM?
[02-08-2025 08:50] PA: Teaching
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