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7/27/2019 Linci gunaseelan

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Linci gunaseelan

Presenting complaints:

Known case of SLE since 2007,

Pulmonary hypertension,

Interstitial lung disease,

Mitral regurgitation,

Polyartralgia,

Past history:

H/O Rt CVA recovered 2007,

H/O Lupus nephrits,

H/O lupus pleurits,

Known DM,HTN,Dysdipidemia,

Total Hysterectomy, cholecytectomy done

Seizure disorder(febrile)

Post herpatic neuralgia-2007

B.P: 140/90 mmhg

Pulse:97/min

Heart:murmur

Investications:

Blood reports

Random blood sugar:87 mgs

Urea:21.22 mgs

Creatinine:1.22mgs

Cholesterol:219 mgs


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Uric acid:5.26 mgs

C.R.P:+ve in in 7.84 mgs

R.A:Negative

c.p.k:40.00 IU/l

H.B:11.8 gms

ESR:8/22 mmhr

Platlet count:2.3 lks

TC:6,800 cells/cumm

Dc :P 66%L32%E2%

Urine routine:

Albumin:+

Deposits:5-10 pus cells,3-5 epi cells

Sugar : nil

Liver funcution test:

Bilirubin (total):0.42 mgs

Direct:0.18 mgs

S.G.O.T: 34 IU/L

S.G.P.T:31IU/L

Alkaline phosphatase:126.0 u/l

Total protein:7.36 mgs

Albumin :3.22mgs

A/G ratio:0.77 ratio

Micro albumin:82.69 mgs

C3-1.71 gm/dl

C4 :0.24gm /dl

Hba1c:6.8%


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ABG:165 mgs

ANA WESTERN BLOT:strong +ve for PCNA,DsDNA,Nucleosomes,histones

Can occurs in SLE in SLE,RA,Drug induced lupus erythematous.

Chest x ray PA view

Cardiomegaly

ECG: sinus tachy cardia,

Antero septal myocardial infarction (possibly Recent V1,V2,V3,V4)

Excessive overload of lt atrium.

CT-Chest: Air space opacities with interstitial thickening fibrosis in basal segments

of bilateral lower lobe minimal fibrosis.Loss of volume in rt middle.

Pneumonitis with secondary cardiac failure changes in lung with early ILD

Mild bilateral pleural effusion

Moderate cardio megaly noted.

ECHO: Normal lt ventricular systolic funcution

LVEF:73%

Mild lt ventricular dysfunction

Mitral regurgitation moderate

Mobile Echogenic mass 3.5*0.76 size attached just below the posterior mitral leaflet

with a membranous portion causing on eccentric obsrtution in the lv cavity during

systolic resulting in dynamic mild lt ventricular outflow obstruction.

Pulmonary HTN_Mild

Pulmonary regurgitation mild

Tricuspid regurgitation-mild

treatment

NAME:Dana sekaran

Presenting complaints:


4/9

Weakness of both upper limb,lower limb.

Sudden onset,not of progressive nature

No h/o fever,diarrhoea

Had h/o frequent urination before onset.

No dysartria

No dysphagia,

Bladder bowel intact

Past history

No DM,HTN

No APD

Smoking,alcohol occ

No surgeries

On examination

Plantar:mute (B/L)

Muscle power:0/5( B/L)

Upper &lower limb

Hand grip:1/5(B/L)

DTR:ABSENT(B/L)

Diagnosis:GBS

Urusthamba ,sarvanga vatam.

Investications

Blood report

RBS:132mgs

Urea:50.00 mgs

Creatinine:1.00mgs

Cholesterol:231 mgs


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Uric acid:6.53mgs

C.R.P:-ve in 5.63 mgs

S.G.P.T:63 IU/L

C.P.K:29.00

HB:14 gms

ESR:2/6 mmhr

TC:8100cells/cumm

Dc:p 60%L35%E5%

Plt.count:2.4 lakhs

Billirubin:total 1.24 mgs

Direct:0.46 mgs

T.F.T- normal

USG-Abdomen &pelvis taken

Mild splenomegaly

Rest of the visualized abdominal organs normal

CT-Brain

Imp:Normal study

MRI Cervical spine

Imp:normal study

NCS

Interpretation:Features suggestive of asymmetrical acquired motor neuropathy of

axonal type.motor neuropathy.

Treatment


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Internally

Ashta varga kashayam- 60 ml 3 times before food

Lasuna ksheera kashayam-100ml at night after food

Resonadi vati-2-0-2(after food)

Bhallataka grutam-10 ml with milk kashayam at night(after food)

Ashwagandharistam 25 ml BD( A.F)

Kasturi gulika 2-0-2 (A.F)

Purna chandrodayam 1-0-1(A.F)

Externally,

I phase:Udwartanam(triphala churnam)

IIphase:Abhyangam ,jambeera pinda svedam(sahacharadi kuzhambu)

IIIphase:Pizhichal,matra vasti (saha vp)

IVphase:Kashaya vasti(Dvi pancha muladi vasti)

Vphase:Abhyangam kashayadhara

Ganeshan


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Moderate kypokinesia of septal antero septal &anterior walls.

Dilated lt ventricle &lt atrium

Moderate lt ventricular systolic dysfunction

LVEF:27%

Mild lt ventricular diastolic dysfunction

Rheumatic heart disease

Aortic regurgitation severe.

Treatment principle

Sophaharam,hrydyam,vata anulomanam,moothralam

Treatment

I phase:

Bruhatyadi kashayam- 60 ml 3 times (B.F)

Maha dhanwantaram gulika -2-2-2 with kashayam(B.F)

Arjuna ksheera kashayam -60 ml at night (A.F)

Nerinjil satavari paneeyam-200ml/day

Dasamoola haritaki-20 gms at night(A.F)

IIPhase:

Arjunaristam -25 ml morning & night after food

Marutham caps-2-2-2 (A.F)

Maha kasturi gulika 3-3-3(A.F)

Nayopaya kashayam-60 ml 3 times (B.F)

Triphala churnam -2 tsp with hot water at night (A.F)

Chandra praba vati-2-0-2(A.F)

Svarna bhasmam-

IIIphase:

Srnga bhasmam-25 mg twice a day after food


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Ardha vilva paneeyam -200 ml /day

Punarnavadi kashayam 60 ml 3 times (B.F)

Kushmanda rasayanam-1 tsp 2 times (A.F)

Prabakara vati -2-2-2(A.F)

Sapta vimsati guggulu -2-0-2(A.F)

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