PG ACADEMICS ONLINE AND OFFLINE MAY 2023
MAY 1st 2023 ( MONDAY)
ICU BED 4
https://pavanichilupurirollno29.blogspot.com/2023/05/this-is-online-e-log-book-to-discuss.html
online discussion
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913673/
Early initiation of ART within 8 weeks of ATT or within 2–4 weeks is associated with a lower risk of mortality, especially among those with low CD4 cell counts, even though there is a higher risk of immune reconstitution inflammatory syndrome
shared and discussion Dr.KEERTHI PGY2
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MAY 2 nd 2023 ( TUESDAY)
icu bed 6
https://drsaicharankulkarni.blogspot.com/2023/04/35-f-with-pain-abdomen.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520843/#cit0032
Latent Autoimmune Diabetes in Adults (LADA) and its Metabolic Characteristics among Yemeni Type 2 Diabetes Mellitus Patients
shared and discussed by Dr saicharan PGY3
https://pubmed.ncbi.nlm.nih.gov/28225998/
heparin and insulin in management of hypertriglyceredemia
shared and discussed by Dr Barath kumarPGY2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515122/
mangagement of peripancreatic collections in acute pancreatitis
shared and discussed by Dr shashikala PGY3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289992/
grey turner sign in acute pancreatitis
shared and discussed by Dr Raveen PGY3
CT images of acute nectrotizing pancreatitis and normal pancreas
shared and discussed by Dr HimajaPGY1
amc bed 1
https://pavanichilupurirollno29.blogspot.com/2023/04/57m-with-altered-sensorium-secondary.html
wegnera granulomatosis
https://pubmed.ncbi.nlm.nih.gov/14968341/
shared and discussed by Dr Himaja PGY1
https://www.sciencedirect.com/science/article/abs/pii/B9780323377157500840
chrug strauss
shared and discussed by Dr Deepika PGY2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165589/
seamens sign
shared and discussed by Dr Deepika PGY2
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MAY 3 rd 2023 ( WEDNESDAY)
icu bed 1
90/M
http://87tharunkumar.blogspot.com/2023/04/90yr-male-with-altered-sensorium.html
offline discussion - Therapeutic Uncertainty of Tuberculosis
icu bed 4
60/M
https://pavanichilupurirollno29.blogspot.com/2023/05/this-is-online-e-log-book-to-discuss.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893425/
Acellular CSF was also commonly reported among other HIV-infected microbiologically-confirmed TBM
online discussion by Dr.Keerthi PGY2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606267/
Tuberculous meningitis (TBM) is still a crippling disease with a high degree of morbidity and mortality. One of the most severe complications of TBM is stroke resulting from vascular involvement. In HIV-infected individuals with TBM, the immune response to the tuberculous bacilli is altered; therefore, pathological features are very different from those seen in patients with relatively normal cell-mediated immunity (CMI). The brains of such individuals showed minimal inflammatory response with parenchymal infarcts and vasculitis, not only in the basal ganglia but in the cortical parenchyma as well.
online discussion by Dr.Keerthi PGY2
icu bed 6
75/F
https://afeefafarzanarollno9.blogspot.com/2023/05/75f-recent-altered-sensorium-right.html
Offline discussion during rounds - Stroke with altered sensorium
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MAY 4 th 2023 ( THURSDAY)
ICU BED 1
90/M
http://87tharunkumar.blogspot.com/2023/04/90yr-male-with-altered-sensorium.html
ICU BED 2
65/M
https://litfl.com/right-atrial-enlargement-ecg-library/
Right atrial enlargement produces a peaked P wave (P pulmonale) with amplitude:
> 2.5 mm in the inferior leads (II, III and AVF)
> 1.5 mm in V1 and V2
Also known as: Right Atrial Enlargement (RAE), Right atrial hypertrophy (RAH), right atrial abnormality
P wave changes with Right Atrial Enlargement
P wave morphology RAE Wagner 2007
Causes of Right Atrial Enlargement
The principal cause is pulmonary hypertension due to:
Chronic lung disease (cor pulmonale)
Tricuspid stenosis
Congenital heart disease (pulmonary stenosis, Tetralogy of Fallot)
Primary pulmonary hypertension
online discussion by Dr.NAVYA PGY1
ICU BED 4
60/M
https://pavanichilupurirollno29.blogspot.com/2023/05/this-is-online-e-log-book-to-discuss.html
https://pubmed.ncbi.nlm.nih.gov/8635178/
the standard antifungal agent for the treatment of CNS fungal infections has been amphotericin B.
online discussion by Dr.KEERTHI PGY2
ICU BED 6
75/F
https://afeefafarzanarollno9.blogspot.com/2023/05/75f-recent-altered-sensorium-right.html
https://stanfordmedicine25.stanford.edu/the25/ics.html
patient who presents with arm and leg weakness may have either a small internal capsule stroke or a large ACA + MCA cortical stroke. Looking at the homunculus in the figure above, the cortical leg area is supplied by the ACA and the arm area is supplied by the MCA. However, the injury to the cortices produces other symptoms and signs that not commonly produced by injury to the subcortical areas.
