Thursday, August 26, 2021

UNIT 3 ADMISSION

36 M came with the c/o decreasing platelets. 

Bank worker for Nalgonda, had a h/o fever with chills on Friday which resolved on taking mediciation after he was hospitalised on Monday, until yesterday evening. 

He had no h/o SOB, Vomitings, Blood in stools. 

On serial observation of his blood count, there was a significant decrease from 1.6 L (Saturday) to 26000 (yesterday afternoon). 

No h/o any surface / visceral bleeding manifestations. 

Since yesterday, his wife gives history of abdominal distension. Patient complains of SOB after taking food and fluids. 

Patient gives history of ?greenish-dark coloured stools. 

Serial Platelet Count since Saturday

Saturday - 1.6L

Monday - 99k 

Tues - 30k

Wednesday (Afternoon) - 26k

No past medical history. 


Appetite - Normal

Diet - mixed 

Sleep - Normal now, but could not sleep in the first 4 days of fever. So, on monday was administered ?sleeping pills (as per his wife) 

Bowel and Bladder - Regular and passed greenish-dark stools 


General Examination - 

NO pallor/ Icyerus/ Cyanosis/ lymphadenopathy/ Clubbing


Vitals at Presentation 

Temp Afebrile

BP 110/80

PR 75 / min

RR 15 / min

GRBS 121

GCS 15/15 

Spo2 98% on RA 


Resp - BAE + , NVBS 

CVS - S1 S2 heard 

Per Abd - soft, non tender 

CNS - NFND 


Provisional Diagnosis - ? Viral Pyrexia with Thrombocytopenia 



Examintion Day 1 @ 8 A.M 

Subjective - 

1. Abdominal Distension since yesterday

2. Reddish Spots on his chest

3. Mild SOB on consuming food and liquids 


Objective - 

BP 110/80 (All same in supine, standing for 2 minute and 3 minutes) 

PR 60 

Temp - 99.6 

Platelets - 40,000

CVS - S1 S2 Heard 

Resp - BAE + , NVBS 

CNS - NFND 

P/A - Diffuse Tenderness + , Fluid Thrill +, Bowel sounds + 




Day 3


SOAP NOTES 

SUBJECTIVE : No fever spikes 

OBJECTIVE : 

BP - 110/70 MM OF HG(SUPINE) , 100/70 (Standing 1 min and 3 min)

PR 80 BPM

Temp - 98.6 

CVS - S1 S2 Heard 

Rsp - BAE + , NVBS 

CNS - NFND 

PA - Soft, non tender 

ASSESSMENT : 

VIRAL PYREXIA WITH THROMBOCYTOPENIA (DENGUE NS 1 NON REACTIVE) with Platelet count 41,000

Plan : 

1. IVF 1 UNIT NS, RK @ 100 ML/HR

2. TAB. DOLO 650 MG /PO/TID

3. INJ NEOMOL 1 GM IV/SOS IF TEMP >101 F

4. TEMP CHARTING 2 HRLY AMD TEPID SPONGING

5. VITALS MONITORING 5 HRLY

6. INJ PAN 40 MG/IV/OD

7. TAB DOXY 100 MG /IV /OD

8. ZYTE GEL 

9. WATCH FOR BLEEDING MANIFESTATIONS AND POSTURAL HYPOTENSION






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Monday, August 23, 2021

UNIT 6 Admission

Patient came to opd with c/o vomitings (in the early hours) since the evening of previous day. 

Pain abdomen (since a day prior to the day of admission)

History : 

Patient, who is a homemaker (inititally labourer in our hospital)  was apparently asymptomatic till 7.00pm then she had sudden onset of vomitings, non projectile , non bilious,contains food particles,.non foul smelling associated with pain abdomen

After 1hr she had another episode till 1am she had 4 episodes of vomitings

Not associated with fever, chest pain, palpitations, loose stools,pedal oedema, blurring of vision

K/c/o DM2(since 5 years)

Since 2years on inj.mixtard (15u--X--10u)

Not a k/c/o htn, asthma, tb, epilepsy

No family h/o DM in immediate family. 

GENERAL EXAMINATION : 

Pt was conscious, coherent and cooperative. Oriented to time, place and person. Moderately built and moderately nourished. 

