1) 34 year old male with history of type 1 diabetes mellitus and chronic kidney disease presented with recurrent urinary tract infections, fever, lower limb weakness and sensory loss.
2) Imaging showed severe axonal polyneuropathy. MRI spine showed transverse myelitis.
3) Differential diagnoses include diabetic peripheral neuropathy (autonomic), Guillain-Barre syndrome, and transverse myelitis.
A slide on Chronic kidney disease. At the beginning of the presentation is a case study, a patient admitted and treated for chronic kidney disease. Other parts covered include relevant anatomy and physiology, aetiopathogenesis and pathophysiology of the condition, as well as management and prevention.
A slide on Chronic kidney disease. At the beginning of the presentation is a case study, a patient admitted and treated for chronic kidney disease. Other parts covered include relevant anatomy and physiology, aetiopathogenesis and pathophysiology of the condition, as well as management and prevention.
during my internship in gastroenterology department i presented the case, chairperson was my beloved sir Prof AHM Rowshan. this is a case about a 20 year old female presented with abdominal pain, fever which was low grade, and weight loss with marked anorexia for few months. the diagnosis was a dilemma. patient was undergone laparoscopic biopsy from intrabdominal enlarged lymph nodes and ultimately the diagnosis was a case of Non-Hodgkin's lymphoma and treated by chemotherapy.
during my internship in gastroenterology department i presented the case, chairperson was my beloved sir Prof AHM Rowshan. this is a case about a 20 year old female presented with abdominal pain, fever which was low grade, and weight loss with marked anorexia for few months. the diagnosis was a dilemma. patient was undergone laparoscopic biopsy from intrabdominal enlarged lymph nodes and ultimately the diagnosis was a case of Non-Hodgkin's lymphoma and treated by chemotherapy.
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docxbartholomeocoombs
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
SOAP NOTE
Name: CL
Date: 9/24/19
Time: 1000
Age: 54
Sex: Female
SUBJECTIVE
CC:
“I’m still having fevers and just feel icky”
HPI:
The patient is a 54-year-old female who is a former paramedic who presents for office visit complaining of generalized weakness, cough and fever that began 4 weeks ago. She was recently diagnosed with Bilateral upper lobe pneumonia at the ER 4 weeks ago. At that time, providers recommended hospitalization, but she refused because she is the primary caregiver for her elderly father. Symptoms have stayed the same since onset. She feels like she isn't moving much air but denies any nausea, vomiting, or diarrhea. She has seen pulmonary since ER visit and was started on Levaquin and prednisone but then changed to Avelox last week here in the office. Pt describes Symptoms associated with fever, chills, and cough along with green sputum production. Symptoms of fever has improved with tylenol but the fever comes back. Her coughing exacerbates her chest pain. She denies any heart palpitations, diaphoresis, dizziness/syncopal episodes or n/v. Pertinent medical history includes COPD and hypertension. Patient adds she would like to consider home health to receive IV antibiotics through her chest port.
Medications: (list with reason for med )
Tylenol Extra Strength 500 mg Caplets, 2 tabs q4-6 hr for fever
Abilify 20mg daily
Baclofen 10mg daily
Clonazepam 1mg QID PRN
Fluoxetine 40mg daily
Lasix 40mg daily
Gabapentin 600mg daily
Klor-Con M10 meq daily
Lisinopril 40mg daily
Losartan/HCTZ 100/25 daily
Metoprolol tartrate 100mg TID
PMH
Allergies: Codeine
Medication Intolerances: Denies
Chronic Illnesses/Major traumas: Von Willebrand disorder, hypertension, anxiety, bipolar disorder, Vitamin D deficiency, COPD, PVD, insomnia.
Hospitalizations/Surgeries: Appendectomy (2001)
Family History
Mother-(deceased): COPD, Hypertension, MI, hypothyroidism
Father-(alive): dementia, anxiety/depression, CHF, CAD, HTN
Social History
General: Born and raised in Great falls, SC.
Marital status: Married
Living situation: Her father lives in the home with the patient’s family.
Children: 17year old boy and 12-year-old girl.
Occupation: Teacher at local elementary school.
Leisure Patterns: Pt states she reads a book when she gets a chance
Social habits: Denies smoking or alcohol consumption. Does not exercise.
Spirituality: Christian
Nutrition: Balanced diet. She mostly cooks at home and rarely eats fast food.
Sleep Patterns: States that she usually gets about 5hrs of
ROS
General
Reports weakness, fatigue, or fever. Denies headache, head injury, dizziness, or lightheadedness.
