43F Recurrent Tinea Corporis, Metabolic Syn, GAD 20 years WB PaJR

 

March 30, 2023

43F with Tinea Corporis

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.

PAST HISTORY:

The patient is 43 years old female who is a high school teacher. She used to suffer from frequent high fever, throat pain and loose motion in her childhood. She had broken her left elbow at the age of 8. In 1989, she suffered from jaundice. She was diagnosed with allergic rhinitis at 14 years of age.

In the year 2002, for the first time she had severe itching in her neck which resulted in pus. At that time she took homeopathic treatment. She experiences severe itchiness in her feet whenever she wears rubber sandal since 2016. She has been suffering from itchiness in her elbows, thighs, feet, shoulder and private parts since October 2022. Her itchiness in elbows started with dryness along with flakes and bleeding. She had used Clotrimazole cream in her private parts which relieved her from the itching in July. She had used moisturizer on her elbows. Itching in her feet, thigh and shoulder have stopped after using the prescribed medicines.

FAMILY HISTORY:

Mother-She has COPD.

Father(late)- He died because of heart failure.

Brother- He has shoulder injury.

CHIEF COMPLAINTS:

-ITCHING

-DRYNESS

-PUS/FLUID

DRUG HISTORY:

-LULICONAZOLE CREAM (2.5 MONTHS)

-EBERCONAZOLE CREAM (2.5 MONTHS)

-FUDIC CREAM (7 DAYS)

-TECZINE (4-5 TABLETS)

06-01-23

PICTURES OF SKIN LESIONS

18-02-23

20-02-23

06-03-23

08-03-23

17-03-23

29-03-23

PRESCRIPTION:

July 02, 2024

[6/12, 11:29 AM] PA: Aldehyde, Ketone and Carboxylic acid

[6/12, 11:29 AM] PA: Alcohol, Phenol and Ethers

[6/12, 11:29 AM] PA: Amine

[6/12, 11:29 AM] PA: Haloalkhane and Haloarene

[6/12, 11:29 AM] PA: D and F block

[6/12, 11:30 AM] PA: Electrochemistry

[6/12, 11:30 AM] PA: Solution

[6/12, 11:38 AM] PA: These chapters are important for entrance exam for Jadavpur University entrance exam for 43FGAD 's elder daughter.

Please send questions to solve and guide @PPM1⁩ @PPM3 @⁨PPM4 @⁨PPM5 @⁨PPM6@⁨ Psychologist⁩ @⁨PPM7⁩

[6/12, 2:06 PM] PPM 1: She has to share questions and we can try to solve them together

[6/12, 3:32 PM] PPM 1: @PPM8⁩ is a well established chemistry teacher who is willing to help

[6/12, 3:36 PM] PA: Thank you very much 🙏

[6/12, 3:53 PM] PPM 8: https://chemistry.stackexchange.com/questions/173262/reaction-of-methyl-triphenylbenzoate-with-concentrated-sulphuric-acid

Ekhane answer ta dewa ache.

[6/12, 3:55 PM] PPM 8: Aami JU er entrance test er question paper pathachi.

Eto hard question hoi na. Basic concepts er theke hoi.

[6/12, 4:21 PM] PA: Can you please send previous years question papers @PPM8

[6/12, 4:22 PM] PPM 8: NEET pattern question hoy.

Organic name reaction ( Aldol, Cannizaro, pinacol, gattarman, sandmayer, arnd esterd, Hans dekar, estarification, wittig, Schimen, Grignard, Williamson, benzoin, diazonium salt, mulikan burker, Tishchenko etc are important) R/S Nomenclature, Sn1/Sn2 reaction(  feasibility order),chiral carbon, enantiomer, diastereomer, nucleophile, electrophile, carbonation/ anion stability order, resonance, hyper conjugation, IUPAC name (both organic or inorganic compounds)

Reaction conversion (like Acitic acid to lactic acid)

[6/12, 4:24 PM] PPM 8: Ok, I'm trying

[6/13, 6:04 PM] PA: Can you please explain the reason behind this acidic strength order? @PPM8

[6/13, 8:39 PM] PPM 3: I'd say the answer is 3>1>2, but not an option.

@⁨Rakesh Biswas New⁩

[6/13, 9:41 PM] PPM 1: 👆@PPM8⁩

[6/13, 10:13 PM] PA: Thank you very much @PPM8

[6/13, 10:16 PM] PPM 3: This explanation of 1>2>3 is based on electronegativity and inductive effect on acidity. My explanation is based on conjugate base stability.

Compound 3 can spread negative charge over 3 oxygen atoms, making it very stable compared to other two @PPM1 sir⁩ how do we look at this?

[6/13, 10:21 PM] PPM 3: Question asks regarding 'acidic strength'. And we can look at it like this

Concept 1-electronegativity is directly related to polarity of OH bond. Inductive effect tells how electron withdrawing groups reduce/weaken acidity. Conjugate base acid principle is very well established in Biochemistry..It directly relates to energetics of acid dissociation reaction and curve..So depends on how we see it and what we weigh more (in ANN terms).

For exams, maybe what previous year answers tells?

For actually understanding concept, maybe different? @⁨Rakesh Biswas New⁩ @⁨Bibek⁩ 

[6/13, 10:31 PM] PPM 3: @⁨PPM1sir so the answer may different for same question based on application part and the application part for most of the above questions in this and other group is to clear exams?

[6/13, 11:12 PM] PPM 8: In 2, Due to the +R effect of OCH3 group, the OH bond strength increases, H+ ions cannot be easily freed

[6/13, 11:13 PM] PPM 3: That's an amazing way to look at it

[6/15, 10:28 AM] PA: Sir good morning 

Can you please make 50 marks question paper for 43FGAD 's daughter 🙏 @⁨PPM8⁩

[6/15, 11:01 AM] PPM 1: Can send her to his coaching centre. I think he lives nearby

[6/15, 11:03 AM] PA: Sir kothay thaken?

