Bimonthly Blended Assessment for June 2021

 Note : The following answers are solely my own interpretations and opinions on the recorded cases from my own observations. Please feel free to comment below, all constructive criticism and feedback is welcome. 

Q1) Peer to peer review of case histories

Note 2 : I have not assigned quantitative markings to the following case histories as the individuals covering it aren't my peers, as I find myself lacking the immense knowledge they possess in comparison to me. I find myself only capable of giving a qualitative review by assessing the details of the case. 

1) Case by : https://lasyamithrakandregula.blogspot.com/2021/06/covid-case-discussion-45-year-female.html?m=1

Diagnosis : Viral pneumonia secondary to COVID-19 and known case of hypothyroidism

Review : 

(1) Primary testing of COVID-19 has been done, which is of prime importance under the current pandemic situation. Dexamethasone, a corticosteroid used for the treatment, not just for COVID-19, but also pneumonia.

(2) As usually in pneumonia, the airways are swollen and inflammation is seen, use of Budecort nebulization and Ascoril syrup to reduce this is very useful and important.

(3) Thyronorm (synthetic Thyroxine, i.e., Levothyroxine) being used to treat the hypothyroidism is very crucial.

Since, thyroxine is very crucial for lung development  and surfactant formation, it's  decrease causes pleural fluid collection, dyspnoea etc.

2) Case by : https://vijaykumarkasturi.blogspot.com/2021/06/70-years-old-female-with-acute-kidney.html?m=1

Diagnosis : Acute Kidney Injury (AKI) secondary to Urosepsis on Chronic Kidney Disease (CKD) secondary to Hypertension  Nephropathy 

Review : 

(1) Use of Nicardia for HTN management so that the CKD doesn't progress to End Stage Renal Disease (ESRD)

(2) Piptaz is here used to treat the UTI causing Urosepsis, along with IV NS.

(3) Nodosis and Pantop used to reduce the gastric acidity, while INJ NaHCO3 to treat the metabolic acidosis, due to accumulation of acids.

Overall good management of the case was done.

3) Case by : https://caseopinionsbyrollno05.blogspot.com/2021/06/case-of-29-year-old-male-patient-with.html?m=1

Diagnosis  : Acute on Chronic pancreatitis

Review : 

(1) Past and present histories were well taken as it shows how the patient has already a habit of chronic drinking addiction which lead to pancreatic.

(2) To maintain gut barrier and early bacterial translocation in the gut, nasogastric tube is placed and entered feeding done.

(3) A treatment of basic antacids, painkillers, anti emetics and mainly, IV fluid therapy is enough, as the patient has to get on rehabilitation for alcohol de-addiction.

4) Case by : https://bejugamomnivasguptha.blogspot.com/2021/05/a-45-years-old-female-patient-with.html?m=1

Diagnosis : Cervical Spondylosis and Recurrent hypokalemic paralysis 

Review : 

(1) Lasix blocks Na, Cl, water reabsorption,  hence expelling the excess fluid from the body. This is to treat the pitting edema in the patient.

(2) Supplements like Shelcal and MVT are given to help treat the spondylosis, which is better for a long term approach.

5) Case by : https://dandushivani.blogspot.com/2021/06/a-36-year-old-male-with-dyspnoea.html?m=1

Diagnosis : Viral pneumonia secondary to COVID-19 infection (severe)

Review :

(1) Here, Remdesivir, an antiviral drug is used to specially  treat the RNA virus, COVID-19. By entering the cell and imitating the ATP molecule as RTP, it's  incorporated  into the RNA of the virus and halts the further virus production.

(2) Methylprednisolone, is used to reduce the severe inflammation in pneumonia.

6) Case by : https://rishithareddy30.blogspot.com/2021/06/covid-case-report.html?m=1

Diagnosis : COVID-19 case

Review : 

(1) Plenty of oral fluids encouraged, as not only does it enhance the first line of defense in the body but also dehydration leads to excess lung fluid accumulation  in this case leading to pneumonia.

(2) Blood thinners like Clexane must always be given in COVID-19 cases to prevent excess clot formation, since it's  a hallmark of COVID-19 cases.

(3) Tests like D Dimer are performed to rule out presence of a severe blood clot and prevent DVT and such diseases.

(4) O2 supplementation, Budecort nebulization, giving antacids and supplements are a must.

7) Case by : https://psaikrupasri175.blogspot.com/2021/06/a-45-year-old-female-came-to-opd-with.html?m=1

Diagnosis : Known case if Type 2 DM, Arthralgia

Review  :

(1) Optineuron here is used for treating the arthralgia, it shows basically  a vit.B12 supplement.

(2) INJ HAI or Hepatic Arterial Injection therapy is given as a short acting insulin.

(3) Tramadol is a painkiller.

8) Case by : https://manvithayechuri169.blogspot.com/2021/06/medicine-case-discussion-8th-june-2021.html?m=1

Diagnosis: Acute pharyngitis with GERD (gastro oesophageal reflux disease), asymptomatic cholelithiasis, 5ongue and palate ulceration 

Review : 

(1) Pantop is a simple basic treatment. Acts as an antacid by irreversibly covalent binding to H+/K+ ATP pump in the gastric parietal cells.

(2) As left ovarian cyst is <5 cm, no medical intervention  required.

(3) Contraction stress test (CST) is done and cholecystectomy done to treat the disease.

(4) Zincovit supplementation enough to treat oral ulceration .

9) Case by :https://preityarlagadda.blogspot.com/2021/05/biatrial-thrombus-in-52yr-old-male.html?m=1

Diagnosis : CCF at presentation (resolved), Atrial fibrillation with Rapid ventricular response (RVR), Biatrial thrombus  with Atrial septal defect with PAH, denovo DM-2

Review : 

(1) Dobutamine was given to raise the falling BP back to normal, which is crucial.

