Tuesday, August 8, 2023

Project illustration of how to process particular patient data into learning themes and demonstrate it's effect on patients illness outcomes (as well as how it can demonstrate learning competence of the learner)

Let's take an ongoing patient example 



where we sort out the learning points (themes) according to the afore mentioned points revisited below 👇

1) General knowledge learning (pull existing knowledge) 

2) Discovery driven insightful learning (push and expand knowledge frontiers ) 

Let the ongoing example be 

1) What are the general knowledge learning points that we gain from this patient's data that is easily accessible online? 

a) Diabetes type 2 v type 3 definitions, pathophysiologies and solutions 

b) Alcoholism current problems and solutions 

c) Pancreatitis current problems and solutions 


2) What are the particular discovery driven learning questions around this patient :

a) Internal Medicine : Diagnostic (type 2 v type 3) and therapeutic uncertainty (insulin v oral hypoglycemics for type 3 therapy) in this particular patient with diabetes, pancreatitis and alcoholism 

b) External Medicine (social determinants of health) 

[7/31, 8:25 AM] Keen Student: 
good morning sir,
our diabetic pajr groups are highly active and we are glad that patient’s are giving their time and effort. But what about the cost burden we are putting on them sir? how can we cut it ? As i have seen they are around 3-6 pajr groups in which 7 point profile of grbs is being posted daily.
each strip costs a minimum of 10 rupees which costs them 70 for a day and 
which is 2100 for a month.!
[7/31, 8:40 AM] Rakesh Biswas: Very good question 👏👏

Further themes represented by our students in the same particular patient data :

Clinical complexity 



Biological:

• Chief complaints of spasm of fingers in upper limbs with tremors, generalized weakness, excessive sweating, and decreased pitch of voice.
• History of neck and shoulder pain, leading to surgery in 2007.
• Diagnosis of pancreatitis in 2008, which required surgery.
• Diagnosis of diabetes and initiation of insulin therapy, but poor follow-up with healthcare.

Psychological:

• Experience of depression following the demise of his father in 2004.
• Increased alcohol consumption as a coping mechanism due to peer pressure and curiosity.
• Stress and emotional strain due to spouse health issues and financial burden.

Social:

• Limited educational background, discontinuing studies after 10th standard.
• Agricultural laborer by occupation, engaged in farming and rearing domestic cattle.
• Lives with his wife, daughter, and son in a house he acquired through a home loan.
• Consanguineous marriage and has two children.
• Financial stress due to home loan and family responsibilities.
• Increased alcohol consumption and smoking as social and coping habits.
• Recent stress due to wife’s surgery, leading to binge drinking.


Now coming to the most important and challenging part of our learning 
exercise :

1) Answers to the above raised questions which are again sorted themes in the data 

2) Thematic analysis: Coding is the primary process for developing themes by identifying items of analytic interest in the data and tagging these with a coding label. More here :

3) Product from above processing of input data : Learning points from the above thematically analysed patient data 

4) Showing the positive (convenience of oral hypoglycemics v inj insulin since 10 years) and negative (too much initial monitoring monetary investment  potential overdiagnosis and overtreatment) impact of the above learning on the patient's illness outcomes 

How does the above demonstrate learning competence of the learner?

Let's revisit the steps the learner needs to develop the competence within to be able to achieve the impactful learning around the patient :

1) Competence in patient data capture 

2) Competence in asking questions around the captured patient data (also known as sorting the themes for thematic analysis) 

3) Competence in finding the answers to the above questions and generating learning points that 

a) may be already known to other more experienced and advanced learners  

b) hitherto unknown to the world and takes us to the edge of discovery and promise of breaking new ground 

4) Competence to demonstrate and communicate (through publications in local and global logs) as to how the above learning points gleaned from the individual patients can influence their own immediate illness outcomes as well as future similar patient illness outcomes. 



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Opd project: Creating persistent clinical encounters through first contact physician user driven EMRs followed by patient user driven PHRs (patient journey records PaJRs) collectively archived in dynamic case reports (EHRs)

The opd project aims to improve health professionals and students OPD patient handling and learning competences that may improve patient illness outcomes. 


