SUNDAY 29 JANUARY 2023
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.
Previous links of this case report are given below 👇
B/L PEDAL DEMA - 20 DAYS
FACIAL PUFFINESS - 20 DAYS
BREATHLESSNESS - 1 DAY
HOPI:
PATIENT WAS APPARENTLY ASYMPTOMATIC 10 YEARS BACK THEN WAS DIAGNOSED WITH DM-1 AND IS ON INSULIN MITARD (20U-X-16U).SHE HAD 2 EPISODES OF WEAKNESS, UNCONTROLLED SUGARS FOR WHICH SHE WAS ADMITTED FOR A DAY &DISCHARGED ( 1ST EPISODE 5YEARS BACK AND 2ND EPISODE 3 YEARS BACK RESPECTIVELY).ON NOV
2022 PATIENT WAS TAKEN TO GOVT HOSPITAL I/v/O SOB AND WAS DIAGNOSED WITH DENOVO HYPERTENSION, UNCONTROLLED SUGARS ( STARTED ON ? HTN MEDICATION).ON 2ND JAN 2023, SHE HAD EPISODES OF VOMITINGS, LOOSE STOOLS AND WAS ADMITTED IN AIIMS & WAS DIAGNOSED WITH PANCYTOPENIA ,DIABETIC NEPHROPATHY, DILATED CARDIOMYOPATHY,HTN ,VIT D DEFICIENCY RIGHT EYE PSEDUOPHAKIA AND LEFT EYE IMSC WITH HYPERPIGMENTED LESION ON RIGHT FOOT (?
CALLOSITY).6 DAYS BACK SHE DEVELOPED PEDAL EDEMA AND SOB WHICH WAS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE (GRADE 2 TO 4) ASSOCIATED WITH ORTHOPNOEA AND WAS BROUGHT TO OUR HOSPITAL AS HER SYMPTOMS DIDN'T SUBSIDE.
PAST HISTORY:
K/C/O DM TYPE 1 SINCE 10 YEARS AND IS ON INSULIN
K/C/O HTN FROM 2 MONTHS AND ON T TELMA+CLINIDIPINE AND T METXL
H/O OF RIGHT EYE CATARACT SURGERY: 8 YEARS BACK
PERSONAL HISTORY:
APPETITE - NORMAL
DIET - MIXED
BOWEL AND BLADDER - REGULAR
SLEEP - ADEQUATE
GENERAL EXAMINATION:
PT IS C/C/C
PALLOR: PRESENT
PEDAL EDEMA - PRESENT, PITTING TYPE, TILL KNEE NO ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY
VITALS ON ADMISSION:
PR-113 BPM
BP- 220/120MM HG
RR- 26 CPM
SPO2- 72% AT RA
GRBS - HIGH
SYSTEMIC EXAMINATION:
1) PER ABDOMEN:
INSPECTION: UMBILICUS IS CENTRAL AND INVERTED, ALL QUADRANTS MOVING EQUALLY WITH RESPIRATION, NO SCARS, SINUSES, ENGORGED VEINS, PULSATIONS.
PALPATION: SOFT, NON TENDER.NO ORGANOMEGALY.
ASCULTATION: BOWEL SOUNDS - HEARD
2)RESPIRATORY SYSTEM:
INSPECTION: SHAPE OF THE CHEST IS ELLIPTICAL. B/L SYMMETRICAL. BOTH SIDES MOVING EQUALLY WITH RESPIRATION..NO SCARS,SINUSES, ENGORGED VEINS,PULSATIONS.
PALPATION:NO LOCAL RISE OF TEMPERATURE AND TENDERNESS.TRACHEA IS CENTRAL IN POSITION.EXPANSION OF CHEST IS SYMMETRICAL VOCAL FREMITUS IS NORMAL
PERCUSSION: RESONANT BIL
ASCULTATION: BAE + , NVBS HEARD
3) CVS:
INSPECTION: B/L SYMMETRICAL, BOTH SIDES MOVING EQUALLY WITH RESPIRATION, NO SCARS, SINUSES, ENGORGED VEINS, PULSATIONS.
PALPATION: APEX BEAT FELT IN LEFT 5TH ICS. NO THRILLS AND PARASTERNAL HEAVES.
ASCULTATION: S1S2 +, NO MURMURS
4) CNS:
PATIENT WAS C/C/C.
HIGHER MENTAL FUNCTIONS- INTACT
GCS - E4V5M6
B/L PUPILS - NORMAL SIZE AND REACTIVE TO LIGHT
NO SIGNS OF MENINGEAL IRRITATION,CRANIAL NERVES- INTACT, SENSORY SYSTEM-NORMAL,
MOTOR SYSTEM: TONE- NORMAL, POWER- 5/5 IN ALL LIMBS REFLEXES: BICEPS - 2+, TRICEPS-2+, SUPINATOR + , KNEE - 2+, ANKLE - 2+
Diagnosis:
TYPE 1 DM WITH UNCONTROLLED SUGARS (RESOLVING)
WITH HYPERTENSIVE EMERGENCY (RESOLVED)
?NEPHROTIC SYNDROME
WITH HFpEF (EF:66%)
BICYTOPENIA SECONDARY TO B12 DEFICIENCY
ANEMIA OF CHRONIC DISEASE
HEPATIC HEMANGIOMA
HTN SINCE 2 MONTHS &DM SINCE 20 YEARS NON PROLIFERATIVE DIABETIC RETINOPATHY]
Treatment:
1.IVF NS @ 30 ML/HR
2.STRICT DIABETIC DIET
3.INJ LASIX 40 MG IV BD
4.T TELMA 40 MG PO BD
5.T CLINIDIPINE 10 MG PO BD
6.T METXL 25 MG PO OD
7.T DYTOR PLUS PO OD
8.T NICARDIA 20 MG PO BD
9.INJ HAI ACCORDING TO GRBS
10.INJ GLARGINE 10 U @ 10 PM
11.T THYRONORM 25 MCG PO OD
BRIEF COURSE IN HOSPITAL: (6/2/23) PATIENT WAS BROUGHT TO THE HOSPITAL WITH ABOVE COMPLAINTS AND NECESSARY INVESTIGATIONS WERE DONE, HER SUGARS WERE FOUND TO BE HIGH AND BP BEING 220/110MMHG ON PRESENTATION AND WAS TREATED SYMPTOMATICALLY. REFRRALS WERE TAKEN FROM ENDOCRINOLOGIST I//O HIGH SUGARS,NEPHROLOGIST I/V/O HIGH CREATININE AND OPTHALMOLOGIST INIO DIABETIC &HYPERTENSIVE RETINOPATHY CHANGES.INITIALLY FOR HYPERTENSION,SHE WAS TREATED WITH T. TELMA 40MG + CLORTHALIDONE 12.5MG AND T.METXL 25MG AND LATER ON WAS FIXED ON T.NICARDIA 20MG PO/BD(8AM-X-8PM) AND ON ADVISE OF NEPHROLOGIST INJ ERYTHROPOIETIN 2000 UNITS S/C WAS GIVEN. THYRONORM 25MCG WAS STARTED I//O HYPOTHYROIDISM ON 4/2/23 AND PATIENT WAS DISCHARGED UNDER HEMODYNAMICALLY STABLE CONDITION.
