64F HFPEF Telangana PaJR

 

16-08-2025 

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.

[16-08-2025 16.45] PPM 1: Presented to OPD with pedal edema and NYHA II since last few days to weeks.

Also distressed by tingling pain in her lower limbs.

Treated with pre load and after load reducing agents (frusemide and telma) and edema and shortness of breath subsided.

Treated with amitriptyline 10 mg at bedtime for her tingling.

Planned for PaJR follow up of BP and weight and edema

Patient's 2D Echo: https://youtu.be/f1JNgoG8uRk?si=d_1hhGaBWfmADHbz

27M Suspected HFPEF Telangana PaJR

 

23-07-2025

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED ATER 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.

[23-07-2025 21.44] PPM 1: OPD 27M first seen on Monday OPD but couldn't log at that time. Reviewed him again today at OPD.

Unexplained pedal edema since one year with no hypoalbuminemia ruling out liver and glomerular origin of his pedal edema.

He does have mild shortness of breath and is highly suspect for heart failure due to metabolic syn from visceral fat phenotype.

History of VP shunt since 8 months of age and revised again three years ago.

On examination prominent striae over abdomen and functional VP shunt.

48F OPD Diabetes Mellitus 10yrs Neuropathy Pains Months Telangana PaJR

 

JANUARY 29, 2024

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.

48F OPD PATIENT WITH DIABETES MELLITUS II SINCE 10YRS AND NEUROPATHY SINCE 15 DAYS.

A 48 year old female came to the OPD for regular check up.

History of Presenting Illness:

A 48 yr old female came to OP for regular check up and is a K/C/O Diabetes Mellitus since 10 yrs and also complains of pins and needles sensation in B/L foot since 15 days which is aggravated on walking and relieved on resting.

Past History:

K/C/O Diabetes Mellitus since 10yrs and is on Glimi-M1

H/O right leg cellulitis 1 month back.

74F Altered Sensorium Uremic Encephalopathy Telangana PaJR

 

16-06-2025 

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.

[16-06-2025 17.36] PPM 1: @PPM3 can you share her brief history and a lateral view of her arms and abdomen?

NOTES 👆

[17-06-2025 15.40] PPM 1: @PPM3 why is she hypoxic? Please share her chest X-ray.

[17-06-2025 19.01] PPM 1: Sarcopenia and abdominal obesity

40M Son has the same and developed DM 2 since he was 25!

Talk about epigenetic transformations promoting onset of metabolic syn and DM2 earlier in each generation! @PPM4 @PPM2

[17-06-2025 22.06] PPM 2: "Diets of the same feather, flock together!"

PPM 1: 👍

[17-06-2025 23.41] PPM 4: ## Epigenetic Acceleration of Metabolic Dysfunction: The Generational Decline toward Early-Onset Sarcopenic Obesity and Type 2 Diabetes

The *alarming trend* of earlier-onset metabolic syndrome (MetS), type 2 diabetes (T2DM), and sarcopenic obesity (SO) across generations—exemplified by your 40M son developing T2DM at 25—reflects a complex interplay of *environmental triggers* and *epigenetic reprogramming*. Here's how epigenetic mechanisms drive this generational decline and potential therapeutic strategies to break the cycle.

---

23M Nephrotic Syn, 18yrs, Cushings, Diabetes, Hypothyroidism Telangana PaJR

 

12-06-2025

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.

BRIEF HISTORY

23 year old male admitted in SICU

For right lower limb cellulitis with ? Necrotising fascitis 

At the age of 5-6years

 patient had anuria with anasarca and was 

Diagnosed to have nephrotic syndrome 

Initially was started on steroids

Later diagnosed as steroid resistant nephrotic syndrome biopsy -FSGS (2014)

Was treated with Iv rituximab 2doses

Followed by Azathiaprine 2014 to 2017

2017 -Started on Calcineurin inhibitors - tacrolimus

Had complete remission from 2017 to 2021

1/20 - on complete remission with tacrolimus treatment.

2 /21 -Tacrolimus stopped to due to 

? Tacrolimus induced uncontrolled sugars

Followed by relapse

10/21 - 2nd dosage of IV rituximab 2doses given 

Irregular follow-up and no consultation for 3years.

During these years was on tacrolimus 0.5mg

Telmisartan 20mg atorvastatin 20mg

And metformin 500mg bd

Also diagnosed with hypothyroidism and is on thyronorm 12.5mcg

12/2024- went for follow up again 

With c/o bilateral pedal odema

Was started on tab prednisolone 40mg and tab.Mycophenolate Moefitil 360mg now on Prednisolone 10mg weekly once (Mycophenolate stopped 3- 4months back).

