October daily academics
DEPARTMENT OF GENERAL MEDICINE ACADEMICS ( OCTOBER 2022 )
10 - 11 am : ICU rounds
1)Cause for thrombocytopenia in 19/F
Iron deficiency anemia can be associated with thrombocytopenia. It should be thought of after ruling out serious differential diagnosis like TTP; thrombocytopenia caused by IDA responds to iron replacement therapy, which can cause a transient drop in platelets initially.
( Quoted from below link )
2) USG findings of 65 /F whether it is renal abscess or complex renal cortical cysts
11 am - 1pm
Case 1 : 2018 batch Chandana ( UG )
Knee clonus :https://youtube.com/shorts/OgyRk03IheQ?feature=share
Glucocorticoids in SLE :
"The activation of the non-genomic pathway starts at doses >100 mg/day of prednisone or equivalent. This pathway is especially sensitive to methylprednisolone (MP) and dexamethasone, which have non-genomic effects up to five times more potent than genomic ones [8]. "
"The “classical” standard 1 mg/kg/day prednisone dose is not supported by either basic pharmacology or clinical evidence (Figure 1) [19,20]. It is unlikely that anti-inflammatory effects increase significantly after prednisone doses have reached 30–40 mg/day, since such doses already result in a saturation of almost 100% of the genomic pathway [12,19]. Recent data suggest that higher initial doses of prednisone are associated with higher cumulative doses [21] with the well proven result of increasing damage accrual [1,22,23,24,25]. "
"The “Rituxilup” schedule, which consisted of rituximab and MP, followed by maintenance treatment with mycophenolate mofetil and no oral steroids, resulted in 72% of patients with LN class III, IV, or V eventually achieving complete remission within a median period of 36 weeks [32]. "
"In 2018, Danza et al. compared the efficacy and rates of infections among patients with several autoimmune conditions, including SLE, treated with MP pulses, for a total dose over three days ≤1500 mg, <1500 to ≤3000 mg and >3000 mg [19]. No differences among the different doses were seen in patients achieving complete response, partial response, or no response. No patients in the ≤1500 mg group suffered infections, vs. 9.1% in the high dose group. "
Y Muller 's muscle hyperactive
Case 2 : 19/F with Anemia
Iron absorption and Dietary iron intake
Attended
PGY3 - Manasa
Interns ( attended ) : raveena, bhavani , Rishi, arooshi, pavan
2-4pm
Case report : http://amitsharma1996.blogspot.com/2022/10/78-years-old-female-with-giddiness-and.html
1st admission link: https://caseopinionsbyrollno156.blogspot.com/2022/02/cbble-udhc-similar-cases.html
Presentation link : https://youtu.be/SMkYhw2pB7Q
Faculty - Dr.Zain Sir (SR)
Topic - approach to altered sensorium
PGY3
Dr. Manasa
Dr.Durga krishna
Dr.vinay
Dr.Vamsi
Dr. Pradeep
Dr.Sai charan
Dr.shailesh - Nephrology (M)
Dr.Sashikala - ICU ( M)
Dr.chandana - OPD
PGY1
Dr.Venkat sai
Dr.pavan
Dr.keerthi
Dr.Hari priya
Dr.bharath - nephrology (N)
Dr.nishitha - ICU (N)
Dr.deepika - OPD
Interns - raveena , nikhil , arushi , amesha
Oct -2 : Gandhi Jayanthi ( Holiday )
Oct 3
Case presentation by shishira reddy in11to 1pm class
Questions :
Reason for persistent fever in this patient
despite of low wbc counts
Hemoglobin reduction daily by 1gram without any blood loss
PGY3 : Manasa, vamshi, charan
PGY1 - Pavani
Interns : shirisha , Shiva
OPD : DK, Pradeep and Pavan
ICU : Shashikala, Nishitha
Nephrology : Shailesh, bharath
2 to 4 session :
intern shradda presented the case
Presentation link :https://youtu.be/Mh5ihnM3eV4
interns attended the class- Shradda and Shiva i
PGs who attended the class
PGY3 :manasa,vamshi,vinay, chandana,
PGY1 : pavani, Keerthi,venkat sai
Emergency duty : Nishitha, Shashikala ( ICU )
Nephro : Shailesh , Bharath
OPD : Pradeep, DK, Pavan
Oct -4 : Amith ( intern ) Presentation
Case report
2 pm to 4 pm: Mortality Meet
Cause for respiratory acidosis :
Attended
PGY3 : Manasa, vamshi, dk, Chandana, Raveen
PGY1 : Keerthi, Pavani, Haripriya
Emergency :PGY3 - shashikala, Shailesh,
PGY1 -Bharath, Nishitha
OPD : Deepika ( PGY1 ), charan (PGY3 )
OCTOBER -5 : Dasara
Online discussion
Discussion whether IC bleed is because of setroid or ITP or despite of using steroid
Platelets in ITP patients exist in an activated state. In patients who are responsive to steroids, the treatment reverses this situation.