This is attempted through regular logging of every patient visiting us in the daily OPD by our interns and students. Senior residents posted to the OPD for that day are responsible for supervising this daily there

Regularly logged data currently archived in links below :




For every opd patient shared here :

Health professionals and students in the opd develop competences to log their:

Sequence of events beginning with the time they had absolutely no problems they can recall. 

Their routine when they were perfectly alright 

Next what happened to their routine once the disease took hold on their lives 

Specifically which part of their hourly routine was disrupted 

Their current requirements from us like if we had to give them a single medicine which problem would they prefer it to address 

Their examination findings with images of visceral fat and muscle mass for everyone among other more specific findings 

Prepare their problem list and perceived requirements list in order of priority 

Formulate a plan for each one of the problem requirements  listed

More here on how they may create a dynamic case report (EHR)  : 


The original project published decades back outlined the conceptual model to create persistent clinical encounters detailed here in the link below : 


The dynamic case report EHR, archiving persistent clinical encounters  is fed by the OPD first contact physician user driven EMRs followed by patient user driven PHRs  (patient journey records PaJRs) 


Key considerations for the translation of the conceptof the Patient Journey Record Systems (PaJR) into 
real world systems was first shared and archived here below :

"Patient Journey Record Systems (PaJR): The Development of a Conceptual Framework for a Patient Journey System. In R. Biswas, & C. Martin (Eds.), User-Driven Healthcare and Narrative Medicine: Utilizing Collaborative Social Networks and Technologies (pp. 75-92). Hershey, PA: Medical Information Science Reference. doi:10.4018/978-1-60960-097-6.ch006 at http://www.igi-global.com/chapter/patient-journey-record-systems-pajr/49246

The key concept lies in the use of regular patient reported outcomes to locate the phase of illness in a 
patient journey.

More here :

http://userdrivenhealthcare.blogspot.com/2022/09/current-pajr-workflow-and-how-to-make.html?m=0




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Sunday, July 30, 2023

KNRUHS Document 2 : Medicine department publications with summary, author details and citations 2023-2018

Document 2 : Medicine department publications with summary, author details and citations 2023-2018 (in the KNRUHS university reference circular dated 18/07/2023  format of departmental publications, image below) :


Medicine department citations image :



KNRUHS circular :





2023:

1) Samitinjay A, Vaishnavi K, Gongireddy R, Kulakarni SC, Panuganti R, Vishwanatham C, Manikanta AK, Biswas R. Understanding clinical complexity in organ and organizational systems: Challenges local and global. J Eval Clin Pract. 2023 Jun 19 doi: 10.1111/jep.13886.PMID: 37335625.
Summary : Complexities exist clinically in making a diagnosis, and organizationally, in the variables and nodes dictating patient outcomes. Clinical complexities cannot be simplified but have to be navigated in an optimized way to improve clinical outcomes.We present our analysis of the complexities faced clinically and, in our local healthcare system.
1Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India.2 Department of General Medicine, Government Medical College, Sangareddy, India.3Independent Researcher.4Department of General Medicine, Vijaya Hospital, Godavarikhani, Telangana, India

2022 : 

2) Dhavala A, Samitinjay A, Khairkar P, Podder V, Price A, Fatima SH, Biswas R. Integrated case-based clinical approach in understanding pathways, complexities, pitfalls and challenges in neurodegenerative disorders. Am J Neurodegener Dis. 2022 Jun 20;11(2):22-33. PMID: 35874938; PMCID: PMC9301093.
Authors: Aashitha Dhavala 1, Aditya Samitinjay 2, Praveen Khairkar 3, Vivek Podder 4, Amy Price 5, Syeda Hira Fatima 6, Rakesh Biswas 7
Affiliations:1Junior Resident in General Medicine, Kamineni Institute of Medical Sciences Narketpally, India.2Senior Resident in General Medicine, Government General & Chest Hospital Erragada, Hyderabad, India.3HOD & Professor in Psychiatry, Kamineni Institute of Medical Sciences Narketpally, India.4Visiting Lecturer, The University of Adelaide Australia.5Senior Research Scientist Stanford School of Medicine CA, USA.6Junior Resident in Psychiatry, Kamineni Institute of Medical Sciences Narketpally, India.7HOD & Professor in General Medicine, Kamineni Institute of Medical Sciences Narketpally 508254, India.

