THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER 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
[14-10-2025 12.30] PPM 1: OPD now:
Internal medicine data can be deduced in the attached video.
External medicine data aka community medicine aka public health: Was beaten up by his youngest son 7 years back due to his selling off one acre of his land for his youngest daughter's dowry following which he went into altered sensorium and then developed speech and mobility deficits gradually progressive since 7 years
👆@PPM3 @PPM4 @PPM5
[14-10-2025 12.42] PPM 3: @PPM1 sir, if we give a visual cue- like asking him to step in to the box (marked on tiles) or to cross the lines (again on the tiles)- does the gait improve?
[14-10-2025 12.43] PPM 5: Of course. Based on the text provided from the file, here is a structured and analyzed summary of the medical case, focusing on the "External medicine / Public Health" details.
This is a complex case with significant medical and social dimensions.
### Case Summary
This is the case of an elderly individual (implied by the context of having adult children and land to sell) who suffered a traumatic event 7 years ago, leading to severe and progressive neurological decline.
### Detailed Medical History (from the text)
* **Precipitating Event:** Seven years ago, the patient was physically assaulted ("beaten up") by his youngest son.
* **Reason for Assault:** The assault was a retaliatory act because the patient sold one acre of his land to fund his youngest daughter's dowry.
* **Initial Symptom:** Following the assault, the patient developed an **altered sensorium** (a state of confused consciousness and awareness).
* **Progressive Neurological Deficits:** Since the event, the patient has developed:
1. **Speech Deficits**
2. **Mobility Deficits**
* **Course:** These deficits have been "gradually progressive" over the 7-year period.
### Medical Analysis & Deductions
1. **Primary Cause:** The sequence of events strongly suggests the neurological damage was caused by the physical assault. The most likely diagnosis is a **Traumatic Brain Injury (TBI)**.
2. **Pathophysiology:** The beating could have caused:
* **Subdural Hematoma:** A collection of blood on the brain's surface, which can develop slowly and cause progressive neurological symptoms like the ones described.
* **Diffuse Axonal Injury:** Widespread damage to the brain's nerve fibers from the force of the trauma.
* **Chronic Traumatic Encephalopathy:** Progressive brain degeneration from repeated head trauma (though a single severe event can also trigger a similar process).
3. **Clinical Presentation:** The "altered sensorium" was the acute phase, which then evolved into chronic and worsening problems with communication (speech deficits) and motor function (mobility deficits), consistent with significant brain injury.
### Public Health & Social Analysis
This case is a stark example of how social issues directly cause severe health outcomes.
* **Elder Abuse:** The patient is a clear victim of physical and likely financial elder abuse by a family member.
* **Dowry System:** The root cause of the violence is linked to the practice of dowry, a harmful socio-cultural tradition that can lead to family conflict and violence.
* **Gender-Based Disparity:** The conflict highlights a family dynamic where resources for a daughter (dowry) are resented by a son, pointing to underlying issues of gender inequality and inheritance disputes.
* **Long-Term Care Burden:** The patient's progressive condition indicates a need for long-term, likely intensive, care. This places a significant physical, emotional, and financial burden on the family and the healthcare system. The original caregiver (potentially the wife or the daughter) is now in a very difficult situation.
### Conclusion
This is not just a medical case of progressive neurological decline but a **preventable tragedy stemming from family violence and harmful social practices**. The patient's health condition is a direct consequence of a physical assault motivated by a dispute over dowry and property.
**In a clinical setting, the next steps would involve:** a thorough neurological workup (like an MRI), assessment for rehabilitation potential (speech therapy, physiotherapy), and a critical social work intervention to address elder abuse and provide support for the caregivers.
[14-10-2025 13.19] PPM 1: Will check that in the afternoon. Thanks. Admitted him now. Thanks. This will be valuable external medicine addition to his case report. Will create his PaJR group shortly.
[14-10-2025 21.34] PPM 6: Ok sir
[16-10-2025 13.06] PPM 1: https://youtu.be/mjdeqNalW0Q?si=dAPY7qcEXkupyGgu
[16-10-2025 13.06] PPM 1: https://youtu.be/mjdeqNalW0Q?si=dAPY7qcEXkupyGgu
The Frontal lobar gait challenge test? @PPM2
[16-10-2025 13.07] PPM 2: Will try finding the reference in Paul Brazis
[16-10-2025 21.44] PPM 6: Sensory - Intact
Motor examination
Tone- Some rigidity on Rt upper limb and other limbs normal
power -5/5 on all limbs
reflexes-ankle, knee reflexes absent;biceps, triceps +2,b/L plantar flexors
cerebellum-Normal
Please share his four point sugar profile!
