This document summarizes the pre-operative diagnosis, operative findings, and specimens collected for a patient undergoing an exploratory laparotomy for a suspected ovarian tumor. The 53-year-old patient presented with abdominal distension and discomfort and imaging showed a large pelvic mass arising from the left ovary. During surgery, an extensive left adnexal mass measuring 20x20x22cm was found involving the left pelvic side wall and colon. The uterus, right ovary, and both fallopian tubes were embedded in the mass. Specimens including the uterus with left ovarian tumor, omentum, and appendix were sent for histopathological examination.
Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure.
A 29-year-old woman, G2P1001 at 39 weeks and 3 days gestation by dates, presented with headache, epigastric pain, and preeclampsia with severe features. She was admitted and stabilized with IV magnesium sulfate loading and maintenance doses, nifedipine tablets twice daily, and antibiotics. Her ultrasound showed a cephalic presentation with normal fetal growth and Doppler studies. She was started on induction of labor with cytotec 50mcg orally every 4 hours if the non-stress test was reactive. Her labor was monitored closely and she delivered vaginally with a good outcome, giving birth to a 4kg baby with APGAR scores of 9-10.
1. A 31-year-old pregnant woman experienced acute fetal distress during labor and underwent an emergency cesarean section, delivering a healthy baby girl.
2. Postpartum, the woman developed hematuria and left flank pain. Imaging revealed a tear in her left renal pelvis causing hydronephrosis.
3. She underwent left percutaneous nephrostomy and cystoscopy, which identified a bladder injury possibly related to stitches from the cesarean section. The injuries were successfully treated without need for nephrectomy.
1) A 35-year-old woman at 37 weeks and 3 days with twin pregnancy presented in late labor and was admitted. She delivered via c-section twins A and B weighing 4kg and 2.8kg respectively.
2) A 57-year-old woman with a history of 6 pregnancies and 5 live births presented with abdominal pain, distension and weight loss. Imaging found abdominal masses. She was admitted for hydration and further investigation including CT scan and ultrasound.
3) A 29-year-old primigravida at 41 weeks gestation by dates was admitted for induction of labor by cervical ripening with cytotec. She had not achieved active labor after her fifth dose.
A 27-year-old woman presented with severe abdominal pain and was found to have a heterotopic pregnancy, with an intrauterine twin gestation and a ruptured right tubal ectopic pregnancy. She underwent laparoscopic salpingectomy for the ectopic pregnancy. Heterotopic pregnancies occur when a simultaneous intrauterine and extrauterine pregnancy occur, with the latter usually being ectopic. Risk factors include assisted reproductive techniques and pelvic inflammatory disease. The presence of an intrauterine pregnancy does not rule out a coexisting ectopic pregnancy. The patient's intrauterine twins were successfully delivered via c-section at 35 weeks.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
1. The document summarizes pre-operative meetings for 4 patients scheduled for hernia repair surgeries. It includes details of each patient's diagnosis, medical history, examination findings, investigations and planned procedures.
2. Pre-op assessments and plans are discussed for Anisah for laparoscopic cholecystectomy, Tan Beng Wah for left open hernioplasty, Perumal for left open hernioplasty, and Wong Kok Mun for left open hernioplasty.
3. Relevant medical histories including comorbidities, previous operations and investigations are documented for each patient. Plans are made for admission, consent, anesthesia review and peri-operative management.
Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure.
A 29-year-old woman, G2P1001 at 39 weeks and 3 days gestation by dates, presented with headache, epigastric pain, and preeclampsia with severe features. She was admitted and stabilized with IV magnesium sulfate loading and maintenance doses, nifedipine tablets twice daily, and antibiotics. Her ultrasound showed a cephalic presentation with normal fetal growth and Doppler studies. She was started on induction of labor with cytotec 50mcg orally every 4 hours if the non-stress test was reactive. Her labor was monitored closely and she delivered vaginally with a good outcome, giving birth to a 4kg baby with APGAR scores of 9-10.
1. A 31-year-old pregnant woman experienced acute fetal distress during labor and underwent an emergency cesarean section, delivering a healthy baby girl.
2. Postpartum, the woman developed hematuria and left flank pain. Imaging revealed a tear in her left renal pelvis causing hydronephrosis.
3. She underwent left percutaneous nephrostomy and cystoscopy, which identified a bladder injury possibly related to stitches from the cesarean section. The injuries were successfully treated without need for nephrectomy.
1) A 35-year-old woman at 37 weeks and 3 days with twin pregnancy presented in late labor and was admitted. She delivered via c-section twins A and B weighing 4kg and 2.8kg respectively.
2) A 57-year-old woman with a history of 6 pregnancies and 5 live births presented with abdominal pain, distension and weight loss. Imaging found abdominal masses. She was admitted for hydration and further investigation including CT scan and ultrasound.
3) A 29-year-old primigravida at 41 weeks gestation by dates was admitted for induction of labor by cervical ripening with cytotec. She had not achieved active labor after her fifth dose.
A 27-year-old woman presented with severe abdominal pain and was found to have a heterotopic pregnancy, with an intrauterine twin gestation and a ruptured right tubal ectopic pregnancy. She underwent laparoscopic salpingectomy for the ectopic pregnancy. Heterotopic pregnancies occur when a simultaneous intrauterine and extrauterine pregnancy occur, with the latter usually being ectopic. Risk factors include assisted reproductive techniques and pelvic inflammatory disease. The presence of an intrauterine pregnancy does not rule out a coexisting ectopic pregnancy. The patient's intrauterine twins were successfully delivered via c-section at 35 weeks.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
1. The document summarizes pre-operative meetings for 4 patients scheduled for hernia repair surgeries. It includes details of each patient's diagnosis, medical history, examination findings, investigations and planned procedures.
