Care You Can Trust.

Hello everyone! I am an intern and logging this case as I have seen plueral tap done for this patient and felt interesting as we didn't get any fluid when we done 1st. I got details of this case from my colleague intern,Advytha and I am thankful for that.

                  Here is the case of a 43year old female came with pain in right hypochondrium.

Case:

A 43year old female came to opd with cheif complaint of right side hypochondrial pain , stabbing type , non radiating.increasd with inspiration and on lying down on rt side ,

c/o low grade fever ,intermittent since 10 days , 

H/0 medication used for 4 days from 24 rth . Amikacan , sulbactum + ceftriaxone 

From 28/ 5/ 20 Piptaz , levoflox for 4 days 

No h/0 wt loss , cough , evening rise of temperature, decreased micturation , burning mituration .

PAST HISTORY 

c/o fever for which she went to hospital 20 years back for which she used medication for 3 moths ? Pulmonary TB

No h/o DM , HTN , CKD , BA ,Thyroid

ON EXAMINATION 

Pt c/ c

Temperature 98.6  F 

Pule 85 bpm

RR 20 cpm

BP 160/ 80mmhg 

Spo2 99%

Cvs :S1 S2 heard ,no murmurs 

p/ A : soft , non tender 

CNS : HMF intact

           Speech normal

           Sensory system N

           Motor system N 

Respiratory system examination:

Inspection-

 shape of the chest: elliptical

symmetry:b/l symmetry

position of trachea: central

apex beat: seen in 5th intercostal space midclavicular line

Rr-18 cpm

rhythm-regular

type- thoracoabdominal

old scar in left neck region.

no accessory or intercostal muscles usage .

no dilated veins/pulsations

no obvious spine abnormality

PALPATION- 

            all inspectory findings are confirmed.

position of trachea- central

apex beat- felt ( 5th intercostal space midclavicular line)

movements.      rt.                      lt

upper thorax.     --.                      N

anterior.              --.                      N

posterior.           decreased.      N

chest expansion - felt

inspection - patient can't take deep breath due to pain

No subcutaneous emphysema

chest expansion.          lt.          rt

supraclavicular.             N.         N

infraclavicular.               N.         N

mammary.                      N.         decreased

axillary.                            N.         decreased

infraaxillary.                    N.         decreased

suprascapular.               N.         N

interscapular                  N.         decreased

infrascapular                  N.         decreased

VOCAL FREMITUS.       lt.          rt

supraclavicular.             N.         N

infraclavicular.               N.         N

mammary.                      N.         decreased

axillary.                            N.         decreased

infraaxillary.                    N.         decreased

suprascapular.               N.         N

interscapular                  N.         decreased

infrascapular                  N.         decreased

PERCUSSION                 lt.                 rt

supraclavicular.             resonant        resonant

infraclavicular.               resonant.       resonant

mammary.                      resonant.       dull

axillary.                            resonant.       dull

infraaxillary.                    resonant.       dull

suprascapular.               resonant        dull

interscapular                  resonant.       dull

infrascapular                  resonant.       dull

 tidal percussion - normal

AUSCULTATION.              lt.         rt

supraclavicular.            nvbs.     nvbs

infraclavicular.              nvbs      absent/reduced

mammary.                     nvbs       reduced

axillary.                           nvbs.      absent

infraaxillary.                   nvbs.      absent

suprascapular.              nvbs.       reduced

interscapular                 nvbs.       absent

infrascapular                 nvbs.       absent

 no added sounds

no wheeze/crepts/rub

INVESTIGATIONS

Haemogram:

Hb :9.5 gm/ dl 

TLC :16000 cells / cumm

Lymphocytes:15%

RBC : 4.12 

Plt- 7.7 lakhs cells /cumm

Smear :

Normocytic hypochromic with neutophelia and thrombocytosis 

LFT:

TB - 0.6 mg/ dl 

DB - 0.2 mg/ dl 

SGOT - 16

SGPT- 27

Alp - 239

TP-6.8

Albumin -2.9

A/G- 0.74

Pleural fluid analysis:

Pleural tap was done following all the aseptic measures, on right side 6 th posterior intercostal space, white viscous fluid was taken out and sent for analysis.

 

Cytology report:

Smears showed rich cellularity composed of degenerating neutrophils only against eosinophilic proteniacious background 

Impression: cytology suggestive of acute inflammatory condition.