The presence of these cortical signs may exclude an internal capsule stroke:
gaze preference or gaze deviation
expressive or receptive aphasia
visual field deficits
visual or spatial neglect
If any of these signs are present, the patient may have a cortical stroke, not an internal capsule stroke.
Online discussion by deepika PGY2
Amc bed 1
70/F
https://pavanichilupurirollno29.blogspot.com/2023/05/this-is-online-e-log-book-to-discuss_3.html
Amc bed 3
https://nitishdampuru33.blogspot.com/2023/05/65-year-old-female-with-cough-since-4.html
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MAY 5 th 2023 ( FRIDAY )
ICU BED 1
53/M
http://mdparvezahmedansari.blogspot.com/2023/05/53m-with-altered-sensorium-secondary-to.html
ICU BED 2
65/M
ICU BED 4
60/M
https://pavanichilupurirollno29.blogspot.com/2023/05/this-is-online-e-log-book-to-discuss.html
ICU BED 6
75/F
https://afeefafarzanarollno9.blogspot.com/2023/05/75f-recent-altered-sensorium-right.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599520/
By Dr.DEEPIKA PGY2
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MAY 6 th 2023 ( SATURDAY)
ICU bed 6
https://afeefafarzanarollno9.blogspot.com/2023/05/75f-recent-altered-sensorium-right.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599520/
white matter hyperintensities
shared by Dr Deepika PGY2
AMC BED 6
https://rishitharaok.blogspot.com/2023/05/35-female-with-diminision-of-vision-in.html
https://eyewiki.aao.org/
Reverse_Relative_Afferent_Pupillary_Defect_(RAPD)
RAPD
shared and discussed by Dr Navya PGY1
https://www.ncbi.nlm.nih.gov/books/NBK525985/
CRVO
Patients with CRVO will often describe the blurry or distorted vision in one eye that began suddenly. This vision loss will be painless.
On examination of the ocular fundus, central retinalvein occlusions are described as a “blood and thunder” appearance, which comes from the extensive hemorrhages seen throughout the retina.
Shared and discussed by Dr Keerthi PGY2
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MAY 8th 2023( MONDAY)
ICU BED 3
https://alampallynikithchandrarollno10.blogspot.com/2023/05/65m-hypoactive-state-kco-cvalft-side.html
There is no evidence of thrombophlebitis
The patient is on foleys catheter since 1 year( as the patient is immobilized) changing the catheter once every 10 days
On admission patient had 6-8 pus cells in CUE
The culture sensitivity showed poly microbial flora growth - asked for repeat culture
On admission patient had TLC of 13500/cumm now the counts are gradually increasing to 28500/cumm sir
Patient had fever spikes from the day 1 of admission sir and now there are increased frequency of fever spikes
discussed by Dr Ajay PGY1
AMC BED 2
https://alampallynikithchandrarollno10.blogspot.com/2023/05/blog-post.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804268/
central pontine mylenosis and osmotic demyelination syndrome
shared and discussed by DR Govardini PGY1
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MAY 9 th 2023 ( TUESDAY)
2-4 PM: Central meet- Mortality meet.
56/M
diagnosis - submassive pulmonary thromboembolism with type 2 respiratory failure secondary to pulmonary edema with Acute kidney injury secondary to sepsis with acute liver injury with heart failure with preserved ejection fraction.
presentation by Dr.DEEPIKA PGY2
Questions around the case
Can the management be initiated with heparin/ thrombolysis prior CTPA?
How certain is the diagnosis of pulmonary embolism in this case?
Underlying factors attributing to ?PE
? Malignancy
Is the sr. Lactate level raised secondary to hypotension or sepsis?