2. Pre-op assessments and plans are discussed for Anisah for laparoscopic cholecystectomy, Tan Beng Wah for left open hernioplasty, Perumal for left open hernioplasty, and Wong Kok Mun for left open hernioplasty.
3. Relevant medical histories including comorbidities, previous operations and investigations are documented for each patient. Plans are made for admission, consent, anesthesia review and peri-operative management.
Multidisciplinary case chronic myelogenous leukemia in pregnancyDR MUKESH SAH
Pregnancy and CML
While pregnancy in and of itself does not affect the course of CML, there is a risk for maternal disease progression if CML remains untreated for the duration of pregnancy. Unfortunately, treatment of CML during pregnancy is complicated due to the teratogenic nature of TKIs
The document discusses the case of a 29 year old pregnant woman with a history of cesarean section who presented with vaginal spotting and was diagnosed with uterine didelphys. She underwent a repeat cesarean section to deliver a healthy baby boy. The document also provides background information on uterine didelphys including associated anomalies, diagnostic methods, surgical treatments, and postoperative care.
Acute Renal Failure 2* to Rhabdomyolysis 2* to Motor Vehicular AccidentDJ CrissCross
The document presents a case study of a 20-year-old male who developed acute renal failure secondary to rhabdomyolysis caused by a motorcycle accident. He was admitted with abdominal pain and distension. His creatinine levels increased significantly over his hospital stay, indicating acute kidney injury. He received various treatments including IV fluids, medications, and multiple hemodialysis sessions. His condition gradually improved and he was discharged after three weeks with instructions for outpatient follow up and medication.
Case Systemic Lupus Erythematosus EnteritisKuan Yu Chiang
This 54-year-old female presented with intermittent vomiting and diarrhea for two months. She had a history of systemic lupus erythematosus but had been lost to follow up for 16 years. Imaging showed bilateral hydronephrosis and diffuse fluid-filled distention of the small bowel. Laboratory results confirmed hypoalbuminemia and positive markers for systemic lupus erythematosus. She was diagnosed with lupus enteritis and admitted for treatment with prednisone and plaquenil, showing improvement of symptoms before being discharged.
1. 41 year old G4P3003 woman at 34 weeks and 5 days gestation admitted with severe polyhydramnios and intrauterine growth restriction with multiple congenital anomalies.
2. She developed severe low back pain and shortness of breath 5 days prior and was transferred for further management after being evaluated at Remera Rukoma District Hospital.
3. On examination, she was in moderate respiratory distress. Vital signs were stable. Lungs were clear on auscultation.
A 59-year-old diabetic male presented to the emergency department with left-sided abdominal pain, abdominal distension, and decreased urine output over two days. Imaging revealed gas in the left renal calyces and retroperitoneal spaces, consistent with emphysematous pyelonephritis. The patient was admitted to the ICU for IV fluids, antibiotics, and glycemic control. A nephrostomy tube was placed and aspirated pus and air. Antibiotics were adjusted based on culture results identifying E. coli. The patient's condition improved with treatment and he was later discharged.
UTI in kidney transplantation recipients 2017CHAKEN MANIYAN
This patient is a 21-year-old female kidney transplant recipient who presented with dysuria and suprapubic pain. Initial investigations revealed a urinary tract infection with E. coli. She was treated with ciprofloxacin initially but symptoms did not improve. Further workup found hydronephrosis of the transplant kidney and myoma uteri. She was hospitalized and treated with ertapenem intravenously. Repeat investigations showed improvement in symptoms and graft function.
Case presentation post caesarean pregnancyymadhu326
A 28-year-old woman, G3P1L1A1 with 9 months of amenorrhea, presented with complaints of abdominal pain for 2 hours. She had a previous cesarean section delivery. On examination, her uterus was enlarged corresponding to 36 weeks gestation with a single live fetus in cephalic presentation. She was diagnosed with 36 weeks gestation with 1 previous cesarean section and scar tenderness. An emergency cesarean section was performed under spinal anesthesia and a live preterm male baby was delivered. The postoperative period was uneventful.
1) A 25-year-old pregnant woman presented with severe lower abdominal pain for 1 day. On examination, she had tenderness all over her abdomen.
2) An ultrasound showed a right ovarian cyst. She underwent surgery where they found an enlarged right ovary with old blood.
3) She was diagnosed with a ruptured ovarian cyst and hospitalized. She recovered well and was discharged after 5 days.
This 47-year-old male with a history of liver cirrhosis and HBV was admitted to the ER for hemoptysis for 2 days. He has a left neck mass and complaints of dysphagia and bleeding after eating. A CT scan showed a bulky tumor involving the left lateral oropharyngeal, hypopharyngeal and laryngeal walls, with enlarged lymph nodes. A laryngoscopy found a left hypopharyngeal cancer with ulceration and blood clot but no active bleeding. The tentative diagnosis is left hypopharyngeal cancer with ulceration and active bleeding status post endotracheal intubation to protect the airway, along with anemia from tumor bleeding,
This document presents the case of a 21-year-old female admitted for abdominal pain. She has a history of smoking and is diagnosed with pelvic inflammatory disease (PID) based on symptoms of abdominal pain and vaginal discharge. She is treated with antibiotics and blood transfusions and shows improvement. The document also discusses PID, its causes, symptoms, diagnosis and treatment guidelines. It profiles the patient's family and their economic situation.
Pregnancy Induced Hypertension - Pre eclampsiaomar143
This document provides information about a 33-year-old pregnant woman admitted to the hospital with mild preeclampsia at 36 weeks of gestation. It includes her medical history, symptoms, physical exam findings, lab results, diagnosis, and notes on preeclampsia and its management. The key details are that she presented with swelling in her lower limbs and a history of amenorrhea for 8 months, and was found to have elevated blood pressure and mild preeclampsia at 36 weeks of pregnancy.
