Anahita behara

 Draft ??? 17/05/2025 Draft: Optimizing Clinical Complexity Around Fever in Narketpally Introduction Febrile Illness is among the most commonly seen clinical symptomatology and presents a  diagnostic challenge in resource-limited and epidemiologically complex regions like Narketpally, Telangana. This semi-urban setting experiences a broad spectrum of febrile illnesses influenced by seasonal patterns, endemic infections, and a dual burden of communicable and non-communicable diseasesThis review of 77 cases of a wide array of fever diagosis and its management would help us understand the challenges faced by healthcare providers and patients to the challenges faced with this clinical complexity. Optimizing the clinical approach to fever in such a context necessitates a refined, context-specific strategy. Clinical Complexities and Challenges Diagnostic Overlap : The overlapping symptomatology of many febrile illnesses, such as myalgia, rash, and headache, complicates early diag...

INTRODUCTION  https://www.ncbi.nlm.nih.gov/books/NBK538197/  Dandy-Walker malformation or syndrome is a rare congenital neurological anomaly that affects the development of the cerebellum, the region of the brain responsible for motor coordination and balance. This posterior fossa anomaly is characterized by agenesis or hypoplasia of the vermis and cystic enlargement of the fourth ventricle, causing upward displacement of the tentorium and torcula. Most patients have hydrocephalus at the time of diagnosis. Dandy-Walker malformation is the most common posterior fossa malformation, and it typically occurs sporadically. The syndrome can manifest with a wide spectrum of neurological and developmental symptoms, making timely recognition and management crucial for improving patient outcomes CASE REPORT  A 13 year old boy presented to the general medicine OPD of KIMS, Narketpally on 17th May 2025 , with the following complaints dribbling of urine from the back of the p...

 I am Dr.Anahita Behara from KIMS,Nkp and today I shall demonstrate the benefits of a case based learning ecosystem (CCBLE) , as a budding medical student full of curiosity ,  i was fascinated by the revelling mystery of the numerous diseases encountered during my study . I was deeply disturbed  by my inability to make a change . I had such big dreams but no way of achieveing them , until I was introduced to the concept of Case-based learning or  Patient-centric learning , following up on patients even after they were discharged and monitoring their lifestyle habits , gave us a window to view not only the "dis-ease" but the "ease" as well , linking all the domains of health .  It humanises the patient and forces us to look at the bigger picture.

Introduction  Acetamiprid belongs to a new systemic neonicotinoid insecticide that is effectively used for crop protection and flea control in agricultural works [ 1 ]. It has low toxicity in mammals, but ingestion of large amounts can cause severe toxicity. It is described in a case report that a buffalo exhibited severe gastrointestinal symptoms and respiratory distress following accidental ingestion of acetamiprid in India [ 2 ]. Here we describe a case of a 34 year old male with diabetic ketoacidosis and acetamiprid ingestion  Case Report  This is the case of a 34 year old male who is a resident of Nalgonda m, Telangana , who is a farmer by occupation , was brought to the casuality at 6:00am with history of Acetamipride 20% (insecticide) ingestion  approximately 50gm powder in 2 glasses of water , he presented with 3 episodes of turquoise colored vomitus and shortness of breath since 1:00am   There is n/h/o pain abdomen , giddiness , nausea , chest pain...

 Fungal 

 Admission Date: 07/03/2024 01:00 PM Discharge Date Date:21/04/2024 Discharge Type: Relieved Diagnosis CKD ON MHD Case History and Clinical Findings C/O PEDAL EDEMA SINCE 1 WEEK C/O DECREASED URINE OUTPUT SINCE 1 WEEK PT WAS APPARENTLY ASYMPTOMATIC 1 WEEK AGO THEN HE DEVELOPED PEDALEDEMA SINCE 1WEEK , WHICH WAS INSIDIOUS IN ONSET AND GRADUALLY PROGRESIVE IN NATURE ALSO C/O DECREASED URINE OUTPUT SINCE 1 WEEK N/K/C/O HTN , CVA , CAD , ASTHMA O/E: NO PALLOR ICTERUS CYANOSIS CLUBBING AND GENERALIZED LYMPHADENOPATHY PEDAL EDEMA PRESENT TEMPERATURE 97.8 PR- 79BPM RR-18CPM BP- 140/90 GRBS 112 SPO2- 98% AT RA CVS- SI S2HEARD NO THRILLS AND MURMURS RS- B/LAE NVBS HEARD P/A- SOFT AND NON TENDER NO PALPABLE MASS CNS - NFND CRANIAL NERVES INTACT SENSORY AND MOTOR SYSTEM NORMAL Investigation LIVER FUNCTION TEST (LFT) 06-03-2024 12:55:PM Total Bilurubin0.77 mg/dlDirect Bilurubin0.20 mg/dlSGOT(AST)10 IU/LSGPT(ALT)10 IU/LALKALINE PHOSPHATASE473 IU/LTOTAL PROTEINS7.4 gm/dlALBUMIN3.68 gm/dlA/G RATI...