Patient has been in constant touch with our doctor’s via PAJR group
Here’s the conversation from today(19/2/23)
Ragi mudda na ??
With jaggery...
That's too much sugar! Please avoid Jaggery 😳
FEBRUARY 25, 2023
A 29 Y/O FEMALE WITH SOB, EDEMA, FACIAL PUFFINESS
edema, facial puffiness and sob
NECESSARY INVESTIGATIONS WERE DONE, HER SUGARS WERE FOUND TO BE HIGH AND BP BEING 220/110MMHG ON PRESENTATION AND WAS TREATED SYMPTOMATICALLY. REFRRALS WERE TAKEN FROM ENDOCRINOLOGIST I//O HIGH SUGARS,NEPHROLOGIST I/V/O HIGH CREATININE AND OPTHALMOLOGIST INIO DIABETIC &HYPERTENSIVE RETINOPATHY CHANGES.INITIALLY FOR HYPERTENSION,SHE WAS TREATED WITH T. TELMA 40MG + CLORTHALIDONE 12.5MG AND T.METXL 25MG AND LATER ON WAS FIXED ON T.NICARDIA 20MG PO/BD(8AM-X-8PM) AND ON ADVISE OF NEPHROLOGIST INJ ERYTHROPOIETIN 2000 UNITS S/C WAS GIVEN. THYRONORM 25MCG WAS STARTED I//O HYPOTHYROIDISM ON 4/2/23 AND PATIENT WAS DISCHARGED UNDER HEMODYNAMICALLY STABLE CONDITION.
Patient has been in constant touch with our doctor’s via PAJR group
28/1/23:-
BLOOD PRESSURE TIMELINE:-
10 am - 220/110
11 am - 200/100
12 pm - 200/100
2 pm -190/100
3pm-180/90
5pm -170/90
6pm -170/90
7pm -170/80
8pm-160/80
9pm-150/90
10pm140/90
29/01/23:
GRBS TIMELINE: -
12 am - 256
1 am - 249
2 am - 276
3am -323
4 am -382
5 am - 426
6 am -494
7 am-499
8am -482
9am -460
10am-540
11am- 493
12pm-480
1pm-460
2 pm -456
3pm-420
5pm -395
6pm -314
7pm -254
8pm-134
9pm-148
10pm-140
11pm-79
Here’s the conversation from today(19/2/23)
Ragi mudda na ??With jaggery...That's too much sugar! Please avoid Jaggery 😳Yesterday -(24/02/23)- Friday
8am- 159/123- Tab .Nicardia 20mg
10am- 112/66
11am- 125/76
1pm-150/98- Tab .Telma 40mg
3pm-152/96
4:30pm- 154/98 .
6:15pm- 193/119 -Tab Nicardia 20mg
8pm-152/103
9:30pm- 115/65
10:20pm- 121/78
Conversation from today ( 25/2/23)
For lunch-
Took 6 Units of insulin today
25/02/23 (Saturday)-
Dinner -
Yesterday - 25/02/23- Saturday
GRBS TIMELINE:-
8am- 278 (GRBS)- 8units HAI.
Lunch- No GRBS- 6 HAI
8:30pm-GRBS-155- 6units HAI
10pm- Glargine - 8units
BLOOD PRESSURE TIMELINE:-
8am-162/126 -Tab Nicardia 20mg
10am- 126/74
11:15am -124/75
1pm- 139/92- tab Telma 40mg
3PM-146/100.
5PM-163/108- Tab Nicardia 20mg .
6:30pm -130/84
7:30pm -113/69
10pm -134/86- Tab Amlodipine 5mg.
26/02/23 (Sunday):-
For Breakfast -
GRBS TIMELINE:-(26/02/23)
9:10am- 8HAI units - No GRBS.
1pm- 266- 12HAI.
8pm- 81 - 4 HAI.+ 8 Glargine
For Lunch
8:50am -HAI-8 u
1:15 pm- 279-HAI- 6 u
8:05 pm -359-HAI - 8u
10:00 pm - glargine-10 u
Anti hypertensive medication: -
8am- tab Nicardia 20mg
1pm - Tab Telma 80mg
5pm - Tab Nicardia 20mg
9pm- Tab Amlodipine 5mg.
28/02/22- Tuesday :-
GRBS-
9am- 8units HAI-
1pm- 265-10 HAI
8pm- 135-6HAI + 8 Glargine
March 1 st 2023:-
8am- 148/102- tab Nicardia 20mg
10am- 103/59
11am- 109/58
12pm- 114/68
1pm-126/82- Tab Telma 80mg
2:45- 129/81
4:15- 136/88
5:30- 149/94 -tab .Nicardia 20mg
8:10pm- 126/78
10pm- 118/72- Tab Amlong 5mg
1/03/23- GRBS
9am- FBS -322- 10HAI
1:30pm- 361-12 HAI
8pm- 63- No HAI + 8 Glargine.
Thursday: 2/03/23:-
8AM- 167/106.- Tab Nicardia 20mg
10:30AM- 105/58
12PM- 114/67
1PM- 128/80- *Tab Telma 80mg
3PM- 133/82
4:30PM- 146/95- *Tab Nicardia 20mg
6:30PM- 146/97
10PM- 111/65.- *Tab Amlong 5mg
Thursday - 2/03/23 - GRBS
8AM- Not seen-8 HAI
1PM- High -12 HAI
3PM- 226
8PM- Not seen.- 6 HAI + 8 Glargine
3/03/23- Friday
8:10am- 155/105- Nicardia 20mg
10:00 am - 105 by 53
11:00 am -107 by 63
1:00 pm - 130 by 82- Tab Telma 80mg
3pm- 126/83
4:15pm- 139/90
6:15pm- 145/94- *Tab Nicardia 20mg
8pm- 146/98
10pm- Amlodipine 10mg ?
GRBS:-
9pm- 214 - 8HAI
1:30pm- Lunch- 10HAI
8:30pm- Dinner - 226- 8 HAI+ 8 Glargine.
4/03/23- Saturday:-
8AM- 143/93- Tab Nicardia 20mg
10:30 am - 105 /59
11:30 am- 115 / 69
1pm- 130/81- Tab Telma 80mg
3PM- 141/93
4:30PM- 138/88
6PM- 149/97- Tab Nicardia 20mg
8PM- 149/101
10PM- 118/64.- Tab Amlodipine 10mg
GRBS :-
8AM- No GRBS- 6 HAI
2PM- H1- 12 HAI
8PM- 241- 8 HAI.+ 8 Glargine
5/03/23- Sunday :-
8am - No GRBS- 8 HAI.
1pm- 372- 12 HAI.
8pm- 359- 8 HAI.+ 8 Glargine.