This document summarizes the case of a 36-week pregnant primigravida woman who presented with absent fetal movements for 2 days and was diagnosed with intrauterine fetal demise. Her antenatal period was otherwise uneventful. Evaluation of the stillborn fetus, placenta, and maternal factors found no anomalies or risks except for acute chorioamnionitis seen on placental histopathology. A thorough evaluation was conducted including autopsy, cultures, and genetic testing to investigate the cause, though it remained undetermined.
1) A 27-year-old primigravida woman with gestational diabetes presented at 37 weeks and 2 days of gestation with elevated blood glucose levels.
2) She was treated with insulin but eventually underwent an emergency c-section at 38 weeks and 3 days for fetal distress.
3) Her baby was delivered via c-section but suffered complications of maternal diabetes and was admitted to the NICU. Both mother and baby recovered well and were discharged healthy on the 8th post-operative day.
1. A 23-year-old woman at 30 weeks gestation with twin pregnancy and polyhydramnios was referred for management. She had discomfort from inability to sit for long periods.
2. She received dexamethasone injections and planned amnioreduction after steroid administration to prepare lungs for possible preterm delivery at 32 weeks.
3. Her exam found a gravid uterus consistent with twins, no other issues, and ultrasound confirmed twin pregnancy with polyhydramnios causing discomfort.
This document describes the case of a 4-day old male neonate admitted to the hospital for evaluation of antenatally detected bilateral hydronephrosis. The baby was delivered full-term via normal vaginal delivery and initial examinations were normal. Antenatal ultrasounds showed progressively worsening bilateral hydronephrosis. Postnatal ultrasound confirmed bilateral hydronephrosis more severe on the left side. Laboratory tests and renal function were normal. A micturating cystourethrogram detected bilateral vesicoureteral reflux grade 3 on the right and grade 2 on the left. The baby received antibiotics and was discharged with instructions to follow-up in one month and continue prophylactic medications.
A 35-year-old male auto driver was admitted with decreased urine output for 3 days and abdominal pain and fever for 10 days. Examination found pallor and abdominal tenderness. Tests showed acute kidney injury and a urine culture grew gram-negative bacilli. He was diagnosed with acute pyelonephritis likely caused by E. coli infection. He received IV and oral antibiotics and underwent hemodialysis. His kidney function and other lab values gradually improved with treatment.
This document reports on a case of a 29-year-old woman admitted to the hospital with vaginal bleeding at 35-36 weeks of pregnancy. She was diagnosed with severe preeclampsia, placenta previa totalis, and was at risk of eclampsia. She underwent an emergency cesarean section to deliver a healthy baby girl weighing 2400 grams. Post-operation, the mother received magnesium sulfate and antihypertensive treatment and recovered well.
This document discusses the case of a preterm baby born at 28 weeks and 2 days gestation who experienced respiratory distress syndrome, apnea of prematurity, sepsis, and grade 1 germinal matrix hemorrhage but was eventually discharged home on oxygen and follow up care. The baby was treated with CPAP, caffeine, antibiotics, phototherapy, and other supportive care measures over 38 days in the NICU.
Multidisciplinary case chronic myelogenous leukemia in pregnancyDR MUKESH SAH
Pregnancy and CML
While pregnancy in and of itself does not affect the course of CML, there is a risk for maternal disease progression if CML remains untreated for the duration of pregnancy. Unfortunately, treatment of CML during pregnancy is complicated due to the teratogenic nature of TKIs
The document discusses the case of a 29 year old pregnant woman with a history of cesarean section who presented with vaginal spotting and was diagnosed with uterine didelphys. She underwent a repeat cesarean section to deliver a healthy baby boy. The document also provides background information on uterine didelphys including associated anomalies, diagnostic methods, surgical treatments, and postoperative care.
Acute Renal Failure 2* to Rhabdomyolysis 2* to Motor Vehicular AccidentDJ CrissCross
The document presents a case study of a 20-year-old male who developed acute renal failure secondary to rhabdomyolysis caused by a motorcycle accident. He was admitted with abdominal pain and distension. His creatinine levels increased significantly over his hospital stay, indicating acute kidney injury. He received various treatments including IV fluids, medications, and multiple hemodialysis sessions. His condition gradually improved and he was discharged after three weeks with instructions for outpatient follow up and medication.
Case Systemic Lupus Erythematosus EnteritisKuan Yu Chiang
This 54-year-old female presented with intermittent vomiting and diarrhea for two months. She had a history of systemic lupus erythematosus but had been lost to follow up for 16 years. Imaging showed bilateral hydronephrosis and diffuse fluid-filled distention of the small bowel. Laboratory results confirmed hypoalbuminemia and positive markers for systemic lupus erythematosus. She was diagnosed with lupus enteritis and admitted for treatment with prednisone and plaquenil, showing improvement of symptoms before being discharged.
1. 41 year old G4P3003 woman at 34 weeks and 5 days gestation admitted with severe polyhydramnios and intrauterine growth restriction with multiple congenital anomalies.
2. She developed severe low back pain and shortness of breath 5 days prior and was transferred for further management after being evaluated at Remera Rukoma District Hospital.
3. On examination, she was in moderate respiratory distress. Vital signs were stable. Lungs were clear on auscultation.
A 59-year-old diabetic male presented to the emergency department with left-sided abdominal pain, abdominal distension, and decreased urine output over two days. Imaging revealed gas in the left renal calyces and retroperitoneal spaces, consistent with emphysematous pyelonephritis. The patient was admitted to the ICU for IV fluids, antibiotics, and glycemic control. A nephrostomy tube was placed and aspirated pus and air. Antibiotics were adjusted based on culture results identifying E. coli. The patient's condition improved with treatment and he was later discharged.