Cardiovascular
Denies any troubles with her heart, rheumatic fever, or heart murmurs. Denies having chest pain or discomfort, palpitations, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, or edema.
Skin
Denies rashes, lumps, sores, itching, and changes in color. Denies changes in his nails or hair. Denies changes in size or color of moles.
Respi.
Renal Case StudyA 51 year old Caucasian-American female pres.docxcarlt4
Renal Case Study
A 51 year old Caucasian-American female present to the emergency department with a headache of 8 of 10 on a pain scale. She reported the headache as a pulsation in her ear that is typical when her blood pressure rises. She also reported accompanying visual blurring, intermittent chest pressure, non-exertional shortness of breath, and episodic abdominal pain with nausea. She reports not taking her Labetalol.
PMH:
Type I DM since age 8 with history of impaired renal function that has continued to progress to a chronic stage and hypertension.
Family history:
Positive for DM, hypertension, CAD and Cancer.
SH:
Quit tobacco 5 years ago
Meds:
Labetalol, Lasix 20mg qd prn, Lantus 20 units at hs, Protonix 40mg qd, ASA 81mg qd, and Tylenol prn
ROS:
Constitutional:
Denies fever or chills
Eyes:
Reports blurred vision, no floaters
ENT:
Denies sinus pressure or congestion, denies sore throat
Respiratory:
Denies cough, non-exertional dyspnea reported
Cardiovascular:
Admits intermittent chest pressure, denies palpitations
Physical Exam:
General:
Alert and oriented in no acute distress
Vitals:
T 36.7C, BP 193/98, HR-88, Weight 87.5kg
Eyes: PERRLA, EOMI, moist mucus membranes
Neck:
supple, No JVD
Lungs: CTA A&P
Heart:
RRR without MGR
Abdomen:
soft, non-distended, nromoactive bowel sounds
LE:
edema to mid-thigh
Skin/Integument:
no cyanosis or clubbing
The patient was admitted for hemodialysis due to her progression of renal functioning but also admitted to control the hypertensive urgency and headache.
Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information
Discussion Questions:
Explain what happens physiologically with chronic renal failure and the GFR. Support with evidence. Include important labs that are monitored in the process.
Explain the role of Angiotensin II and proteinuria as they relate to advancing renal disease.
List at least three other body systems that are impacted by chronic kidney disease and why.
.
Comment by Morgan, Dorothy Tali Do not forget to include a runniLynellBull52
Comment by Morgan, Dorothy Tali: Do not forget to include a running head to follow APA guidelines
Health History
Yensi Aguilar
Benjamin Leon School of nursing
NUR1060C: Adult Health Assessment
Professor Dorothy Morgan
April 7, 2021
Health History
Identifying data
Date of history: 28/02/2021
Examiner: Yensi Aguilar
Name: L.P.
Address: 3403 SW 6h Street
Phone Number: 786-597-3071
Age:46
Sex: Female
Race: White
Place of Birth: Honduras
Marital Status: Married
Significant Other: Husband
Occupation: Teacher
Religion: Christian
Primary Language: Spanish
Secondary Language: English
Source of referral: The patient found the hospital’s address on the internet
Source of history: Documents with the patient’s health history gave information concerning the patient. The patient also talked concerning her health status.
Reliability: Currently, the patient seems to have a stable mental and physical state.
Chief Complaints/Reasons for Visit: According to the patient, she started experiencing high fever, blood-stained sputum, night sweats, coughing, and weight loss.
Present Illness
Time of onset: according to the patient, she started experiencing symptoms two weeks ago.
Type of onset: The patient says that she started by occasionally sweating, mild cough, headache, and pain in the abdomen area. Over time, these conditions became severe.
Original Source: The patient complains of pain in her chest and respiratory tract.
Severity: During the day, the patient does not feel many discomforts, but it becomes worse at night due to lower temperatures. Hence, the condition does not deter the patient from executing tasks during the day. The severity of her state is at 5 out of 10 on a 0-to-10-point scale.
Radiation: At night, the patient feels severe pain throughout her chest region
Time Relationship: At first, this condition was still developing and was easy to handle. However, it has evolved and has gotten worse.
Duration: It has been two weeks since the patient started experiencing the symptoms.
Association: The symptoms experienced by the patient are similar to those of flu.
Source of Relief: According to the patient, she feels better when resting after doing some light physical exercise.
Source of Aggravation: The symptoms become worse during the night. Again, exposure to allergens such as dust or cold increases the symptom’s severity.
Past History
General State of Health: The patient’s general condition is fair, considering she is suffering from a chronic illness.