OCTOBER -6 :
Case presentation by Manisha ( ug )
65year old male patient with necrotising fascitis
Case report :
Pgs who attended 11to 1 session
Dr manasa(PGY3 ) , Dr pavani (PGY1)
Intern : Shiva
Emergency :PGY3 - shashikala, Shailesh
PGY1 -Bharath, Nishitha
OPD : Deepika ( PGY1 ), charan (PGY3 )
Topics covered (with NMC codes)
IM 1 : heart failure
IM 4: fever
IM 24 :Geriatric
IM 26 :Role of physician in community
PATHOPHYSIOLOGY OF BULLOUS LESION
The identification of Dsg3 as a major antigenic target represented a critical moment in the process of understanding PV and, after its discovery, the prevailing view of disease immediately narrowed. For the next decade, the design and interpretation of almost all experiments were informed by an underlying assumption that anti-Dsg autoAb were the sole drivers of disease in pemphigus, ignoring the potential role of other, non-Dsg autoAbs. Although the importance of anti-Dsg3 autoAb is clear, this limited view may have slowed the progression of understanding the true complexity of disease. The impact of how this desmoglein-centric view fundamentally influenced the way researchers understood PV is epitomized by the development of the desmoglein compensation hypothesis. This elegant hypothesis asserts that anti-Dsg3 and anti-Dsg1 autoAb profiles can predict which epithelial surface(s) will be affected, as well at what level the loss of cell-cell adhesion will occur in the epidermis (24). The foundation of this hypothesis are the differential expression patterns of Dsg3 and Dsg1 between mucosal and cutaneous epidermis, and the idea that Dsg3 or Dsg1 alone can sustain cell-cell adhesion. In a series of experiments Mahoney et al. demonstrated that: (1) murine mucosal tissue expresses Dsg3 throughout the entire epidermis, with strongest expression in the superficial layers, while Dsg1 expression is highest in the superficial layers and very low in the deeper layers, and (2) murine cutaneous epidermal tissue expresses Dsg3 most highly in the basal layer with lower expression seen in the more superficial layers, whereas Dsg1 expression is high in superficial epidermis and decreased in the deeper layers. The tissue specific expression patterns of Dsg3 and 1 in mice are similar to that of human epidermis, with the exception that Dsg1 expression in human mucosal epidermis is very low (25–27).