Vitals at presentation: 

Temp - Afebrile 

BP - 140/80

PR - 90 bpm

RR - 15 cpm

Spo2 - 98% @ RA

GRBS - 588 mg/dl 




CVS - S1, S2 heard, no murmurs

Resp - BAE + , NVBS + 

P/A - Soft, non-tender, no organomegaly, bowel sounds heard 

CNS - NFND

Provisional diagnosis: Diabetic ketoacidosis secondary to gastritis




 Day 1 @ 4;30 A.M.

1. INJ. HAI 6U I.V. STAT FOLLOWED BY INJ HAI 1 ML (40 UNITS) + 39 ML NS @ 6ML/HR TILL

GRBS IS 200 MG/DL

THEN INSULIN INFUSION CONTINUED ALONG WITH 5% DEXTROSE

2. GRBS 1 HRLY

3. IVF 2 UNITS NS AND 2 UNITS RL @ 100 ML/HR

4. I/O CHARTING

Day 1 @ 8:30 A.M

SUBJECTIVE : DECREASED VOMITINGS AND PAIN ABDOMEN

OBJECTIVE :

PT IS C/C WITH

BP - 150/80

PR - 83/MIN

I/O - 1.5L/500ML

GRBS - 128 MG/DL

CVS - S1 S2 HEARD

RESP - BAE +, NVBS

CNS - NFND

P/A - SOFT , NON- TENDER

ASSESSEMNT : DKA SECONDARY TO GASTRITIS

PLAN : NBM TILL FURTHER ORDERS

1. INJ HAI INFUSION @ 2ML/HR + 5% DEXTROSE INFUSION @ 75 ML/HR TILL ACIDOSIS

RESOLVES

2. GRBS 1 HRLY

3. INJ PAN 40 MG I.V. OD

4. STRICT I/O CHARTING

5. BP/PR/RR/TEMP/SPO2 CHARTING 4TH HRLY

Day 1@ 6:00 PM

1. GRBS 6TH HRLY ( 8 AM - 2 PM- 8 PM- 2 AM)

2. INJ HAI S/C TID (PREMEAL) AFTER INFORMING PG

3. INJ PANTOP 40 MG PO OD

4. IVF NS, RL @ 75 ML/HR

Day 2 @. 8.00 a m.

SUBJECTIVE - NO COMPLAINTS

OBJECTIVE -

BP 140/80

PR 84 BPM

I/O 3000ML/2000ML

CVS - S1 S2 HEARD

RESP - BAE +, NVBS

CNS - NFND

P/A - SOFT , NON- TENDER

GRBS @ 8 AM - 351 MG/DL (16 U HAI GIVEN)

GRBS @ 2 PM - 246 MG/DL (14U HAI GIVEN)

ASSESSMENT - DKA SECONDARY TO GASTRITIS

PLAN -

1. INJ HAI S/C AFTER INFORMING GRBS TO PG

2. INJ PAN 40 MG I.V. OD

3. IVF 1 UNIT NS AND RL @ 75 ML/HR


Day 3 @ 8.00 am

SUBJECTIVE - NO COMPLAINTS

OBJECTIVE -

BP 110/70

PR 88 BPM

CVS - S1 S2 HEARD

RESP - BAE +, NVBS

CNS - NFND

P/A - SOFT , NON- TENDER

GRBS @ 8 AM 466(8U HAI ,10UNPH)

ASSESSMENT - DKA WITH DMII SINCE 5 YRS

PLAN -

1. 8 AM - INJ REGULR INSULIN 8U+NPH 10U

 2 PM-INJ REGULARINSULIN 8U

 8PM - INJ REGULAR INSULIN 8U + NPH 10 U

2. IVF 1 UNIT NS AND RL @ 75 ML/HR

Day 4 @ 8 am 

SUBJECTIVE - NO COMPLAINTS

OBJECTIVE -

BP 110/70

PR 88 BPM

CVS - S1 S2 HEARD

RESP - BAE +, NVBS

CNS - NFND

P/A - SOFT , NON- TENDER

GRBS @ 8 AM 350(8U HAI ,8 U NPH)

ASSESSMENT - DKA WITH DMII SINCE 5 YRS

OPTHALMOLOGY REFERREL




PLAN -

1. 8 AM - INJ REGULR INSULIN 8U+NPH 10U

 2 PM-INJ REGULARINSULIN 8U

 8PM - INJ REGULAR INSULIN 8U + NPH 10 U

2. IVF 1 UNIT NS AND RL @ 75 ML/HR

Planning for discharge today. 