(2) Digoxin, a cardiac glycoside, is used to treat the Arrhythmia caused by AF. Also, Heparin, Acitrom and other anti coagulants used to prevent clot formation. 

(3) Carvedilol treats the high BP if there's any spikes by acting on the aloha-1 adrenegic receptors, which causes vasodilation of smooth muscle in the vessels.

10) Case by :https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html?m=1

Diagnosis : Wernicke's encephalopathy secondary to chronic alcohol dependence, Uraemic encephalopathy, Alcohol withdrawal syndrome, chronic ulcer on right foot heel.

Review : 

(1) Not only IV NS, but also IV RL (Ringer's lactate) is given for treating dehydration.

(2) Inj. Thiamine is given as alcoholics are deficient in Vit.B1 and this may lead to serious neurological disorders later on. 

Note : IV Thiamine is always given first before IV Glucose, as in starvation, minimum rate of glycolysis is always maintained, so if glucose is given first it will only be absorbed continuously producing more lactic acid (instead of giving full fledged ATPs) causing metabolic acidosis.

This in turn raises the reactive oxygen species in the blood and causes cell death or apoptosis.

(3) Lorazepam  used to treat anxiety in patients and also Potchlor, which maintains the K+ and electrolyte balance in the body, hence indirectly reducing anxiety.

(4) Surgical intervention  needed for the treatment of ulcer.

(5) GRBS - General random blood sugar is done 6th hourly to check on his diabetes.

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Q2) Patient case history report

Here is the case report of a patient I have been following till date :

https://www.blogger.com/blog/post/edit/4111998552635123711/2241170760340410634

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Q3,4) Reflection upon the few given cases

Case 1 : https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1

Review : 

(1) Cerebral malaria was suspected even though the serological investigations were negative. Reasons yet unknown to me.

(2) DKA was resolved with insulin and IV fluids, whereas the associated coagulation was treated with Vit. K supplementation.

(3) The Hepatic encephalopathy with coagulopathy and metabolic seizure - was well suggested to be treated with liver transplantation, as this lead to the Multi system inflammatory syndrome along with COVID-19.

(4) Hence, treating the root cause, the COVID-19 disease in the patient, cascadingly treated the MSIS in the patient, is my observation.

(5) To treat and prevent the altered sensorium and epileptic episodes, Levipil was suggested. This is important prognosis treatment for the patient to live a normal life.

(5) Udiliv also suggested to prevent any gall stone formation in the already susceptible and weak liver of the patient. Rifagut is the main medication for Hepatic encephalopathy here and also treats diarrhea.

(6) Hepa Merz is used as a prognosis medication, to protect the liver and maintain it healthy. This occurs as, 2 amino acids in this help in boosting the detoxification of ammonia quicker so the liver isn't damaged.

This is an overall beautifully managed case by all the assigned team members 😊.

Case 2 : https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1

Review : 

(1) In this case, a thing to keep in mind is that the patienis infected by TB. So, it might have hematogenously disseminated into the kidneys and the bowels and cause incontinence.

(2) Hence, taking the incontinence and the myalgia into account, the patient was diagnosed with quadriparesis.  

(3) It's secondary to Infectious spondylitis, because of TB again.

(4) For myalgia, Optineuron and Thiamine were prescribed, so that the nerves become stronger. Whereas ATT and Monocef was to treat the core cause, the TB disease was well done.

Case 3 : https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1

Review : 

(1) As the gross ascites and general anasarca must be promptly treated, Nodosis and NaHCO3 (to reduce the acid levels in the body and neutralize it) are given along with Lasix (which blocks Na,Cl reabsorption hence excess fluid lost is increased)

(2) Hemodialysis is also recommended to maintain the Acute Kidney Injury and the permanent solution is to go for transplantation.

Case 4 : https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

Review : 

(1) To treat the AF, Amiodarone is given as a class - III anti-arrhythmic. It blocks the potassium channels in the heart cells and hence, allows for depolarization again.

(2) Clexane is used as a preventive measure for coagulation.

(3) Atrial fibrillation in thid patient I'd mainly cause by Hyperthyroidism. Thyroid hormone reduces the Action Potential Duration of the heart, causing this. 

Case 5 : https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

Review : 

(1) Magnex forte has Sulbactam, which inactivates the beta lactamase enzymes in the bacteria, hence acting as a good antibiotic against Urosepsis.

(2) To treat the anemia, Orofer and such supplements are given.

(3) To treat the Hypokalemia, K+ along with IV NS is given, this treatment is of primary utmost importance.

(4) Norfloxacin, a quinolone antibiotic, is used for stopping bacterial growth, helping the urosepsis.

All these treatments aid to treating the AKI.

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Q5) Reflective observations on the telemedicine approach towards cases

To be honest, I haven't communicated with any patients using telemedicine as I haven't called any patient directly. But in the case report I have covered about Phenytoin toxicity induced Cerebellar atrophy, I have learnt a lot, even additional to the pre-clinical subjects I have studied the previous year.

This was truly an enlightening opportunity and from this case, I have learnt this : 

1) Diagnosis is important but not the only thing required. One must also observe and learn from the various possibilities considered before reaching the most accurate diagnosis, so that they can diagnose future patients quicker and more accurately.

2) Consent, ethics, empathy etc are very much important while dealing with a patient or their relatives as any sort of disease/infection maybe not only biologically but also psychologically, socially, financially be exhausting them. Rather than sympathy, empathy is a much more important attitude to be owned by the medical professionals, along with compassion.

3) Extensive research must become a lifestyle if the medical professional wants to give the patient the utmost prime healthcare and see good prognosis, not only simply treating the ailment, but also psychologically, socially etc.