Childhood Illnesses: She suffered from smallpox and measles as a child
Adult Illnesses: Hypertension, Anemia, and asthma
Psychiatric Illnesses: She has experienced mild depression in the past
Accidents and Injuries: Never had an accident or injuries
Operations: The patient denies any surgical operations
Hospitalizations: After visiting the hospital, the patient got an admission to the Jackson Hospital for one week to undergo treatment for asthma and hyper ...
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
Spectroscopy is a branch of science dealing the study of interaction of electromagnetic radiation with matter.
Ultraviolet-visible spectroscopy refers to absorption spectroscopy or reflect spectroscopy in the UV-VIS spectral region.
Ultraviolet-visible spectroscopy is an analytical method that can measure the amount of light received by the analyte.
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
DERIVATION OF MODIFIED BERNOULLI EQUATION WITH VISCOUS EFFECTS AND TERMINAL V...Wasswaderrick3
In this book, we use conservation of energy techniques on a fluid element to derive the Modified Bernoulli equation of flow with viscous or friction effects. We derive the general equation of flow/ velocity and then from this we derive the Pouiselle flow equation, the transition flow equation and the turbulent flow equation. In the situations where there are no viscous effects , the equation reduces to the Bernoulli equation. From experimental results, we are able to include other terms in the Bernoulli equation. We also look at cases where pressure gradients exist. We use the Modified Bernoulli equation to derive equations of flow rate for pipes of different cross sectional areas connected together. We also extend our techniques of energy conservation to a sphere falling in a viscous medium under the effect of gravity. We demonstrate Stokes equation of terminal velocity and turbulent flow equation. We look at a way of calculating the time taken for a body to fall in a viscous medium. We also look at the general equation of terminal velocity.
Toxic effects of heavy metals : Lead and Arsenicsanjana502982
Heavy metals are naturally occuring metallic chemical elements that have relatively high density, and are toxic at even low concentrations. All toxic metals are termed as heavy metals irrespective of their atomic mass and density, eg. arsenic, lead, mercury, cadmium, thallium, chromium, etc.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
In this webinar we give an overview of advanced applications of the IVM system in preclinical research. IVIM technology is a provider of all-in-one intravital microscopy systems and solutions optimized for in vivo imaging of live animal models at sub-micron resolution. The system’s unique features and user-friendly software enables researchers to probe fast dynamic biological processes such as immune cell tracking, cell-cell interaction as well as vascularization and tumor metastasis with exceptional detail. This webinar will also give an overview of IVM being utilized in drug development, offering a view into the intricate interaction between drugs/nanoparticles and tissues in vivo and allows for the evaluation of therapeutic intervention in a variety of tissues and organs. This interdisciplinary collaboration continues to drive the advancements of novel therapeutic strategies.
1. Staff Round
Prof. Dr. Aassem Seif
Presented By :
Riham Hamdy Mostafa
Neurology Resident
2. Personal History :
OM.F.E male patient, 34 years old ,born and living
in Haram, married for 9 years with no offspring.
tailor, with no special habits of medical importance
and he is right handed.
5. O The patient sought medical advice, where
investigations were done and revealed UTI and
neurogenic bladder. He was prescribed Antibiotics,
NSAIDS and pyridostigmine. He overused the
NSAIDS.
O His symptoms were temporarily relieved and
returned again after stoppage of medications.
Present History :
6. O2 weeks ago, UTI and fever recurred again and
the condition was associated with dyspnea on
exertion, orthopnea, LL edema followed by
abdominal distention, epigastric pain, nausea and
vomiting of food particles not related to meals.
O There is history of occasional diarrhea, but no
history of jaundice or bleeding from any body
orifices. No history of PND, chest pain or
palpitations. No history of cough, hemoptysis or
expectoration.
Present History :
7. OOne week later ,the patient experienced
bilateral LL weakness , acute in onset, more on the
left side, distal more than proximal, not associated
with abnormal movements or wasting.
O The condition was associated with diminished
sensation in both LL ,also numbness and tingling
sensation till both knees , but no symptoms
suggesting deep sensory loss.
Present History :
8. Present history:
OThree days , later the patient started to have stool
and urine incontinence and loss of morning
erection. There’s history of retrograde ejaculation
diagnosed 5months ago but no history of symptoms
suggestive of cranial nerves or speech affection. No
history of trauma. The pt was transferred to our ER
O No history of other system affection.
O Patient is not known hypertensive.
9. Past History :
O H/O hospital admission at age of 14 due to
DKA.
O H/O of argon laser ablation for his retina
(diabetic retinopathy )
O No history of blood transfusion or operations.
