Munukutla Sai Mythili

A 28 year old female from Sagar ,a farmer by occupation presented to the casuality with Chief complaint Shortness of breath since 3 days Tingling and pain in wrists bilateral since 3 days Epigastric pain since 3 days History of presenting illness Patient was apparently asymptomatic  When she developed sob grade 4 She was just sitting when it suddenly started Immediately she also developed tingling sensation along with pain and was unable to extend the wrist Past history N/K/C of  Diabetes Hypertension Tuberculosis Asthma Menstrual and obstetrics history Married 12 years ago 3 kids First child Male - 10 years Lscs Birth 2.5 kg No NICU Full term Second child Male - 5 years Lscs Birth 3 kg No NICU Full term Third child Male - 2 years Lscs Birth 2.5 kg No NICU Full term Uneventful pregnancy Personal history Diet normal  appetite normal  micturition normal Normal bowel movements Normal sleep Addictions none FAMILY HISTORY: - No significant history Provisional diagnosis

This is an online e log book to discuss our patient’s de- identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patient’s clinical problems with collective current best evidence based inputs. This e-log book reflects my patient centered online portfolio and your valuable inputs on the comments is welcome.” A 45 year old gentlemen who was a farmer from suryapet came to the hospital with chief complaint of Cheif complaint Decreased urine output Right sided lower abdominal pain  since 10 days History of presenting illness Patient was apparently asymptomatic 4 years back Then he developed pain in right knee which was  gradual ,progressing, nonradiating, dull in nature Pain was not aggravated while sitting or bending After 1 month there was decrease in knee pain and then ankle started to pain There was involv