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May 10th 2023 (WEDNESDAY)
ICU BED 6
https://182shasireddy.blogspot.com/2023/05/35m-dm2-for-10years-on-insulin-7-years.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5445342/
efficacy of BUN to creatinine ratio
shared by Dr Navya PGY1
https://pubmed.ncbi.nlm.nih.gov/12427149/
sugnificance od FeNa in differentiating prerenal AKI and acute tubular necrosis
shared by Dr Lohith PGY1
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May 11 th 2023 ( Thursday)
ICU BED 1
50/M
http://tejasridevaruppala36.blogspot.com/2023/05/acute-cerebrovascular-accidentleft.html
https://pubmed.ncbi.nlm.nih.gov/28592028/
ELPhad no special physical signs. Inflammation indexes, such as white blood cell, neutrophil percentage, ESR, C reactive protein, procalcitonin, D-Dimer, and blood lipid levels were usually normal. Radiological features of ELP mainly included consolidation, mass or nodules, with a little ground-glass opacity. Some patients had ventilation and/or diffusion dysfunction. The diagnostic methods included CT-guided percutaneous lung biopsy, thoracoscopy, thoracotomy or autopsy. Histopathological findings showed accumulation of large foamy macrophages in the alveolar spaces, with a few lipid deposition and polykaryocytes. Pathological examination was the gold standard for diagnosis, and the preferred means of sampling was bronchoscopy.
The main treatment of ELP was cessation of lipid material contact.
Shared by GOVARDHINI PGY1
ICU BED 4
45/M
http://nehapradeep99.blogspot.com/2023/05/45m-with-ckd-on-mhd-since-2-years.html
ICU BED 6
65/F
https://pubmed.ncbi.nlm.nih.gov/20581136/
shared by AJAY PGY1
https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)47615-X
https://pubmed.ncbi.nlm.nih.gov/1191463/
https://go.gale.com/ps/i.do?p=AONE&u=googlescholar&id=GALE|A128075131&v=2.1&it=r&sid=AONE&asid=7d1af1d7
shared by AJAY PGY1
https://www.ncbi.nlm.nih.gov/books/NBK441871/
Treatment of PNES may be difficult, but it is clear that anti-epileptic drugs (AEDs) are of no benefit. In addition to unnecessary costs and the potential side effects of AEDs for these patients, life-threatening side effects such as respiratory depression may occur if psychogenic nonepileptic status epilepticus is treated with large dosages of benzodiazepines.
shared by NAVYA PGY1
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May 12 th 2023 ( Friday)
ICU BED 1
50/M
http://tejasridevaruppala36.blogspot.com/2023/05/acute-cerebrovascular-accidentleft.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8570373/
Ninety-three stroke (26 women, 66.7 ± 12 years) and 39 control participants (15 women, 68.7 ± 7 years) were available at 3 years. TBV loss in stroke patients was greater than controls: stroke mean (M) = 20.3 cm3 ± SD 14.8 cm3; controls M = 14.2 cm3 ± SD 13.2 cm3; [adjusted mean difference 7.88 95%CI (2.84, 12.91) p-value = 0.002]. TBV decline was greater in those stroke participants who were cognitively impaired (M = 30.7 cm3; SD = 14.2 cm3) at 3 months (M = 19.6 cm3; SD = 13.8 cm3); [adjusted mean difference 10.42; 95%CI (3.04, 17.80), p-value = 0.006]. No statistically significant differences in HV change were observed.
Mixed neuropathologies are ubiquitous in late-life dementias (26), and a greater understanding of vascular neurodegenerative imaging signatures would assist in diagnostic assignment and clinical treatment. Total and regional brain atrophy rates may serve as useful tools to assess treatment response for interventions to reduce post-stroke secondary degeneration and vascular cognitive impairment, especially as most recent multimodal intervention trials for dementia prevention largely targeted cardiovascular risk
Shared by deepika PGY2
ICU BED 6
57/M
https://basanisravanthirollno18.blogspot.com/2023/05/57-m-with-cva.html?m=1
AMC CUBICLE
74/F
https://ramyareddy105pebbeti.blogspot.com/2023/05/74year-old-female-with-abdominal.html
The most important parameter to determine the cause of ascites is the serum‐ascites albumin gradient (SAAG). The SAAG correlates with the sinusoidal pressure,6 and a SAAG ≥1.1 g/dL (high SAAG ascites) indicates a hepatic vein–portal vein pressure gradient more than 11 mm Hg (i.e., portal hypertension). High SAAG ascites is almost always caused by a sinusoidal or postsinusoidal source of the ascites.
