Anahita behara

 A 65 year old Hindu woman a housewife a resident of west bengal having a Bsc degree and belonging to middle class according to modified kuppuswamy scale presented to the general medicine OPD with  chief complaints of  -constipation since the past 3 years  -continuous dribbling of urine since the past 4 years    History of presenting illness   Patient was apparently asymptomatic 26 years ago , when she developed continuous dull aching pain in both the knee joints , which was exaggerated in the mornings and was bearable throughout the day , it was aggravated on walking and relieved on rest  associated with redness around the knees no history of trauma no history of evening rise of temperature  no history of cosmetic deformity(varicosity, skin discoloration) -she underwent a bilateral knee replacement for knee stiffness  -is on DMARDS since 25 years  patient was incidentally diagnosed with hypertension 20 years ago during a follow up visit  -she was started on antihypertensive medicat

WARD CASE - 11th September 2023 A 65 year old uneducated lambadi woman a resident of Bhongir , working as a daily wage worker since 40 years earning 250 rupees a day , belonging to low socioeconomic status according to modified kuppuswamy scale presented to the general medicine OPD with chief complaints of : - swelling in both the legs since 15 days  - cough and shortness of breath since 10 days    History of presenting illness  Patient was apparently asymptomatic 6 months ago , when she developed swelling in the lower limbs which was insidious in onset and gradually progressive , it was associated with pain which was dragging in type and aggraveted on walking and working and was relieved on rest. -not associated with trauma  -not associated with any joint pains  -no history suggestive of previous filarial infection she was diagnosed with renal failure secondary to hypertension and started on dialysis    She has swelling of the lower limbs since 15 days which was insidious in onset and