BLOOD PRESSURE TIMELINE:-
8am- 142/92- Tab Nicardia 20mg.
10:00am -102/ 55
11:00 am- 107 /63
12:40 pm - 112/ 69 -tab Telma 80mg
3pm- 127/97.
4:40 pm- 135/ 81
6:50 pm -137 /91--Tab .Nicardia 20mg.
10:00 pm - 101/ 58 -Tab Amlodipine 10mg.
6/03/23..Monday:-
8:20am- 145/90- *Tab Nicardia 20mg
10:30am- 102 /54
11:40am- 103 /57
1pm- 110/69- *Tab Telma 80mg
3pm- 110/71
4:15pm- 124/76
6:20pm- 121/80- *Tab Nicardia 20mg
8pm- 122/74
10pm- 108/63- *Tab Amlodipine 10mg
GRBS-
8am- 541- 10HAI.
11am- 407
1pm- 261-10HAI.
4pm- 103
8pm- 262- 6 HAI + 8 Glargine.
7/03/23- Tuesday:-
8:20am- 141/91- *Tab Nicardia 20mg*
10:30 am- 95 /51
11:30 am -109/ 62
1pm- 126/73- *Tab Telma 80mg*
3:00 pm-124/ 76
4:00 pm-128 /80.
5:40 pm- 136/ 86.
6:30 pm- 148/ 93- Tablet Nicardia 20mg
10pm- 108/62- *Tab Amlodipine 10mg*
2:20am( 8/03/23)- 132/82
GRBS-
8AM- no GRBS - 8 HAI
11AM- 459
1PM- 387- 12 HAI.
3PM- 161.
8PM- 248- 6 HAI. + 8 Glargine.
2AM- 165 - ( 8/03/23).
9/03/23- Thursday:-
8AM- 129/79 . *Tab Nicardia 20mg
10:30AM - 102/ 60.
11:30 AM- 111/64
1:00 PM- 124/73.. *Tab Telma 80mg
3:30pm- 125/78
4:30 pm- 136 /80.
6:30 pm -131/84 -Tab Nicardia 20mg
8:00 pm - 130/84
10pm- 107/66- *Tab Amlodipine 10mg
GRBS:-
8AM- No GRBS- 10 HAI
1PM- 222- 10 HAI
8PM- 98- 6 HAI + 8 Glargine
10/03/23- Friday
8:15 AM- 139/91- Tab Nicardia 20mg
10:30 am- 106/ 57
11:30 am - 109 /65
1:00 pm - 114/ 70 -Tab.Telma 80mg
4:30 pm - 129 /82
6:30 pm - 139/ 86Tab Nicardia 20mg
8:00 pm - 136 /88
10:00 pm - 110/ 63Tab Amlodipine 10mg*
GRBS-
8AM- 377- 10HAI.
1PM- No GRBS- 10HAI
8PM- 155- 6HAI + 8 Glargine.
11/03/23- Saturday
9:30 am- 117 / 67 *.Tab Nicardia 20mg*
11:30 am -99 /60
1:00 pm -124 /81 . *Tab Telma 80mg*
2:30 pm- 146/86
4:00 pm -134 /83
5pm- 139/89
6:20pm- *145/92 ..Tab Nicardia 20mg
8pm- 110/63
10pm- 121/73- *Tab Amlodipine 10mg
GRBS-
8:20am- 591- 12 HAI
1pm- No GRBS- 10HAI.
8pm- 294- 8 HAI + 8 Glargine.
2AM- 434 .( On 12/03/23).
12/03/23- Sunday
8AM- 141/88.. *Tab Nicardia 20mg*
10:30 am -108 /59.
11:40 am -108 / 65.
1:00 pm -123 /75..Tab Telma 80mg.*
3:00 pm -129/80
4:20 pm - 131 /81
6:40 pm -149/ 92 ...Tab Nicardia 20mg.*
8:15 pm - 125 /77.
10:00 pm- 103/65-Tab Amlodipine 10mg.*
GRBS-
8Am- 541- 12 HAI
1:00 pm- 424...12 HAI
8 PM- No GRBS- 8 HAI + 10 Glargine.
14-03-23(Tuesday)
8:00 am bp is 142 by 92...Tab.Nicardia 20
10:00 am bp is 110 by 57
1:00 pm...not checked..Tab.Telma 80..
3:40 pm bp is 118 by 75
4:30 pm bp is 130 by 82
6:15 pm bp is 136 by 89...tab.nicardia20
GRBS-
8:15 am grbs is 285...HA-12 u
12:40 pm -not checked...HA-12 u
15/03/23- Wednesday.
8am- 139/94- Tab Nicardia 20mg*
10:30 am- 96 /56
1:00 pm - 122/ 75-Tab Telma 80 mg*
4:00 pm -134/ 88
5:30 pm- 139 /89.
6:20 pm-139/92-Tab.Nicardia 20 mg*
8:00 pm- 100 /62.
10:00 pm- 121/ 74-Tab Amlodipine 10mg*
GRBS-
8am- 12HAI.
1pm- 364...12 HAI.
8pm- 181. 6 HAI + 10 Glargine.
16/03/23-Thursday
8am- 141/88- Tab Nicardia 20mg.
10:30 am: 101/ 60
11:30 am: 100/ 63
1:00 pm: 125/ 74- Tab. Telma 80
3:00 pm- 127 /79
5:30 pm -145/ 97
6:15 pm- 155/ 100-Tab Nicardia 20mg
8:15 pm-117/ 67
10:15 pm- 129 /79-Tab Amlodipine 10mg.
GRBS-
8am- 464- 14 HAI
1Pm- No GRBS- 12 HAI
8pm- 320- 8HAI + 12 Glargine
17/03/23- Friday
8:00 am- 154 /101-Tab Nicardia 20mg*
10:30 am: 105 /63
11:30 am :108/ 65
1:00 pm: 123 / 80-Tab Telma 80mg
2:20 pm: 132/81
4:00 pm: 144 /95
5:40 pm: 151/ 94-Tab Nicardia 20mg
8:00 pm:132 /86
10:00 pm: 119/ 75-Tab Amlodipine 10mg*
GRBS-
8am- No GRBS - 14 HAI
2pm- 121 -8 HAI
8pm- 310- 10 HAI+ 12 Glargine
19/03/23- Sunday
8Am- High(H1).. *14 units HAI*
2pm- 446-12 HAI.
8pm- 174- 8 HAI.+ 12 Glargine.
Blood pressure: -
8:10am- 144/96.. *Tab Nicardia 20mg*
10:30 am- 106/ 62
11:30 am -110 /57
1:00 pm- 110/ 72-Tab Telma 80mg*
3:00 pm- 134 /87
4:30 pm -139/ 90
6:30 pm - 155 /94...Tab Nicardia 20mg*
7:40 pm - 131/80
10:00 pm- 115 /66-Tab Amlodipine 5mg
22/03/23- Wednesday
8:00 am-144/ 92...Tab Nicardia 20mg*
10:30 am- 110 / 64.
