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AMC 4 th bed 34yr/M A 34 yr male barber by occupation came to the opd with chief complaints of giddiness and fall 3 days ago  patient was apparently alright 5 years back in 2016- patient had jaundice,for which he used herbal medicine following which he had binge alcohol and severe loose stools,watery consistency (20 episodes/day) - for which he was admitted in outside hospital ,patient reports that he was in altered sensorium for 3 days in ICU during that admission (no records available).3 pints PRBC transfusion in ICU was done at that time of hospital stay.since discharge patient was fine and in 2018 patient went for regular check up ,he says blood investigations were normal at that time 3 days ago- patient c/o giddiness and fall in washroom with injury on left side of forehead ,then he went to a local RMP and on routine investigation was found to have pancytopenia and was referred here ,no h/o any ENT bleed , convulsions,LOC, blood loss during fall ,he complaints of generalised weakn
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 bed 3 60yr/M A 60 yr old male  daily wage labourer by occupation b came to the casualty with chief complaints of fever with chills since 10 days c/o dry cough since 10 days c/o burning micturition  since 10 days patient was apparently alright 10 days ago and then developed high fever which was intermittent , associated with chills ,relieved with medication/o dry cough not associated with sputum since 10 days,SOB since 10 days which was intermittent C/o burning micturition since 10 days   no c/o of vomitings, loose stools   history of pulmonary kochs 3 yrs ago used ATT for 6 months , (coughassociated with sputum and low gade fever) past history  not a known case oc HTN,DM,CAD ,CVA appetite- normal bowel movements- regular micturition- normal no addictions no significant family history general examination no pallor,icterus, cyanosis, lymphadenopathy and edema pulse rate: 104bpm BP: 110/80 mmHg respiration: 29/min spo2 : 98%at RA CVS s1,s2 heard RS : BAE + ,NVBS,right inframammary and in
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ICU bed 6  54yr /M A 54 yr old male labourer by occupation , came to the the casualty with chief complaints of SOB grade since 4 months  increased since 4 days from grade 2 to 3,and c/o orthopnea and PND patient was apparently alright 15 yrs back and found to have hypertension on regular check up  8 yrs ago H/O CVA involving left upper and lower limbs  weakness and deviation of mouth to left (? infarct) -resolved after 1 month  5 yrs ago diagnosed with DM, but on irregular medication  March 2021 -C/O B/L pedal edema -patient came to the hospital and was told to have hypothyroidism and hypercholestrolemia ( but patient did not use any medication)  1 month ago-C/O  LBA - diagnosed with renal calculi 7 mm and used medication  since 4 weeks C/O SOB grade 2 to 3 ,and progressed to geade 4 since 4 days associated with orthopnea,PND ,no H/O fever pedal edema  K/C/O HTN(15 yrs) ,DM (5yrs) ,Hypothyroid  personal history appetite-normal bowel movements-regular micturition -normal  addictions-occ
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55 yr old female came to casualty with complaints of pedal edema since 6 days, which is insidious in onset and gradually progressive, worsening since 3 days. - c/o abdominal distension since 6 days - h/o decreased urine output since 2 days - h/o vomiting s 4-5 episodes since 1 day HOPI :pt was apparently asymptotic 1 week back, then he developed pedal edema ,which is bilateral ,pitting type it is worsening since 3 days H/o  burning micturition H/o vomitings ,4-5 episodes which are non bilious,non projectile No H/o loose stools H/o fever in the last month, and that was diagnosed to be Dengue possitive and was treated symptomatically Past history : She is not a k/c/o DM, HTN , Asthma ,TB , epilepsy On examination :  Pt is C/C/C No pallor , icterus clubbing cyanosis lymphadenopathy, edema Vitals :temp : 98.6f CVS :S1S2 + RS : BAE+ , NVBS CNS - No focal deficits Provisional diagnosis Ascites under evaluation ,B/l pleural effusion (SAAG 1.1),? systemic sclerosis: Treatment 1)Fluid restricti
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A 65 yr old male came to opd with HOPI He is a 60 yr old who was a toddy tree climber for 30 yrs.later on continued as daily wage labourer along with his wife.he stopped working since 4 yrs. His daily activities inude waking up at 8/9 in the morning, attending nature call, rice for breakfast going back to sleep around 9/9:30 AM, waking up again around 3/4 PM having lunch, going back to sleep around 8PM, having dinner or indulging in alcohol weekly once with his relatives who visits their house. On Friday .He had tingling sensation throughout the body starting from lower limbs denies H/O fall/trauma around in the evening as it was not subsiding went to local doctor and was given medication, not subsided. On Saturday morning, in his daily activity .He couldn't get up after going loo.He had to take support of the walls & slowly moved to door, opened the latch and had a fall,with no apparent injuries. He was taken to nakrekal for further management & was not subsided. By evenin
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