2 pm to 4 pm
Faculty : Dr .Nikitha Mam ( SR )
Tutorial : Examination of Respiratory System and CNS
NMC CODES
IM 3.5 : Respiratory System examination
IM 18.5 : CNS examination
Case report :
Presentation link : https://youtu.be/67L1fc1Y5LM
PG 's attended :
PGY3 : Manasa, Raveen, Charan, DK, Pradeep , Chandana
PGY1 : Deepika, Pavani, Keerthi
OCTOBER 7 :
11am - 1pm : UG class for 8th and 5 th semester students
case presentation Shashi Kiran (8th semister)
Presentation link :
IM 3 - Pneumonia
IM 3.5 : Respiratory System examination
IM 4 - Fever
IM 22 - Fluid , Mineral and acid base disorder
Questions discussed
1) Cause of fever and collapse
Collapse secondary to congenital anamoly, post surgery ? Diaphragmatic hernia ? Low lung lobe removal ? Post TB sequalae ? Post surgery atelectasis
2)tracheal position finding
3)Metabolic encephalopathy and common disorders or causes of this condition
4) chronic bronchitis and emphysema
5) ABG analysis
Case presentation by vanshika ( 5th semester )
Case report: https://08arshewarpavankumar.blogspot.com/2022/10/this-is-e-log-book-to-discuss-our.html
USG OF LEFT KIDNEY OF ABOVE CASE
NMC code IM 11 - Diabetes
IM 11.7 - Approach to diabetes
Questions discussed :
Localisation of pain abdomen causes may be diabetic ketoacidosis with pancreatitis
Approache to patient with fever localisation clinically
UG's attendance
Pgs attended the session
PGY3 : Manasa,saicharan,
PGY1 Pavani,pavan,
INTERNS: Vishal ,shrija,pavan
2 pm -4pm :
Faculty : Dr Adithya sir ( SR 2 )
Group Discussion : Examination and Investigations of ascities
Case report
1st
Presentation link
NMC CODE - IM 5 - LIVER DISEASE
IM 5.6 - Ascites
Attendance :
PGY1 : Deepika, pavani, pavan ,keerthi
All PGY3 : Exam
OPD : Haripriya
ICU : Venkat sai
Nephrology : Bharath, Shailesh
Oct - 8 th
1 st case presentation : Prakash (8th sem )
Case report :
Presentation : https://youtu.be/_HK8ZevXE9c
2nd case : Varshitha ( 5th sem ) 47/M with sepsis and MODS
NMC Codes :
IM 10 - Diabetes
IM 11- AKI,
1M 14 -OBESITY
IM 5 - Liver disease
UG attendance
Attended class
PGY3 - Manasa
PGY 1 - Pavani
Interns : sreeja , vishal
12 - 1pm : Renal biopsy in 47 /F
2 pm - 4pm :
Faculty : Dr. Zain sir ( SR )
Case report :
Presentation link :
NMC Codes :
IM 10 - Diabetes
IM 11- AKI,
1M 14 -OBESITY
IM 5 - Liver disease
PG 's attended
PGY 3 : Manasa, Vinay , dk , Pradeep
PGY 1 : Pavani, Pavan, Deepika
October 10 :
10 am - 12 pm : ICU rounds
Discussion on urinary spot sodium and 24 hours sodium , how to differentiate pre renal AKI from AKI to resolve the discrepancy through the lab values
For a one-time urine sample, the normal urine sodium value is around 20 mEq/L. For the 24-hour urine test, the norm ranges from 40 to 220 mEq/L per day
12 pm -1 pm : Case presentation by chandana ( 3 rd sem )
Case report
Intern : https://blendedasessmentmadhukumar.blogspot.com/2022/10/this-is-online-e-log-book-to-discuss.html
Presentation link
2pm -4pm
Faculty : Dr. Nikitha Mam ( SR )
Case report https://caseopinionsbyrollno05.blogspot.com/2022/10/80-year-old-male-with-fever-and-burning.html?m=1
Presentation link https://youtu.be/Cdb5kmDDs-w
NMC CODES
IM - 5 : Liver disease
Attended
PGY3 : Manasa, Vamshi
PGY1 : Pavani, haripriya, keerthi
October 11 :
ICU bed 1 :
1) Cause for right upper lobe collapse
Fungal ball present in right upper lobe - On HRCT chest
2 ) Cause for AKI ?
