THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED PROBLEMS 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.
[9.44 am, 29/05/2026] PPM 1: First history from OPD
Gen medicine history from IP day 1
General surgery handwritten history
Progress notes
[12:43 AM, 5/30/2026] PPM 2: Please if possible mention the type of diabetes in the title, as this becomes the case title and the bot can filter out types correctly in later searches. Will mark it as 2 for now.
[10:26 AM, 5/30/2026] PPM 1: There could be some uncertainty about the type going by the patient's phenotype!
[11:37 AM, 5/30/2026] PPM 1: He's progressing toward bicytopenia even as his creatinine is slowly reducing daily
Do we have his iron profile parameters? From what I vaguely recall from yesterday's notes, iron profile was normal? Is it unexplained anemia that needs a bone marrow? Let's discuss this with pathology team at least in that group. Please add all the willing pathologists and radiologists to that mmch group
[11:39 AM, 5/30/2026] PPM 3: Ok sir. On 21/5/26 report sir
[11:53 AM, 5/30/2026] PPM 1: Ask the patho team how specific is their retic count
Ferritin would have been more useful than what we currently have?
24 hour Urinary protein creatinine and electrolytes are needed if we want to check for glomerular injury as well as renal sodium retention
[11:53 AM, 5/30/2026] PPM 3: Ok sir
[5:31 PM, 5/30/2026] PPM 1: First CT after decompression of the post renal obstructive uropathy?
[5:31 PM, 5/30/2026] PPM 3: Yes sir
[5:32 PM, 5/30/2026] PPM 1: We need to get his and all other diabetic's four point sugar profile as in
Fasting
Two hours Post Breakfast
Two hours post lunch
Two hours post dinner
[5:32 PM, 5/30/2026] PPM 3: Ok sir
[10:23 AM, 6/1/2026] PPM 1: Yesterday's blood sugars?
[10:50 AM, 6/2/2026] PPM 1: Today's update
Problems:
Severe anemia 5.3 hb
Macro micro Hematuria with 6-7 RBCs in urine microscopy
Anorexia, weight loss
Urinary bladder pain and obstructive uropathy currently relieved by Foleys catheterization but planned for cystoscopy and potential prostatic tumor biopsy
Planned for blood transfusion just before biopsy
Already on finasteride and tamsulosin for his lower urinary tract symptoms LUTs since 2 years before his recent bladder pain and Hematuria since one month
The serum creatinine of 4.7 presumably due to his obstructive uropathy has come down to 2.3 over last two weeks
The renal cortical thinning is presumably less on imaging although it's difficult to quantify how much less as we don't have the initial images.
[10:54 AM, 6/2/2026] PPM 1: This is his current renal cortical diameters with cortical thinning reduction although we don't have a visual of his renal cortical thinning before the hydronephrosis was decompressed by the Foleys catheter
[10:56 AM, 6/2/2026] PPM 1: Photo
👆this was the USG image of the kidneys 6 days later
[10:56 AM, 6/2/2026] PPM 1: 👆first ultrasound here but we don't have the image
[11.57 AM, 04/06/2026] PPM 1: Update
Planned for cystoscopy to investigate his urethral obstruction further and essentially to rule out prostatic carcinoma with a cystoscopic biopsy.
@PPM4 @PPM3 in the rounds yesterday there was some discussion on why the urology were not wanting to do a biopsy now as in due to the fear of precipitating further Hematuria?
Also his Hb went up by two points after our PGY1 @PPM4 donated his own blood and we need to know what is the epidemiologic data around the spectrum of Hb rise after one unit of blood transfusion because traditionally on an average it has always been believed that the Hb rises one unit with one unit of blood transfusion. @PaJR Health do share the epidemiologic range of Hb increment values globally after single unit of blood transfusion and share supporting real article links to back your data
Dietician notes demonstrate an interesting potential thesis on dietary interventions including product supplements
@PPM4 also reiterated the four point sugar request here along with making a handwritten note on file of how the Hb changed after a single BT day before yesterday
[12.48 PM, 04/06/2026] PPM 1: This patient grew multi drug resistant CRE (carbapenem resistant enterococci ) in his urine culture and while he did have fever documented once from the OPD on the day of admission on subsequent days he has been afebrile till date on no antibiotics. He did have bladder pain along with fever during admission but even that has subsided dramatically after foleys catheterization.
@PPM4 also reiterated the four point sugar request here along with making a handwritten note on file of how the Hb changed after a single BT day before yesterday
[12.48 PM, 04/06/2026] PPM 1: This patient grew multi drug resistant CRE (carbapenem resistant enterococci ) in his urine culture and while he did have fever documented once from the OPD on the day of admission on subsequent days he has been afebrile till date on no antibiotics. He did have bladder pain along with fever during admission but even that has subsided dramatically after foleys catheterization.
@PaJR Health how do you explain this asymptomatic or mildly symptomatic bacteruria with carbapenem resistant enterococci that didn't require any antibacterials till now?
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