Tuesday, November 28, 2023

2019 pre final General medicine practical marks and student reported (student user driven) learning outcomes

Summary :


Following is a rough draft of the conduct of half of the practicals in the new format previously detailed here : 
http://medicinedepartment.blogspot.com/2023/11/mbbs-general-medicine-revised-practical.html?m=0 by one examiner and his team who chose to take long case (60 marks), OSCE (25 marks), AETCOM (5 marks) and logbook (10 marks) while the other team took  short cases (50 marks), viva (40 marks), log book (10 marks), each taking 100 marks toward an end total of 200. All students were also made to share online, their self reported learning outcomes at the end of the face to face offline  session making it a blended learning assessment experience.


1.HARIKRISHNA https://01harikrishnamunna.blogspot.com/

[11/28, 11:02 AM] Rakesh Biswas: 

Long case 35/60

OSCE 13/25

AETCOM 3/5

Logbook 5/10


 2.Shruthi Arukonda



[11/28, 11:22 AM] Rakesh Biswas: 

Long case : 30/60

Osce : 15/25

AETCOM : 3/5

Log book : 6/10

Shruthi roll no 2 , 

Case : acute pancreatitis. 
Learning points: 
-I’ve learnt the importance of a detailed personal history to come to the final diagnosis. 
-I’ve learnt the importance of helping make the patient at ease so they can be more vocal about their symptoms and routines. 
-I’ve learnt about various complications of chronic pancreatitis.
-I’ve learnt that we must always the patient how much of pain has subsided quantitatively [if he says the pain has subsided]. This is to have a clear idea of how effective the treatment has been working.


3.A.Sri Sai Tarun


[11/28, 11:39 AM] Rakesh Biswas: Couldn't demonstrate joint position sense 

Wrong technique for ankle reflex 

Long case 25/60

OSCE: 13/25

AETCOM : 3/5

Log book : 6/10

A.Sai Tarun rollno-03
Case : peripheral neuropathy
Learning points: 
-I’ve learnt the importance of a detailed personal history to come to the final diagnosis. 
-I’ve learnt that how can a diabetes leads to major complications if ignored.
-I’ve learnt how a detailed history and examination can lead to the diagnosis.
-I’ve learnt how does diabetes effect various systems and lead to a ulcer.
-I’ve learnt how to reach a probable diagnosis by taking a good patient oriented history.


4.Srilasya Akula


[11/28, 12:10 PM] Rakesh Biswas: 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 8/10

04 A Srilasya 
learning points from my case : leprosy 
• Importance of knowing proper history and  prior treatment taken before arriving at diagnosis .
• importance of each clinical feature contributing in differentiating types of leprosy . 
•To get to the diagnosis through and through clinical examination ( i.e by structured understanding of which sensory nerve involved and invoved dermatome) before going for investigations first. 
• To make sure patient feels safe with us and not feel stigmatized of disease and run away as my patient did . 
• importance of early diagnosis and prevention before landing up in irreversible complications


5.Akula vignesh 


[11/28, 12:18 PM] Rakesh Biswas: 

Long case : 30/60

Osce : 10/25

AETCOM : 3/5

Log book : 5/10

A.vignesh
Rollno. 05
Learning points:-
I learned the importance of detailed personal history and daily routine of the patient in a case history 
I learned about how to assess the fat status of the patient who is having ascites where abdominal fat cannot be assessed 
I learnt that having a detailed   history of the patient and  
proper clinical examination will lead to provisional diagnosis.


6.Anvitha reddy


[11/28, 12:49 PM] Rakesh Biswas: 


Long case : 25/60

Osce : 10/25

AETCOM : 3/5

Log book : 4/10

Roll no:6

Name : Anvitha reddy 

Long case: diabetic neuropathy with psoriasis 

Learning points: I learnt how to approach diabetic case and how to administrate insulin injection 
I have learnt how diabetes leads secondary conditions 
I have learnt management approach in treating diabetic case

7.Sivaram (absent)

[11/28, 4:47 PM] 

Roll 8
Anahita 2019 : 

Long case : 50/60

Osce : 20/25

AETCOM : 4/5

Log book : 8/10

Long case : Stroke 
Learning points 
-dilated , non reactive pupil indicative of Edinger Westphal nucleus 
-vascular localization of stroke 
-unique disability ID form and how to apply 
-realistic solutions to patient care

[11/28, 7:09 PM] Rakesh Biswas: Dilated non reactive pupil with abducted eye is indicative of third nerve palsy. What are the other findings in a complete third nerve palsy? Did your patient have complete or incomplete third nerve palsy? 