11:40 am -114/ 70
1pm- *Tab Telma 80mg*
3:00 pm -138 /89
4:00 pm -142 / 90
5:30 pm - 151 /101...Tab Nicardia 20mg*
7;00 pm :129/ 80
8;00 pm :121/77
10:00 pm :118 /72...Tab Amlodipine 10mg*
GRBS-
8am- no GRBS - 10HAI
12pm- Low- 6 HAI
8pm- 488- 12 HAI + 8 Glargine.
23/03/23-Thursday
8:00 am-149/ 98-Tab Nicardia 20mg*
10:30 am - 99 / 53
11:30 am- 110/ 66
1:00 pm - 121 / 74-Tab Telma 80mg*
4:15 pm - 135/ 89
5:40 pm -145/ 95.-Tab Nicardia 20mg*
7:00 pm -142/ 95
8:00 pm - 127 /81-Tab Nicardia 20mg*
10:00 pm -121/73-Tab Amlodipine 10mg*
GRBS-
8am- 310-12 HAI
2pm- No GRBS - 10 HAI
8pm - 92- 6 HAI + 6 Glargine
24/03/23- Friday
8:00 am - 137 /93.
*Tab Nicardia 20mg*
10:30 am- 99 /54
11:40 am - 111 / 64
12:40 pm - 113/ 69-Tab Telma 80mg*
2:30 pm - 129 / 81
3:30 pm -123/ 82
5:30 pm - 148/ 100. *Tab Nicardia 20mg*
8:00 pm -145 / 94
10 :00 pm-101/ 60-Tab Amlodipine 10mg
GRBS-
8am- 332- 8 HAI
2pm- No GRBS- 6 HAI
8pm- 329- 10 HAI + 8 Glargine.
27/03/23- Monday
8:00 am-134 /87-Tab Nicardia 20mg*
10: 30 am - 102 /58
11:30 am - 113 / 67.
12:40 pm - 115/ 69-Tab Telma 80 mg*
3:00 pm -128 /79.
4:30 pm - 132 /81.
5:30 pm -133 /88..Tab Nicardia 20mg
7:00 pm -136 /87
8:00 pm - 136/88
10:00 pm - 104/61...Tab Amlodipine 10mg
GRBS-
8AM: 176... 8HAI
2pm: 192 ...8 HAI
8pm: 149.... 6HAI + 8 Glargine
APRIL 17, 2023
29F BP TRENDS.
[2/23, 2:21 PM] PA: Sir now bp is 143 by 93
[2/23, 2:21 PM] PPM4: Ok
[2/23, 2:21 PM] PA: Mrng 11.00 ap bp is 123 by 73
[2/23, 2:22 PM] PPM 1: Morning what time, how much dose of what BP medicine taken?
[2/23, 2:22 PM] PA: Mrng 8.10 ki nic. Tab veskunna
[2/23, 2:23 PM] PA: Nicardia retard -20
[2/23, 2:23 PM] PA: At 8.10 am
[2/23, 2:24 PM] PA: Sir....3 times BP tablet cheptha annaru kada sir....
[2/23, 2:27 PM] PPM 1: When is the next tablet? Currently only one type of BP tablet?
[2/23, 2:29 PM] PA: Yes sir... present I'm using only one type of bp tablet which is Nicardia 20 at mrng 8 am and evening 6.30 pm sir
[2/23, 3:02 PM] PA: 3 times cheptharaa sir
[2/23, 4:20 PM] PPM 1: Let us see your ten BP readings today and then decide what time do add another tablet
[2/23, 4:57 PM] PA: Ok sir
[2/23, 5:15 PM] PA: 5.10 pm bp is 166 by 110 sir
[2/23, 6:18 PM] PA: 6.15 pm bp is 183 by 122
[2/23, 6:19 PM] PPM 4: Ok.
[2/23, 7:43 PM] PPM 1: Did she take another Nicardia at this time?
[2/23, 7:46 PM] PPM 1: From tomorrow let her take Tablet Telma 40mg after lunch at 1:00 PM and let her take another nicardia tonight after dinner
[2/23, 7:47 PM] PPM 1: Lasix at what time?
[2/23, 8:05 PM] PA: Sir 8.00pm bp is 186 by 121
[2/23, 8:06 PM] PA: 6.15 pm ki nic.tab veskunna sir
[2/23, 8:07 PM] PA: Mrng 8 am and afternoon after lunch 1 pm
[2/23, 9:24 PM] PPM 1: From tomorrow BP tablets and timing:
Tablet Nicardia 20 mg 8:00 AM
Tablet Lasix 40 mg 9:00 AM
Tablet Telma 40mg before lunch 12:00 PM
Tablet lasix 20 mg 2:00 PM
Tablet Nicardia 20 mg 4PM
Tablet Nicardia 20 mg 10 PM
[2/23, 9:25 PM] PPM 4: @PA Okasari potassium chuskondi 15 days tarvatha ... already mee potassium 5.8 undhi.
[2/23, 9:25 PM] PPM 1: Also check BP hourly at random intervals for as many times possible (10-20 times)
[2/23, 9:27 PM] PPM 1: For hyperkalemia it would need to be checked on the same day. I guess that was presumed to be due to Pseudohyperkalemia during blood drawing. Also I guess she can only get these tests when she comes here to visit?
[2/23, 9:28 PM] PPM 4: Ok sir.
[2/23, 9:42 PM] PA: Ok sir
[2/23, 9:42 PM] PA: Repu ha sir
[2/23, 9:59 PM] PA: Now 10.00 pm bp is 113 by 59 sir
[2/23, 9:59 PM] PPM 4: Ok 👍
[2/23, 10:00 PM] PA: Repati nundi ivvi follow avvalaa sir
[2/23, 10:00 PM] PPM 4: Yes repati nundi ivi follow avvali !
[2/23, 10:03 PM] PA: Ok sir
[2/23, 10:13 PM] PPM 1: When was your last BP medicine taken today?
[2/23, 10:14 PM] PA: Sir the exact time is 6.15 pm
[2/23, 10:17 PM] PPM 1: @PPM4 that means the nifedepine action started after 3-4 hours?
[2/23, 10:19 PM] PPM 4: Yes sir...it took 3 hours.
[2/23, 10:19 PM] PA: 6.15 pm ki bp check cheskunna tharvatha tablet veskunna sir
[2/23, 10:26 PM] PPM 4: Ok
[2/24, 9:04 AM] PA: Today mrng 8 am bp is 159 by 123 sir
[2/24, 9:04 AM] PA: Then take nicardia 20 tablet...
[2/24, 9:09 AM] PPM 5: amlodipine given once daily is at least as effective as nifedipine tablets given twice daily in patients with essential hypertension.
[2/24, 9:59 AM] PA: 10 am bp is 112 by 66 sir
[2/24, 9:59 AM] PPM 4: Ok
[2/24, 10:06 AM] PPM 4: *Yesterday* : 23/2/22- Thursday.