Summary: We performed this study within our existing framework of a CBBLE (publication number 2018) when we received an invitation from the American Journal of Neurodegenerative Disorders (AJND). Psychoses can develop in patients with brain disorders secondary to neurodegenerative disorders, tumours, or cerebrovascular accidents. We explored the organic psychopathology of psychosis in neurodegenerative disorders. We postulate that movement disorder is an obvious, logical bio-clinical marker towards organic psychopathology of psychiatric symptoms found in neurodegenerative disorders. 

3) Talukder AK, Schriml L, Ghosh A, Biswas R, Chakrabarti P, Haas RE. Diseasomics: Actionable machine interpretable disease knowledge at the point-of-care. PLOS Digit Health. 2022 Oct 20;1(10):e0000128. doi: 10.1371/journal.pdig.0000128. PMID: 36812614; PMCID: PMC9931276.
Summary: This paper presents an artificial intelligence (AI)-based approach for integrating comprehensive disease knowledge, to support physicians and healthcare workers in arriving at accurate diagnoses at the point-of-care.

Authors: Asoke K Talukder 1 2, Lynn Schriml 3, Arnab Ghosh 4, Rakesh Biswas 5, Prantar Chakrabarti 6 7, Roland E Haas 8
Affiliations:1SRIT India, Bangalore, India.2Computer Science & Engineering, National Institute of Technology Karnataka (NITK), Surathkal, India.3University of Maryland School of Medicine, Maryland, United States of America.4Indian Institute of Technology Bombay, Mumbai, India.5Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

4) Samitinjay A, Ali Z, Biswas R. Nontubercular mycobacterial cough. BMJ Case Rep. 2022 Mar 7;15(3):e246285. doi: 10.1136/bcr-2021-246285. PMID: 35256362; PMCID: PMC8905925.
Summary: Habitual cough suppression leading to non-tuberculous mycobacteria infections and bronchiectasis has been reported. We aim to highlight two key issues-diagnosing MAC infections in a tuberculosis endemic country, and OSA and its long-term clinical implications

Authors: Aditya Samitinjay 1, Zulfikar Ali 2, Rakesh Biswas 3

Affiliations 1General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.2Radiology, Sree Venkateswara Diagnostics, Kadapa, Andhra Pradesh, India.3General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India

5) Samitinjay A, Karri SR, Khairkar P, Biswas R. Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines. BMJ Case Rep. 2020 Sep 6;13(9):e233197. doi: 10.1136/bcr-2019-233197. PMID: 32895250; PMCID: PMC7476468.
Summary : This paper, aims to present two pressing issues—first, strict adherence to guidelines may not always bring the best outcomes and that clinical judgement and critical appraisal of literature is required to improve patient-related outcomes. Second, in a country where nearly two-third of the total annual health expenditure comes from out of pocket, expensive equipment like invasive ICP monitors and advanced neurosurgical equipment may not be readily available and hence it becomes imperative that general surgery residents, particularly in rural tertiary hospitals, are adequately trained in basic neurosurgical care before an appropriate referral is made.
Authors: Aditya Samitinjay,1 Satya Revanth Karri,2 Praveen Khairkar,2 and 1Rakesh Biswas1Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
2Department of Psychiatry, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India

2020:

6) Ghosh R., Dubey S., Chatterjee S., Finsterer J., Biswas R., Lahiri D., Ray B.K. Primary hypoparathyroidism and multiple neuraxial involvement in mitochondrial disorder due to the variant m.15043G>A in MT-CYB. J. Neurol. Sci. 2020;414 
Authors: Ritwik Ghosh 1, Souvik Dubey 2, Subhankar Chatterjee 3, Josef Finsterer 4, Rakesh Biswas 5, Durjoy Lahiri 2, Biman Kanti Ray 2
Affiliations: 1Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India.2Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India.3Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.4Department of Neurology, Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
.5Department of Medicine, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Telangana, India.
Citation and summary:
Cited by : Alston CL, Blakely EL, McFarland R, Taylor RW. The m.15043G > A MT-CYB variant is not a pathogenic mtDNA variant. J Neurol Sci. 2020 Oct 15;417:116950. doi: 10.1016/j.jns.2020.116950.
Summary :This report highlights the importance of full and thorough interpretation of patient genetic data to ensure that the correct diagnosis is ascribed [1]. Moreover, it validates the clinical utility of a diagnostic biopsy and the use of patient material for the functional validation of genetic findings as the inadequate assessment of pathogenicity has the potential to result in patient misdiagnosis and mismanagement.

2019

7) Podder V, Price A, Sivapuram MS, Biswas R. Middle-aged man who could not afford an angioplasty. BMJ Case Rep. 2019 Mar 31;12(3):e227118. doi: 10.1136/bcr-2018-227118. PMID: 30936331; PMCID: PMC6453268.
Summary: This report highlights the challenges and consequences of inappropriate overuse of percutaneous coronary interventions PCI. Also, we outline the current lack of shared decision-making among patients and physicians for the PCI procedure. The challenges, inherent in the assumptions that overuse of PCI is evidence-based, are discussed including recommendations for the practice of evidence based medicine for this intervention.
Authors: Vivek Podder 1, Amy Price 2 3, Madhava Sai Sivapuram 4, Rakesh Biswas 5
Affiliations 1Department of Medicine, Tairunnessa Memorial Medical College and Hospital, Gazipur, Bangladesh.2Department of Continuing Education, University of Oxford, Oxford, UK.3Stanford MedicineX, University of Stanford, School of Medicine, Stanford, USA.4Department of Medicine, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinoutapalli, Andhra Pradesh, India.5Department of Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

2018

8)Webb E, Kali Vanan N, Biswas R. Empirical treatment of tuberculosis: TB or not TB? BMJ Case Rep. 2018 Jul 10;2018:bcr2018224166. doi: 10.1136/bcr-2018-224166. PMID: 
29991543; PMCID: PMC6047727.
Summary : In this report we highlight the challenges faced due to lack of centralised medical records (which can prevent unnecessary investigations and treatment and we also share a few  user driven healthcare solutions deployed).
Authors: Eika Webb 1, Narmadha Kali Vanan 1, Rakesh Biswas 2
Affiliations: 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.2Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