Course in the hospital -

PATIENT CAME TO THE HOSPITAL WITH COMPPLAINTS OF VOMITINGS AND PAIN

ABDOMEN. SHE WAS DIAGNOSEDAS DKA WITH DM II SINCE 5 YRS WITHHBAC 6.9 . SHE WAS

TREATED WITHINJ. HAI 6U I.V. STAT FOLLOWED BY INJ HAI 1 ML (40 UNITS) + 39 ML NS @

6ML/HR TILL GRBS IS 200 MG/DL THEN INSULIN INFUSION CONTINUED ALONG WITH 5%

DEXTROSE @ THE TIME OF ADMISSION .

PATIENT SYMPTOMATICALLY IMPROVED WITH DECREASE IN PAIN ABDOMEN AND

VOMITINGS, CONTROL IN GRBS.

Advice on discharge - 

8 AM -INJ REGULAR INSULIN 8U +NPH 8U

2 PM- REGULAR INSULIN 8 U

8PM - REGULAR INSULIN 8U+NPH 8 U




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Saturday, July 31, 2021

NON-VERBAL COMPETENCY DURING GENERAL MEDICINE INTERNSHIP

1. LEARNT HOW TO TAKE VENOUS SAMPLES, AND ARTERIAL SAMPLES

2. LEARNT HOW TO PLACE A CANNULA 

3. PERFORMED ASCITIC TAP THRICE 

1. PATIENT WITH MASSIVE ASCITIS - UNDER THE GUIDANCE OF DR VINAY 

2. PATIENT 31 M CHRONIC ALCOHOLIC - UNDER THE GUIDANCE OF DR VAMSI 

3. PATIENT - K/C/O CKD ON MHD WITH MASSIVE ASCITIS UNDER THE GUIDANCE OF DR VAMSI 


4. PLACED A CENTRAL VENOUS CATHETER IN THE RIGHT FEMORAL VEIN - ON 17TH JULY 2021 ON A CKD ON MHD PATIENT UNDER THE GUIDANCE OF DR VAMSI 




 


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VERBAL COMPETENCY DURING GENERAL MEDICINE INTERNSHIP

I have presented cases during rounds and in the post lunch sessions number of times, most of them have not been recorded.

This is the glimpse of the INTERNSHIP TRAINING PROGRAMME presentation.




The case being presented http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

https://docs.google.com/presentation/d/1-uMpO8i536zYy1syQ70BLvuvowpaV_8znbbMBhjzqpg/edit

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June 2021 INTERNSHIP COMPLETION ASSESSMENT

The following assessment is for my internship completion for the month of June. The link below is that of the question paper. 

 https://medicinedepartment.blogspot.com/2021/06/medicine-department-paper-for-june-2021.html?m=1


Question 1: Competency tested for Peer to peer review and assessment. 

Answer - I will be assessing the answer to the  third question -

“WHAT COULD BE THE CAUSE OF HER ACUTE EXACERBATION ?”

“May be due to  INFECTION( infection  causes inflammation in lungs leading to narrowing of airways , blockage may occurs due to swelling and mucus production” 

Qualitative - PATIENT DOES NOT HAVE A HISTORY OF FEVER. HER TLC IS 5700. I DONOT THINK IT IS AN INFECTION, PER SE. THERE IS H/O SEASONAL EXACERBATION SINCE YEARS.

Quantitative - 5/10


“3) causes for Acute exacerbation are caused by a viral or bacterial lung infection, but they may also be triggered by things or situations that make it difficult for you to breathe, such as smoking or being exposed to smoke or air pollution.”

Qualitative - PATIENT DOES NOT HAVE A HISTORY OF FEVER. HER TLC IS 5700. I DONOT THINK IT IS AN INFECTION, PER SE. THERE IS H/O SEASONAL EXACERBATION SINCE YEARS.

We might need eosinophil, lymphycyte and neutrophil count to justify this.

Quantitative - 5/10


“he cause of acute Exaberation in this patient is probably due to generalised weakness due to the drugs or due to upper respiratory tract infection.”

