Sanjay

80 yr old came to casualty with chief complaints of SOB since 4 days  HOPI  PATIENT WAS APPARENTLY ASYMPTOMATIC 4 YEARS BACK THEN HE HAD CHEST PAIN  ECG FINDINGS SHOW ANTERIOR WALL MI AND RIGHT BUNDLE BRANCH BLOCK  CABG AND STUNTING WAS DONE IN 2017  H/O WEIGHT LOSS SINCE 4 MONTHS  H/O LOSS OF APPETITE SINCE 4 MONTHS  NO H/O RENAL CALCULI  SINCE THEN PATIENT WAS ON TAB .ECOSPORIN AV 70/20 PO/OD  TAB.MET XL 25 MG PO/OD  SINCE 3 MONTHS BURNING MICTURITION , POLYURIA, INCREASED URINARY FREQUENCY  ?BOWEL AND BLADDER INCONTINENCE  GENERALIZED WEAKNESS SINCE 3 MONTHS  SOB SINCE 4 DAYS  INITIALLY GRADE 3 PROGRESSED TO GRADE 4  SINCE LAST NIGHT ASSOCIATED WITH ORTHOPNEA  COUGH ASSOCIATED WITH SPUTUM ,CHILLS AND RIGOR  NO CHEST PAIN, SWEATING,SYNCOPAL ATTACK , PALPITATIONS,GIDDINESS  H/O SIMILAR COMPLAINTS IN THE PAST  H/O BURNING MICTURITION 4 MONTHS BACK  TREATED CONSERVATIVELY  TREATMENT HISTORY  DENOVO DM  H/O CATARACT SURGERY B/L 6 MONTHS BACK  CAD IN 2017  PHYSIC

Chief complaints  C/o SOB since 1 week  C/o swelling in the legs  C/o decreased urine output  HOPI A 50 yr old Farmer doing his regular work, of driving tractor till one week ago when he had sob with sweating, taken to a doctor outside ,where his grbs was recorded low ,was revived with eating a chocolate only, but he continued to take his oha even after that,rft showed increased creatinine,since 3 days his symptoms aggrevated and was brought here for further management ,2 sessions of dialysis  1 st -19/2/22 from 10 am to 2 pm , 2 nd - 20/2/22 were done   PAST HISTORY  known case of DM since 3 years on medication  HTN since 6 months (giddiness first symptom ) NO H/o asthma ;TB;EPILEPSY PERSONAL HISTORY  Marital status - married  Occupation - Farmer  Appetite - Normal  Diet - Decreased appetite  Bowel and bladder movements - regular Addictions -  Chronic alcoholic since 20 years daily 180 ml. Chronic smoker since 20 years  daily 2-4 beedis per day. No significant family

 Chief complaints - A 55 year old female presented to casualty with c/o of anuria since yesterday night  HOPI- PATIENT was apparently asymptotic 1 year ago , when her sister died she cried a lot , felt weak and was taken hospital , routine investigations were done and was told she had kidney problem and was referred to kamineni I/v/o dialysis and was admitted for 2 sessions of dialysis .Urology opinion was taken for ?obstructive uropathy , ?kidney operation was done ,used medication for 3 months and the symptoms were relieved  H/o nsaid use for 1year h/o pedal edema and facial puffiness 6 months ago . Sob not present  Comorbities - hypertensive since 6 months  Headache (frontal since  2 months ) H/o fever since 4 days associated with chills  H/o anuria since 1 day  H/o vomitings 1 episode (non projectile,non bilious ),food as contents  No h/o hematuria , frothy urine  No h/o cold , cough , loose stools , burning micturition  Family history  Not significant  Personal history  Occupation

  A 68 yr old female came to casuality with C/O   1. Tingling and numbness in right lower limb and right upper limb since 3 pm yesterday 2. Slurring of speech since 3 pm yesterday 3. Weakness in right lower limb since 3 pm yesterday HOPI: Patient was apparently asymptomatic 1 day ago  Then she developed tingling and numbness in right lower limb and right upper limb,slurring of speech and weakness in right lower limb since 3 pm yesterday No H/O headache, vomiting, dysphagia. No h/o  regurgitation, involuntary micturition and defecation No other complaints PAST HISTORY: Not a K/C/O HTN/DM/TB/Epilepsy/CVD/CAD PERSONAL HISTORY: Diet - mixed Appetite - normal Sleep - adequate Bowel movements - regular Micturition - normal No known allergies Patient has a habit of chewing betel leaf(zarda) since 50 years FAMILY HISTORY: Not significant GENERAL EXAMINATION: Pt is C/C/C Vitals: Temp - Afebrile BP-100/70 mmHg Pr-78 bpm RR-22 cpm SpO2- 98% at RA GRBS- 117 mg/dL