Creatinine-0.7

Provisional diagnosis:

              right sided pleural effusion ? Empyema 

PROCEDURE:

I have seen plureral tap done on this patient with the help of 2d echo.Here is the video of 2d echo done by Pg,Dr Rashmitha Rao mam:

   https://drive.google.com/file/d/1OC8vILComgJg8sN_bXx-CNKItuZqUXNH/view?usp=drivesdk

 pleural tap which is done by our professor,Dr Rakesh biswas sir:

https://drive.google.com/file/d/1OBmdnDf29JwB4AjOYSVT8Mq7dDsot0Us/view?usp=drivesdk

Thoughts:

1) can we suspect pseudomans infection based on colour of the fluid?

2)Or is there any fungal infection which produce greenish colour fluid?

3)what is the best way to drain fluid either suction or intercostal drainage?

4)what treatment can be given before getting plueral analysis as there is severe pain?

NEET

NEET:

12/05/2020:

cervical radiculopathy is an lower motor neuron lesion  here acute lesion is due to disc prolapse where as gradual condition is due to osteophytes.

 cervical myelopathy is an upper motor neuron lesion.

Taking insulin injection and doing exercise cause HYPOGLYCEMIA due to increased blood flow by which insulin absorption is increased.

13/05/2020:

Renal tubular acidosis- Type 1:  DCT is involved and inability to excrete acid into urine is present.

Type 2:PCT is involved and bicarbonate is excreted in excess in this type.

Type 4:In this deficiency or inability to respond to aldosterone is the main pathology and has persisting hyperkalemia.

Type 1 RTA gives rise to nephrocalcinosis and nephrolithiasis due to:

• Patients have a constant release of calcium phosphate from bones to buffer the extracellular H⁺.

• Patients have decreased reabsorption of calcium and phosphate, leading to hypercalciuria and hyperphosphaturia.

• Patients have relatively alkaline urine, which promotes calcium phosphate precipitation.

• Metabolic acidosis and hypokalemia lead to hypocitraturia, a risk factor for stones. Citrate in the urine complexes calcium and inhibits stone formation.

14/05/2020:

Sacubitril is a new antihypertensive drug which acts by increasing ANP by inhibiting neprilysin(enzyme that degrades ANP).

It is usually used in combination with valsartan(ARB) as sacubitril increases angiotensin 2 level.

You Deserve Health.

Here is the case of a man who came to opd who has already been treated in our hospital with complaint of pedal edema.

Details of this patient was given by my colleague intern,madhuri.I am thankful for that.

Case:

14/01/2020

A 35year male presented with complaints of shortness of breath since 2weeks and pedal Edema since 2weeks

Patient was apparently asymptomatic 1month back then he developed fever ,associated with chills ,which is high grade for which he took treatment at local rmp where he was given anti malarial drugs and treated symptomatically after which patient felt better currently from 2weeks he is complaining of b/l pedal edema ,extending up to knees ,pitting type,progressing in nature shortness of breath from 2weeks ,initially NYHA 3 after treatment now grade 2 h/o paroxysmal nocturnal dyspnea and generalised weakness from 2weeks

No h/o fever ,vomitings ,abdominal distension ,diarrhoea ,cough,cold

PAST HISTORY :

No history of similar complaints in the past

Not a known case of DM ,HTN,Epilepsy,CVA,CAD

PERSONAL HISTORY :

mixed diet with normal appetite and normal bowel&bladder habits

H/o alcohol and smoking occasionally

No significant family history

GENERAL EXAMINATION:

well built and well nourished

Afebrile

Pallor absent

Noicterus,cyanosis,clubbing,lymphadenopathy

Edema upto knees (grade2)

BP:130/80mmhg

PR:80bpm

CVS:s1s2heard

RS:right ISA early inspiratory crepts +

P/A:soft and non tender

CNS:Hmf normal

Cranial nerves intact

Motor system normal

Sensory system normal

No cerebellar signs

JVP of this patient

https://drive.google.com/file/d/1Gr2xuU5bcPUbNmQaPjVIavwn1m-FK7gr/view?usp=drivesdk



INVESTIGATIONS:

Heamoglobin :15.2

Tlc:9600

Platelet:2.39

FBS:102

PLBS:205

Total cholesterol:150

Triglycerides:87

Hal:33

LDL:72

Vldl:17.4

Urea:24

Creatinine:0.8

Uric acid :6

USG abdomen:

                      right moderate pleural effusion ,grade1 fatty liver,mild ascites

2D ECHO:

                     EF-27%,IVC dilated(2.3cm)not collapsing,mild TR+,severe MR+,trivial AR+,dilated all chambers ,global hypokinesia,severe LV dysfunction,mild PAHT,no MS/AS,no PE/LV clot

DIAGNOSIS:

                heart failure with reduced ejection fraction secondary to viral myocarditis with denovo DM type 2

TREATMENT:

Tab.lasix 80mg...40mg...40mg

Tab.isosorbide mononitrate10mg bd

Tab.hydralazine 25mg

Tab. Telma20mg

Tab.metformin 500mg po od

Fluid restriction <1litre/day

Salt restriction <2gms/day

On 14/05/2020:

Patient came for opd with complaints of pedal odema and shortness of breath  since 1week 

Patient is investigated for 2d echo and findings are: left ventricular dilatation ,left atrial dilatation,end point septal separation distance is increased,right atrial and ventricular dilatation ,global hypokinesia.

Based on the above findings we have increased the dosage of vymarda 50mg BD  (sacubitril 26mg +valsartan24mg) to vymarda to 100 mg BD.

He have been asked to revisit after 1 month for check up.

PROCEDURE:

Today I have seen 2d echo which is done by our Pg mam for a congestive cardiac failure patient where we can see mitral valve is not able to touch interventricular septum which clearly explains improper functioning of heart with reduced stroke volume and with left ventricular hypertrophy. 

Here is the video of 2d echo:

 https://drive.google.com/file/d/1K9Fk66l6c79ziOF-dIYQ3vDlGbSavlr7/view?usp=drivesdk

Here is the comparison between systolic and diastolic images of heart helps in knowing ejaculatory fraction

Better Doctors. Better Care.

Hello everyone, I am an intern in medicine and I am logging cases those I have seen.so that I can share my ideas and can have others thoughts which help in diagnosing or treating patients.

Here is the case of a young boy who came to medicine opd:

CASE:

12/05/2020:

A 18yr old male presented with complaints of difficulty in walking since 1 month

bilateral lower limbs weakness since 1 month

pain in the lower limbs calf muscles since 1 month.

Patient was apparently asymptomatic 1 month back then he gradually developed weakness in both lower limbs which initially felt from getting down from a tractor 1 month back and then he walked with support (walls) which is progressive in nature.

H/o pain in the calf muscles while walking/calf tender positive.

H/o difficulty in standing from sitting position.

H/o difficulty in climbing stairs

H/o difficulty in holding chappals

H/o wasting and thinning of muscles (LL>UL)

No h/o difficulty in getting up from lying down.

no h/o difficulty in holding pen/buttoning/unbuttoning

no h/o difficulty in breathing 

no h/o difficulty in lifting the head off the pillow

no h/o difficulty to roll over the bed

no h/o involuntary muscles

no h/o fasciculations/muscle twitchings

h/o slippage of chappal while walking without knowledge

no h/o sensory deficit in feeling clothes

no h/o sensory deficit for hot/cold

no h/o tingling and numbness in UL & LL

no h/o band like sensation

no h/o low backache

no h/o trauma 

no h/o giddiness while washing face

no h/o cotton wool sensation

no h/o urgency/hesitancy/increased frequency of urine

no h/o urinary incontinence

h/o fever/

No h/o nausea/ vomiting/diarrhea

no h/o seizures

no h/o spine disturbances

no h/o head trauma

no h/o loss of memory

no h/o abnormality in perception of smell

no h/o blurring of vision

no h/o double vision/difficulty in eye movements

no h/o abnormal sensation of face

no h/o difficulty in chewing food

no h/o difficulty in closing eyes

no h/o drooling of saliva

no h/o giddiness/swaying

no h/o difficulty in swallowing

no h/o dysphagia/dysphasia

no h/o tongue deviation

no h/o difficulty in reaching objects

no h/o tremors/tongue fasciculations

no h/o incoordination during drinking water

no h/o fever/neck stiffness

Past history:

no h/o similar complaints in past

not a known case of DM/HTN/EPILEPSY/CVA/CAD

personal history:

mixed diet with normal appetite and normal bowel/bladder movements

h/o alcohol since 2y weekly twice.

No h/o smoking

no significant family history.