Qualitative - PATIENT DOES NOT HAVE A HISTORY OF FEVER. HER TLC IS 5700. I DONOT THINK IT IS AN INFECTION, PER SE. THERE IS H/O SEASONAL EXACERBATION SINCE YEARS.

We might need eosinophil, lymphycyte and neutrophil count to justify this.

YES, THIS CAN BE DUE GENERAL DECLINE IN PATIENT HEALTH.

Quantitative - 5/10

“it could be due any infection”

Qualitative - PATIENT DOES NOT HAVE A HISTORY OF FEVER. HER TLC IS 5700. I DONOT THINK IT IS AN INFECTION, PER SE. THERE IS H/O SEASONAL EXACERBATION SINCE YEARS.

We might need eosinophil, lymphycyte and neutrophil count to justify this.

Quantitative - 5/10
“Ans : The cause of acute Exacerbation in this patient is probably due to generalized weakness due to the drugs or due to upper respiratory tract infection.”

Qualitative - PATIENT DOES NOT HAVE A HISTORY OF FEVER. HER TLC IS 5700. I DONOT THINK IT IS AN INFECTION, PER SE. THERE IS H/O SEASONAL EXACERBATION SINCE YEARS.

We might need eosinophil, lymphycyte and neutrophil count to justify this.

Quantitative - 5/10
“Cause due to current acute exacerbation is due to infection (bacterial, viral)”

Qualitative - PATIENT DOES NOT HAVE A HISTORY OF FEVER. HER TLC IS 5700. I DONOT THINK IT IS AN INFECTION, PER SE. THERE IS H/O SEASONAL EXACERBATION SINCE YEARS. 

SHE IS A K/C/O BRONCHIECTESIS. MOST PEOPLE SEEM TO BE MISSING THIS POINT. 

We might need eosinophil, lymphycyte and neutrophil count to justify this.

Quantitative - 5/10

“Recently, her HRTC showed signs of bronchiectasis. [A condition where bronchial tubes of lungs are permanently damaged, widened and thickened. These damaged air passages allow bacteria and mucus to build up and pool in the lungs blocking the airways] This could be a trigger factor for the current acute exacerbation.”

QUALITATIVE - YES, THIS COULD BE TRUE. I STILL DONOT AGREE WITH THE INFECTION PART. IT COULD BE NARROWING OF AIRWAYS DUE TO BRONCHIECTASIS
 
QUANITITATIVE 8/10
QUALITATVE AND QUANTITATIVE SAME AS REVIEW 1-6

“Respiratory infection, being responsible for approximately half of COPD exacerbations. Common bacterial pathogens of acute exacerbations include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.[7]Less common bacterial pathogens include Chlamydia pneumoniae and MRSA.
Allergens, e.g., pollens, wood or cigarette smoke, pollution[5]
Toxins, including a variety of different chemicals[5]
Air pollution[citation needed]
Failing to follow a drug therapy program, e.g. improper use of an inhaler”

QUALITATIVE - ALLERGENS COULD BE THE CAUSE. BUT BRONCHIECTASIS OCCURS IN A CHRONIC LUNG PATHOLOGY. THIS PATIENT HAS A LONG STANDING HISTORY OF SEASONAL EXACERBATIONS. THIS EXCERBATION COULD BE BECAUSE OF COR PULMONALE - WHERE THERE IS A HEART FAILURE - BECAUSE IT IS NOT REDUCING WITH HER REGULAR MEDICATION AND IT IS FOLLOWED BY A KIDNE FAILURE. 

QUANTITATIVE 7/10

“ The possible causes of her acute exacerbation can be due to the following: 
Exposure to allergens which could make it a possible occupational hazard 
Infections by Moraxella, H. influenzae or Pneumococcus (Bacterial), Influenza, Rhinovirus, Coronavirus (Viral)
Dust or pesticides exposure”

QUALITATIVE AND QUANTITATIVE REVIEW SAME AS REVIEW 1-5

Question 2 : Q2) Share the link to your own case report of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case. 

The following case is of a 19 F who I encountered on my Unit’s OutPatient day. I remember examining her in the OP, feeling a sense of pleasure when I was the first to find her splenomegaly. 
The history in the blog made by the students of 2019 batch was sent by me, after i properly spoke to the patient, typed down the history and forwarded that along with the reports of the investigations. 