9) Podder V, Price A, Sivapuram MS, Ronghe A, Katta S, Gupta AK, Biswas R. Collective Conversational Peer Review of Journal Submission: A Tool to Integrate Medical Education and Practice. Ann Neurosci. 2018 Jul;25(2):112-119. doi: 10.1159/000488135. Epub 2018 Apr 3. PMID: 30140123; PMCID: PMC6103343
Summary: In this study, we demonstrate a collective collaborative, conversational, pre-publication peer review of a randomized controlled trial. Open peer review involving a group of reviewers at a time produces multidirectional reviewing concepts, thus helps to improve the quality of paper and also may reduce the time between review and publication.
Authors: Vivek Podder 1, Amy Price 2 3, Madhava Sai Sivapuram 4, Ashwini Ronghe 5, Srija Katta 6, Avinash Kumar Gupta 7, Rakesh Biswas 8
Affiliations:1Undergraduate Medical Student of Tairunnessa Memorial Medical College, Dhaka, Bangladesh.2Patient Editor (Research and Evaluation), The BMJ, London, United Kingdom.3Continuing Education, The University of Oxford, Oxford, United Kingdom.4Undergraduate Medical Student of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, India.5Undergraduate Medical Student of Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India.6Undergraduate Pharmacy Student of St. Peters Institute of Pharmaceutical Sciences, Warangal, India.7Undergraduate Medical Student of Universal College of Medical Sciences, Bhairahawa, Nepal.8Professor of Medicine, Kamineni Institute of Medical Sciences, Nalgonda, India.
10) Podder V, Dhakal B, Shaik GUS, Sundar K, Sivapuram MS, Chattu VK, Biswas R. Developing a Case-Based Blended Learning Ecosystem to Optimize Precision Medicine: Reducing Overdiagnosis and Overtreatment. Healthcare (Basel). 2018 Jul 10;6(3):78. doi: 10.3390/healthcare6030078. PMID: 29996517; PMCID: PMC6163835.
Summary: We examine the role of precision medicine within a case-based blended learning ecosystem (CBBLE) as a practicable tool to reduce overdiagnosis and overtreatment.
Authors: Vivek Podder 1, Binod Dhakal 2, Gousia Ummae Salma Shaik 3, Kaushik Sundar 4, Madhava Sai Sivapuram 5, Vijay Kumar Chattu 6, Rakesh Biswas 7
Affiliations:1Department of Internal Medicine, Tairunnessa Memorial Medical College, Gazipur 1704, Bangladesh. drvivekpodder@gmail.com.2Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. bdhakal@mcw.edu.3Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India. drshaiksalma@gmail.com.4Department of Neurology, Rajagiri Hospital, Chunanangamvely, Aluva 683112, India. skaushik85@gmail.com.5Department of Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutapalli 521101, India. madhavasai2011@gmail.com.6Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine 0000, Trinidad and Tobago. vijay.chattu@sta.uwi.edu.7Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 

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KNRUHS Document 1: Ongoing research projects in medicine department from 2020

Document 1: Ongoing research projects in medicine department in the KNRUHS university (reference circular dated 18/07/2023)  format


Image of the circular  below :






Begun  in 2023:
1) Dr ⁨Nithin:
Core project: Factors influencing  recovery outcomes in patients with respiratory failure 
Additional projects  :
Managing respiratory failure in patients with neuroparalytic disorders and two year outcomes 
Echocardiography changes of pulmonary hypertension developing over time influenced by the duration of respiratory failure
2) Dr Harika 

Core Project :

Diagnostic and therapeutic factors influencing outcomes of patients with anemia in chronic renal failure

Additional project:

2) Therapeutic uncertainties in management of metabolic acidosis due to renal failure


3)Clinico radiological correlation of outcomes in patients with renal failure severity, chronicity and implications on further management 

3)  Dr Prachetan 

Core  project  

Diagnostic and therapeutic uncertainties influencing outcomes in patients presenting to general medicine with abdominal pain with and without comorbidities 



Additional project 

2): Diagnostic and therapeutic factors influencing the clinical outcomes of patients with diarrhoea 

3)Role of GI endoscopy and other factors influencing the diagnostic and therapeutic outcomes of patients presenting with dyspepsia and constipation 


4) Dr Navya 

Core project :

Diagnostic and therapeutic factors influencing outcomes in patients with sepsis 

Additional 

2) Diagnostic and therapeutic uncertainty around patients of suspected Acinetobacter sepsis influencing illness outcomes

3)Optimizing utilization of diagnostic and therapeutic modalities in sepsis to promote better patient outcomes as well as antibiotic stewardship 

4)Factors influencing total dose requirements of inotropes and Iv fluids   in septic shock 

5) Dr Himaja 

Core project :

Biopsychosocial factors influencing outcomes in patients with visceral fat and multisystem comorbidities


2) Ultrasound imaging correlations of muscle mass and visceral fat in Metabolic syndrome outcomes 

3) Clinical and echocardiographic evaluation of heart failure with preserved ejection fraction in patients with multimorbidities and suspected left ventricular failure 

 6) Lohith :

Core project :

Diagnostic and therapeutic outcomes in patients of suspected portal hypertension 


Additional projects  

2) Optimizing outcomes in patients with visceral fat with and without early suspected liver cirrhosis using regular informational continuity guided life style modifications 