EMR summary:
Admission Date: 14/10/2025 04:15 PM
Diagnosis:
FRONTAL LOBAR magnetic robotic GAIT
Metabolic syn HTN
ORGANIC MOOD DISORDER, MODERATE DEPRESSIVE EPISODE, TOBACCO DEPENDENCE SYNDROME, ALCOHOL HARMFUL USE
1 episode suggestive of seizures 2 weeks back
Recent cough
CHIEF COMPLAINTS: PT CAME WITH C/O INVOLUNTARY MOVEMENTS OF BOTH UL AND LL SINCE 2 WEEKS
HOPI: PT WAS APPARENTLY ASYMPTOMATIC 2 MONTHS BACK THEN DEVELOPED SUDDEN ONSET INVOLUNTARY MOVEMENTS OF BOTH UL AND LL FOR ABOUT 5 MINUTES NOT CONSCIOUS DURING THE EPISODE, UPROLLING OF EYES PRESENT.
H/O COUGH SINCE 3 YEARS, DRY COUGH CONTINUOUS, A/W SOB EVEN ON REST,
NO H/O CHEST PAIN, PALPITATIONS, PEDAL EDEMA, ORTHOPNEA, PND.
H/O FEVER SINCE 5 DAYS HIGH GRADE WITH CHILLS RELIEVED ON MEDICATION.
NO H/O BURNING MICTURITION, LOOSE STOOLS, VOMITINGS, ABDOMINAL PAIN, HEADACHE.
NO H/O BOWEL INCONTINENCE, H/O HEAD TRAUMA DURING CHILDHOOD.
K/C/O HTN SINCE 3 YEARS (T. TELMA 40 MG PO/OD)
N/K/C/O TB, DM, THYROID, CVA, CAD
PERSONAL HISTORY: STAYS AT HOME, MIXED DIET.
APPETITE – NORMAL, REGULAR BOWEL AND BLADDER MOVEMENTS.
ALCOHOL – EVERY SUNDAY SINCE 5 YEARS.
TOBACCO – BEEDI SINCE 2 YRS, CHUTTA SINCE 50 YRS.
NO KNOWN ALLERGIES.
PT IS C/C/C.
VITALS:
TEMP – AFEBRILE, BP: 130/70 mmHg, RR: 16 CPM, PR: 94 BPM, SPO₂: 96%
GENERAL EXAMINATION:
EDEMA OF FEET PRESENT ON AND OFF SINCE 1 YR (history or examination or both)?
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING OF FINGERS, OEDEMA, LYMPHADENOPATHY.
RS: NVBS.
BAE: PRESENT
P/A: SOFT NON-TENDER
CVS: S1 S2 HEARD NO MURMURS
CNS: TONE – UL: NORMAL, LL: NORMAL
POWER:
UL RT – 5/5, LT – 5/5
LL RT – 4/5, LT – 5/5
REFLEX:
B-RT +2 LT +2; T-RT +2 LT +2; S-RT +2 LT +1; K-RT – LT; A-RT – LT
Plantar: FLEXOR
Gait: Magnetic or robotic gait
15/10/25 PSYCHIATRY OPINION IV/O Psychometric ASSESSMENT
IMPRESSION:
? ORGANIC MOOD DISORDER, MODERATE DEPRESSIVE EPISODE, TOBACCO DEPENDENCE SYNDROME, ALCOHOL HARMFUL USE
Advised:
TAB. SERTRALINE 25 MG 9AM-X-X
NICOTINE GUMS 2 MG PO SOS IF CRAVING PRESENT
BRIEF PSYCHOTHERAPY
TAB. ZOLPIDEM 5 MG X-X-8PM FOR SLEEP DISORDER
---
Investigation
14/10/25:
HB: 12.2, PCV: 34.1, TLC: 3300, RBC: 4.2, PLT: 1.8 L, GRBS: 138
RFT: UREA: 57, CREAT: 1.7
NA+: 139, K+: 3.9, CL–: 101
LFT: TB: 2.26, DB: 1.79, SGOT: 29, SGPT: 17, ALP: 271, TP: 7.3, ALB: 4.3, GLOB: 3.0, AG RATIO: 1.43
SEROLOGY: NEGATIVE
CUE: ALB <30, SUGARS NIL, BILE SALTS AND PIGMENTS NIL, PUS 2–4, EPI 2–3
---
MRI Brain Plain – Impression:
CHRONIC LACUNAR INFARCT IN B/L CORONA RADIATA AND B/L THALAMUS
CHRONIC SMALL VESSEL ISCHEMIA
15/10/25 RFT:
UREA: 55, CREAT: 1.8, NA+: 138, K+: 3.8, CL–: 99
LFT: TB: 1.02, DB: 0.42, SGOT: 26, SGPT: 12, ALP: 292, TP: 6.5, ALB: 4.1, GLOB: 3.0, AG RATIO: 1.71
16/10/25 HBA1C: 5.9
PPBS: 145
---
Treatment Given (Enter only Generic Name)
SALT RESTRICTION <2G/DAY
TAB. TELMA 40MG PO/OD
TAB. PCM 650MG PO SOS
TAB. SERTRALINE 25MG 9AM-X-X