When the SAAG is ≥1.1 g/dL and the total protein in the ascites is low (<2.5 g/dL), the cause of the ascites is undoubtedly cirrhosis and portal hypertension.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490258/
Budd–Chiari syndrome (BCS) can present with ascites. In early BCS, the SAAG will be ≥1.1 g/dL and the total protein will be greater than 2.5 g/dL. As BCS progresses to cirrhosis, the SAAG will remain elevated, but the total protein will decline to less than 2.5 g/dL.
SHARED BY DR.KEERTHI PGY2
as the SAAG corelates with the sinusoidal pressure
- pathogenesis of budd chiari
Blockage of two or more major hepatic veins increases the sinusoidal pressure ( HIGH SAAG ) and reduces sinusoidal blood flow.
The primary cause of portal hypertension in cirrhosis is an increase in intrahepatic vascular resistance due to massive structural changes associated with fibrosis and increased vascular tone in the hepatic microcirculation. As portal hypertension develops, the formation of collateral vessels and arterial vasodilation progress, which results in increased blood flow to the portal circulation.
SHARED BY DR.KEERTHI PGY2
The patient has an elevated SAAG (≥1.1 g/dL), which is found in both heart failure and cirrhosis-related ascites.
She has an ascites total protein level of 3.5 g/dL, which is greater than the 2.5- g/dL threshold and suggests her ascites is related to heart failure.
This pattern occurs because hepatic sinusoids are normally permeable in heart failure–related ascites, which allows for leakage of protein-rich lymph into the abdominal cavity.
In cirrhosis, hepatic sinusoids are less permeable due to fibrous tissue deposition, resulting in ascites with low protein content.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144153/#
shared by DR.LOHITH PGY1
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May 13 th 2023 ( saturday)
ICU BED 1
50/M
http://tejasridevaruppala36.blogspot.com/2023/05/acute-cerebrovascular-accidentleft.html
https://pubmed.ncbi.nlm.nih.gov/23449262/
The estimated incidence of dying from Aspiration Pneumonia and choking among patients who died with stroke was 5% (~12 000 deaths per year) and 1% (~3700 deaths per year) according to information reported on death certificates. Efforts are needed to reduce the number of deaths from these 2 preventable complications.
shared by GOVARDHINI PGY1
Asymptomatic bacteruria
Diagnosis of asymptomatic bacteriuria is made by urine culture. Either a properly collected clean-catch specimen or a catheterized specimen is acceptable. The Infectious Diseases Society of America (IDSA) has established criteria for diagnosing asymptomatic bacteriuria.
Midstream clean catch urine specimen:
* For women, two consecutive specimens with isolation of the same bacteria species with at least 100,000 colony-forming units (CFUs) per ml of urine.
* For men, a single specimen with isolation of one bacteria species with at least 100,000 CFUs per ml of urine.
Catheterized specimen:
* For women or men, a single specimen with isolation of one bacteria species with at least 100 CFUs per ml of urine.
Most patients with asymptomatic bacteriuria will not develop symptomatic urinary tract infections and will have no adverse consequences from asymptomatic bacteriuria.
Specifically, children, patients with diabetes, older patients, patients with spinal cord injuries, and patients with indwelling urinary catheters do not benefit from treatment with antibiotics for asymptomatic bacteriuria. Treatment in these patients does not decrease the incidence of symptomatic urinary tract infections or improve survival.
However, it does increase the likelihood of adverse effects from antibiotics and the development of antibiotic-resistant bacteria.
https://www.ncbi.nlm.nih.gov/books/NBK441848/#:~:text=Asymptomatic%20bacteriuria%20is%20the%20presence,its%20incidence%20increases%20with%20age
shared by lohith PGY1
AMC BED 3
50/F
http://drsaicharankulkarni.blogspot.com/2023/05/50f-with-fever-and-knee-joint-pains.html
AMC BED 6
35/M
https://182shasireddy.blogspot.com/2023/05/35m-dm2-for-10years-on-insulin-7-years.html
https://www.mdpi.com/2077-0383/12/4/1705
P-kidney biopsies of patients aged ≥ 18 years with T2DM admitted between 1 August 2005 and 31 July 2022. The clinical, demographic and histopathological data were evaluated. The spectrum of kidney involvement in the form of DKD and/or NDKD was studied.
I-kidney biopsies performed in the department between the study period from 1 August 2005, till 31 July 2022
C-Diabetic kidney disease and non dianetic kidney disease in diabetes
O-In this study, we analyzed clinical, laboratory and pathological features in 538 T2DM patients who underwent kidney biopsies for various indications. This accounted for one-tenth of all the biopsies performed at our center. While nearly one-third had only DKD, 70% had NDKD, of which 50% had pure NDKD and 20% had NDKD with DKD. Given the high pre-test probability of NDKD, a higher percentage of NDKD was expected, reiterating the findings of Sharma et al. [4]. On the contrary, nearly a third of diabetic patients with atypical clinical features eventually had DKD on biopsy.