General examination:

Moderately built;poorly nourished

afebrile

Pallor present 

Icterus negative

No cyanosis,clubbing,lymphademopathy,Edema.

no short neck

no scars;no h/o tropic ulcers

no neurocutaneous markers

Bp 100/60 mmhg

Pr 80 bpm

Cvs s1 s2 hears no murmurs

Rs bae + nvbs hears

P/a soft ,nontender

Cns  HMF- patient conscious

        oriented to place/time/person

no h/o aphsia/dysarthria

no h/o dysphonia

no h/o memory loss

no h/o emotional lability

MMSE- 30

cranial nerves- intact

MOTOR SYSTEM 

                                              Right.         Left

Bulk:    inspection       decreased.     decreased

             palpation.       decreased.     decreased

Measurements  U/l   28.5cm.   28.5cm

                                  L/L 37 cm    37 cm

Tone:               ul.            normal.         Normal

                         LL.         hypotonia.      hypotonia

Power              UL.                5/5.              5/5

               iliopsoas                3/5.              3/5

   adductor femoris            4/5.               4/5

       gluteus medius             3/5.               3/5

   gluteus maximus            3/5.               3/5

              hamstrings            3/5.               3/5

quadriceps femoris            3/5.               3/5

tibialis anterior.                   3/5.               3/5

tibialis posterior.                 3/5.               3/5

peroneii.                                3/5.               3/5

gastronemius.                     4/5.               4/5

extensor -

         digitorum longus.       3/5.               3/5

flexor digitorum longus      3/5.               3/5

Reflexes.  

   Superficial reflexes

                       Right.           Left

Corneal.            P                  P

Conjunctival    P.                  P

Abdominal.      +               +

Plantar            mute           mute

cremasteric.    +                +

    Deep tendon reflexes 

                     Right.             Left

Biceps.          P.                     ---

Triceps.         ---.                   ---

Supinator.     ---                    ---

Knee              ---                    ---

Ankle.            ---                    ---

 

SENSORY SYSTEM 

                                    RIGHT.           LEFT

SPINOTHALAMIC 

             crude touch.   N.                   N

                 pain.             N.                   N

            temperature.   N.                   N

post:

             fine touch.      N.                   N

             vibration.        N.                   N

     position sensor.    N.                   N

 cortical 

 2 point discrimination  N.                   N

tactile localisation.        N.                   N

CEREBELLUM

titubation - absent

ataxia - absent

hypotonia.                present            present

INVESTIGATIONS

HEMOGRAM : 

HB            10.4gm/dl

Platelets  2.56lakhs/cumm

TLC            10400 cells/cumm

lymphocytes 10%

smear -microcytic hypochromic anemia

 serum electrolytes

Na+ 143 meq/l

k+.    3.9meq/l

cl-.       95meq/l

13/5/2020

CASE:

S- patient is conscious

O-

Bp-130/90mmhg

Pr-84 bpm,regular

Cvs: s1 s2 present no murmurs

Rs bae+ nvbs heard.

P/a soft, non tender

cns-hmf intact. 

                          rt.                    lt

tone   ul.          N.                    N

            ll.   decreased.    decreased

power ul.         4/5.                4/5

            ll.          3/5.                 3/5

biceps.              ---                    ---

triceps.             ---                     ---

supinator.        ---                     ---

knee.                ---                      ---

ankle.               ---                      ---

plantar        mute.             mute

Temperature charting:

Investigations-

CREATININE KINASE- 92 IU/L     

                            THIS IS DONE TO CHECK FOR ANY NEUROMUSCULAR CONDITION BUT IT CAME NORMAL.

PERIPHERAL BLOOD SMEAR-  

      Normocytic normochromic 

                    It was sent to see any macrocytes or hypersegmented neutrophils to see for any subacute combined degeneration of spinal cord responsible for paraperesis

        

SEROLOGY:

HIV,HBsAg,HBC all came as negative.

   So that we can exclude viral involvement.

CHEST X-RAY-

ECG:

        

Diagnosis-

 Paraparesis  under evaluation -LMN lesion, peripheral neuropathy.

                   

                   

 

Treatment -

1)T.PCM 650mg/ TID

2)INJ.NEOMOL 100ml/ IV INFUSION IF TEMPERATURE >101F

3) TEMPERATURE CHARTING 4th HOURLY AND TEPID SPONGING

I came to know that chest x-ray and ecg are done for the most patients as general investigations to rule out other comorbid conditions and have a baseline ECG and chest x-ray.

14/5/2020

S- patient is conscious

O-

Bp-120/80mmhg

Pr-82bpm,regular

Cvs: s1 s2 present no murmurs

Rs bae+ nvbs heard.

P/a soft, non tender

cns-hmf intact. 

                          rt.                    lt

tone   ul.          N.                    N

            ll.   decreased.    decreased

power ul.         4/5.                4/5

            ll.          3/5.                 3/5

biceps.              ---                    ---

triceps.             ---                     ---

supinator.        ---                     ---

knee.                ---                      ---

ankle.               ---                      ---

plantat.          mute.             mute

Temperature charting

On examination it came to know that he is having scabies  as the lesions are present in the webspaces and on asking history he told there are same lesions in his group of members and acquired from each other.(contagious)

To my question these lesions are not pruritic! Which gave me thought of is he immunocompromised letting him no feel of itch!

And may be this immunocompromised state is the reason for his paraperesis. But serology turned out negative.

Investigations-

THYROID PROFILE : it was sent in view of weight loss with myopathy with proximal muscle involvement ?thyroid myopathy!

  

Diagnosis-

1) paraparesis  under evaluation -LMN lesion, peripheral neuropathy

2)scabies

Treatment -

1)T.PCM 650mg/ TID

2)INJ.NEOMOL 100ml/ IV INFUSION IF TEMPERATURE >101F

3)PERMETHRIN 5% LOTION OVERNIGHT APPLICATION ALL OVER BODY EXCEPT FACE

Thoughts-

 1)Can it be any other condition where it can be progressing otherthan viral and demyelination diseases?

2)Why hypofunction of thyroid is seen in spinal cord injury? 

https://pubmed.ncbi.nlm.nih.gov/6619835/

https://pubmed.ncbi.nlm.nih.gov/8591067/

3) If we think case is a spinal cord injury case based on low T3 levels then why there are no upper motor neuron lesion signs.

15/05/2020:

S- patient is conscious

O-

Bp-126/80mmhg

Pr-83bpm,regular

Cvs: s1 s2 present no murmurs

Rs bae+ nvbs heard.

P/a soft, non tender

cns-hmf intact. 

                          rt.                    lt

tone   ul.          N.                    N

            ll.   decreased.    decreased

power ul.         4/5.                4/5

            ll.          3/5.                 3/5

biceps.              ---                    ---

triceps.             ---                     ---

supinator.        ---                     ---

knee.                ---                      ---

ankle.               ---                      ---

plantat.          mute.             mute

  

Investigation: 

                  we planned to do Nerve conduction study so that we can know whether defect is in axon or myelin sheath.

Treatment:

1)T.PCM 650mg SOS

2)B PLEX OD

16/05/2020:

S- patient is conscious

O-

Bp-120/80mmhg

Pr-80bpm,regular

Cvs: s1 s2 present no murmurs

Rs bae+ nvbs heard.

P/a soft, non tender

cns-hmf intact. 

                          rt.                    lt

tone   ul.          N.                    N

            ll.   decreased.    decreased

power ul.         5/5.                5/5

            ll.          3/5.                 3/5

biceps.              ---                    ---

triceps.             ---                     ---

supinator.        ---                     ---

knee.                ---                      ---

ankle.               ---                      ---

plantat.          mute.             mute

Investigations:

NERVE CONDUCTION STUDIES:

Diagnosis:

1) Paraparesis secondary to peripheral neuropathy (bilateral common peroneal nerves and sural nerves).

2)scabies

Treatment:

1)T.PCM 650mg SOS

2)T.B COMPLEX OD

17/05/2020:

S- patient is conscious

O-

Bp-130/80mmhg

Pr-76bpm,regular

Cvs: s1 s2 present no murmurs

Rs bae+ nvbs heard.

P/a soft, non tender

cns-hmf intact. 

                          rt.                    lt

tone   ul.          N.                    N

            ll.   decreased.    decreased

power ul.        4+/5.               4+/5

            ll.          3/5.                 3/5

biceps.              ---                    ---

triceps.             ---                     ---

supinator.        ---                     ---

knee.                ---                      ---

ankle.               ---                      ---

plantat.          mute.             mute

Diagnosis:

1) Paraparesis secondary to peripheral neuropathy (bilateral common peroneal nerves and sural nerves).