8:10 AM: BP not seen - Tab Nicardia 20mg -taken.
11 AM- 123/73
14:20 -143/93
5:10PM: 166/110
6:15PM: 183/122 (tab Nicardia 20mg was taken)
8pm: BP: 186/121
10pm: 113/59.
[2/24, 10:06 AM] PPM 4: @PA. ninna night BP tablet esukunnara ??
[2/24, 10:07 AM] PPM 4: Night 10 pm tarvatha tablet gurinchi em update ledhu.
[2/24, 10:25 AM] PPM 6: Same thing we observed in our patient here sir
23/2/22- Thursday.
8:10 AM: BP not seen - Tab Nicardia 20mg taken.
11 AM- 123/73
14:20 -143/93
5:10PM: 166/110
6:15PM: 183/122 - Tab Nicardia 20mg was taken
8pm: BP: 186/121
10pm: 113/59.
[2/24, 11:12 AM] PA: Ninna evng 6.15 pm ki tablet veskuntunna sir
[2/24, 11:12 AM] PA: And today mrng 8 am ki veskunna sir
[2/24, 11:16 AM] PA: 11: 10 am bp is 125 by 76 sir
[2/24, 11:17 AM] PA: Nyt 10 pm tharvatha tablet veskoledu sir
Today mrng 8 am ki veskunna sir
[2/24, 12:50 PM] PPM 4: Ok
[2/24, 1:06 PM] PA: 1:00 pm bp is now 150 by 98 sir
[2/24, 1:10 PM] PPM 4: Ok
[2/24, 1:11 PM] PPM 4: Tab Telma 40 mg vesukunnara ??
[2/24, 1:11 PM] PA: Ledu sir
[2/24, 1:11 PM] PA: Ippudu veskunta
[2/24, 1:14 PM] PPM 4: Ok
[2/24, 1:38 PM] PA: Exactly 1:30 ki telma 40 veskunna sir
[2/24, 3:01 PM] PA: 3:00 pm bp is 152 by 96 sir
[2/24, 3:02 PM] PPM 4: Ok
[2/24, 3:05 PM] PPM 1: Let's list the medications timing and BP for today again @PPM4
[2/24, 4:28 PM] PA: 4:30 pm bp is now 154 by 98 sir...
[2/24, 4:45 PM] PPM 4: *Today -* 24/02/23- Friday
8am- 159/123- Tab .Nicardia 20mg
10am- 112/66
11am- 125/76
1pm-150/98- Tab. Telma 40mg
3pm-152/96
4:30pm- 154/98.
Sorry for the delay sir...i was in journey.
[2/24, 4:49 PM] PPM 1: Thanks
[2/24, 4:53 PM] PPM 7: Can we give Telma AM (40/10) OD and Nicardia 20 OD? @PPM1 sir?
[2/24, 4:56 PM] PPM 1: Looking at these data @PPM5 @PPM8 @PPM9 Shall we add the Amlodipine 5mg to her schedule tonight at 10:00 PM before sleep?
Do you feel the action of telmisartan hasn't begun yet till 4:30 PM? Also 8:00 AM Nicardia action peaked at 11:00 AM and then stopped working so ideally it's duration of action looks just three hours? @PPM4 Is this an SR preparation of nifedipine?
@PPM7 combinations increase patient adherence aka concordance but they are difficult to titrate
[2/24, 6:19 PM] PA: 6.15 pm bp is now 193 by 119 sir
[2/24, 6:20 PM] PA: Now I'm intake Nicardia 20 tablet
[2/24, 6:29 PM] PPM 4: Initially she was on Cilinidipine 10mg ...but her bp was not controlled, so she was started on tab.Nicardia by treating team.
[2/24, 6:41 PM] PPM 9: Could you put a picture of the tablets you have taken since morning
[2/24, 6:43 PM] PA: Ok sir
[2/24, 6:43 PM] PPM 9: Telma has been taken at 1pm but still the action hasn't begun yet. Telmasartan action usually begins within 1-2 hrs of intake.
[2/24, 6:57 PM] PPM 1: Thanks. So @PPM5 @PPM9 @PPM8 This is giving us an opportunity to realize how a lot of what has been recorded about certain pharmacological actions need to be reunderstood and rewritten?
[2/24, 6:59 PM] PPM 5: Following oral administration, peak concentrations (Cmax) of telmisartan are reached in 0.5-1 hour after dosing. Food slightly reduces the bioavailability of telmisartan, with a reduction in the area under the plasma concentration-time curve (AUC) of about 6% with the 40 mg tablet and about 20% after a 160 mg dose. The absolute bioavailability of telmisartan is dose dependent. At 40 and 160 mg the bioavailability was 42% and 58%, respectively. The pharmacokinetics of orally administered telmisartan are nonlinear over the dose range 20-160 mg, with greater than proportional increases of plasma concentrations (Cmax and AUC) with increasing doses. Telmisartan shows bi-exponential decay kinetics with a terminal elimination half life of approximately 24 hours. Trough plasma concentrations of telmisartan with once daily dosing are about 10-25% of peak plasma concentrations. Telmisartan has an accumulation index in plasma of 1.5 to 2.0 upon repeated once daily dosing
[2/24, 7:11 PM] PPM 5: https://pubmed.ncbi.nlm.nih.gov/1534713/
It has high oral bioavailability (60-80%) and accumulates to a steady-state with once-daily administration over a period of 1-1 1/2 weeks. Fluctuation of plasma drug concentration between doses is between 20 and 25% when once-daily dosing is used. Onset of effect is gradual after oral administration which is due, in part, to an intermediate rate of drug absorption (peak plasma drug concentration occurs 6-8 h after dosing) and perhaps also to the physicochemical characteristics of the drug-cell membrane-receptor interaction. The pharmacodynamic profile of the drug in hypertensive patients is consistent with the disposition of the drug. After single doses, blood pressure decreases gradually over 4-8 h and may slowly return to baseline over 24-72 h. No change in heart rate is noted after the dose as the onset is gradual and physiological reflexes are not activated.
[2/24, 7:18 PM] PPM 5: Pharmacodynamics
In normal volunteers, a dose of telmisartan 80 mg inhibited the pressor response to an intravenous infusion of angiotensin II by about 90% at peak plasma concentrations with approximately 40% inhibition persisting for 24 hours.
Plasma concentration of angiotensin II and plasma renin activity (PRA) increased in a dosedependent manner after single administration of telmisartan to healthy subjects and repeated administration to hypertensive patients. The once-daily administration of up to 80 mg Telmisartan to healthy subjects did not influence plasma aldosterone concentrations. In multiple dose studies with hypertensive patients, there were no clinically significant changes in
electrolytes (serum potassium or sodium), or in metabolic function (including serum levels of cholesterol, triglycerides, HDL, LDL, glucose, or uric acid). In 30 hypertensive patients with normal renal function treated for 8 weeks with Telmisartan 80 mg or telmisartan 80 mg in combination with hydrochlorothiazide 12.5 mg, there were no
clinically significant changes from baseline in renal blood flow, glomerular filtration rate, filtration fraction, renovascular resistance, or creatinine clearance.