3 ) Physiology of non oliguric AKI to Oliguric AKI
ICU BED NO-2
Questions:-
1)Reason for severe PAH
2)Is there might be any underlying connective tissue disorder
3)Reason for severe anemia(Hb-1.5) & thrombocytopenia
4)Is blood transfusion indicated??
ICU BED NO-4
Questions:-
1)Should we get CECT abdomen for arogyashree purpose/Is it really indicated??
ICU BED NO-5
13F - DKA(due to skipped insulin) with TYPE-1 DM
AMC
1. Skin involvement - No active but history of photosensitive rash +
2. Oral or nasal ulcers - Negative
3. Nonscarring alopecia - +
4. Serositis - Yes and active pericardial effusion
5. Synovitis - ? Reports history of PIP joint pains. No active inflammation
6. Renal - Nephritic syndrome (number 11 somewhere here )
7. Neurological - None / Subtle cognitive defects (not taking as involved)
Hematological - 8. Anemia +
9. No Thrombocytopenia
10. No Leukopenia
Cr and urea trends after giving the pulse therapy of Inj methylprednisolone 500mg iv /OD for 3 days in 47/F ( case report link is above )
A paper on Clinico pathological correlation between kidney biopsy findings and renal course of those patients.
Patient 17, although much younger - had a 35 month duration of renal disease and her creatinine was 7.19 mg/dl (converted from micromol) at presentation and although she did require RRT she eventually made a full recovery. With her last follow up creatinine at 0.8 and no proteinuria.
This patient was treated with 2g MP and MMF too.
Clinical complexity of patients :
https://1drv.ms/w/s!Av7DWVJIXT3agRQSf9Zj0BRk6ChO
11 am - 1pm
Case 1 : https://rishikoundinya.blogspot.com/2022/10/32-yr-old-male-with-chronic-pancreatitis.html?m=1
Case 2 : Presenter -Manisha ( 8th sem )
Presentation link : https://youtu.be/Wenz2E9GS-I
Case -3 :
Attended
PGY3 : Manasa , Raveen
PGY1 : Pavani
2pm- 4pm
Morbity meet :
11 am - 1pm
Case 1 : Case presentation by
Case report
Presentation link
Case 2 : Case presentation by
Case report
Presentation link
PGY3 : Manasa
PGY1 : Pavani
Interns : Siddhanth, Murali , Laharika
2 pm - 4pm
Guest lecture
Oct 13 th
9 am to 10 am :
Meet in mini auditorium by Hospital adminstration
Topic : Accreditation of hospitals
11 am -1pm
Case 1 : Presentation by hruday ( 8th sem )
Case report
Case 2 : Presentation by Niharika ( 8 th sem )
PGY3 : Manasa
Interns : laharika , siddhanth, srujini , Swetha, Sahithi , Neha
2pm - 4pm
Faculty : Dr . Nikitha Mam ( SR )
Approach to weakness
Attended
PGY1 : Haripriya , Manasa
OCT 15 :
11am to 1 pm
Case discussion on
1)urinary incontinence ,
2)Micro and macro albuminuria
3)Liver abscess cases
NMC CODES
IM - 5 : Liver disease
IM - 10 : AKI and CKD
2 pm to 4pm :
Faculty : Dr. Zain sir ( SR )
Case 1 : Z+ with diarrhea
Case 2 : involuntary movements(? Myoclonic jerks )
Presentation link : https://youtu.be/CagskGbsAgY
NMC CODES
IM 6 - HIV
IM 16 - Diarrhoeal disorder
IM 19 - Movement disorder
OCT 16 - Sunday
OCT 17 th
11 am to 1pm
Case 2 : Presentation by siddhanth ( Intern ) htt
Case 3 :