We found DR only in 45% of patients with DKD compared to more than 60% in previous studies [31,32], which suggests the declining correlation between the two micro-vasculopathies, similarly evidenced by Pedro et al., who found DR in <30% of T2DM with DKD [33]. More importantly, up to 80% of the patients without DR eventually had NDKD. Similarly, many recent studies also showed that 70–80% of diabetic patients with NDKD had no DR [34,35]. Accordingly, “the renal-retinal relation” in T2DM may be better asserted, as the absence of DR may reasonably point towards NDKD. However, the presence of DR does not predict DKD, as also evidenced in other previous studies [36,37]. Similarly to this one no correlation between diabetic neuropathy and DKD was found in a previous study
shared by Dr.NAVYA PGY1
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MAY 15 th 2023 ( monday)
AMC BED 1
65/F
Age, number of lesion sites, size of encephalomalacia, and seizure frequency were independent risk factors for the prognosis of patients with REAE (OR > 1, P < 0.05). Surgical treatment was an independent protective factor associated with the prognosis of patients with REAE
variety of causes can lead to liquefaction and necrosis of brain tissue and the formation of encephalomalacia [9]. These causes include trauma, cerebrovascular disease, and intracranial infection [10]. The pathological manifestations of brain soft focus ranged from early neuronal necrosis to neuronal disappearance and then to glial cell proliferation. There are no nerve cells in the brain softening focus, which does not cause epileptic discharge. The real pathological site of epileptic discharge is the peripheral nerve tissue [11]. The traction of fibrous scar tissue in the brain can embed the remaining normal neurons cause abnormal discharge and disrupt the function of intertwined proliferative cells. It affects the electrical activity of normal neurons, resulting in seizures. A study suggested that glial cells can lead to epileptic seizures through mechanisms such as increasing the excitability of normal neurons, neuronal cluster discharge, and failure to inhibit the excitability of neurons
AMC BED 2
60/M
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9273423/
SHARED BY DR.DEEPIKA PGY2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398017/
Shared by DR.PRACHETHAN PGY1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608038/
SHARED BY DR.KEERTHI PGY2
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1334-2
SHARED BY DR.NAVYA PGY1
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MAY 16 th 2023 ( tuesday )
superspeciality ward
http://amilidutta137.blogspot.com/2023/05/61y-male-suffering-from-psoriasis.html
https://pubmed.ncbi.nlm.nih.gov/21787207/
acetretin efficacy shared and discussed by tejasree intern
ICU BED 1
http://tejasridevaruppala36.blogspot.com/2023/05/acute-cerebrovascular-accidentleft.html
https://pubmed.ncbi.nlm.nih.gov/15292036/
is tube feeding ass with altered o2 saturation in stroke patients
shared and discussed by keerthi pgy2
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MAY 17 th 2023 ( wednesday)
AMC BED 4
http://drsaicharankulkarni.blogspot.com/2023/05/50f-with-fever-and-knee-joint-pains.html
https://www.ncbi.nlm.nih.gov/books/NBK526080/
hypoalbuminemia shared by Dr lohith pgy1
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MAY 18 th 2023
AMC BED 6
https://chat.whatsapp.com/BxGM3SjmjvzEh4AEfHyYSm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8695827/
efficacy of cilinidipine
shared by Dr Navya pgy1
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MAY 19 2023
https://chat.whatsapp.com/F7V6VdNHkhPGAwoNMqnWRa
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640113/
association between iron deficiency anemia and csom
shared by Dr prachetan pgy1
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MAY 22
ICU BED 1
http://tejasridevaruppala36.blogspot.com/2023/05/acute-cerebrovascular-accidentleft.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9717451/#ref28
when and how to deescalate antibiotic therapy
shared by Dr Keerthi pgy2
https://pubmed.ncbi.nlm.nih.gov/25586681/
carbapenem therapy is ass with improved survival compared to piptaz
shared by Dr keerthi pgy2
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MAY 24
https://muskaangoyal.blogspot.com/2023/05/60m-alcohol-withdrawalhypoalbuminemia.html
https://pubmed.ncbi.nlm.nih.gov/10192155/
quantitative estimation of protein lost through scales in exfoliative dermatitis
shared by Dr Govardini
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