[2/24, 8:08 PM] PA: 8.00 pm bp is now 152 by 103 sir
[2/24, 8:37 PM] PPM 1: @PPM4 Please update the BP chart here again in single text along with the drug timings
[2/24, 9:01 PM] PPM 4: *Today -* 24/02/23- Friday
8am- 159/123- Tab .Nicardia 20mg
10am- 112/66
11am- 125/76
1pm-150/98- Tab. Telma 40mg
3pm-152/96
4:30pm- 154/98.
8pm- 152/103.
[2/24, 9:08 PM] PPM 6: @PA, Regarding your query 'index must be in ok range'
It is all about selecting the proper cuff size for accurate bp recordings
[2/24, 9:09 PM] PPM 1: Thanks. Well searched 👏👏, @PPM7 I was unable to search and find this.
Now @PPM6 or @PPM7 Can you explain it to the patient in Telugu?
[2/24, 9:12 PM] PPM 1: So that OK was about cuff length and perhaps not width if we again look at the image shared by the patient advocate?
[2/24, 9:12 PM] PPM 1: He did. But I thought you too were GM
[2/24, 9:34 PM] PA: 9.30 pm bp is now 115 by 65 sir
[2/24, 10:25 PM] PA: 10;20 pm bp is now 121 by 78 sir
[2/24, 10:32 PM] PPM 1: With what?
Did the telmisartan start working now?
[2/24, 10:36 PM] PPM 1: OK thanks.
So the BP came down due to the Nicardia taken at 6:15 PM
Can your patient take Tablet Amlodipine 5 mg now and daily every night?
[2/25, 9:35 AM] PA: Today 8:00 am bp is 162 by 126 sir
[2/25, 9:36 AM] PA: Then take nicardia 20 tablet...
[2/25, 9:40 AM] PPM 1: Did the patient take the Amlodipine 5 mg last night? I guess you couldn't purchase it at night yesterday. Please purchase and keep one strip of ten tablets of Amlodipine 5 mg please.
@PPM4@PPM10 @PPM11 Please share the list of antihypertensives with timings and BP recordings taken yesterday in one single text message like yesterday
[2/25, 9:48 AM] PA: No sir....Patient Amlodipine veskoledu
[2/25, 10:07 AM] PA: 10:00 am bp is 126 by 74 sir
[2/25, 11:16 AM] PA: Amlodipine veskoledu sir
[2/25, 11:17 AM] PA: Veskomani cheppaledu kada sir
[2/25, 11:17 AM] PA: 11:15 am bp is 124 by 75 sir
[2/25, 11:22 AM] PPM 12: @PPM 1 already she has amlodipine tablets sir. She hasn't took the tablet yesterday night sir.
[2/25, 1:08 PM] PA: 1:00 pm bp is 139 by 92 sir
[2/25, 1:08 PM] PA: Telma 40 veskunna sir
[2/25, 1:41 PM] PPM 4: Ninna nicardia night veskunnara or evening veskunnara ??
[2/25, 1:43 PM] PA: Ninna 6:20 pm ki nicardia veskunna sir
[2/25, 1:43 PM] PA: Nyt veskoledu
[2/25, 1:43 PM] PPM 4: Ok
[2/25, 1:48 PM] PPM 4: *Yesterday -* 24/02/23- Friday
8am- 159/123- *Tab .Nicardia 20mg*
10am- 112/66
11am- 125/76
1pm-150/98- *Tab. Telma 40mg*
3pm-152/96
4:30pm- 154/98.
6:15pm- 193/119, *Tab Nicardia 20mg*
8pm-152/103
9:30pm- 115/65
10:20pm- 121/78
[2/25, 2:46 PM] PPM 1: 👆@PPM12@PPM4 We asked her patient to take the Amlodipine here yesterday night but it was understandably late.
Let her take it from today 9:00 PM?
[2/25, 2:48 PM] PPM 1: Going by yesterday's BP and intervention timeline the telmisartan didn't act at all? @PPM12 @PPM4 @PPM5 @PPM9 @PPM8
[2/25, 2:59 PM] PA: Yes sir
[2/25, 2:59 PM] PA: 3:00 pm bp is 146 by 100 sir
[2/25, 3:01 PM] PA: Amlodipine a time ki veskovali sir
[2/25, 3:02 PM] PPM 1: 9:00 PM
[2/25, 3:04 PM] PA: Mari nicardia eppudu veskovali sir
[2/25, 3:04 PM] PA: Nicardia, Telma 40, Amlodipine, Ivvi 3 veskovala sir e roju nundi
[2/25, 3:05 PM] PPM 1: Ninna taken same time: 6:30 PM
[2/25, 3:05 PM] PPM 1: Once the tablet Amlodipine starts working we shall try to slowly remove the Nicardia
[2/25, 3:06 PM] PA: Ok sir
[2/25, 3:06 PM] PA: Ok sir
[2/25, 3:58 PM] PPM 4: Ok sir.
[2/25, 5:02 PM] PA: 5:00 pm bp is 163 by 108 sir
[2/25, 5:03 PM] PA: Nicardia veskunna sir
[2/25, 5:03 PM] PA: Now
[2/25, 5:05 PM] PPM 1: 👆@PPM4 Should have taken nicardia here at 3:00 PM
[2/25, 6:17 PM] PPM 4: Yes sir...i thought of same.
[2/25, 6:29 PM] PA: 6:30 pm bp is 130 by 84 sir...
[2/25, 7:33 PM] PA: 7:30 pm bp is 113 by 69 sir...
[2/25, 7:36 PM] PPM 4: Ok
[2/25, 8:36 PM] PPM 1: Let her take the Amlodipine 5 mg now
[2/25, 10:07 PM] PA: 10:00 pm bp is 134 by 86 sir...
[2/25, 10:07 PM] PA: Amlodipine veskunna sir...
[2/25, 10:53 PM] PPM 4: Ok
[2/26, 12:11 PM] PA: Bp machine koncham problem vachindi sir
[2/26, 12:12 PM] PA: So today bp check cheskoledu sir
[2/26, 12:12 PM] PA: But....mrng nicardia veskunna sir
[2/26, 12:40 PM] PPM 1: Tab Amlodipine was taken twice yesterday?? 😳😨 8:30 PM and 10:00 PM!!
[2/26, 12:42 PM] PPM 1: As per this chart Telma didn't work at all even yesterday? How many days does it take to start working? What can be the reasons for it's not working at all? @PPM4 @PPM6 @PPM12 @PPM8 @PPM5
[2/26, 12:54 PM] PA: No sir.... yesterday 8:30 pm ki Amlodipine veskoledu sir
[2/26, 12:55 PM] PA: Nyt 10:10 pm ki Amlodipine veskunna sir
[2/26, 1:40 PM] PPM 4: Yesterday - 25/02/23- *Saturday*
*8am-* Bp-162/126. (Tab Nicardia 20mg)
*10am-* 126/74
*11:15am -* 124/75
*1pm*- 139/92- tab Telma 40mg
*3PM-* 146/100.