UTI in kidney transplantation recipients 2017CHAKEN MANIYAN
This patient is a 21-year-old female kidney transplant recipient who presented with dysuria and suprapubic pain. Initial investigations revealed a urinary tract infection with E. coli. She was treated with ciprofloxacin initially but symptoms did not improve. Further workup found hydronephrosis of the transplant kidney and myoma uteri. She was hospitalized and treated with ertapenem intravenously. Repeat investigations showed improvement in symptoms and graft function.
Case presentation post caesarean pregnancyymadhu326
A 28-year-old woman, G3P1L1A1 with 9 months of amenorrhea, presented with complaints of abdominal pain for 2 hours. She had a previous cesarean section delivery. On examination, her uterus was enlarged corresponding to 36 weeks gestation with a single live fetus in cephalic presentation. She was diagnosed with 36 weeks gestation with 1 previous cesarean section and scar tenderness. An emergency cesarean section was performed under spinal anesthesia and a live preterm male baby was delivered. The postoperative period was uneventful.
1) A 25-year-old pregnant woman presented with severe lower abdominal pain for 1 day. On examination, she had tenderness all over her abdomen.
2) An ultrasound showed a right ovarian cyst. She underwent surgery where they found an enlarged right ovary with old blood.
3) She was diagnosed with a ruptured ovarian cyst and hospitalized. She recovered well and was discharged after 5 days.
This 47-year-old male with a history of liver cirrhosis and HBV was admitted to the ER for hemoptysis for 2 days. He has a left neck mass and complaints of dysphagia and bleeding after eating. A CT scan showed a bulky tumor involving the left lateral oropharyngeal, hypopharyngeal and laryngeal walls, with enlarged lymph nodes. A laryngoscopy found a left hypopharyngeal cancer with ulceration and blood clot but no active bleeding. The tentative diagnosis is left hypopharyngeal cancer with ulceration and active bleeding status post endotracheal intubation to protect the airway, along with anemia from tumor bleeding,
This document presents the case of a 21-year-old female admitted for abdominal pain. She has a history of smoking and is diagnosed with pelvic inflammatory disease (PID) based on symptoms of abdominal pain and vaginal discharge. She is treated with antibiotics and blood transfusions and shows improvement. The document also discusses PID, its causes, symptoms, diagnosis and treatment guidelines. It profiles the patient's family and their economic situation.
Pregnancy Induced Hypertension - Pre eclampsiaomar143
This document provides information about a 33-year-old pregnant woman admitted to the hospital with mild preeclampsia at 36 weeks of gestation. It includes her medical history, symptoms, physical exam findings, lab results, diagnosis, and notes on preeclampsia and its management. The key details are that she presented with swelling in her lower limbs and a history of amenorrhea for 8 months, and was found to have elevated blood pressure and mild preeclampsia at 36 weeks of pregnancy.
This document summarizes the case of a 36-week pregnant primigravida woman who presented with absent fetal movements for 2 days and was diagnosed with intrauterine fetal demise. Her antenatal period was otherwise uneventful. Evaluation of the stillborn fetus, placenta, and maternal factors found no anomalies or risks except for acute chorioamnionitis seen on placental histopathology. A thorough evaluation was conducted including autopsy, cultures, and genetic testing to investigate the cause, though it remained undetermined.
1) A 27-year-old primigravida woman with gestational diabetes presented at 37 weeks and 2 days of gestation with elevated blood glucose levels.
2) She was treated with insulin but eventually underwent an emergency c-section at 38 weeks and 3 days for fetal distress.
3) Her baby was delivered via c-section but suffered complications of maternal diabetes and was admitted to the NICU. Both mother and baby recovered well and were discharged healthy on the 8th post-operative day.
1. A 23-year-old woman at 30 weeks gestation with twin pregnancy and polyhydramnios was referred for management. She had discomfort from inability to sit for long periods.
2. She received dexamethasone injections and planned amnioreduction after steroid administration to prepare lungs for possible preterm delivery at 32 weeks.
3. Her exam found a gravid uterus consistent with twins, no other issues, and ultrasound confirmed twin pregnancy with polyhydramnios causing discomfort.
This document describes the case of a 4-day old male neonate admitted to the hospital for evaluation of antenatally detected bilateral hydronephrosis. The baby was delivered full-term via normal vaginal delivery and initial examinations were normal. Antenatal ultrasounds showed progressively worsening bilateral hydronephrosis. Postnatal ultrasound confirmed bilateral hydronephrosis more severe on the left side. Laboratory tests and renal function were normal. A micturating cystourethrogram detected bilateral vesicoureteral reflux grade 3 on the right and grade 2 on the left. The baby received antibiotics and was discharged with instructions to follow-up in one month and continue prophylactic medications.
A 35-year-old male auto driver was admitted with decreased urine output for 3 days and abdominal pain and fever for 10 days. Examination found pallor and abdominal tenderness. Tests showed acute kidney injury and a urine culture grew gram-negative bacilli. He was diagnosed with acute pyelonephritis likely caused by E. coli infection. He received IV and oral antibiotics and underwent hemodialysis. His kidney function and other lab values gradually improved with treatment.
This document reports on a case of a 29-year-old woman admitted to the hospital with vaginal bleeding at 35-36 weeks of pregnancy. She was diagnosed with severe preeclampsia, placenta previa totalis, and was at risk of eclampsia. She underwent an emergency cesarean section to deliver a healthy baby girl weighing 2400 grams. Post-operation, the mother received magnesium sulfate and antihypertensive treatment and recovered well.
This document discusses the case of a preterm baby born at 28 weeks and 2 days gestation who experienced respiratory distress syndrome, apnea of prematurity, sepsis, and grade 1 germinal matrix hemorrhage but was eventually discharged home on oxygen and follow up care. The baby was treated with CPAP, caffeine, antibiotics, phototherapy, and other supportive care measures over 38 days in the NICU.