Case 4 :
Attended
PGY3 : Manasa, Raveen
Interns : Sahithi, Shivani, siddhanth , Neha , manogna
2 pm - 4pm
Case presentation by Manogna ( intern )
Presentation link :
Attended
PGY3 : Manasa, Vamshi , Chandana
PGY1 : Haripriya
Interns : Sahithi, Shivani, Manogna
OPD : Dk, Vinay, Pavan
Oct - 18 :
Case presentation by Charan ( PGY3 )
20 /F with acute flare up of SLE
47 /F with Lupus Nephritis
Presentation link :https://youtu.be/LVlBdePjIMs
PGY3 : Manasa, Vamshi, pradeep, Charan, vinay, chandana
PGY1 : haripriya, Pavan
OPD : Deepika, Raveen
Interns : Shivani, Neha, manogna , srujini
2pm - 4pm
Mortality meet
PG' s attended
PGY3: Manasa, Vamshi , chandana, vinay
PGY1 : Pavan , Keerthi
OCT -19 :
11 to 1pm
1) Discussion on SLE and APLA
2) Discussion on Metabolic syndrome and NAFLD
3 ) Discussion on LBA
4 )Lupus Nephritis v/s Diabetic nephropathy
Attended
PGY3 : Manasa, chandana, vamshi, Viany
PGY1 : Keerthi, Pavan, Deepika
2 pm -4pm
Integrated Meet on Haemorrhage and shock
PG's Attended
PGY3 : Manasa , Chandana
PGY1 : Keerthi
Oct 20 :
9 to 10 : Clinical meet presented by Dr Adithya sir ( SR2 ) and Charan ( PGY3)
10pm to 12pm- ICU rounds
12pm to 1pm
Cause for peripheral cyanosis in a young boy
PGY3 : Manasa
PGY1 : Pavani , Pavan
Interns : vineesha , Srujini , Rishitha
2 - 4 pm
Case presentation by Pavani ( PGY1 )
Approach to Pyrexia of unknown origin
Presentation link
Faculty : Dr Nikitha Mam ( SR )
Attended
PGY3 : Manasa, Pradeep, Dk, Chandana
PGY1 : Pavan, Pavani, Haripriya
Interns : Vineesha , rishitha, gsrujini
OCT 21 :
10 am - 12 pm : Icu rounds
12 pm - 1pm
RCT on OHA in DM2
2pm - 4pm : Bimonthly examination for all PGY1 and PGY3
OCT 22 :
9am to 1pm : CME conducted by Microbiology department
-->It's a great session on how to interpret the culture reports, appropiate use of antibiotics and how to choose the antibiotic and for how long and how to stop the overuse and prevent the resistance to antibiotics
2pm - 4pm
Faculty : Dr Zain sir ( SR )
Presentation link : https://youtu.be/9HfgaHwxRFQ
Attended
PGY3 : Manasa
PGY1 : pavani, pavan, venkat sai, Deepika, Haripriya
Interns : Vineesha, Aishwarya, Neha, Swetha, rishitha, divya
OCT 23 : Sunday
OCT 24 : DIWALI
OCT-25
12 pm - 1pm
Overall, *361 T2DM patients* were selected from Zhujiang Hospital, Southern Medical University from March 2019 to January 2021.
*A bioelectrical impedance analyzer (BIA) (Jawon Medical Co., Ltd., Korea) was applied to determine body composition, which is now recognized as a reproducible, convenient and noninvasive method for body composition evaluation*.
In addition, previous studies have shown that BIA delivers comparable measurements and high accuracy compared with computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) when assessing fat mass and muscle mass [19, 20]. Hence, the following parameters were used: body fat mass, muscle mass, and body fat percentage. The fat-tomuscle ratio (FMR) was calculated as body fat mass (kg) divided by muscle mass (kg).