*5PM-* 163/108- Tab Nicardia 20mg.
*6:30pm -* 130/84
*7:30pm* -113/69
**10pm* -*134/86- Tab Amlodipine 5mg.
[2/26, 4:14 PM] PA: 4:10 pm bp is 141 by 99 sir
[2/26, 6:42 PM] PA: 6:40 pm bp is 172 by 110 sir...
[2/26, 6:42 PM] PA: Nicardia 20 veskunna sir
[2/26, 8:30 PM] PPM 1: Should have taken it at 4:10 PM
@PPM4 @PPM5 Theoretically based on past reports when can we expect tablet Amlodipine to start working?
[2/26, 8:58 PM] PPM 4: Sir, Shall we start on tab Nicardia 20mg at 4pm and stop tab Nicardia at 1pm sir??
[2/26, 9:05 PM] PPM 1: 👆She didn't take nicardia at 1PM?
[2/26, 9:06 PM] PPM 4: @PA eeroju madyanam patient em veskunnaru ??
[2/26, 9:14 PM] PA: Telma 40 sir
[2/26, 9:15 PM] PA: Ninna, monna e roju afternoon telma 40 sir
[2/26, 9:49 PM] PPM 4: Today morning, she didn't check her BP...
Sir, I think Removing tablet Telma and starting Nicardia 20mg at 2pm and if morning BP is ok..shall we continue tab amlong 5mg in the night??
[2/26, 9:50 PM] PPM 1: Let her check her BP the whole day tomorrow then before we make any changes to what you have already listed above for yesterday
[2/26, 9:50 PM] PPM 4: Ok sir.
[2/26, 10:01 PM] PPM 5: In a study comparing telmisartan 40–120 mg with the long-acting calcium channel blocker amlopidine 5–10 mg, both treatments produced comparable reductions in clinical blood pressure after 12 weeks in patients with mild-to moderate hypertension (Lacourcière et al 1998). Clinic measurements revealed that both telmisartan and amlodipine reduced trough blood pressure, with no significant difference between the two treatments.
[2/26, 10:05 PM] PPM 1: What was the mean time of onset of action for both these drugs?
What was the time range for their onset of action?
[2/26, 10:24 PM] PPM 5: Telmisartan onset of action is 3 hrs sir.
Amlodipine peak plasma conc is 6-8hrs
[2/26, 10:35 PM] PA: 10:30 pm bp is 116by 71 sir
[2/26, 10:35 PM] PA: Ippudu Amlodipine veskovalaa vodda sir
[2/26, 10:35 PM] PA: Inka veskoledu
[2/26, 11:00 PM] PPM 4: Veskondi
[2/27, 8:09 AM] PPM 1: Looks like both these drugs haven't worked at all for her till now although we may not be having properly captured data to infer that perhaps but @PPM5 what do you think would be the reason someone may not respond to either of these drugs? In your review of literature how many patients could you find who didn't respond to these drugs at all and what were the hypothesis postulated for these non responses?
[2/27, 8:10 AM] PPM 1: @PPM4 Ask her to monitor her BP hourly for these few days while we are trying to adjust the optimal combination for her
[2/27, 8:23 AM] PPM 4: @PA, patient ninna night amlodipine vesukunnara??
Oka 2-3 days konchem hourly BP chudara.
[2/27, 8:29 AM]PA: Ninna nyt Amlodipine veskoledu sir
[2/27, 8:30 AM] PPM 4: Endhuku veskoledhu ??
[2/27, 8:30 AM] PPM 4: Ninna morning and evening oka nicardia theskunnaru
[2/27, 8:30 AM] PPM 4: Tarvatha madyanam oka telam anthena
[2/27, 8:30 AM] PPM 5: Yeah sir msgd u take the medicine also.
[2/27, 8:30 AM] PPM 4: ??
[2/27, 8:30 AM] PA: Today 8:10 am bp is 157 by 111 sir, Nicardia veskunna sir
[2/27, 8:31 AM] PPM 4: Reply ichanu kada
[2/27, 8:31 AM] PA: Mimmalni adigaka veskundam ani aginaa sir.....
But... sorry for that sir
Meeru reply iche lope padukunna sir
[2/27, 8:33 AM] PA: Ninna mrng 8:10 am and evng 6:45 pm...
Two times Nicardia veskunna sir
[2/27, 8:33 AM] PA: Ninna 3 times veskunna sir
[2/27, 8:36 AM] PA: Ninna total 3 bp tablet s veskunna sir
[2/27, 8:37 AM] PA: Only night Amlodipine is missing sir...
[2/27, 8:43 AM] PA: Sorry sir...ninna mis chesanu....
[2/27, 8:43 AM] PPM 4: Ok👍..no problem.
[2/27, 9:26 AM] PPM 13: How about her salt intake in various forms?
[2/27, 9:27 AM] PA: Salt avoid chesaa sir....Salt veskovatledu...
[2/27, 10:15 AM] PA: 10:15 am bp is 105 by 61 sir
[2/27, 10:19 AM] PPM 1: 8AM nicardia 20 is working now.
Going by theory vs this patient's data that can be scrolled above, when do you think she would need the next dose of nifedipine 20? @PPM5 @PPM9 @PPM 4 Let's increase her tablet telmisartan to 80mg from today in the morning
[2/27, 10:24 AM] PPM 5: Sir for today 1pm TELMA 80 we will start and 4pm NIFEDIPINE 20mg and 8pm AMLODIPINE 5mg
[2/27, 10:24 AM] PPM 5: Will that be fine sir?
[2/27, 10:26 AM] PPM 1: Yes but let's wait for the hourly BP values which hopefully the patient should share to decide the exact time of the next drug but for now the above is a good plan except that I may want to delay the 4PM nifedepine to understand if Telma 80 is working at all
[2/27, 11:17 AM] PA: 11:15 am bp is 113 by 69 sir
[2/27, 12:27 PM] PA: 12:30 pm bp is 121 by 81 sir
[2/27, 1:05 PM] PA: 1:00 pm ki telma 40 veskunna sir
[2/27, 1:15 PM] PPM 5: not TELMA 40, sir told TELMA 80mg
[2/27, 2:43 PM] PA: 2:40 pm bp is 137 by 91 sir
[2/27, 4:01 PM] PA: 4:00 pm bp is 141 by 94 sir..
[2/27, 4:31 PM] PPM 1: మీరు ఈరోజే Telmisartan 80 mg తీసుకుంటే బాగుండేది
Mīru īrōjē Telmisartan 80 mg tīsukuṇṭē bāguṇḍēdi
[2/27, 4:32 PM] PA: Afternoon veskovalaa sir idi.....
[2/27, 4:33 PM] PA: Repati nundi veskunta sir...
[2/27, 4:34 PM] PPM 4: Ok
[2/27, 5:01 PM] PA: 5:00 PM bp is 151 by 102 sir...