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Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
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This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
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We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
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International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
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Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
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Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
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2. Pre op diagnosis: G5P2+2 at 15weeks1days for Missed Miscarriage
Post op diagnosis: Para2+3 Post suction and curettage for Missed Miscarriage
Operation: Suction and Curettage
Norfazalina Binti Ghazali
IC: 811108-02-5744/ RN: 1439740
LMP: 14/11/20 GP2+2 @15wks +1day POA
Electively admitted for suction and curettage for Missed miscarriage
Initially p/w to KK with PV bleeding x 3/7 (soaked 3 pads) associated with Lower
abdominal pain x 1/7,
Otherwise, no passing out blood clots or POC, no fever
TAS (21/1/21) IUGS seen. No fetal heart echo
Visited EPAU on 1/2/21 with similar complaints, impression: pregnancy of
unknown viability
TAS/TVS (1/2/21): uterus 8.5x 4.9 cm, IUGS seen, 2.3cm, no CRL
Obs hx :
TAS/TVS on (10/2/21): anteverted uterus, IUGS seen 2.3cm, no CRL
TAS (24/2/21): IUGS with irregular margin 3.3cm, no fetal pole, fetal echo. uterus
anteverted 5.9 x 4.4cm
TCS: uterus anteverted, irregular IUGS 3.3cm, no fetal pole/ fetal echo. Right
ovary: corpus luteal cyst 2.5 x 1.9cm
left ovary: normal
OBS history:
2007/ SVD/ male/ BW: 2.8kg/ term
2011/ ELLSCS/ male/ BW: 3.5kg/ term
2009/ D&C for abortion
2017/ laparoscopic and salphingectomy for right ectopic pregnancy
ANC
1. 1 previous scar in 2011 ELLSCS for transverse lie, no VBAC
Upon admission, no PV bleeding, no abdominal pain, no passing out of POC, no
anemic symptoms
O/E: Alert,pink, vitlas stable
PA: soft, not tender
V/E : VVNAD , cervix: posterior tubular, os parous, uterus at 8w, adnexal free
TAS/ TVS in EPAU : uterus anteverted, 5.4 x4.7cm, empty IUGS seen, 25mm, no
fetal pole
Operative Findings:
Vulva/vagina: NAD
os: open
Cervix: Normal
Uterus : 8 weeks anteverted
Uterus sound till 8cm
Dilated with Hegar dilator 8
POD free
POC 30 cc evacuated
EBL: minimal
POC for HPE sent
Plan
1. Tab PCM 1g QID
2. TCA stat if abdominal pain /fever/increase PV bleeding
3. To call back patient if HPE abnormal
3. Evacuation of Retained
Product of Conception
For Incomplete Miscarriage
Awatif Binti Ahmad
960415-08-6028
RN: 1439711
1/3/2021
4. Pre op diagnosis: G2P1 at 9weeks2days for Incomplete Miscarriage
Post op diagnosis: Para1+1 Post Evacuation of retained product of conception for incomplete miscarriage
Operation: Evacuation of retained product of conception
Awatif Binti Ahmad
IC: 960415-08-6028/ RN: 1439711
LMP: 25/12/20 G2P1 @9wks +1day POA
Admitted for incompete miscarriage
P/w with PV bleeding x 1/52 (soaked 3 pads/day, no blooc clots) associated with
Lower abdominal cramp x 1/7, and passing out of the POC at 12am (28/2/21) in
ED
Otherwise, no fever, no foul smelling PV discharge.
TAS (28/1/21) IUGS seen. No fetal heart echo
TCS: uterus anteverted, irregular IUGS 3.3cm, no fetal pole/ fetal echo. Right
ovary: corpus luteal cyst 2.5 x 1.9cm
OBS history:
2017/ EMLSCS for impending eclampsia
ANC
1. 1 previous scar in 2017 for impending eclampsia
2. Alpha Thalassemia intermedia, HbH disease, on monthly blood transfusion
since 6 yo. Latest Hb on 28/2/21- 8.9 (Transfused 2 pint leukodepleted
packed cell in the ward prior to op- 28/2/21, 1/3/21)
Upon admission, still having minimal PV bleeding, no abdominal pain, no anemic
symptoms, remain afebrile
O/E: Alert,pink, vitals stable
PA: soft, not tender
V/E at EPAU: VVNAD , cervix: posterior tubular, os open
Per speculum at EPAU: Cervix normal tubular, minimal oozing of blood from os,
os closed.
IM Syntometrine 1/1 stat given in EPAU
Reassessed at 28/2/21
Per speculum: Cervix normal, os open, minimal PV bleeding
VE: VVNAD , cervix: tubular, os tip of finger, uterus 8 weeks size, adnexa free
TAS: Ut anteverted, ET thick
TVS: Ut anteverted 6.6 X 4.9 cm, ET 20mm
Operative Findings: (1/3/21)
Vulva/vagina: NAD
os: open
Cervix: Normal
Uterus : 8 weeks anteverted
Uterine sound till 8cm
POD free
POC 30 cc evacuated, no vesicles seen
EBL: minimal
POC for HPE sent
Plan
1. Tab PCM 1g QID
2. TCA stat if abdominal pain /fever/increase PV bleeding
3. To call patient if HPE result abnormal
5. EMLSCS for severe pre-eclampsia
complicated with acute
pulmonary edema
Nadia Nabilah Binti Adnan
911230076068
1439841
1/3/2021
6. Patient’s details Indication and progression Outcomes
Nadia Nabilah Binti Adnan
911230076068
1439841
29 years old
G2P1 @ 34weeks6 days
Admitted on 1/03/2021 for severe pre-eclampsia
complicated with acute pulmonary edema
ANC:
1. Iron deficiency anemia
- given 1st dose of IV Sucrofer on 26/2/21
2. History admission to ACC on 25/2/21 for
symptomatic anemia and newly diagnosed
gestational hypertension and UTI,
discharged on 26/2/21
2. 1st child of second union
3. UTI
- On T Cephalexin 500mg
4. LCB 8 years ago
- on IUCD for 7 years, removed in March 2020
EMLSCS for severe pre-eclampsia complicated with acute pulmonary edema
Presented with SOB sinc discharge from ACC, worsening on the day of
admission, unsble to sleep
denies chest pain
complain of contraction pain, No PV bleeding, good fetal movement
O/e at PAC: alert, tachypneic, tachycardic
BO: 166/101
PR: 100, T: 37, SPO2: 100% under Npo2 2L/min
lungs: bilateral crepitations from LZ til MZ
CVS: murmur heard
ECG: sinus tachycardia
P/A: soft, contraction felt, uterus @ 34week size, singleton, cephalic,
VE: v/v NAD, os 2cm, cervix 1.5cm, mid, average, station -2, vertex
presentation, membrane intact, no cord, no placenta
bilateral pedal edema til knee
reflexes not brisk
TAS: singleton, cephalic, fetal heart acivity present
placenta PUS, no retroplacenta clot
urine output: 1000cc, clear urine
urine dipstick: Blood: Trace, Nitrite: neg, Leu: Neg, Protein: 1+
Reassessment, BP: 154/107, started on IVI Hydralazine and given IV Lasix
40mg stat
1/3/21
Hb: 7.7 WBC: 11.6 PLT: 381
PT: 10.3 aPTT: 31.3 INR: 0.99
Na: 136 K: 3.3 urea: 2.7 creat: 45
Alb; 20 ALT: 8 ALP: 94
Mg: 0.7 Po4: 1.12 Ca: 2.34 uric acid: 400.7
ABG under NPO2:
pH: 7.495 Pco2: 22.4 Po2: 166 Sao2: 100%, Hco3: 20.1 BE: -6
Operative Findings:
1. Peritoneal Cavity: normal
2. Lower Segment: Formed
3. Engagement: head not engaged
4. Placenta: PUS
5. Uterus: normal
6. Tube: Both normal
7. Ovary: Both normal
8. Liquor: clear, 200 cc
9. Abnormalities of other structures: none
Post-op Urine: clear
EBL: 300 cc
Baby girl delivered, Apgar 4 at 1min, 10 at 5mins, no weighing
machine available in GOT, will weigh in NNW
Admitted to NNW for post resuscitation care and respiratory
distress
ABG- pH: 7.237, PaO2:- , PaCO2:53, HCO3:18.4/ BE : -4.8
VBG- pH: 7.239, PaO2:15.9, PaCO2:50.7, HCO3:18.0/ BE : -
5.9
11. Pre-op diagnosis: Ovarian tumour most likely malignant RMI: 228987
Post-op diagnosis: Carcinoma of Ovary FIGO Stage 2B- pending HPE
Operation: Exploratory Laparotomy,Total Hysterectomy, Bilateral Salphingo-oophorectomy, Supracolic Omentectomy and Appendicectomy
Norjan Binti Abdul Majid, I/C: 680119-07-5002, RN: 1440296
53/ Nulliparouns/Menopause at 45 years old. BMI: 24kg/m2
E/A for exploratory laparotomy, total hysterectomy, bilateral salphingo-oopherectomy, omentectomy,
appendicectomy, Pelvic lymph node disection +- bowel resection and colostomy.
Case referred from Metro hospital on 8/2/2021
P/w abdominal distension and discomfort x 2/52
With LOW/ LOA
Ca 125 ( 31/1/21): 25443, Alpha feto protein: 2.3
CEA ( 31/1/21): 10.15
CT Abdomen pelvis on 31/2/21 in metro hospital
A well defined heterogenous enchancing custic mass in the pelvis. Predominantly on the left side ,measuring
about 10.3x 2.7x 2.3xm. Displacing uterus fundus to the right side.
Right side ovary measuring about 3.7x 2.7
No enhacing peritoneal nodules or mass seen.
Liver has smooth surface. Homogenous density. No diffuse or focal perenchyma liver parenchyma lesion.
Intrahepatic ducts are not dilated. Porta hepatis is clear for any mass or lymphadenoapthy.
Pnacrease normal. No focal lesion. Duct not dilated
Gall Bladder is well distanded with Gall stone present
Gross ascities present
Kidney normal. No hydromeorhosis. Ureters not dilated.
CT thorax 3/2/21 in metro hospital
Small areas of lung fibrosis in both a
upper lobes and medial segment of r
clear evidence of lung metastasis.
No mediastinal LN.
Gross asicties and gall stone
Done peritoneal tapping x2 in HPP (9
Peritoneal cell block for HPE (9/2/21
suspicious of adenocarcinoma
Peritomeal fluid cytology (9/2/21): o
large atypical epithelial cell
Peritoneal cell block (16/2/21): occa
cell in the background of chornic per
Peritoneal fluid cytology (16/2): A fe
background of chronic peritonitis
TAS (9/2/21): multiloculated solid cy
gross ascities
Unable to visualise ovary
TAS on (3/3/21): multuseptated tum
12. Pre-op diagnosis: Ovarian tumour most likely malignant RMI: 228987
Post-op diagnosis: Carcinoma of Ovary FIGO Stage 2B- pending HPE
Operation: Exploratory Laparotomy,Total Hysterectomy, Bilateral Salphingo-oophorectomy, Supracolic Omentectomy and Appendicectomy
Operative Findings:
Peritoneal Cavity : Hemorrhagic ascitic fluid about 1500 mls
Left adnexal mass measuring 20x20x22cm most likely arising from the
left ovary with extensive adhesion to the left pelvic side wall and
rectosigmoid colon- ruptured during manipulation releasing
hemorrhagic fluid
Also noted solid component in the cyst highly suggestive of malignant
tumour
Uterus and right ovary embedded in the mass
POD completely obliterated
Noted extensive thickening of the pelvic peritoneum most likely due to
tumour involvement
Uterus normal size - cut opened post-operatively --> no obvious
tumour seen
Cervix normal
Both fallopian tubes not identified most likely embedded by the
tumour
No enlarged pelvic or paraortic lymph nodes
Small and large bowel, omentum normal
Appendix normal
Liver and subdiaphragmatic area smooth
Total Estimated Blood Loss: 1000 mls
Transfused 3 pints WB and 1 pint PC
Specimens Sent:
(1) Cytopathology/cell block: Peritoneal Washing
(2) Histopathology: 1)Uterus with left ovarian
tumour ? right ovary and ?both fallopian tubes and
ovaries
2)Omentum
3)Appendix
Discharge plan:
TCA gycae-onco on 30/3/21.
15. e-op diagnosis: Advanced primary peritoneal/ovarian malignancy (RMI 15867)
ost-op diagnosis: Carcinoma of Ovary FIGO Stage 4B (Metastatic nodule at umbilicus)
peration: Interval Debulking, Exploratory Laparotomy, Total Hysterectomy and Bilateral Salphingo-oophorectomy and Omentectomy
eoh Chai Hoon, I/C: 490630-07-5504, RN: 1440280
2yo, Para 2, BMI 18.31kg/m2, Menopause at 50 y/o
nderlying:
Hypertension
- On T Perindopril 8mg OD, T Amlodipine 10mg OD, T Bisoprolol 5mg OD
esented with abdominal mass for 2 months associated with bilateral lower limb swelling
therwise, no abdominal pain, no constitutional symptoms, no SOB/ chest pain, menses
gular previously
ECT TAP (13/11/20):
Multiple intraabdominal and pelvic masses involving peritoneum may represent ovarian
alignancy with peritoneal metastases. Differential diagnosis is primary peritoneal
alignancy.
Splenic lesions likely to represent metastases
Cervical, mediastinal, abdominal and pelvic lymphadenopathy suggestive of metastases.
Left pleural effusion.
A: soft, mass felt up to 18 weeks size more towards right side
gital examination: procidentia, noted cervical growth: removed for HPE using punch biopsy
rceps.
lateral lower limb: Pitting oedema
Cervical mass for HPE (25/11/20) :
Pseudoepitheliomatous hyperplasia with mild acute
on chronic cervicitis, negative for malignancy
Peritoneal fluid cell block (30/11/20) :
Moderately differentiated carcinoma
Suggestive of serous carcinoma of female genital
tract, favouring ovarian in origin
Referred to urology for mass protruding from
urethra.
Flexible cysto-endoscopy (24/11/2020): Bladder
trabeculated, no tumour seen, prolapse posterior
urethral mucosa, no tumour along urethra
CEA (1/12--17/12/20--12/1/21): 1.2/1.2/3.0
CA125 (1/12--17/12/20--12/1/21): 2616/ 1733/ 401
CECT TAP (21/1/21):
Known case of advanced primary peritoneal/
ovarian malignancy post chemotherapy with:
16. Pre-op diagnosis: Advanced primary peritoneal/ovarian malignancy (RMI 15867)
Post-op diagnosis: Carcinoma of Ovary FIGO Stage 4B (Metastatic nodule at umbilicus)
Operation: Interval Debulking, Exploratory Laparotomy, Total Hysterectomy and Bilateral Salphingo-ophorectomy, Omentectomy
Operative Findings:
Peritoneal Cavity : No ascites, no adhesion
Uterus normal size - cut opened post-operatively --> no obvious tumour
seen
Cervix normal but edematous due to prolonged prolapsed
Bilateral residual ovarian tumour- right side measuring 5x5 cm, left side
6x5 cm
Both fallopian tubes normal
Also noted residual omental caking with extension to the umbilicus
measuring 4x4cm
Multiple small nodules (< 1cm) over the mesentery of small and large
bowel
Appendix not visualized
Multiple nodules (<1cm) over under surfaces of both diaphragm
Liver surface smooth
Total Estimated Blood Loss: 200mls
Intra-op transfused 2 pints of pack cells
Post-op Urine: 700 mls
Clear Urine
Specimens Sent:
(1) Cytopathology/cell block: Peritoneal Washing
(2) Histopathology: 1)Uterus, cervix, bilateral
ovarian tumors and both fallopian tubes
2)Omentum
Discharge plan
TCA Gynaeonco clinic on 7/4/21. (KIV for
chemotherapy)
17. Pre-op diagnosis: Ovarian Tumour most likely malignant (RMI 7113)
Post-op diagnosis: Carcinoma of Ovary FIGO Stage 2B (Pending Final HPE)
Operation: Exploratory Laparotomy, Total Hysterectomy and Bilateral Salphingo-oophorectomy, Supracolic Omentectomy and Appendicectomy
Operative Findings:
Peritoneal Cavity : No ascites
Uterus normal size - cut opened post-operatively --> normal looking
endometrial cavity
Cervix normal
Bilateral ovarian tumour highly suggestive of malignancy
right side measuring 20x20x22cm, biloculated, mainly cystic with some
solid component. Noted tumour deposit at its surface measuring
1x1cm.
left side measuring 5x5cm, cystic component.
Both fallopian tubes normal
No enlarged pelvic or paraaortic lymph nodes
Small and large bowel, appendix, omentum normal
Liver and subdiaphragmatic area smooth
Total Estimated Blood Loss:500 mls
Post-op Urine:150 mls
Clear Urine
Specimens Sent:
(1) Cytopathology/cell block: Peritoneal Washing
(2) Histopathology:
1)Uterus, cervix, bilateral ovarian tumours and both
fallopian tubes
2)Omentum
3)Appendix
Discharge plan:
TCA gynae-onco on 29/3/21
18. Nor Faiza Bt Osman
820711-08-5826
1440292
4/3/21
19. Pre-op diagnosis: Ovarian Tumour most likely malignant (RMI 7113)
Post-op diagnosis: Carcinoma of Ovary FIGO Stage 2B (Pending Final HPE)
Operation: Exploratory Laparotomy, Total Hysterectomy and Bilateral Salphingo-oophorectomy, Supracolic Omentectomy and Appendicectomy
Nor Faiza Bt Osman, I/C: 820711-08-5826, RN: 1440292
38yo, Para 3, BMI 22.27kg/m2, LMP: 20/2/21
Underlying: NKMI
1. H/O LSCS x2
- 2016: PP Major
- 2007: Breech presentation
Presented with abdominal distension x1/12, Alternate constipation with
diarrhoea x 1/12
Otherwise, no abdominal pain, no constitutional symptoms, no SOB/
chest pain, menses regular
Pap smear (13/1/21): Negative for intraepithelial lesion of malignancy
Pipelle Sampling (13/1/21): Mid secretory endometrium
CECT TAP (27/1/21):
- Large heterogeneously cystic pelvic mass with fatty component, Ddx:
ovarian teratoma/ immature ovarian teratoma/ malignancy
- Right non obstructive nephrolithiasis
Tumour marker (13/1/21): CA-125 2371, CEA 3.7, AFP 1.7
TAS (15/2/21): Uterus 6.8x4.7cm, ET: 21mm, Right multi-septated cyst
with solid area 9.2x8cm, Left ovarian cyst 3x4.3cm, no ascites
Repeated TAS (3/3/21):
Uterus 6.1x4.3cm, ET 5mm, Multiloculated ovarian tumour with solid
cystic area measuring 10.5x10.1cm and 8.1x7.9cm, no ascites
21. Pre op diagnosis: G3P0+2 at 12 weeks for Missed Miscarriage
Post op diagnosis: Para 0+3 post suction and curettage for missed miscarriage
Operation: Suction and curettage
Nurul Syakila Binti Hamezah
IC: 900222-02-5988 RN: 1440313
LMP: 9/12/20 G3P0+2 @12 weeks POA
Electively admitted for suction and curretage for missed miscarriage
Initially referred by KD Teluk Kumbar to HPP for overt diabetes and for insulin
commencement on 25/1/21. Warded in C13 from 26/1/21-1/2/21 for optimization
of blood sugar.
Otherwise,
Afebrile
No abdominal pain
No PV bleeding
No passing out POC
TVS (26/1/21): IUGS seen. No fetal pole seen.
TVS (11/2/21): IUGS seen. No fetal pole seen.
TAS (18/2/21): Uterus anteverted. IUGS seen 4.8cm. No fetal pole seen.
TVS (18/2/21): Uterus anteverted. CRL seen 12.5mm. No fetal echo seen.
No cyst/fibroid.
Obstetric history:
2018/Complete abortion @ 6/52 / D&C not done
2019/Missed miscarriage@ 13/52 / D&C done at HPP
ANC
1.Maternal obesity
3.History of 2 previous miscarriage
-2018/Complete abortion @ 6/52 / D&C not done
-2019/Missed miscarriage@ 13/52 / D&C done at HPP
4. Pseudoprimigravida
5. Hypochromic microcytic RBC (Hb:13.1) TRO Thalasemia
-Mentzer index:12.575
-Not investigated before
Upon admission, no PV bleeding, no passing out POC, no abdominal pain, no
anemic symptoms, no fever
O/E: Alert, not pale, vitals stable
PA: soft, not tender, uterus not palpable
Reassessed on 3/3/21
VE: VVNAD , Os Closed, Cx tubular , uterus 8 week
TAS/TVS: IUGS seen 44.7mm. CRL 10.3mm (7week 1 day). No fetal heart seen.
Operative Findings: (4/3/21)
Vulva/vagina: Normal
os: open
Cervix: Normal
Uterus : 10 weeks anteverted
Uterine sound up to 10cm
POD free
POC 100 cc evacuated, no vesicles structures seen
23. Pre operative diagnosis: Left Labia Majora Abscess
Post operative diagnosis: Left Labia Majora Abscess
Operation: Incision & Drainage of Left Labia Majora Abscess
Name : Hartini Binti Abdul Hadi @ Paulus
Passport : 831230-02-5420 / RN: 1440543
Para 1+2
U/L:
1. Diabetes mellitus (diagnosed in 2018)- on T. Metformin 1g BD
2. Morbid obesity- BMI: 64
3. Bronchial asthma- on MDI Salbutamol & MDI Budesonide
4. Polycystic ovarian syndrome
5. H/o admission to H. Melaka for prolonged menses in 2011
Initially p/w swelling & pain over left labia majora for 1/52
- Progressively increasing in size, no PV discharge/ bleeding, no
fever, no itchiness, no h/o trauma to labia.
On inspection of left labia majora:
- Swelling 5x4cm, tender on palpation, no punctum, no redness/
not erythematous, indurated surface, no fungal infection
surrounding perineum.
Operative findings:
- Left labial swelling around 5x4cm
- no punctum
- Pus drained : 10cc
Specimen sent : Pus and swab for culture and sensitivity
Pre-Hb: 10.5
TEBL : Minimal
Discharge plan:
- Memo to KK Bayan Baru for optimization of blood glucose
- For KK to trace pus and swab culture and sensitivity.