2)scabies

Treatment:

1)T.B COMPLEX OD

2)PERMETHRIN 5% LOTION OVERNIGHT APPLICATION ALL OVER BODY EXCEPT FACE

18/05/2020:

S- patient is conscious

O-

Bp-120/80mmhg

Pr-72bpm,regular

Cvs: s1 s2 present no murmurs

Rs bae+ nvbs heard.

P/a soft, non tender

cns-hmf intact. 

                          rt.                    lt

tone   ul.          N.                    N

            ll.   decreased.    decreased

power ul.        4+/5.               4+/5

            ll.          3/5.                 3/5

biceps.              ---                    ---

triceps.             ---                     ---

supinator.        ---                     ---

knee.                ---                      ---

ankle.               ---                      ---

plantat.          mute.             mute

Investigations:

            Planned to do Sural Nerve biopsy so that we can know pathology.

Diagnosis:

1) Paraparesis secondary to peripheral neuropathy (bilateral common peroneal nerves and sural nerves).

2)scabies

Treatment:

1)T.B COMPLEX OD

We are here for you.

Hello everyone..  I am an intern in Medicine and i am making this log so that I can share the cases I have been seeing during my posting at medicine department.And as a hope that some will share their new ideas and thoughts.

Details of this patient was given by my colleague intern, Anugna.I am thankful for that

CASE :

A 18YEAR OLD MALE PATIENT CAME TO OPD WITH CHIEF COMPLAINT OF WEAKNESS OF B/L LOWERLIMBS SINCE 20 DAYS

THE WEAKNESS STARTED IN PROXIMAL REGION 2 YEARS BACK WHICH IS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE LATER PROGRESSED TO B/L DISTAL REGION

H/O B/L EDEMA OF LL NON PITTING TYPE

H/O DIFFICULTY IN SQUATTING POSITION AND GETTING UP FROM SQUATTING POSITION

H/O DIFFICULTY IN WEARING AND HOLDING CHAPPALS

NO H/O DIFFICULTY IN COMBING HAIR , BUTTONING AND UNBUTTONING SHIRT

NO H/O CRANIAL NERVE INVOLVEMENT

PAST HISTORY

NOT A K/C/O HTN,DM,CVA, EPILEPSY,CAD,TB,THYROID

PERSONAL HISTORY-

diet-mixed

appetite-normal

sleep-adequate

B&B-regular

FAMILY HISTORY- 

not significant

-no known food or drug allergies

GENERAL EXAMINATION-

-patient was conscious, coherent and coperative

-moderately built and nourished.

-no signs of pallor, icterus, clubbing, cyanosis, lymphadenopathy, edema

-VITALS

1.temperature-AFEBRILE

2.pulse rate-92bpm

3.respiratory rate-18 cycles/min

4.BP-130/90mmhg

5.SpO2-96%

6.GRBS-142mg/dl

SYSTEMIC EXAMINATION

I.CVS-

S1 S2 heard

no added murmurs

2.RESPIRATORY SYSTEM-

-normal vesicular breath sounds heard

-bilateral air entry present

3.PER ABDOMEN-

shape=scaphoid

umbilicus=central and normal in position

all quadrants moving equally on respiration

no tenderness

no organomegaly

bowel sounds-heard

no bruit heard

4.CNS-

patient is conscious, coherent, coperative 

patient well oriented to time, place and person

higher mental functions= normal

Cranial nerves- intact

Motor system-

       tone - normal

       power -  4-/5 in both lower limbs

        reflexes absent in both lower limbs

sensory system-normal

No meningeal signs

No cerebellar signs

Based on the above complaints patients blood samples were sent for 

1.CBP

2.serology

3.RFT

4.ECG

5.CUE

6 MUSCLE BIOPSY

                                                                                                                                                                        

DD - Muscular dystrophy

         Acute on CIDP

TREATMENT

     T Prednisolone 15mg po od

      T Pantop 40mg bbf

        T Met xl 12.5mg od

       Cap Becosules od

        T Chymerol forte od

        T Taxim 200mg bd

         T Vit c od

          T Ultracet sos

 

PROCEDURE:

Have seen muscle biopsy from right quadriceps femoris as investigation for  Becker disease (provisional diagnosis)

 

Here is the sample that has been taken yesterday 

details about this case are presented by our Pg mam and has been uploaded in YouTube here is the link : https://youtu.be/3VVH7w3rWSM.

18/05/2020:

Patient came today and we are planning for randomised control trail with placebo and deoxyribose.

               This is to check whether deoxyribose has effect on myopathy or not.