I have been in contact with the patient’s attenders. The sent me pictures of  the following. 




This patient showed decreased B12 levels. Her bone marrow slides showed erythoid hyperplasia. Need to further check for autoimmune syndrome consisting of thyroid malfunction, anemia. 

Question 3 - Please go through the cases in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.

THE DATE WISE DEPICTION OF HISTORY, CLINICAL OBSERVATIONS, LAB INESTIGATIONS AND THE INTERVENTION IS THE CHERRY ON TOP OF THE CAKE AS IT MAKES THE DATA CONCISE YET DETAILED. 
THE ONLY ISSUE IS WE DONOT KNOW THE DEFINITE CAUSE FOR HIS JAUNDICE IN THE BEGINNING AND A SUDDEN MIRACULOUS RECOVERY WITH N-ACETYL CYSTIENE. 

IN SUCH CASES, THE CLINICAL PATHOLOGY CAN BE LOCALISED WITH CLINICAL EXMINATION AND LATER CONFIRMED USING RADIOLOGY.

CLINICALLY, THE BICEPS REFLEX IS 3+, CONFIRMING THAT THE LESION IS ABOVE C5.
IT IS VERY COMMENDABLE THAT THE PATIENT’S CONDITION AFTER DISCHARGE FROM THE HOSPITAL WAS FOLLOWED UP.

IN SUCH PATIENTS, IT IS IMPORTANT TO MONITOR WEIGHT AND ABDOMINAL GIRTH DAILY TO MONITOR THE ALTERATION IN EDEMA.

DATA CAPTURE IS PRETTY. ACCURATE.
TREATMENT FOR ATRAIL FIBRILLATION IS - AMIODARIONE (ANTI-ARRHYTHMIC) AND CLEXAME (ANTI-COAGULANT) TO PREVENT ANY THROMBUS FORMATION AS A.FIB HAS A HIGH RISK FOR THROMI FORMATION

WHY WERE MAGNEXFORTE AND NORFLOX GIVEN ? CANDIDA WAS ISOLATED, SO SHOULDNT AN ANTI-FUNGAL BE GIVEN ?
ALSO, MAGNEXFORTE AND NORFLOX HAVE THE SAME BACTERIAL COVERAGE, THEN WH BOTH ?

Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):

Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient. 


PROBLEM LIST
1. LOW BACK ACHE SINCE 7 DAYS
2. FEVER SINCE 5 DAYS 
3. JAUNDICE SINCE 3 DAYS 
4. VOMITING, LOOSE STOOLS, BLOOD TINGED URINE - SINCE A DAY BEFORE PRESENTATION
5. FEATURES OF DM SINCE 2 MONTHS
6. DECREASING GCS (AFTER ADMISSION)
7. ANURIA
8. SEIZURES
7. COAGULOPATHY


LOW BACK ACHE, BLOOD TINGED URINE - COULD BE BECAUSE OF THE RENAL CALCULUS
JAUNDICE, VOMITING, LOOSE STOOLS, COAGULOPATHY AND COME MOSTLY DUE TO LIVER FAILURE. 

THERAPEUTIC UNCERTAINITY - 
THE PATEINT SHOWED INDIRECT HYPERBILIRUBINEMIA BUT THERE WAS NO HEMOLYSIS
PORPHYIA SUSPICION WAS CLEARED, AND IT WAS RULED OUT
GASTROENTEROLOGY OPINION ADICED LIVER TRANSPLANT 
MIRACULOUSLY - NAC WHICH REPLENISHES THE GUTATHIONE STORES WORKED . 
COULD THIS BE A PARACETAMOL POISONING ? 


PROBLEM LIST 
1. B/L LOSS OF HAND GRIP
2. PARAPLEGIA
3. BOWEL AND BLADDER INCONTINENCE
4. TB 

LESION FROM THE LEVEL OF C4 (SPONDYLITIS)
THE ONLY WAY TO TREAT THIS WAS ATT AND SURGICAL DECOMPRESSION.


