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.
[20-08-2025 21.49] PPM 1: Consistent with pulmonary vasculitic Hypertension due to scleroderma
[20-08-2025 21:52] PPM 2: Raynaud's history?
[20-08-2025 21:55] PPM 1: @PPM3 @PPM4 @PPM5 please check tomorrow if the patient's advocate has a WhatsApp number.
Meanwhile @PPM6 please see if you can take a telephonic history tomorrow since her childhood. Today during rounds from what we could gather she kept insisting that her major issue was shortness of breath since infancy coming intermittently with exacerbations.
Will also need to get her Hrct chest images from our console
[20-08-2025 22:04] PPM 4: Okay sir
[20-08-2025 22:57] PPM 2: That's a massive RA there. Are you suspecting Primary PAH here? @PPM1 Sir - Needs ILD ruled out too. Hoping to see a CXR
[20-08-2025 22:58] PPM 2: Can see on the blog that is what you think. Curious to discuss this x-ray further
[20-08-2025 23:00] PPM 2: X-ray does show a dilated left heart with straightened border and possible multichamber cardiomegaly. Echo suggests otherwise!
[21-08-2025 07:31] PPM 1: Can you perform her nail bed examination for vascular telengiactatic changes using an ophthalmoscope? @Meta AI please explain the methodology further and it's sensitivity and specificity to diagnose scleroderma
[21-08-2025 07:31] Meta AI: Yes, an ophthalmoscope can be used to examine nailfold capillaries for vascular changes, such as telangiectasias, that are associated with systemic sclerosis (scleroderma). This method is referred to as nailfold capillaroscopy, though a dermatoscope or specialized capillaroscope is more commonly used. Here's how it works and its diagnostic utility:
### Methodology:
1. Preparation:
- Ensure the patient’s hands are warm to optimize blood flow to the capillaries.
- Place the patient’s hand on a flat surface with the fingers extended.
2. Magnification:
- Use the ophthalmoscope at its lowest magnification setting (commonly 20x to 40x).
- Apply a drop of immersion oil or water to the nailfold to improve visualization of the capillaries.
3. Examination:
- Focus on the skin just proximal to the cuticle (nailfold area).
- Observe the capillary loops for abnormalities such as dilated capillaries, avascular areas, hemorrhages, or "giant" capillaries.
4. Findings in Scleroderma:
- Early: Capillary dilations and a few hemorrhages.
- Active: Giant capillaries, capillary dropouts, and disorganized capillary architecture.
- Late: Severe capillary loss and avascular zones.
### Sensitivity and Specificity:
- Nailfold capillaroscopy is highly sensitive and specific for diagnosing systemic sclerosis (scleroderma), particularly when characteristic findings are present.
- Sensitivity: Studies report sensitivity ranges from 80% to 90%, depending on the stage of the disease and the expertise of the examiner.
- Specificity: The specificity is similarly high, often above 90%, because the specific capillary patterns seen in scleroderma (e.g., giant capillaries and avascular zones) are rarely seen in other conditions.
- However, findings may overlap with other connective tissue diseases, such as dermatomyositis or mixed connective tissue disease, reducing specificity in some cases.
### Limitations of Using an Ophthalmoscope:
- The ophthalmoscope is not the ideal tool due to its relatively low magnification compared to a capillaroscope or dermatoscope.
- It may not capture subtle or early changes accurately, reducing diagnostic sensitivity in early disease stages.
Would you like more details on how nailfold findings correlate with disease progression?
[21-08-2025 08.14] PPM 1: @PPM7 @PPM3@PPM5 @PPM4 please check out with the dermatologists if they can do this using a dermatoscope, if they have one
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