Paper for the month of August : Rishika Koloti , Roll number 112
This particular post is an assignment that was given to us for testing the skills we have learnt in the past one month . The link to the questionnaire can be found HERE.
Question 1 : Testing peer review competency in the active reader of this assignment
please go through the long and short cases in the first link shared above -
link 1: link to the written case report - HERE
link 2: link to the synchronous case presentation - HERE
and provide your critical appraisal of the captured data in terms of completeness , correctness , and ability to provide useful leads to analyse the diagnostic and therapeutic uncertainties around the cases shared .
ANSWER -
LONG CASE :
POSITIVES :
- The given case is completely deidentified
- The case report is NOVEL .
- It is very well layed out and follows the structure of an ideal case report .
- It is highly detailed with each each aspect of the patients life accurately explained. For example : How the disease is affecting the patient's ability to carry out day to day functions , "Pain while holding a glass of water or holding a tea cup , joint pains have forced him to take an early retirement ". This provides the reader with the idea to explain how the disease is affecting the patient .
- In addition to the history and examination , Localisation of the problem has been added , i personally found this very helpful as it allowed me to understand how a physician would distinguish between a sign and symptom, and use them to make an acurate diagnosis that would eventually lead to improved health of the patient .
- The topic under the heading "Features to look for " has been added that allowed me to understand the basis of the diagnosis
- The clinical examination that was done has been explained in detail and is supported with appropriately deidentified images
- The X-Rays Findings, urine microscopy findings have been explained under the image
- The section on diagnostic approach is supported with a number of links that justify the treatment .
- References have been linked .
NEGETIVES
- The history could have been written down in a chronological order .
SHORT CASE 1
POSITIVES
- The case sheet is completely deidentified
- The history is very detailed , and explains the progression of the signs and symptoms
- The examination is complete and accurate
- X- RAY and 2-D echo findings have been explained
- Clinical images of the resting tremor has been mentioned in a link
NEGETIVE ;
- Therapeutic leads can be linked .
SHORT CASE 2:
POSITIVES
- The case has been presented well
- Clinical images of the of previous and current striae have been mentioned , helps in showing the progression of the disease .
- The signs that are mentioned for Cushing's syndrome in textbooks for example : abdominal strech marks , easy bruising on the skin , pendulous abdomen with thin extremeties , acne can be appreciated in the clinical imaging done .
- The follow- up treatment has been mentioned .
NEGETIVE
- Therapeutic leads can be linked
Question 2 : Please analyse the above linked long and short cases patient data in order of perceived priority and then discuss the therapeutic and diagnostic uncertainty around the solving those problems
LONG CASE : PROBLEM LIST
- Mildly dilated right heart border and aortic knuckle
- anasarca
- Hyponatremia
- GOUT
- Dysmorphic RBC in the urine
- Frothy urine
- Secondary hypertension
- osteopenia
- Decreasing urine output
- Swelling of the joints
- Pain and edema of the joints
- Burning sensation of the eye
- weight loss
- anorexia
- pallor
Therapeutic interventions :
- Water restriction - hyponatremia
- Prednisolone : used to treat arthritis
- Febuxostat - USed for lowering the uric acid levels in patients with gout
- Hemodialysis - for renal dysfunction
SHORT CASE 1: PROBLEM LIST
- Stiffness and rythmic to and fro oscillations of the index and middle fingers of both hands
- Difficulty in walking
- difficulty climbing up stairs
- monotonous drab
- cog wheel rigidity in right wrist
- hypertension
- erratic bowel habits
- decreased libido
- Absence of reflexes
Therapeutic interventions
- TAB . Syndopa : for treating signs of parkinsons disease : Tremors , Muscle stiffness and difficulty in walking or climbing up stairs
- Tab TELMA ; for lowering blood pressure in hypertension
SHORT CASE 2 : PROBLEM LIST
- Hypertension
- Itchy ring lesions
- Acanthosis Nigrans
- Gynecomastia
- itchy ring lesions
- purple stretch marks
- abdominal distension
- facial puffiness
- thin skin
- Buffalo hump
Therapeutic interventions :
- Tab hixone : for treating
- Tab shelcal
- Tab . Itraconazole
Question 3 : Testing competency in "Evidence based medicine ". Include a review of the literature around the senstivity and specificity of the diagnostic interventions mentioned and same around the efficacy of the therapeutic interventions mentioned for each patient.
Question 4 : Share the link to your own case report this month of a pateint you connected with
Question 5 : Reflect on and share your telemedicine experience from the hospital and as well as from the community patients over the last month particularly while you were e-logging your case report or even in the hospital or perhaps locked down at home .
Answer : The last one month we were called back to college and I was excited that postings will finally begin , that what we read we will be able to observe in person . Unfortunately that did not happen (The pandemic ), we began our offline practical sessions but we are still awaiting a schedule for the postings . Meanwhile we are still continuing making E-Logs but it has not been as effective as July .As seen from a learning perspective , we took history for a patient with CKD who had undergone 4 sessions of dialysis . I felt a little more confident in making the case sheet and writing down the sequence of events that lead to her current condition . It required help from a teammate as i am not well versed with the language , I have to put in more efforts in learning the language than i am doing right now .
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