PROBLEM LIST 
1. ALTERED SENSORIUM
2. FEVER
3. PEDAL EDEMA WITH ANASARCA (CREAT ?11-14.8)
4. SOB GRADE 4
5. 5 YEARS AGO, INCIDENTAL FINDING - SERUM CREAT WAS 3
NO FOLLOW UP STOPPED AFTER 2015
6. K/C/O HTN SINCE 5 YEARS 
K/CO CKD

FEVER CAUSED AKI LEADING TO SOB (FLUID OVERLOAD CAUSING PULMONARY CONGESTION) - INCREASED NITROGEN PRODUCT ACCUMULATION CAUSING ENCEPHALOPATHY 

THERAPEUTIC UNCERTAINITIES 

AMOUNT OF SODIUM BICARBONATE IN SUCH CASES. 
BECAUSE IT CAN CAUSE PARADOXICAL CELLULAR ACIDOSIS. HOW DO WE DECIDE HOW MUCH BI-CARB THAT IS TO BE ADMINISTERED ?
IS STRICT INPUT/OUTPUT CHARTING EVER DONE ? 


PROBLEM LIST 
1. ABDOMINAL DISTENSION
2. SOB GRADE 3 
3. HYPOTHYROIDSIM

AMIODARONE IS THE DRUG OF CHOICE FOR AF. BUT WE DONT USE IT WHEN AF IS OLD BECAUSE OF THE RISK FOR THROMBO-EMBOLIC PHENOMENON DUE TO AF AS AF HIGHLY INCREASES THE RISK FOR THROMBO-EMBOLIC PHENOMENON 
HOW OLD WAS THE AF ? HOW DO WE KNOW WHEN IT IS NEW ONSET ?

Q 5) Testing scholarship competency in  
logging reflective observations on your concrete experiences of this last month : (10 marks) 

Reflective logging  of one's own experiences is a vital tool toward competency development in medical education and research. 

My first day in medicine departement was 3 June 2021. 
I remember how scared I was because I was late for the first day of my internship. I reached the ICU, had no idea what to do, how to do it. 
On the first day, i learnt how to connect and  disconnect an i.v. set, and start i.v. fluids.  
Gave a few i.v..injections when the cannula was on. 
I learnt how to give CPR on my first night duty. 
Learnt how to perform suction, connect o2, type discharge summaries. 
Night duties, ICU duties and Nephrology duties were when i learnt the most. 
I first placed a cannula on a female who was brought to the casuality with seizures. I remember being very scared, but i did it because PGs guiding me were the most patient, i aspire to be that patient to my juniors. 
On the same day i tried to take out  an ABG sample, was not successful. It was an anxiety inducing experience because in casuality there are a lot of people watching you do. 
I remember not knowing how to disconnect a urobag, I felt extremely embarassed. 
But I have  come a long way. 
Now I am confident about taking samples, examining patients (except nervous system examination) taking their history or in general, communicating with them. 
There is so much pain and hope at the same place. It hit me hard especially when the son of a comatose 45 F was talking to her as if she was completely alright, I realised that I had grown indifferent to pain that patients and their relatives feel.
This realisation made me feel extremely guilty because it was originating from a position of authority. Since that day, i have always made sure to try my best to comfort the patients and their attenders, whenever I can. 

I performed 3 ascitic taps, took numerous samples, learnt how to fast-track paper work so patients can be treated faster, placed a central venous catheter, struggled to be upto date with all patients in the ward but failing at it. 
I am leaving with the thought that this is where i have started to learn practical/clinical medicine and there is a long way to go and I am looking forward to that. 




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Monday, April 26, 2021

40 y/o Male on Maintenance Hemodialysis

 This is an online E logbook to discuss our patient’s de-identified health data shared after taking his signed informed consent.

Here we discuss our individual patient’s problems through series of inputs from the global online community of experts with an aim to solve those patient’s clinical problems with collective current best evidence-based inputs.

This E-logbook reflects my patient-centered online learning portfolio. 

Read more »
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Saturday, April 24, 2021

PALPITATIONS IN 47 Y/O MALE

This is an online E logbook to discuss our patient’s de-identified health data shared after taking his signed informed consent.

Here we discuss our individual patient’s problems through series of inputs from the global online community of experts with an aim to solve those patient’s clinical problems with collective current best evidence-based inputs.

This E-logbook reflects my patient-centered online learning portfolio. 

Read more »
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