[2/27, 5:07 PM] PPM 5: U had to take NIFEDIPINE 20mg no now... did'nt you take?
[2/27, 5:08 PM] PPM 1: Telma 40 is not working. Please take nifedepine 20 mg now
[2/27, 5:15 PM] PA: Naku antha confused ga undi sir.....
[2/27, 5:16 PM] PA: Repati nundi em veskovalo oka paper meda rasi pettandi sir
[2/27, 5:16 PM] PA: Avvi theppinchukoni repati nundi follow avutha sir
[2/27, 5:17 PM] PA: Amlodipine and nicardia vodda sir mari
[2/27, 5:31 PM] PPM 4: 8am- tab Nicardia 20mg
1pm - Tab Telma 80mg
5pm - Tab Nicardia 20mg
9pm- Tab Amlodipine 5mg.
[2/27, 5:32 PM] PA: Ok sir
[2/27, 6:10 PM] PA: 6:00 pm bp is 166 by 107 sir...
[2/27, 6:10 PM] PA: Nicardia 20 ippude veskunna sir
[2/27, 6:57 PM] PPM 4: Ok
[2/27, 7:13 PM] PA: Telma 80 dorakatledu sir ma village lo...
[2/27, 7:13 PM] PA: Two medical shop s untayi ma village lo
[2/27, 7:14 PM] PA: Ekkada dorakaledu sir
[2/27, 7:23 PM] PPM 4: Rendu tablets veskondi...
[2/27, 7:23 PM] PPM 4: Ekkadiki vellakandi
[2/27, 8:03 PM] PA: Ok sir
[2/27, 8:04 PM] PA: 8:00 pm bp is 181 by 110 sir
[2/27, 10:00 PM] PA: 10:00 pm bp is 147 by 94 sir..
[2/27, 10:00 PM] PA: Amlodipine veskunna sir....
[2/27, 10:07 PM] PPM 1: @PPM 5 @PPM 4 Let's hope this early morning high recorded here will be taken care of by Amlodipine? Only problem is as she would be asleep and may be unable to take any further readings before tomorrow morning, we may not know when if when it starts acting
[2/28, 8:41 AM] PA: Today 7:15 am bp is 144 by 94 sir....
[2/28, 8:41 AM] PA: 8:05 am bp is 144 by 95 sir....
[2/28, 8:42 AM] PA: Nicardia 20 veskunna sir
[2/28, 10:35 AM] PA: 10:30 am bp is 100 by 57 sir...
[2/28, 11:32 AM] PA: 11:30 am bp is 110 by 66sir
[2/28, 11:34 AM] PPM 1: 👆idi pani chestundi ippudu
[2/28, 12:55 PM] PA: 1:00 pm bp is 125 by 76 sir
[2/28, 12:55 PM] PA: Ippudu telma 80 veskovalaa sir
[2/28, 1:23 PM] PA: Veskunna sir 👍
[2/28, 3:41 PM] PA: 3:40 pm bp is 135 by 87 sir..
[2/28, 5:01 PM] PA: 5:00 pm bp is 146 by 97 sir...
[2/28, 5:04 PM] PPM 1: @PPM5 Is Telma 80 working? Let's see
[2/28, 5:05 PM] PPM 1: What was 5PM BP yesterday @PPM4 ?
[2/28, 5:17 PM] PA: 151 by 102 sir
[2/28, 6:16 PM] PA: 6:15 pm bp is 161 by 102 sir...
[2/28, 6:16 PM] PA: Nicardia 20 veskunna sir
[2/28, 7:40 PM] PPM 1: So @PPM5 @PPM8 @PPM4 Is this 5mm systolic and diastolic blood pressure reduction a result of increasing Telma 40mg to 80 mg today?
[2/28, 7:49 PM] PPM 5: Looks like that only sir
[2/28, 8:03 PM] PA: 8:00 pm bp is 149 by 101 sir...
[2/28, 9:56 PM] PPM 1: 👆This is where Amlodipine started working?
[2/28, 10:05 PM] PA: 10:00 pm bp is 109 by 64 sir...
[2/28, 10:05 PM] PA: Amlodipine veskovalaaa sir??
[2/28, 10:06 PM] PPM 4: Haa veskondi
[19-05-2025 20:01] PPM 1: @PPM4 any update on this patient?
[19-05-2025 20:04] PPM 4: @PA patient ela unnaru??
Emadya group la em pettatledhu ??
[19-05-2025 21:07] PA: Not bad sir
[19-05-2025 21:08] PA: Enduku em jarigindi ?? Health Ela undhi?
[19-05-2025 21:11] PA: Nothing much sir
[19-05-2025 21:11] PA: Bagane unnaru
[19-05-2025 21:11] PPM 4: Ok good 👍
[19-05-2025 21:11] PPM 4: Dinner ayinda?
[19-05-2025 21:12] PA: Thinna sir
Chapati, dhal, beerakaya curry
[19-05-2025 21:12] PA: Meeru dinner ainda sir
[19-05-2025 21:19] PPM 1: Ippudu patient serum albumin and last 24 hour urine protein enta undi? Last serum creatinine?
[19-05-2025 21:21] PPM 1: ఆమె ఎంత ఇన్సులిన్ మోతాదు తీసుకుంటోంది?
Āme enta insulin mōtādu tīsukuṇṭōndi?
How much insulin dose is she taking?
[19-05-2025 21:33] PPM 4: Ayindi, Naadhi egg curry, Beet root and panner.
[19-05-2025 21:47] PA: Nenu beetroot thinocha sir
[19-05-2025 21:48] PPM 4: Thinochu ...Ekkuva quantity theskovadhu ..oxalate shatham ekkuva untadi. Baga theskunte stones aye chance untadi
[19-05-2025 21:49] PA: Ok sir 👍
[19-05-2025 21:49] PPM 4: Ekkadanna work chesthunnara ??
[19-05-2025 21:51] PA: Last year September varaku job continue chesa, Ippudu present velladam ledu
[19-05-2025 21:51] PPM 4: Enduku vellatledu
[19-05-2025 21:52] PA: Health support avvatledu workplace lo
[19-05-2025 21:53] PA: May be koncham better ayyaka continue avutha
[19-05-2025 22:34] PPM 4: Ok ..no problem. Malla em ibbandi ayithundi ??
Ippudu inti daggare unnara ??
[19-05-2025 22:38] PPM 4: Recent ga emanna test lu cheyinchinra ?? Creatinine, albumin atla.
[20-05-2025 09:12] PA: Creatinine 1.94, Blood 7.4
[20-05-2025 09:50] PPM 4: Hemoglobin -7.4 aa
[20-05-2025 12:23] PA: Yes sir
[20-05-2025 12:24] PPM 4: Ok.
[20-05-2025 17:28] PPM 4: Entha theskuntunnaru insulin??
[21-05-2025 10:08] PA: HA.I - 5,6,7...(As per requirement)
Glargine lantus- 6 u.
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