  CASE :   DIAGNOSIS :  diagnosis  RTA , TRAUMATIC BRAIN INJURY(20/3/23) WITH INTRAVENTRICULAR HEMORRHAGE(RESOLVED) WITH ASPIRATION PNEUMONIA(RESOLVED) FRONTAL BONE FRACTURE s/p -RIGHT FRONTAL LACERATION SOFT TISSUE REPAIR WITH DEBRIDEMENT WAS DONE ON 21/3/23.HFMEF (EF-50%)  SUDDEN CARDIAC ARREST-? HIE ON MECHANICAL VENTILATION DAY-5 (25/3/23) POST CPR STATUS(2CYCLES) ON (25/3/23 ) ANTERIOR WALL MI (EVOLVED)  S/P TRACHEOSTOMY (29/3/23) RECURRENT HYPOKALEMIA WITH GRADE 2 BED SORE (DAY2) ?SEPSIS with LEFT MIDDLE LOBE CONSOLIDATION ? ventilator associated pneumonia  COURSE IN HOSPITAL  25 YEAR OLD MALE PATIENT BROUGHT TO CASUALTY WITH H/O FALL FROM BIKE UNDER ALCOHOL INFLUENCE AT 9:30 PM NEAR HALIYA,NALGONDA ON 20/03/23. AND THEN TAKEN TO HOSPITAL FOR FURTHER MANAGEMENT.PATIENT IS INVESTIGATED AND DIAGNOSED TO HAVE RTA , TRAUMATIC BRAIN INJURY,WITH INTRAVENTRICULAR HEMORRHAGE WITH FRONTAL BONE FRACTURE WITH ASPIRATION PNEUMONIA AND RIGHT FRONTAL LACE...

date of admission 3/5/2024  date of discharge 16/5/2024   Diagnosis RADIATION ENTERITIS WITH RIGHT HYDROURETERO NEPHROSIS KNOWN CASE OF CARCINOMA CERVIX POSTHYSTERECTOMY STATUS Case History and Clinical Findings C/O PAIN ABDOMEN SINCE 10 DAYS LOOSE STOOLS SINCE 6 DAYS HOPI:PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK, THEN HE DEVELOPED PAIN PAIN ABDOMEN DIFFUSE INSIDUOUS ONSET GRADUALLY PROGRESSIVE AND SUBSIDED YESTERDAY EVENING .SQUEEZING IN NATURE AGGRAVATED ON TAKING FOOD AND RELIEVED ON PASSING TOOLS H/OLOOSE STOOLS SINCE 6 DAYS FOOD AS CONTENT10-12 EPISODES PER DAY H/O FEVER LOW GRADE INTERMITTENT DURING NIGHT RELIEVED ON TAKINGMEDICATION NOT ASSOCIATED WITH CHILLS AND RIGOR NO H/O VOMITING . PAST HISTORY: K/C/O HYPOTHYROIDISM AND ON CARBIMAZOLE 2.5 MG OD NO H/O SIMILAR COMPLAINTS IN THE PAST. N/K/C/O DM, HTN, TB , CKD ,CVA , ASTHMA,EPILEPSY ,THYROID. H/O OF CARCINOMA CERVIX 1 YEAR AGO FOR WHICH HYSTERECTOMY WAS DONE F/B RADIOTHERATY AND CHEMOTHERAPY FOR 3 MONTHS PATI...