22F Lupus Nephritis, Past Azt Pancreatitis, Pyopneumothorax, Meningitis Telangana PaJR

 

Thursday, August 15, 2024

20F Lupus clinical complexity EHR deidentified horcrux links to all three admissions and follow up

 Summary: 

This patient was first presented to Prof Michele Meltzer  in Jan 25, 2022 (link: https://youtu.be/X5NBa_0VVUw?feature=shared) in this CPD linked here: https://medicinedepartment.blogspot.com/2022/12/?m=1 and she first presented to the presenters in September 2022 which is recorded in the link below but to summarise it drastically, she had nephrotic glomerular proteinuria, cutaneous vasculitic lesions, CNS vasculitic lessons (investigated for altered cognition) and endocardial and pericardial inflammation (acute heart failure with pericardial effusion)that was attributed to lupus in view of a strong ANA positivity particularly of the ds-dna fraction in ELISA. https://medicinedepartment.blogspot.com/2024/08/first-admission-september-2022-20f-with.html?m=1

Second admission: She again got admitted in December 2022 with headache, altered sensorium and meningeal signs, which was associated with a minor CNS bleed on MRI was later attributed to warfarin (link:

https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1

Her discharge after September 2022 was relatively uneventful on immunosuppressives and while her cardiac and CNS issues were the first to resolve even during admission, her proteinuria also subsided and she gradually withdrew all immunosuppressives in a year with a brief period of iatrogenic Cushing in between. Recently in June 2024, she presented with an ankle flare along with anasarca that also revealed a nephrotic relapse on evaluation of 24 hour urine protein as archived in her PaJR conversations here:https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1

Her 3rd admission recently in July 2024 was for a right hypochondrial pleuritic pain that ultimately revealed a large hydropneumothorax along with multiple lung abscesses. Again this was possibly an iatrogenic result of the high dose immunosuppressives for just a month! There's still a persistent diagnostic uncertainty around the etiology of her lung abscesses and hydropneumothorax as her dry cough persists and her last antibiotics choice was quinolone!https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1

68M Metabolic Syn HFPEF, Pulmonary Edema Telangana PaJR

 

27-05-2025

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.

[27-05-2025 15.44] PPM 1: Operative scar from 30 years for perforation and 4 years back for adhesions

24/5/25

26/5/25

[27-05-2025 16.27] PPM 1: Afternoon session:

Three heart failure and one altered senso PaJRed

One of them imaged here 👇

https://youtube.com/shorts/Ek5oQEDGNLY?feature=shared

52F With Metabolic Syn Altered Sensorium, TIA, HTN, Diabetes 10 yrs Telangana PaJR

 

14-05-2025

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.

[14-05-2025 15.46] PPM 1: Afternoon session 

52F with metabolic syn altered sensorium, TIA and Hypertension, Diabetes for 10 years along with anxiety attacks for 5 years being managed by @PPM3 

62F Chronic Anasarca, Heart Failure, Post Cholecystectomy since 1 year Telangana PaJR

 

01-05-2025

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.

EMR SUMMARY

MARCH 2025

Age/Gender: 65 Years/Female

Address:

Discharge Type: Relieved

Admission Date: 03/03/2025 12:11 PM

Diagnosis

DECOMPENSATED CHRONIC LIVER DISEASE SECONDARY TO ? NAFLD WITH OESOPHAGEAL VARICES WITH PHGD

GRADE I - II HEPATIC ENCEPHALOPATHY

S/P LAP CHOLECYSTECTOMY 1.5 YEARS AGO K/C/O TYPE II DIABETES MELLITUS SINCE 10YEARS K/C/O HYPOTHYROIDISM SINCE 30YEARS

61M Hypertension 2004, Hematuria 2007-2009 WB PaJR

20-07-2024

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.

DESCRIPTION 

September 2024

[13/09, 11:59] PPM 1: @⁨Genau PaJR CEO CFHE IIT⁩ do you have the previous records shared here? As

 his case report wasn't made and I changed my phone I'm unable to see any of the previous records

 shared here 

2004 started with blood in sperms

Reduced with ofloxacin 

On silodosin since then

Also put on statins 

And has been asymptomatic since then and gets scared with repeated ultrasound measurements

 informing him that his prostate is this enlarging!

[13/09, 12:03] PPM 1: Also whenever the cardiologist sees his ECG he is asked if he feels faint because

 he has LBBB. He hasn't brought his ECG today. @⁨Genau PaJR CEO CFHE IIT⁩ check if it was shared

 in the group earlier