[6/15, 12:29 PM] PPM 8: Coochbehar e

[6/15, 12:37 PM] PA: Sir 43FGAD o tar meyra Jalpaiguri te thake.

[6/15, 12:41 PM] PPM 8: JU er admission test mone hoy 24th June

[6/15, 12:47 PM] PA: Hain Sir

[6/15, 2:28 PM] PPM 8: Ei muhurte joto beshi shonkhok question paper 

Practice kora jabe toto beshi valo hobe,

Amar mone hoy NEET question base kichu boi ( jemon Objective NCERT Fingertips etc) jodi theke thake tobe oi boi guno theke chapter gulo valo kore practice korle entrance test er jonno confidence pawa jete pare. Ami baire thakar jonno question paper set korte ei muhurte parchina, jodi pore somoy thake tobe set kore pathiye debo.

[6/15, 2:29 PM] PA: Ok Sir

[6/15, 2:30 PM] PA: MTG r magazine ache barite @⁨PPM8⁩

[6/19, 9:50 PM] PA: Please help me solve Question no.34 and 35. @PPM8

[6/19, 10:22 PM] PPM 8: Aami ei muhurte Darjeeling e Ghurte eshechi, bari fire dekhe dibo.

[6/21, 10:10 AM] PA: Sir thank you very much 🙏

Amar mey ajkei bolchilo apnar katha j sir question guno slove kore dile khub valo hoto.

[6/21, 10:14 AM] PA: Sir mock test paper kindly toiri kore dewa jabe or jonno?

Specially kono part a besi jor dite hobe?

[6/21, 10:57 AM] PA: Sir, Jadavpur er previous year question no.18,19,23,45 guno kindly slove kore deben 🙏

[6/21, 11:27 AM] PPM 1: Sir er upor ebhabe eto chap dewa ta thik noi Ideally student ek ekta problem solve korar jonye nije ki effort korechen sheta aage ekhane share korle taholei kono Sir aegute pare

[6/21, 11:29 AM] PPM 1: Jadavpur er previous question guno kei mock paper bhebe student oguno solve korar jonye ki procheshta koreche sheta aage ekhane share korle @⁨PPM8 Sir nijer teaching Inputs otar bhittite dite paren

[6/21, 11:36 AM] PA: Student erJadavpur r previous year question tar rough work guno khub siggiri akhane share kora hobe.

[6/21, 1:39 PM] PA: Sir Chemistry r total seat koto kindly clarify korben 🙏. 

Amar mey other board @⁨PPM8

[6/21, 2:06 PM] PPM 8: Fixed seat nei(70-80 approx ), change hoy,

Tobe other board er khetre seat WB board er theke kom.

[6/21, 2:07 PM] PPM 8: Previous year er list dewa ache.

[6/21, 9:34 PM] PA: Student er rough work pathano holo@⁨Rakesh Biswas New⁩ @⁨Bibek⁩

[6/21, 9:36 PM] PPM 1: 👆Eta to shudhu question paper

Rough work er thekeo beshi dorkar eta jana je student ek ekta question solve korar jonye ki bhabe bhabna chinta koreche

[6/21, 9:41 PM] PA: Student question dekhe tar knowledge /learning theke recall kore slove korar chesta kore. Rough work guno nicher dike ache. Ojana question guno se sekheni ba jane na @⁨PPM1 sir⁩ (According to student)

[6/21, 10:09 PM] PPM 1: 👆Etai nicher dikeo pelam na

[6/21, 10:10 PM] PPM 1: Recall based question depending only on factual memory?

[6/21, 10:19 PM] PA: Not only on factual recalling but also logical understanding.

[6/21, 10:26 PM] PPM 1: Can you share one example of how the logic developed in let's say question 1?

[6/26, 6:15 PM] PA: 43FGAD er meyer entrance exam valo hoyeche. Akhon tara result er opekhay. Amra antorik vabe apnader dhannabad janachhi @⁨PPM1⁩ @⁨PPM8⁩ @Psychologist⁩ West Bengal a centralized portal er madhhome onnao college a form fill up suru hoyeche. 

Kon kon college a Kolkata university Chemistry o Microbiology te form fill up kora jete pare a bisoy a apnader motamot proyojon @⁨PPM1⁩ @PPM8🙏

[6/26, 8:00 PM] PPM 8: https://university.careers360.com/colleges/list-of-bsc(hons)-in-chemistry-degree-colleges-in-kolkata

Ekhane college gulo er review dewa ache.

[03-04-2025 12:47] PPM 1: Please describe the events in detail since 2016.

How many similar events?

What was the duration of each event?

What medications were used previously?

Is that white sticky substance all clobetasol ointment?

[03-04-2025 13:09] PA: 43FGAD washroom jawar somoy juto pore jete pochhodo kore. 2016 te juto r fite area te itching r choto choto jol vora fuskuri uthte suru kore. 

4 _ 5 bar arokom hoyeche  .

Akjon dermatologist Clobetasol prescribed korechilen o hawai porte nished koren .

2-3 mas dhore cholto. 

Tarpor se hawai pora bondho kore dey. 

Aber khub norom hawai pore tar khub valo legeche kintu ai prothom tar payer tolay ai jol vora boro boro fuskuri uthe. 

Clobetasol use kora hoyechilo tai se a bar Clobetasol lagate suru kore last 2 days theke. 

Hain sticky substance holo Clobetasol ointment.

[03-04-2025 19:35] PPM 1: @PPM9 your inputs on the best solution to this problem