3) Factors influencing development of Ascites in patients with chronic renal failure 


7) Dr Ajay 

Core project :

Factors influencing the  development of heart failure and other outcomes in patients with suspected chronic CAD spectrum 

Additional projects:

2) Time taken to echocardiographic IVC collapsibilty indicating attainment of optimal volume status after standard diuretic intervention for patients with left ventricular failure


3)Clinical Diagnosis of Electrical versus Anatomic Left Ventricular Hypertrophy: Prognostic and Therapeutic Implications


8) Dr Govardhini 

Core project :


Spectrum of clinical presentations in diabetes with multimorbidities and factors influencing their outcomes 

Additional projects:

2) Nail fold capillaroscopic changes in patients with type 2 diabetes mellitus👇





3) Fatty liver and diabetes outcomes  in a spectrum of patients with high visceral fat and low muscle mass 


9) Dr Vivek Kurma 

Core project :

Factors influencing outcomes in patients with neuroparalysis 

Additional projects:

2) Resolving clinical complexity and improving outcomes in patients of chronic headache 

3) Factors influencing outcomes in patients with  hyponatremia and osmotic demyelination syndromes 


10) Dr Kiran Kumar 

Core Project :

Factors influencing outcomes in patients with diabetes and renal failure with and without other multimorbidities 

 Additional projects:

 2) Evaluation of nailfold microcirculation in patients with chronic renal failure


3)Resolving clinical complexity and improving outcomes in patients of chronic Spondyloarthropathy

4) Resolving diagnostic and therapeutic uncertainties in subclinical hypothyroidism 

More here about project investigators who began their projects in 2022-23: 



Begun in 2021-22: More here about project investigators who began their projects in 2022-23: https://medicinedepartment.blogspot.com/2022/08/2021-md-batch-formative-assessment.html?m=1

1) Dr Pavan : Managing sarcopenia and visceral fat outcomes in patients with diabetes 

2) Dr Pavani :Clinical complexities in the management and outcomes of anemia: https://medicinedepartment.blogspot.com/2022/07/draft-thesis-project-plan-clinical.html?m=0 

Additional project :Prospective follow up of daily diet to resolve etiology and improve outcomes in patients of anemia 
3) Dr Bharat :

Outcomes of monitoring suspected acute and chronic glomerular injuries with random and 24 hour urinary protein creatinine estimations along with patient events 



Additional project :

Resolving clinical complexity and improving outcomes in patients of chronic headache 

4) Dr Kranthi :

Resolving diagnostic and therapeutic uncertainties around heart failure outcomes in CKD patients 



Additional project :

Initial events in the etiology of renal failure and time gap between the initial events and renal failure  

5) Dr Deepika:

Clinical and radiological factors  influencing outcomes of patients with stroke 


6) Dr Keerthi :

Diagnostic and therapeutic uncertainty in patients with suspected tuberculosis 


7) Dr Nishitha :

Resolving diagnostic and therapeutic uncertainties around patients with 
poorly differentiated fever 


8) Dr VenKat Sai 

Factors influencing outcomes of patients with chronic liver disease   


9) Narasimha Reddy :

Clinical complexity in Diabetes: Qualitative evaluation of patients, interventions and outcomes



10) RISK FACTORS, CLINICAL SPECTRUM, DIAGNOSTIC AND therapeutic OUTCOME influencers OF PATIENTS WITH ENCEPHALOPATHY


Previous link for the allocated 2021-22 batch project plans: https://medicinedepartment.blogspot.com/2022/07/2021-20-allocated-thesis-and-other.html?m=0


Begun  in 2020-21

Dr Pradeep 


Dr Manasa 


Dr Chandana


Dr Vamsi krishna



Dr Saicharan



Dr Raveen 



Dr Vinay


Dr Shailesh


Dr Durga Krishna 


Dr Shashikala: 




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2022 entry MD (General Medicine) batch portfolios

1) Dr Nithin Goutam 

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