A total of 361 T2DM patients aged 56.8 ± 11.1 years were enrolled in the research, of which 59.0% (n = 213) were men and 41.0% (n = 148) were women. And the characteristics of participants by sex are summarized. Compared to males, significantly higher levels of fat mass and body fat percentage were observed in females, while the muscle mass was obviously lower (all p < 0.001). *The mean FMRs for males and females were 0.331 and 0.530, respectively (p < 0.001).*
2pm- 4pm
Morbidity meet
OCT 26 :
10 am -12 pm : ICU rounds
12pm - 1am
Discussion about oral v/S iron therapy was done as we have a young female with IDA due to ? Blood loss .. as patient is also intolerance to oral medications review was done .. but according to the studies though IV iron has less GI side effects , it has more life threating complications like hypotension which is more dangerous
RCT on oral v/s IV iron therapy
After initiation of therapy, hemoglobin in oral iron group raised from 6.45 (0.72) to 8.84 (0.47) on day 14 and to 9.69 (0.47) on day 28. Hemoglobin in IV iron group increased from 6.34 (0.86) to 10.52 (0.61) on day 14 and to 11.66 (0.84) on day 28. Serum ferritin in oral iron group increased from 8.3 (1.9) to 33.8 (1.29) on day 14 and to 43.61 (8.8) on day 28. Serum ferritin in IV iron group raised from 8.23 (4.64) to 148.23 (11.86) on day 14 but decreased to 115.76 (15.3) on day 28. The data were statistically significant for IV iron therapy on day 14 and day 28. Of 100 patients, 18 patients (12 in oral and 6 in IV iron groups) had adverse effects
2pm-4pm
Integrated Meet
OCT -27
9am- 10 am : Clinical meet
2pm -4pm
Faculty : Dr Nikitha Mam ( SR )
Approach to ABG
Thesis review of DK and Chandana
Attended
PGY3 : DK, Chandana
PGY1 : Keerthi, Pavani , haripriya
PGY3 :Manasa and shashikala are in thesis review with the committee
OPD : Vamshi, Venkat sai
Nephrology : Shailesh and Bharath
ICU : Nishitha
OCT 28
2pm -4pm
Faculty : Dr.Adithya sir ( SR2 )
Approch to laboratory reports
Case Presentation by Dr. Keerthi ( PGY1 )
Discussion by Dr . Durgakrishna ( PGY3 )
Presentation link https://youtu.be/JZdW4dJYFVs
Attended
PGY3 : Manasa, DK
PGY1 : Keerthi, kranthi, pavan ,venkat sai, pavani , Deepika
OPD : Vinay and Haripriya
PGY3 :Chandana and Pradeep are in thesis review with committee
OCT 29 :
9 am -11 am : Online discussion
Discussion on how to measure the MAC amd abdominal circumference measurements as most of the individual presentation here in our department has central obesity with sarcopenia ( decreased muscle mass )of biceps and triceps .. The measurements are taking here in all individuals to see the association between MAC/AC ratio with the presenting complications like CVA, MI , and Diabetes
2 pm-4pm
Faculty : Dr .Sushmitha Mam ( SR )
Attended
PGY 3 : Manasa
PGY1 : Pavani, Venkat sai, Deepika
OCT 30 : Sunday
OCT 31 :
Discussion on long distance patient
67 M Alleged history of sudden fall from bicycle 1 ½ year ago followed by gradually forgetting the recent things. History of left leg swelling gradually progressive pitting type associated with skin lesion over the body associated with itching. History of fall (The eveng explained by attenders as he had sudden onset of palpitations while he was in vegetable market .. he got scared and started walking fast to his way home, next day while walking on raod had h/of fall with hit to speed breaker ) followed by pain at the left hip with restricted movement.
Irregularly irregular rhythm
Rate : 80
Left axis deviation
RBBB morphology
Down sloping ST segment.
P wave not regularly seen.
Any history please
Repeat ecg done after 2 hours
P waves have appeared but it looks like the ventricles are still repolarizing and unable the p wave is unable to "capture" the ventricles.
Therefore the subsequent broad complex QRS
Planning for a 24 hour holter monitoring
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