 Diagnosis DENGUE PYREXIA (NS POSITIVE) CHRONIC KIDNEY DISEASE ON MAINTENANCE HEMODIALYSIS Case History and Clinical Findings PATIENT CAME WITH C/O FEVER SINCE 3DAYS, CHEST PAIN SINCE TODAY MORNING HOPI- PT WAS APPARENTLY ASYMPTOMATIC TILL TODY MORNING THEN SHE DVELOPED CHEST PAIN WHICH IS SUDDEN IN ONSET, GRADUALLY PROGRESSIVE(BURNING TYPE, LOCALISED, LEFT SIDED) ASSOCIATED WITH SOB GRADE III C/O PEDAL EDEMA, BILATERAL PITTING TYPE, GRADE II H/O FEVER 3 DAYS AGO WITH GENERALISED BODY PAINS TESTED NS POSITIVE 3 DAYS AGO WITH YESTERDAY PLATELETS 65OOO NO C/O BURNING MICTURITION, VOMITINGS, LOOSE STOOLS, BLEEDING GUMS, HEMATEMESIS, HEMOPTYSIS, PURPURA, RASHES, PALPITATIONS. PAST HISTORY- H/O LEFT PCNL + DJ STENTING DONE 3 MONTHS AGO WITH STENT REMOVAL DONE LEFT MULTIPLE CALCULI , B/L HUN WAS PRESENT L>R K/C/O CKD SINCE 3 MONTHS ON DIALYSIS SINCE 20 DAYS ,8 HD DONE. NOT A K/C/O DM, HTN, CAD,CVA, ASTHMA, THYROID DISORDERS. FAMILY HISTORY- INSIGNIFICANT MENTRUAL HISTORY- MENOPAUSE AT...

 Diagnosis date of admission 27/1/2024  date of discharge 29/1/2024 DENGUE FEVER, WITH THROMBOCYTOPENIA, NS1 POSITIVE DENOVO TYPE 2 DM Case History and Clinical Findings PATIENT CAME WITH C/O FEVER SINCE 10 DAYS, COUGH, COLD WITH 10 DAYS, LOOSE WATERY STOOLS 10 DAYS BACK PATIETN WAS APPARENTLY ASYMPTOMATIC 10 DAYS AGO , THEN DEVELOPED FEVER LOW GRADE, ASSOCIATED WITH CHILLS AND RIGORS, PERIODIC, ASSOCIATED WITH COUGH, COLD 10 DAYS BACK, DRY COUGH AND RESOLVED 5 DAYS BACK. LOOSE STOOLS , NON BLOOD STAINED, 3-4 EPISODES 10 DAYS BACK, RESOLVED 5 DAYS BACK NO H/O VOMITING, BURNING MICTURITION PAST HISTORY NO H/O HTN, DM, TB, ASTHMA, EPILEPSY NO ADDICTIONS PERSONAL HISTORY: DIET:MIXED SLEEP:ADEQUATE BOWEL AND BLADDER:REGULAR ADDICTIONS:NO APPETITE:NORMAL GENERAL EXAMINATION: PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE,WELL ORIENTED TO TIME,PLACE AND PERSON. NO PALLOR,ICTERUS CYANOSIS,CLUBING,LYMPHADENOPATHY,EDEMA. VITALS: TEMPERATURE:98.6 BP:120/80 MM HG PR:84 BPM RR:18 CPM SYSTEMIC ...

 Diagnosis DENGUE FEVER WITH THROMBOCYTOPENIA TYPE -2 DIABETES MELLITUS SINCE 2 YEARS Case History and Clinical Findings C/O FEVER SINCE 3 DAYS HEAD ACHE SINCE 3 DAYS WEAKNESS SINCE 3 DAYS SWELLING OF BOTH LOWER LIMBS SINCE 1 WEEK PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN DEVELOPED FEVER WHICH WAS LOW GRADE PERIODIC,ASSOCIATED WITH CHILLS AND RIGORS HEAD IS SUDDEN IN ONSET,ASSOCIATED WITH FEVER NO H/O COUGH ,COLD,VOMOTINGS,DIARRHEA,BLOOD STAINED STOOLS,VOMITINGS K/C/O DIABETES MELLITUS ON TAB.METFORMIN 500 MG SIONCE 2 YEARS NO H/O HYPERTENSION,TB,ASTHMA,EPILEPSY CHRONMIC SMOKER 2-3 (CHUTTA) PER DAY SINCE 20 YEARS NO H/O SIMILAR COMPLAINTS IN THE PAST GENERAL EXAMINATION :- PATIENT WAS CONSCIOUS COHERENT AND COOPERATIVE NO PALLOR ICTERUS CYANOSIS CLUBBING LYPHADENOPATHY AND EDEMA VITALS :- TEMP- AFEBRILE PULSE RATE- 82 BPM RR- 16 CPM BP- 110 / 70 MMHG GRBS- 98 MG/DL SYSTEMIC EXAMINATION :- CVS- S1 S2 HEARED, NO MURMURS RS - BAE + , NVBS CNS - NFND P/A - SOFT NON TENDER , B...