O No h/o food or drug allergy
O No history of TB or B
10. Family History :
O His mother and father are of second
degree relatives
O His father was diabetic
O No similar conditions in his family
11. SUMMARY
O 34 yrs old male with T1DM
O 5 months ago: recurrent UTI and fever
O 1 month ago: UTI, fever, dyspnea on
exertion, LL edema and abd distention,
epigastric pain, vomiting
O 2 weeks ago: acute onset of weakness
and sensory loss in both LL, urine and
stool incontinence, loss of morning
erection.
13. O Head and neck examination:
O Pallor
O Inflammed gums and tongue
O Lost teeth
O No jaundice or cyanosis
O Trachea is central and carotid pulse equally felt on
both sides
O No congested neck veins or palpable lymph nodes
General Examination :
14. O Extremities :
UL:
O 1st degree clubbing
O No tremors
O No palmer erythema
LL:
O Diabetic dermopathy
O Intact peripheral pulsations
O Lax calf muscles
O loss of hair
General Examination :
15. O Cardiac examination :
OApex in the 5th Lt intercostal space MCL
ONo evidence of chamber enlargement
ONormal S1& S2.
ONo additional sounds or murmurs
O Chest examination:
ONormal vesicular breathing
OEqual breath sounds on both sides
ONo additional sounds
Examination:
16. O Abdominal examination:
O Inspection:
Epigastric pulsations, abdomen is mildly distended
but moves freely with respiration, divarication of
recti, umbilicus is shifted down, normal in shape with
no pigmentation, scar, discharge or impulse on
cough. Normal skin, no visible or dilated veins,
normal hair distribution, normal genitalia and back
examination.
Examination :
17. O Palpation:
* Superficial Palpation: no tenderness, rigidity or
palpable masses
* Deep Palpation:
liver: Upper border of the liver is in the 5th space rt
MCL
No other organomegaly by deep palpation
Renal angle not tender
O Percussion : by light percussion liver is felt 2 finger
below costal margin
no ascites detected by shifting dullness
O Auscultation: Normal audible intestinal sounds
No renal artery bruit
Examination :
18. Examination :
O Neurological examination:
O Speech : normal
O Cranial nerves: pupils RRR but delayed reaction bil,
O Motor :
O Inspection:
No wasting or hypertrophy ,no fasciculation
No involuntary movement or skeletal deformities
O Tone :
Hypotonia in LL
19. O Power;
OUpper limb : normal
OLower limb : Weakness ( see table)
Extensors more than flexors
Proximal =distal
O Reflexes:
Deep: areflexia in LL ,
Pathological: -ve ,
Superficial: equivocal , preserved abdominal
reflexes
Examination :
Neurological examination:
Motor :
side right left
upper 5 5
lower 3 , 4+ 2, 4
20. O Neurological examination:
O Sensory:
Upper limb : normal
Lower limb :
Superficial sensation: gloves and stocks hypothesia
below knees
Deep sensation :vibration sensation affected till
patella
Sense of position and joint movement
affected
Romberg sign cant be assessed
Examination :
Sensory level
till T 12
Gloves and
stocks
21. O Neurological examination:
O Coordiantion : normal
O Gait : cant be assessed
ambulant with bilateral support
O Back and spine : normal
O Cranium and neck : normal
Examination :
22. Investigations:
O Laboratory:
TLC 19 ALT 21 CA 8.2
HB 6.4 AST 25 MG 1.4
MCV 73 UREA 14 NA 131
MCH 25 CREAT 3.36 K 5.8
PLT 633 URIC
ACID
9.1 CRP 95.1
PC 65 BIL T/D 0.4/0.1 ESR 1ST 122
PT 16 ALP 178 MICROA
LB
1563
INR 1.32 ALB 2.8 HBa1c 11.4
IRON 23 T PTN 6.8
TIBC 201 RETICS 1.20
T.SAT 7.6% ACETON
E
NIL
24. O Laboratory:
Investigations :
3/5 1/7 9/7 15/7
Pus cells 60-70 Over 100 70-80 20-25
albumin + + nil +
glucose + ++ +++ ++
creat 3.0 3.46
c/s E coli E coli
25. O Imaging:
O Ecg : normal sinus rhythm
O Urodynamic studies 16/3/2017:
Investigations:
26. O Imaging:
O Abdominal ultrasound 19/7/2017:
O Right kidney 127x61 mm
O Left kidney 119x60
O Bilateral grade two to three nephropathy
O Mild ascites
O Biliary mud
O hepatomegaly
Investigations:
27. O Imaging:
O Nerve conduction velocities 22/7/2017:
Severe sensory motor axonal polyneuropathy in both
upper and lower limb
Investigations: