A 13-year old girl was admitted to the Federal Medical Center in Keffi, Nigeria on December 30, 2022 for newly diagnosed type 1 diabetes mellitus with hyperglycemia and glycosuria. Her diagnosis and treatment are documented in her patient records, which include administering insulin, monitoring her blood sugar and vital signs, counseling her mother, and ensuring her general condition remains fair.
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
Clinic psychosocial Case on Antenatal cum Post Natal CareYogesh Arora
A 27-year-old woman living in Chandigarh is a third gravida at 37+4 weeks pregnant with a history of 1 previous cesarean section and 2 abdominal surgeries. She has been admitted to the hospital for a planned vaginal birth after cesarean. Her previous pregnancies and medical history were unremarkable except for a history of abdominal tuberculosis 3 years ago. On examination, she is stable and her pregnancy is progressing normally.
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...DR. METI.BHARATH KUMAR
PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra
If Anyone need this they can contact me via
dr.m.bharathkumar@gmail.com
This case discusses a 62-year-old woman with type 1 diabetes and hypoglycemia unawareness who underwent professional continuous glucose monitoring on two occasions. The initial monitoring revealed no overnight hypoglycemia but significant hyperglycemia throughout the day. Therapy was adjusted based on these results. Follow-up monitoring showed fewer post-meal excursions but continued hyperglycemia after high-fat dinners. Examination of the patient's diary revealed she had been inaccurately recording her blood glucose levels. Professional CGM was useful in identifying patterns of hyperglycemia and informing changes to the patient's insulin regimen and dietary advice.
The document outlines plans for a Clinical Nutrition Specialist Program in 2025 that will uphold ethical standards, meet competence requirements, contribute to nutrition research, and provide high quality clinical nutrition services. The program aims to be a leading center of excellence and will provide comprehensive clinical training encompassing scientific, medical, and service aspects of nutrition.
NAMRATA GDM CASE PRESENTATION NEW editedMeetAgrawat
1. A 27-year-old primigravida woman presented for routine antenatal care at 38 weeks gestation. She had a history of diabetes mellitus prior to pregnancy.
2. Laboratory investigations including HbA1c, lipid profile, and blood sugars were performed and found to be stable. Ultrasound showed a fetus in longitudinal lie with cephalic presentation and normal Doppler flow.
3. Due to high floating head with inlet cervical dilation, an emergency lower segment cesarean section was performed and a baby boy was delivered weighing 2775 grams with good Apgar scores. The patient was started on metformin post-operatively for blood sugar control.
Case studies in the managment of type 2 diabetes NasserAljuhani
Case 1:Poorly controlled type 2 diabetes on triple oral therapies
Case 2:Morning hypoglycemia on premixed InsulinCase 3
Case 3:Newly diagnosed D.M Type1D.M or type 2 D.M ?
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
Clinic psychosocial Case on Antenatal cum Post Natal CareYogesh Arora
A 27-year-old woman living in Chandigarh is a third gravida at 37+4 weeks pregnant with a history of 1 previous cesarean section and 2 abdominal surgeries. She has been admitted to the hospital for a planned vaginal birth after cesarean. Her previous pregnancies and medical history were unremarkable except for a history of abdominal tuberculosis 3 years ago. On examination, she is stable and her pregnancy is progressing normally.
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...DR. METI.BHARATH KUMAR
PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra
If Anyone need this they can contact me via
dr.m.bharathkumar@gmail.com
This case discusses a 62-year-old woman with type 1 diabetes and hypoglycemia unawareness who underwent professional continuous glucose monitoring on two occasions. The initial monitoring revealed no overnight hypoglycemia but significant hyperglycemia throughout the day. Therapy was adjusted based on these results. Follow-up monitoring showed fewer post-meal excursions but continued hyperglycemia after high-fat dinners. Examination of the patient's diary revealed she had been inaccurately recording her blood glucose levels. Professional CGM was useful in identifying patterns of hyperglycemia and informing changes to the patient's insulin regimen and dietary advice.
The document outlines plans for a Clinical Nutrition Specialist Program in 2025 that will uphold ethical standards, meet competence requirements, contribute to nutrition research, and provide high quality clinical nutrition services. The program aims to be a leading center of excellence and will provide comprehensive clinical training encompassing scientific, medical, and service aspects of nutrition.
NAMRATA GDM CASE PRESENTATION NEW editedMeetAgrawat
1. A 27-year-old primigravida woman presented for routine antenatal care at 38 weeks gestation. She had a history of diabetes mellitus prior to pregnancy.
2. Laboratory investigations including HbA1c, lipid profile, and blood sugars were performed and found to be stable. Ultrasound showed a fetus in longitudinal lie with cephalic presentation and normal Doppler flow.
3. Due to high floating head with inlet cervical dilation, an emergency lower segment cesarean section was performed and a baby boy was delivered weighing 2775 grams with good Apgar scores. The patient was started on metformin post-operatively for blood sugar control.
Case studies in the managment of type 2 diabetes NasserAljuhani
Case 1:Poorly controlled type 2 diabetes on triple oral therapies
Case 2:Morning hypoglycemia on premixed InsulinCase 3
Case 3:Newly diagnosed D.M Type1D.M or type 2 D.M ?
This patient presented with bleeding at 33 weeks and 3 days of gestation and was diagnosed with Placenta Previa Type IV. She underwent an elective lower segment Caesarean section to deliver a baby boy in an uncomplicated procedure. She had a history of gestational diabetes and HbE thalassemia trait. The baby was admitted to special care for monitoring due to low birth weight. She was discharged with medications and instructions to follow up in one week and six weeks.
A 27-year-old woman was admitted to the hospital with severe pre-eclampsia at 35 weeks and 3 days of gestation. She had a blood pressure of 180/110 mmHg, proteinuria, edema, headache, and blurred vision. She received magnesium sulfate and antihypertensive medications. She later had a cesarean section under general anesthesia and delivered twins weighing 1.8 kg and 1.6 kg. The nursing care focused on monitoring her vital signs and symptoms, managing her blood pressure and fluids, providing rest and medications, and health education. Recommendations included improving equipment, guidelines, and staff training for managing severe pre-eclampsia.
On Duty Report Saturday Morning 20.08.2022.pptxBagusPutra76
- The on-duty report summarizes the patients seen on Saturday morning, August 20th 2022 at the hospital. I Gusti Ngurah Made Suwarba was the supervisor, and there were various residents and co-assistants on duty. A total of 2 ER patients, 4 UNUD hospital patients, and 5 one day care patients were seen. There were also summaries of ward patients, consultations, births, COVID-19 patients, outpatients, deaths, and discharges provided. No safety events were reported.
A 52-year-old man with type 2 diabetes of 8 years was uncontrolled on insulin therapy and gaining weight. He was obese, had hypertension and dyslipidemia. Dapagliflozin was added to his insulin regimen while reducing his insulin dose by 25%. This led to reductions in his HbA1c, weight, blood pressure, and lipid levels over 6 months of follow up while preventing further increases to his insulin needs. Dapagliflozin provided glycemic control and weight loss without increasing hypoglycemia risk for this patient with multiple comorbidities.
The document describes a case study of a 25-year-old pregnant woman diagnosed with gestational diabetes mellitus (GDM). At 16 weeks of pregnancy, her oral glucose tolerance test (OGTT) showed elevated blood sugar levels, confirming a diagnosis of GDM. She was placed on a diabetic diet and exercise regimen and had her blood sugar monitored regularly. When diet and exercise failed to control her blood sugar, she was started on insulin therapy and educated on diabetes management. She delivered a healthy baby at 37 weeks gestation through spontaneous labor and vaginal delivery. Both mother and baby were discharged in good health.
Hypoglycemia Hyperglycemia In The Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
Hypoglycemia and Hyperglycemia in the Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
Baby Nasrin, a 30 hour old male, presented with jaundice since 19 hours of age and reluctance to feed for 10 hours. Examination found jaundice up to the thighs and lethargy. Investigations confirmed Rh incompatibility with positive direct Coombs test and hyperbilirubinemia. He was diagnosed with neonatal jaundice due to Rh incompatibility and early onset sepsis. He received phototherapy and antibiotics, showed improvement and was discharged on day 7 after jaundice resolved up to the chest.
Anushka Wankhede, a 7-month old female infant, was admitted to the pediatric department with complaints of lethargy, poor weight gain, and difficulty feeding for 1 month. Investigations revealed anemia, elevated liver enzymes, and persistence of fetal hemoglobin. She was diagnosed with Pretremor Infantile Tremor Syndrome and treated with vitamin B12 injections, antibiotics, iron supplementation, and nutritional support. Her condition improved and she was able to feed orally before being discharged with advice to continue vitamin B12 treatment and follow up in 4 weeks.
Kim, stacy clinical - major case study presentationdkim930
This case study describes the hospital course of a 66-year-old woman admitted with radiation enteritis following cervical cancer treatment. She experienced nausea, vomiting, diarrhea and weight loss. Her oral intake was poor. She was treated with clear liquids, pureed foods, and nutrition supplements. Her symptoms improved and she was discharged to rehabilitation with recommendations to follow-up with oncology and improve her oral intake and nutritional status.
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANIDR SHASHWAT JANI
This document contains information from Dr. Shashwat Jani regarding gestational diabetes mellitus (GDM). It discusses the increasing prevalence of GDM in India and its associated risks for both mother and baby. It provides details on screening and diagnostic protocols, management through medical nutrition therapy, glycemic control, fetal monitoring and delivery planning. The importance of a multidisciplinary approach and glycemic control for optimizing maternal and neonatal outcomes is emphasized.
The patient came for a scheduled cesarean section due to a history of pregnancy-induced diabetes during her first pregnancy at age 33 and undergoing two previous cesarean deliveries. During hospitalization, she underwent a cesarean section and bilateral tubal ligation. She accepted her condition positively and adapted well to the changes in diet and limited activity required during her recovery.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first diagnosed during pregnancy. The risks associated with GDM are similar to those with pregestational diabetes. Screening and diagnosis typically involves a 75g oral glucose tolerance test. Management of GDM focuses on achieving metabolic control through diet, exercise, insulin or oral hypoglycemic agents. Fetal surveillance is important during pregnancy and delivery should be monitored closely due to risks of complications. Postpartum care involves glucose monitoring and determining if diabetes persists after delivery.
Hypoglycemia and hyperglycemia in the pregnanat patientKelly Miller
This document discusses normal and abnormal blood glucose levels in pregnancy. It defines gestational diabetes and outlines screening and management. Hypoglycemia and hyperglycemia in pregnancy are defined, along with their signs, symptoms, and treatment. Complications of uncontrolled diabetes in pregnancy include birth defects, large baby, preterm birth, and pregnancy complications. Prevention includes healthy lifestyle before and during pregnancy.
Hypoglycemia Hyperglycemia In The Pregnant PatientKelly Miller
This document discusses normal and abnormal blood glucose levels in pregnancy. It defines gestational diabetes and outlines screening and management. Hypoglycemia and hyperglycemia in pregnancy are defined, along with their signs, symptoms, and treatment. Complications of uncontrolled diabetes in pregnancy include birth defects, large baby, preterm birth, and pregnancy complications. Prevention includes healthy lifestyle before and during pregnancy.
The patient is a 33-year-old female who was admitted to the hospital for blurry vision and headaches associated with pre-eclampsia. She has experienced nausea, vomiting, and lethargy since admission. The patient requires assistance with activities of daily living and has an altered nutrition status due to being on a low-sodium, low-fat diet. Her hospitalization has impacted her views on health and lifestyle. The patient interacts well with her family and healthcare providers.
This document summarizes the case of a 4-year-old boy with frequent relapse nephrotic syndrome who presented with swelling of the whole body and abdominal pain. He was hospitalized for 22 days and treated for nephrotic syndrome relapse and peritonitis. During his hospital stay, he developed hyponatremia and hypocalcemia, which caused a seizure. He was treated with IV fluids and electrolyte supplementation and discharged after his condition improved. The case highlights the importance of managing electrolyte imbalances in nephrotic syndrome patients.
Abdulmoein Al-Agha discusses the use of insulin degludec in managing pediatric diabetes. Insulin degludec is an ultra-long acting basal insulin that provides over 42 hours of basal insulin coverage and achieves similar glycemic control to insulin glargine with less overnight hypoglycemia. Insulin degludec has a half-life of approximately 25 hours, double that of insulin glargine. It also has significantly less day-to-day variability in glucose-lowering effect compared to insulin glargine. These properties allow for more flexibility in dosing time compared to other basal insulins.
Basal bolus insulin therapy resulted in improved glycemic control compared to sliding scale insulin therapy for hospitalized patients with type 2 diabetes, according to the RABBIT 2 trial. The mean daily blood glucose was 27 mg/dL lower in patients receiving basal glargine plus prandial glulisine compared to those receiving sliding scale regular insulin. Both regimens resulted in a similar rate of hypoglycemia and length of hospital stay. Basal bolus insulin provided better glycemic control and achieved target blood glucose levels under 140 mg/dL in more patients than sliding scale insulin alone.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This patient presented with bleeding at 33 weeks and 3 days of gestation and was diagnosed with Placenta Previa Type IV. She underwent an elective lower segment Caesarean section to deliver a baby boy in an uncomplicated procedure. She had a history of gestational diabetes and HbE thalassemia trait. The baby was admitted to special care for monitoring due to low birth weight. She was discharged with medications and instructions to follow up in one week and six weeks.
A 27-year-old woman was admitted to the hospital with severe pre-eclampsia at 35 weeks and 3 days of gestation. She had a blood pressure of 180/110 mmHg, proteinuria, edema, headache, and blurred vision. She received magnesium sulfate and antihypertensive medications. She later had a cesarean section under general anesthesia and delivered twins weighing 1.8 kg and 1.6 kg. The nursing care focused on monitoring her vital signs and symptoms, managing her blood pressure and fluids, providing rest and medications, and health education. Recommendations included improving equipment, guidelines, and staff training for managing severe pre-eclampsia.
On Duty Report Saturday Morning 20.08.2022.pptxBagusPutra76
- The on-duty report summarizes the patients seen on Saturday morning, August 20th 2022 at the hospital. I Gusti Ngurah Made Suwarba was the supervisor, and there were various residents and co-assistants on duty. A total of 2 ER patients, 4 UNUD hospital patients, and 5 one day care patients were seen. There were also summaries of ward patients, consultations, births, COVID-19 patients, outpatients, deaths, and discharges provided. No safety events were reported.
A 52-year-old man with type 2 diabetes of 8 years was uncontrolled on insulin therapy and gaining weight. He was obese, had hypertension and dyslipidemia. Dapagliflozin was added to his insulin regimen while reducing his insulin dose by 25%. This led to reductions in his HbA1c, weight, blood pressure, and lipid levels over 6 months of follow up while preventing further increases to his insulin needs. Dapagliflozin provided glycemic control and weight loss without increasing hypoglycemia risk for this patient with multiple comorbidities.
The document describes a case study of a 25-year-old pregnant woman diagnosed with gestational diabetes mellitus (GDM). At 16 weeks of pregnancy, her oral glucose tolerance test (OGTT) showed elevated blood sugar levels, confirming a diagnosis of GDM. She was placed on a diabetic diet and exercise regimen and had her blood sugar monitored regularly. When diet and exercise failed to control her blood sugar, she was started on insulin therapy and educated on diabetes management. She delivered a healthy baby at 37 weeks gestation through spontaneous labor and vaginal delivery. Both mother and baby were discharged in good health.
Hypoglycemia Hyperglycemia In The Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
Hypoglycemia and Hyperglycemia in the Pregnant PatientKelly Miller
This document discusses hypoglycemia and hyperglycemia in pregnancy. It defines normal blood glucose levels during pregnancy and classifications of diabetes in pregnant women. It covers screening, signs and symptoms, and management of hypoglycemia and hyperglycemia in pregnancy. Potential complications of uncontrolled blood sugar levels during pregnancy are also outlined. A case study example is provided to demonstrate discussion and management of gestational diabetes.
Baby Nasrin, a 30 hour old male, presented with jaundice since 19 hours of age and reluctance to feed for 10 hours. Examination found jaundice up to the thighs and lethargy. Investigations confirmed Rh incompatibility with positive direct Coombs test and hyperbilirubinemia. He was diagnosed with neonatal jaundice due to Rh incompatibility and early onset sepsis. He received phototherapy and antibiotics, showed improvement and was discharged on day 7 after jaundice resolved up to the chest.
Anushka Wankhede, a 7-month old female infant, was admitted to the pediatric department with complaints of lethargy, poor weight gain, and difficulty feeding for 1 month. Investigations revealed anemia, elevated liver enzymes, and persistence of fetal hemoglobin. She was diagnosed with Pretremor Infantile Tremor Syndrome and treated with vitamin B12 injections, antibiotics, iron supplementation, and nutritional support. Her condition improved and she was able to feed orally before being discharged with advice to continue vitamin B12 treatment and follow up in 4 weeks.
Kim, stacy clinical - major case study presentationdkim930
This case study describes the hospital course of a 66-year-old woman admitted with radiation enteritis following cervical cancer treatment. She experienced nausea, vomiting, diarrhea and weight loss. Her oral intake was poor. She was treated with clear liquids, pureed foods, and nutrition supplements. Her symptoms improved and she was discharged to rehabilitation with recommendations to follow-up with oncology and improve her oral intake and nutritional status.
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANIDR SHASHWAT JANI
This document contains information from Dr. Shashwat Jani regarding gestational diabetes mellitus (GDM). It discusses the increasing prevalence of GDM in India and its associated risks for both mother and baby. It provides details on screening and diagnostic protocols, management through medical nutrition therapy, glycemic control, fetal monitoring and delivery planning. The importance of a multidisciplinary approach and glycemic control for optimizing maternal and neonatal outcomes is emphasized.
The patient came for a scheduled cesarean section due to a history of pregnancy-induced diabetes during her first pregnancy at age 33 and undergoing two previous cesarean deliveries. During hospitalization, she underwent a cesarean section and bilateral tubal ligation. She accepted her condition positively and adapted well to the changes in diet and limited activity required during her recovery.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first diagnosed during pregnancy. The risks associated with GDM are similar to those with pregestational diabetes. Screening and diagnosis typically involves a 75g oral glucose tolerance test. Management of GDM focuses on achieving metabolic control through diet, exercise, insulin or oral hypoglycemic agents. Fetal surveillance is important during pregnancy and delivery should be monitored closely due to risks of complications. Postpartum care involves glucose monitoring and determining if diabetes persists after delivery.
Hypoglycemia and hyperglycemia in the pregnanat patientKelly Miller
This document discusses normal and abnormal blood glucose levels in pregnancy. It defines gestational diabetes and outlines screening and management. Hypoglycemia and hyperglycemia in pregnancy are defined, along with their signs, symptoms, and treatment. Complications of uncontrolled diabetes in pregnancy include birth defects, large baby, preterm birth, and pregnancy complications. Prevention includes healthy lifestyle before and during pregnancy.
Hypoglycemia Hyperglycemia In The Pregnant PatientKelly Miller
This document discusses normal and abnormal blood glucose levels in pregnancy. It defines gestational diabetes and outlines screening and management. Hypoglycemia and hyperglycemia in pregnancy are defined, along with their signs, symptoms, and treatment. Complications of uncontrolled diabetes in pregnancy include birth defects, large baby, preterm birth, and pregnancy complications. Prevention includes healthy lifestyle before and during pregnancy.
The patient is a 33-year-old female who was admitted to the hospital for blurry vision and headaches associated with pre-eclampsia. She has experienced nausea, vomiting, and lethargy since admission. The patient requires assistance with activities of daily living and has an altered nutrition status due to being on a low-sodium, low-fat diet. Her hospitalization has impacted her views on health and lifestyle. The patient interacts well with her family and healthcare providers.
This document summarizes the case of a 4-year-old boy with frequent relapse nephrotic syndrome who presented with swelling of the whole body and abdominal pain. He was hospitalized for 22 days and treated for nephrotic syndrome relapse and peritonitis. During his hospital stay, he developed hyponatremia and hypocalcemia, which caused a seizure. He was treated with IV fluids and electrolyte supplementation and discharged after his condition improved. The case highlights the importance of managing electrolyte imbalances in nephrotic syndrome patients.
Abdulmoein Al-Agha discusses the use of insulin degludec in managing pediatric diabetes. Insulin degludec is an ultra-long acting basal insulin that provides over 42 hours of basal insulin coverage and achieves similar glycemic control to insulin glargine with less overnight hypoglycemia. Insulin degludec has a half-life of approximately 25 hours, double that of insulin glargine. It also has significantly less day-to-day variability in glucose-lowering effect compared to insulin glargine. These properties allow for more flexibility in dosing time compared to other basal insulins.
Basal bolus insulin therapy resulted in improved glycemic control compared to sliding scale insulin therapy for hospitalized patients with type 2 diabetes, according to the RABBIT 2 trial. The mean daily blood glucose was 27 mg/dL lower in patients receiving basal glargine plus prandial glulisine compared to those receiving sliding scale regular insulin. Both regimens resulted in a similar rate of hypoglycemia and length of hospital stay. Basal bolus insulin provided better glycemic control and achieved target blood glucose levels under 140 mg/dL in more patients than sliding scale insulin alone.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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1. Federal Medical Center, Keffi
PATIENT CARD/E-FOLDER
Number: 20335666 Category: General
Name: JIBRIN SALIHA Phone No: 08142388189
Sex: Female Religion: Islam
Age: 14 Ethnic: HAUSA
Address: ANGWAN DADI KEFFI Next of Kin: FATIMA JIBRIN
3/1/2023 12:06 pm Notes RECORDED BY
MORNING DUTY REPOTY:
DIAGNOSIS: Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: A 13 year old girl admitted on the 30/12/2022. Being managed of the said diagnosis,
met off iv fuid
Vital signs not checked ( Pt not in bed)
Mother reassured and counselled about her babys condition
Patient G/C is fair
momoh constance divine @Paediatric Medical Ward PMW
RESULT DATE LAB RESULT PERFORMED BY
3/1/2023 7:53 am
Test Parameters
FBC((WBC/PLT CT/PCV/DIFFERENTIALS)
Paed NEW Name Result Range Unit
Twbc 7.1 4000-11000 x10^9/l
platelet count 278 150-400 x10^9/l
Packed cell volume
PCV
36 35-45(female) %
Lymphocyte 39
Neutrophil 47
Monocyte 06
Eosinophils 08
Basophils 00
Film Report:
Anisocytosis(+)
ALUGO VICTOR
3/1/2023 7:53 am Chief Medical Laboratory Scientist: ALUGO VICTOR
2/1/2023 8:33 pm General PERFORMED BY
PC:
As long acting insulin is currently unavailable
PLAN
Increase dose of actrapid from 4iu to 8 iu .
Provisional Diagnosis:
…
Yusuf Shalom Habu
Printed by UTAJI ONYI HELEN on 3/1/2023 2:10 pm Page 1 of 14
2. 2/1/2023 6:30 pm Notes RECORDED BY
EVENING DUTY:
DIAGNOSIS: Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PATIENT: A 13 year old Teenager admitted on the 30/12/2022. Being managed of the above diagnosis,
met off IVF
Vital signs checked and recorded
Due medication administerd short acting soluble insulin 4 IN at 6:00pm and there was no needle to administered long acting Glargine
patient and mother reassured and supported psychologically
Patient G/C is fair.
NRS. ROSELINE DANGIWA @Paediatric Medical Ward PMW
2/1/2023 10:36 am Notes RECORDED BY
NURSES NOTE:
MORNING DUTY
DIAGNOSIS: Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: A 13 year old girl admitted on the 30/12/2022. Being managed of the said diagnosis,
met off iv fluid and was eating with mum outside
Vital signs checked and recorded T-36.4*c ,P-78b/m and R-20c/m
Mother reassured and counselled about her babys condition
Patient G/C is fair.
Nrs. Babagambo Halima @Paediatric Medical Ward PMW
2/1/2023 10:30 am Notes RECORDED BY
null: Nrs. Babagambo Halima @Paediatric Medical Ward PMW
2/1/2023 10:23 am General PERFORMED BY
PC:
RWR(Dr Eke)
A 13year old female adolescent who was referred from GOPD yesterday on account of suspected Newly diagnosed DM patient with FBG of 20.3mmol/l. c/o
Excessive Urination x 1yr
Excessive eating x 1yr
At presentation FBG-20.3mmol/l
Being managed for 1. Diabetic mellitus 2. Gungivial hyperplasia ? Cause
Currently on
-Tabs Vit c
-Subcutaneous insulin (long and short acting)
Available investigations
HBAIc- 7.2 %,
Urinalysis-, glucose 2+, normal ketone,
EUCR-- essentially normal except for slight Hypercalcaemia 11.2mg/dl , HCO3-18.0mmo/l .
O/E
-Conscious, and alert,, afebrile(35.2*c), well hydrated, not cyanosed, nil pedal edema. Wt-36kg
Ht-1.07m
BMI=31.4kg/m"2
Tanner Stage 2 CVS
PR- 96bpm
BP- 100/70mmHg HS- S1&S2
Chest
RR- 18bpm
Equal chest expansion
Yusuf Shalom Habu
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3. VBS
Abd
FMWR
Nil abdominal tenderness
LOSOKO
CNS
Conscious, oriented in TPP
Pupils 4mm, round, reactive to light Nil neck stiffness
Tone normal in the limbs
ASS
1. Diabetic mellitus
2. Gungivial hyperplasia ? Cause
PLAN
-Ct Tab Vitamin C 200mg tds x 2/52
-Ct Subcutaneous Insulin therapy using short soluble Insulin ( Actrapid ) and long acting insulin Glargine.
-Give Short acting subcut Insulin (Actrapid ) 4IU 30mins pre breakfast,(6-7am ) lunch ( 2pm ) and Dinner ( 6pm ) then
-Give Long acting subcut Insulin ( Glargine ) 10IU by 8pm
- Advise parents to get Glucometer to monitor RBG before every meal , 2hrs post prandial and at bed time charted in an RBG CHART.
- Dietary counselling to reduce carbohydrate intake and optimize protein intake especially plant protein and vegetables.
-Monitor urine output and ensure adequate intake of at least 3L//day
-counsel parent on child’s condition , possible complications
Provisional Diagnosis:
…
2/1/2023 5:00 am Notes RECORDED BY
NURSES NOTE:
NIGHT DUTY REPORT:
DIAGNOSIS: Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T-37.3*c ,P-100b/m and R-24c/m
Has sub. insulin (Actrapid 4iu) administered at 6am
Patient ate after 30 minutes of injection
Mother reassured and counselled about her babys condition
Patient G/C is fair
NRS. JACOB STEPHENIE IVEREN @Paediatric Medical Ward PMW
1/1/2023 10:03 pm Notes RECORDED BY
NURSES NOTE:
B/P-80/60mmgh
NRS. JACOB STEPHENIE IVEREN @Paediatric Medical Ward PMW
1/1/2023 5:37 pm Notes RECORDED BY
EVENING DUTY:
DIAGNOSIS: Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T-36.3*c ,P-101b/m and R-24c/m
Chinyere Glory @Paediatric Medical Ward PMW
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4. Has sub. insulin (Actrapid 4iu) administered at 6pm
Patient ate after 30 minutes of injection
Mother reassured
Patient G/C is fair
1/1/2023 9:08 am Notes RECORDED BY
MORNING DUTY:
DIAGNOSIS: Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T-36.3*c ,P-100b/m and R-24c/m
Has sub. insulin (Actrapid 4iu) administered at 2pm
Patient ate after 30 minutes of injection
Mother reassured
Patient G/C is fair
NRS. AINA ELIZABETH ADUKE @Paediatric Medical Ward PMW
1/1/2023 6:13 am Notes RECORDED BY
MORNING DUTY:
DIAGNOSIS: Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T-36*c P-100b/m R-26c/m
RBS 10.9mmol/l at 5:55am
has sub. insulin (Actrapid 4iu) administered at 6am
Patient ate after 30 minutes of injection
Patient G/C is fair
Mother reassured
She was transfered to PMW
NRS. MERCY ARUWA @Emergency Paediatric Unit /Ward (EPUW)
1/1/2023 5:14 am Notes RECORDED BY
null:
DIAGNOSIS:Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T-36.2*c P-100b/m R-24c/m
RBS 10.9mmol/l at 5:55am
has sub. insulin (Actrapid 4iu) administered at 6am
Patient ate after 30 miin of injection
Patient G/C is fair
Mother reassured
NRS. AGBO IKOH @Ophthalmology GSRF service unit
31/12/2022 6:13 pm Notes RECORDED BY
EVENING DUTY:
DIAGNOSIS:Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T-36.2*c P-100b/m R-24c/m
has sub. insulin (Actrapid 4iu) administered at 6pm
Patient ate after 30 minit of injection
Patient G/C is fair
Mother reassured
Muhammed Sanni Habiba @Ophthalmology GSRF service unit
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5. 31/12/2022 2:09 pm General PERFORMED BY
PC:
EPU WWR - (Dr Emeh)
A 13year old female adolescent who was referred from GOPD yesterday on account of suspected Newly diagnosed DM patient with FBG of 20.3mmol/l.
c/o
Excessive Urination x 1yr
Excessive eating x 1yr
At presentation FBG-20.3mmol/l
Being managed for 1. Diabetic mellitus
2. Gungivial hyperplasia ? Cause
Currently on
-Tabs Vit c
-Subcutaneous insulin (long and short acting)
Available investigations
HBAIc- 7.2 %,
Urinalysis-, glucose 2+, normal ketone,
EUCR-- essentially normal except for slight Hypercalcaemia 11.2mg/dl , HCO3-18.0mmo/l .
O/E-Conscious, and alert,, afebrile(36.8*c), well hydrated, not cyanosed, nil pedal edema.
Wt-36kg
Ht-1.07m
BMI=31.4kg/m"2
Tanner Stage 2
CVS
PR- 102bpm
BP- 100/70mmHg
HS- S1&S2
Chest
RR- 16bpm
Equal chest expansion
VBS
Abd
FMWR
Nil abdominal tenderness
LOSOKO
CNS
Conscious, oriented in TPP
Pupils 4mm, round, reactive to light
Nil neck stiffness
Tone normal in the limbs
ASS
1. Diabetic mellitus
2. Gungivial hyperplasia ? Cause
PLAN
-Ct Tab Vitamin C 200mg tds x 2/52
-Ct Subcutaneous Insulin therapy using short soluble Insulin ( Actrapid ) and long acting insulin Glargine.
-Give Short acting subcut Insulin (Actrapid ) 4IU 30mins pre breakfast,(6-7am ) lunch ( 2pm ) and Dinner ( 6pm ) then
-Give Long acting subcut Insulin ( Glargine ) 10IU by 8pm
- Advice parents to get Glucometer to monitor RBG before every meal , 2hrs post prandial and at bed time charted in an RBG CHART.
- Dietary counselling to reduce carbohydrate intake and optimize protein intake especially plant protein and vegetables.
-Monitor urine output and ensure adequate intake of at least 3L//day
-Counsel parents on child"s condition , possible complications .
Dr. Oguaju Joy Chidinma
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6. Provisional Diagnosis:
…
31/12/2022 10:57 am Notes RECORDED BY
NURSES NOTE:
MORNING DUTY
DIAGNOSIS:Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T-36.2*c P-104b/m R-26c/m
FBS at 6:30am 18.4mmol/L, Insuline 8iu administered at 6:50 am
Patient ate her breakfast at 7:20am
Patient G/C is fair
Mother reassured
NRS. AYIMA HUSSEINI RABI @Ophthalmology GSRF service unit
31/12/2022 7:09 am General PERFORMED BY
Provisional Diagnosis:
…
Yusuf Shalom Habu
31/12/2022 7:09 am LABORATORY REQUESTS
Name Specimen Comment Raised By
FBC((WBC/PLT CT/PCV/DIFFERENTIALS) Paed NEW Blood Yusuf, Shalom Habu
urine m/c/s/ (child) Urine Yusuf, Shalom Habu
Urinalysis (Child) NEW Urine Yusuf, Shalom Habu
Other Informaion: null
31/12/2022 6:09 am Notes RECORDED BY
NIGHT DUTY REPORT:
DIAGNOSIS:Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
IN/PT: 13 year old girl admitted on the 30/12/2022 and managed for the above diagnosis
Patient was met sitting on bed on duty resumption
Vital signs checked and recorded T 36.2*c P 84b/m R 24c/m
FBS at 6:30am 18.4mmol/L, Insuline 8iu administered at 6:50 am
Patient ate her breakfast at 7:20am
Patient G/C is fair
Mother reassured
NRS. AGNES EDET LAWRENCE @Ophthalmology GSRF service unit
30/12/2022 10:47 pm General PERFORMED BY
PC:
A 13year old female adolescent born to Afor Muslim parents residing at Keffi Nasarawa state referred from GOPD on account of suspected Newly diagnosed DM patient with FBG of 20.3mmol/l.
c/o
Gwafan Kuyet
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7. Excessive Urination x 1yr
Excessive eating x 1yr
Child was in apparent state of health when she noticed excessive urination. She had an increased night time urination of 4 and daytime frequency of 5, compared to frequency of 2/0
No hx of pain on micturition, no change in colour, no urgency, no haematuria.
No history of facial swelling or ay other part of the body
There is also a history of excessive feeding described as increased frequency of meals from 3 times daily in premorbid state to 5 times daily when symptoms started.
Child also feels hungry immediately after eating a meal. but no weight gain
However there is mild weight loss , evidence by loose ftting of previously fitted clothes.
There is associated excessive thirst.
However no abdominal pain, no nausea, no vomiting, no passage of watery stools.
Mother is a known diabetic diagnosed at 29 years of age. On follow in DASH
At onset of illness, she was taken to GH Keffi, 3 months ago where she was diagnosed based on account of above symptoms and raised RBG , nutritional counselling was done, and no medications
given. With persistence of symptoms Child presented to GOPD samples taken for investigations at Alheri lab which showed the following -:
FBG - 20.3mmol/l , HBAIc- 7.2 %, Urinalysis-, glucose 2+, normal ketone,
EUCR-- essentially normal except for slight Hypercalcaemia 11.2mg/dl , HCO3-18.0mmo/l .
She was subsequently referred here for further management.
No past hx of admission , no blood transfusion or surgery in the past.
Genotype is unknown, no hx suggestive of scdx
A product of term gestation, pregnancy was booked at 4mo GA in this facility, Pregnancy went unevenful, carried to term delivered at home, cord was severed by a nurse, no neonatal complications
Was exclusively breast fed for 6mo, complimentary feeds introduced there after , and weaned off breast milk at 14mo
Fully immunized according to the NPI schedule
Detailes of when milestone was achieved cannot be remembered by the mother she however said milestones were achieved at same time as her other children
She is currently in Js 3 class , last position was 10th out of 24 students.
Child is the 4th out of 5 children in a mongamous family setting. Other Children are alive and doing well.
Father is 50yrs old mechanic while mother is a 40yrs old food trader. Both parents have 1LOE
They live in a 4bedroom flat
Source of drinking water is sachet water
Source of cooking fuel is firewood
Sleeps under ITN
ROS: essentially normal
Has no known drug allergy
O/E
Conscious, and alert,, afebrile(36.7*c), well hydrated, not cyanosed, nil pedal edema.
Wt-36kg
Ht-1.07m
BMI=31.4kg/m"2
Tanner Stage 2
CVS
PR- 80bpm
BP- 90/60mmHg
HS- S1&S2
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8. Chest
RR- 18bpm
Equal chest expansion
VBS
Abd
FMWR
Nil abdominal tenderness
LOSOKO
CNS
Conscious, oriented in TPP
Pupils 4mm, round, reactive to light
Nil neck stiffness
Tone normal in the limbs
ASS
1. Diabetic mellitus
Plan
Cont ongoing management
Provisional Diagnosis:
Dm
30/12/2022 9:53 pm General PERFORMED BY
PC:
Update (Discussed with Dr adebiyi)
As long acting insulin is currently unavailable
PLAN
Increase dose of actrapid from 4iu to 8 iu .
If rbs is less than 4 mmol/l .... allow food intake prior to insulin actrapid dose.
If rbs is greater than 4 mmol/ l, give insulin before food intake
Ensure postprandial rbs check.
Provisional Diagnosis:
Dm
Gwafan Kuyet
30/12/2022 7:10 pm General PERFORMED BY
Dr. Obinwa Chinonye Modesta
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9. PC:
PTOC- SR Review- Dr. Keji
A 13yr old JSS 3 student who was diagnosed as a diabetic pt 3 month ago at GH Keffi but yet to start medication. Complains of
Excessive eating x 1 year
Excessive thirst x 1 year
Excessive urination x 1 year
Gum enlargement x 6/12
Headache x 2/52
Excessive eating was noticed 1 year ago, described as increased frequency of meals from 3 times daily in premorbid state to 5 times daily when symptoms started.
Child also feels hungry immediately after eating a meal.
Excessive urination also started about a year ago, described as a change from three to five times urination during the day and from nil to four times night voiding. Nil painful urination. Nil bedwetting. Nil
incontinence. Nil blood in urine.
There is increased thirst necessitating pt waking up to drink at least twice at night.
Nil fever. Nil abdominal pains.
Gum enlargement was noticed 6 month ago by child's teacher and mother. Gum infiltrated between the teeth progressively but has been static in the last 2 month. Nil pain.
There is associated gum bleeding while sleeping on 2 occasions while brushing daily.
Nil mal odourious breath
Nil bleeding from any other part of the body.
Headache started 2/52 ago, frontal in location, mild in severity, usually occurred in the evening, dull in character.
Nil eye/ear ache. Nil double vision. Nil poor vision. Nil neck pain. Nil fever. Nil rash.
Nil history of abdominal trauma. Nil hx of mumps in childhood. Nil hx of abdominal surgery. Nil hx of exposure to pesticides/chemicals.
Mother is a known diabetic diagnosed at 29yrs and is on medication.
Nil previous hospital admission/nil blood transfusion.
There is hx of diabetes in mother's paternal uncle. Nil hx of recurrent boils or infection in pt.
No hx of similar symptoms in 6yr old and 22yr old female siblings and 28yr and 20yr old male siblings.
Since onset of ill health, child was initially taking herbal concoction from different herbalist at different times. Child stopped herbal concoction just a week ago.
Child presented at GH Keffi 3 month ago and was diagnosed to be diabetic and placed on dietary modification. Child then presented at GOPD a day ago and was referred here.
O/E
Conscious, active, afebrile, well hydrated, not cyanosed, nil pedal edema.
Tanner Stage 2
CVS
PR- 80bpm
BP- 90/60mmHg
HS- S1&S2
GIT
Gum hypertrophy
Good oral hygiene
Nil abdominal tenderness
LOSOKO
CNS
Conscious, oriented in TPP
Speech I'd coherent
Pupils 4mm, round, reactive to light
Nil neck stiffness
Tone normal in the limbs
Chest
RR- 18bpm
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10. VBS
ASS
1. Diabetic mellitus
2. Gungivial hyperplasia ? Cause
PLAN
- Tab Vitamin C 200mg tds x 2/52
- Ct earlier outlined management
- Retrieve pending investigation
- Counsel parents on diagnosis and prognosis
Provisional Diagnosis:
1. Diabetic mellitus
2. Gungivial hyperplasia ? Cause
30/12/2022 7:01 pm Notes RECORDED BY
EVENING DUTY:
ADMISSION NOTE
ASS- Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
NEW PT=13year old female adolescent born to Afor Muslim parents residing at Kef Nasarawa state referred from GOPD on account of suspected Newly diagnosed DM patient with FBG of 20.3mmol/l.
c/o Excessive Urination x 1yr
Excessive eating x 1yr
O/A/E O/E- Conscious, not in obvious distress, afebrile () , pale, anicteric , not cyanosed, not signifcant peripheral lympadenopathy, no pedal oedema.
Wt-36kg
P/M/S/HX Child was seen in GH Kef 3 months ago where she was diagnosed type 1 DM
F/S/HX =She is currently in Js 3 class , last position was 10th out of 24 students.
Child is the 4th out of 5 children in a mongamous family setting. Father is 50yrs old mechanic while mother is a 40yrs old food trader . parents have primary level of education.
They live in a 4bedroom flat.
NSG ACTIONS
child admitted and made comfortable on couch in consulting room
vital signs checked and recorded
-pt was Commenced on Subcutaneous Insulin therapy using short soluble Insulin ( Actrapid ) administered at 7/20pm.
-Give Short acting subcut Insulin (Actrapid ) 4IU 30mins pre breakfast,(6-7am ) lunch ( 2pm ) and Dinner ( 6pm ) then
-Give Long acting subcut Insulin ( Glargine ) 10IU by 8pm
child reassured
g/c is fair
Muhammed Sanni Habiba @Ophthalmology GSRF service unit
30/12/2022 5:36 pm General PERFORMED BY
PC:
Fasting Blood Glucose (29/12/2022)- 20.4 (3.9-6.0)mmol/l
HbA1C (29/12/2022)- 7.2 (<6)%
E/u/cr (29/12/2022)
Na- 138.6 (135-148)mmol/l
K- 4.5 (3.5-5.5)mmol/l
Cl- 98.5 (96-106)mmol/l
HCO3- 18.0 (21-33)mmol/l
Urea- 3.5 (1.9-8.3)mmol/l
Creatinine- 67.8 (40-106)umol/l
URINALYSIS (29/12/2022)
Dr. Obinwa Chinonye Modesta
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11. Appearance- Amber and slightly cloudy
pH- 6.0
Blood- Normal
Glucose- ++
Urobilinogen- Normal
Bilirubin- Normal
Protein- Normal
Nitrite- Normal
Ketone- Normal
Ascorbic Acid- Normal
Provisional Diagnosis:
..
30/12/2022 12:04 pm General PERFORMED BY
PC:
13year old female adolescent born to Afor Muslim parents residing at Keffi Nasarawa state referred from GOPD on account of suspected Newly diagnosed DM patient with FBG of 20.3mmol/l.
c/o Excessive Urination x 1yr
Excessive eating x 1yr
Child"s problem was noticed a year ago when she started going to pass urine more than usual times in the day , about 4 times per day and 4 times in the night as against D/N of 2/0 .there is associated
increase in volume of urine , no hx of nocturia, no dyuria.no hx of bedwetting.
There is hx of associated frequency of eating with large quantity of food intake now 5 times in a day.She feels nauseated but no hx of vomiting, abdominal pain or distension.No hx of weight loss but
appetite said to be good and eats much.
No history of headache, loss of consciousness or fainting episodes.
Mother is a diabetic been followed up at DASH.
Child was seen in GH Keffi 3 months ago where she was diagnosed based on account of above symptoms and RBG was done which as high but was given dietary counsel and was not placed on
medication . Child presented to GOPD yesterday on account of frequent urination necessitating samples taken for investigations at Alheri lab which showed the following -:
FBG - 20.3mmol/l , HBAIc- 7.2 %, Urinalysis-, glucose 2+, normal ketone,
EUCR-- essentially normal except for slight Hypercalcaemia 11.2mg/dl , HCO3-18.0mmo/l .
She was subsequently referred here for further management.
No past hx of admission , no blood transfusion or surgery in the past.Genotype is unknown, no hx suggestive of scdx.
Yet to achieve menarche.
Prenatal , natal ,post natal could not be ascertained as mother is not available .
She was adequately immunized for age.
She is currently in Js 3 class , last position was 10th out of 24 students.
Child is the 4th out of 5 children in a mongamous family setting. Father is 50yrs old mechanic while mother is a 40yrs old food trader . parents have primary level of education.
They live in a 4bedroom flat.
O/E- Conscious, not in obvious distress, afebrile () , pale, anicteric , not cyanosed, not significant peripheral lympadenopathy, no pedal oedema.
Wt-36kg
Ht-1.07m
BMI=31.4kg/m"2
CVS
PR- 108bpm NVR pulses
BP- 90/60mmHg sitting
HS- 1st and 2nd only
RESP
spo2- 97% in room air.
RR-21breaths/min
Trachea- central
DR. OGIDI J.P
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12. Equal chest expansion
Good air entry
VBS
ABD
Full,mwr, not tender
LoSoKo.
CNS
Conscious , oriented in TPP
No neck stiffness
Normal tone in the limbs
No signs of meningeal irritation
Repeat RBG- 19.6mmol/l @ 1pm
Urinalysis
Colour- amber
Appearance - clear
Glucose -++
PH-7.0
ASS- Newly Diagnosed Type 1 DM with Hyperglycaemia/gycosuria
PLAN
Reviewed with Dr Adebiyi/Akunegbu
Admit under Team D
-Commence Subcutaneous Insulin therapy using short soluble Insulin ( Actrapid ) and long acting insulin Glargine.
-Give Short acting subcut Insulin (Actrapid ) 4IU 30mins pre breakfast,(6-7am ) lunch ( 2pm ) and Dinner ( 6pm ) then
-Give Long acting subcut Insulin ( Glargine ) 10IU by 8pm
- Advice parents to get Glucometer to monitor RBG before every meal , 2hrs post prandial and at bed time charted in an RBG CHART.
- Dietary counselling to reduce carbohydrate intake and optimize protein intake especially plant protein and vegetables.
-Monitor urine output and ensure adequate intake of at least 3L//day
-Do FBC, Urine mcs, daily urinalysis
-Counsel parents on child"s condition , possible complications .
Provisional Diagnosis:
? Newly diagnosed Type DM
30/12/2022 11:03 am General PERFORMED BY
PC:
A 13 year old female JSS-3 Student of eminent royal crown academy, keffi. brought by father on follow up for T1-DM diagnosed ABOUT ONE-YEAR ago at general hospital keffi not yet on any drugs.
Complains of increased urinary frequency, polydipsia, polyphagia and recurrent generalised body weakness x 1 year.
said to be apparently well until about 1 year ago developed above complains
Nil dysuria, vomiting nor diarrhea, nil weight loss nor any other complain.
YET TO ATTAIN MENARCHE.
mother is a known diabetic on treatment- ? age of onset
RESULTS- HBA1C= 7.2%
DR OBELE YAKUBU ABALAKU
Printed by UTAJI ONYI HELEN on 3/1/2023 2:10 pm Page 12 of 14
13. FBG= 20.3mmol/l
Urinalysis= glucose (++)
O/E- CONSCIOUS CALM NOT PALE ANICTERIC ACYANOSED
PR- 100
HS- S1 S2
CHEST, ABD- NAD
CNS- NAD
Provisional Diagnosis:
T1DM WITH HYPERGLYCEMIA(FBG- 20.3mmol/l) YET TO START MEDICATIONS
Treatment Plan:
Counsel
Discuss with consultant- DR. ANIBASA
REFER TO EPU
30/12/2022 10:58 am Clinic Referral PERFORMED BY
Patient was referred from General Outpatient GOPD to Paediatric Endocrinology
Transfer Notes: T1DM WITH HYPERGLYCEMIA(FBG- 20.3mmol/l) YET TO START MEDICATIONS
DR OBELE YAKUBU ABALAKU
30/12/2022 8:18 am VITAL SIGNS PERFORMED BY
Temperature: 36.3 Respiratory Rate: 24 Pulse Rate: 112
Weight: 38 Height: null BMI: 0
Systolic B.P.: null Diastolic B.P.: null BSA: 0
Random Blood Sugar: null Fasting Blood Sugar: null
Oxygen Saturation: null Pain Score: null Urinalysis: null
Comment:
MOSHOOD ABDULRAHEEM
22/12/2022 8:47 am General PERFORMED BY
PC:
A 13 year old female. A known diabetic patient as diagnosed 4/12 ago at general hospital keffi.
Complains of increased urinary frequency and generalised body weakness x 1 year.
HPC:
There is associated polyphagia and polydipsia.
Patient has not been on medications but has been on dietary control.
There is family history of DM in her mother.
Clinical Examination:
O/E; GCS
DR. DANIEL FREEMAN
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14. PR: 104bpm.
WT: 32kg.
Provisional Diagnosis:
? Type 1 DM.
Treatment Plan:
Patient education.
Investigations.
Review with results.
22/12/2022 8:47 am LABORATORY REQUESTS
Name Specimen Comment Raised By
POCT-sugar test(FBS/RBS) Paed NEW Blood DR. DANIEL, FREEMAN
Glycated heamoglobin (HBA1C) NEW Blood DR. DANIEL, FREEMAN
E/U/Cr (children)(NEW) Blood DR. DANIEL, FREEMAN
Other Informaion: null
22/12/2022 8:36 am VITAL SIGNS PERFORMED BY
Temperature: 36.1 Respiratory Rate: 24 Pulse Rate: 104
Weight: 32 Height: null BMI: 0
Systolic B.P.: null Diastolic B.P.: null BSA: 0
Random Blood Sugar: null Fasting Blood Sugar: null
Oxygen Saturation: null Pain Score: null Urinalysis: null
Comment:
NRS. OMOLARA OBAMUWE GRACE
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