TAB. ZOLPIDEM 5MG X-X-8PM FOR SLEEP DISORDER
SYP ASCORIL 10ML PO/TID 10ML–10ML–10ML
NICOTINE GUMS 2MG PO SOS IF CRAVING PRESENT
BRIEF PSYCHOTHERAPY
---
Advice at Discharge
SALT RESTRICTION <2G/DAY
TAB. TELMA 40MG PO/OD TO BE CONTINUED
TAB. PCM 650MG PO SOS
TAB. ZOLPIDEM 5MG X-X-8PM FOR SLEEP DISORDER
TAB. SERTRALINE 25MG 9AM-X-X
SYP ASCORIL 10ML PO/TID 10ML–10ML–10ML FOR 5 DAYS
NICOTINE GUMS 2MG PO SOS IF CRAVING PRESENT
BRIEF PSYCHOTHERAPY
---
Follow Up:
REVIEW TO GM OPD AFTER 2 WEEKS OR SOS
When to Obtain Urgent Care:
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care:
AVOID SELF MEDICATION WITHOUT DOCTOR’S ADVICE.
DO NOT MISS MEDICATIONS.
In case of Emergency or to speak to your treating FACULTY or For Appointments, please contact
---
[17-10-2025 15.33] PPM 1: 
[17-10-2025 15.33] PPM 6: Ophthal referral done sir. Thanks share his four point sugar profile since admission
[17-10-2025 15.33] PPM 6: This is the only profile I found sir. Fasting appears to be in diabetic range? Yes sir
[18-10-2025 09.29] PPM 1: @PPM6 @PPM9 @PPM8 update?Did the patient fall down from his bed yesterday? How's he now? Can you send his relative to meet me in the OPD now?
[18-10-2025 10.10] PPM 6: Patient is fine sir
Asked sister also, he did not fall from bed sir.
[4:12 pm, 18/10/2025] PPM 1: @PPM6 @PPM9@PPM10 please give him tablet Ultracet half six hourly for today
[18/10, 15:49] Patient Advocate 80M: Hello sir, my father is suffering from knee pain. He is not able to walk at all. He is not able to go to the washroom. Sir, he is crying a lot. He is not able to use any medicine since morning. Sir, you don't know who has not given him anything. Sir, can you please take a look at it.
[18/10, 16:09]pm: Yes I saw him in the morning. We shall give him medications for his knee pain
[4:18 pm, 18/10/2025] Rakesh Biswas Sir: Today's morning rounds history taking and examination update:
Yesterday after discharge he had a seizure and while he didn't fall from his bed he did urinate near the bed and we aren't sure if that's a sign of his frontal lobar loss of urinary inhibition or inability to move to the bathroom due to his magnetic gait or due to his seizure.
He's having frequent seizures since three years monthly and yet hasn't received any anti epileptic drugs till date!
Asked @PPM6 to start him on tablet phenytoin 100 mg three times a day
[7:22 pm, 18/10/2025] PPM 6: I will enquire and let u know sir
[8:10 pm, 18/10/2025] PPM 6: Tablet Phenytoin is not available in the pharmacy here sir
[8:46 pm, 18/10/2025] PPM 1: What is available?
[8:33 am, 19/10/2025] PPM 6: Available in Apollo pharmacy outside hospital sir i enquired, i will get it for him today sir
[11:30 am, 19/10/2025] PPM 1: Also available free of cost in all government primary health centres
[11:33 am, 19/10/2025] PPM 6: Given the mrng dose sir
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