 Diagnosis VIRAL PYREXIA WITH THROMBOCYTOPENIA Case History and Clinical Findings 80YR OLD MALE CAME WITH CHIEF COMPLAINTS OF FEVER SINCE 5 DAYS AND GENERALISED WEAKNESS SINCE 5 DAYS HISTOR OF PREENTING ILLNESS : PATIENT WAS APPARENTLY ASYMPTOMATIC 5 DAYS BACK , THEN HE DEVELOPED HIGH GRADE FEVER WITH DIURNAL VARIATION ASSOCIATED WITH HEADACHE AND NOT ASSOCIATED WITH CHILLS AND RIGORS NO H/O COLD , COUGH , SOB , ABDOMINAL DISTENSION NO H/O PAIN ABDOMEN , LOOSE STOOLS , NAUSEA , VOMITINGS NO H/O BURNING MICTURITION PAST HISTORY : K/C/O DM SINCE 1 YR ON TAB GLYCOMET GP1 H/O CHEST PAIN ? CAD 6 YRS BACK N/K/C/O CVA , SEIZURES , THYROID , ASTHMA GENERAL EXAMINATION- THE PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE MODERATELY BUILT AND NOURISHED NO SIGNS OF PALLOR, ICTERUS, CYANOSIS, CLULBBING, EDEMA VITALS: TEMP: 97 F PR: 74 BPM RR: 16 CPM BP: 140/90 MM HG PO2: 96% @ RA GRBS: 320 MG/DL CVS: S1, S2 HEARS, NO MURMURS RS: BAE+, NVBS TRACHEA: CENTRAL NO DYSPNOEA AND WHEEZE NO RHONCHI ABDOMEN...

 Diagnosis VIRAL PYREXIA WITH THROMBOCYTOPENIA (RESOLVING) ACUTE GE (RESOLVED) ORAL CANDIDIASIS S/P 2 SDP TRANSFUSIONS ON 6/4/24 , 8/4/24 Case History and Clinical Findings A 35Y/F CAME WITH C/O FEVER SINCE 3DAYS , LOOSE MOTIONS AND VOMITINGS SINCE 3 DAYS PT. WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO , THEN SHE DEVELOPED FEVER , WHICH WAS INSIDIOUS IN ONSET , HIGH GRADE , INTERMITTENT A/W CHILLS RESOLVED ON MEDICATION H/O VOMITINGS 5-6 EPISODES , FOOD ASSOCIATED , NON-PROJECTILE, NON-BILIOUS H/O LOOSE STOOLS -3 EPISODES PER DAY , WATERY IN CONSISTENCY H/O PETECHIAE OVER PALATE , RETRO ORIBITAL PAIN , MELENA , SOB N/H/O PAIN ABDOMEN PAST HISTORY N/K/C/O DM,HTN,ASTHMA,EPILEPSY,THYROID DISORDERS GENERAL EXAMINATION PATIENT IS CONSCIOUS COHERENT CO-OPERATIVE TEMP 98 F PR 88 BPM RR 20 CPM BP 110/70 MMHG SPO2 98 CVS S1 S2 HEARD NO MURMURS RS: DYSPNEA: GRADE II TO III NYHA, TRACHEA CENTRAL, VESICULAR BREATH SOUNDS ABDOMEN: SCAPHOID, SOFT, NON TENDER CNS: GCS E4V5M6, CONSCIOUS, NORMAL SPEECH ...