How does he apply for disability pension? Why didn't he apply since last two years?

[11/28, 7:41 PM] Anahita 2019 KIMS: A complete third nerve palsy presents with complete ptosis, with the eye positioned downward and outward with the inability to adduct, infraduct, or supraduct, as well as a dilated pupil with sluggish reaction

He had incomplete third nerve palsy as he gaze upwards and downwards with his left eye 

As for the disability pension , he needs a certificate of the grade and type of disability from the district hospital and then apply for a unique disability card online 

Since the last 2 years the patient was then hope of complete recovery , now the patients condition had become a financial and emotional burden on his family and they are looking to avail government aid sir


[11/28, 7:45 PM] Rakesh Biswas: Where is the origin of his third nerve palsy? Why third nerve nucleus and not peripheral third nerve lesion? What is the relation of the Edinger Westphal nucleus to the rest of the source of third nerve origin?

Roll no 09
Name A Sanvith
LONG CASE: CHRONIC PANCREATITIS
i have learnt about the patient based exposure and learnt about how to approach.
Learning points:
I’ve learnt about, how the patient presents with a case of pancreatitis and how to get proper diagnosis.
i’ve learnt to evaluate the underlying cause by careful examination of patient.
I’ve learnt about the complications, if it is not treated properly.

Ankam Anusri Roll no :10

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 5/10

Key learning points:
- It is important to establish a strong rapport with the patient.
- Communicating effectively with the patient's attendants is equally important
- Conducting a comprehensive patient history facilitates the diagnostic process.
- learning the significance of foot care in diabetes management.
- Witnessing the impact of a disease on a patient's daily life and its subsequent effect on their family.
- Improved my communication skills.
- Educating patients regarding their condition for an improved prognosis.

Ankesh sahu
Roll no- 11

Long case : 31/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10

Long case:- Paucibacillary leprosy 
Learning points:-
-l learnt about the severity of leprosy and how to approach it
-Importance of knowing proper history and prior treatment taken before arriving at diagnosis
-Importance of each clinical features helps in differentiation of different types of leprosy
-learnt about how to do the palpation of nerves involved in leprosy
-To make sure the patient feels comfortable with us and didn't feel stigmatise and willing to get the tests done

[11/28, 12:25 PM]  Med Pg: 12.Ashish

Long case : 29/60

Osce : 10/25

AETCOM : 2/5

Log book : 4/10


[11/28, 10:57 PM] : Ashish roll no 12 
Long case - peripheral neuropathy secondary to dm 
Learning points: 
I’ve learnt the importance of a detailed personal history to come to the final diagnosis. 
I’ve learnt the importance of having a great rapo with the patient .
Building up confidence for the final practical’s

13.B. Medha

Long case : 35/60

Osce : 14/25

AETCOM : 3/5

Log book : 6/10

[11/28, 4:46 PM] Medha 2019: Learning points

- I have learnt about the importance of AETCOM
- Learnt that this patient needs a wholistic approach to the treatment.
- I have also learnt the importance of knowing the daily routine of the patient in order to come to a diagnosis and to know the etiology

[11/28, 6:09 PM] Rakesh Biswas: Which patient? What made you learn all that?

[11/28, 6:26 PM] Medha 2019: His history and daily routine reveals h/o alcohol consumption since 6-7 years which leads to the etiology and diagnosis - alcoholic liver disease 
- wholistic approach is because he needs help with attainment of abstinence from alcohol, nutritional therapy.


[11/28, 7:07 PM] Rakesh Biswas: Why call it holistic? We are just trying to tackle the root cause. But why did he consume alcohol more than others?

[11/28, 12:40 PM] : 14.Banuri Varun

Long case : 25/60

Osce : 10/25

AETCOM : 2/5

Log book : 4/10

[11/28, 11:00 PM] : 

Varun roll no 14
Long case: acute pancreatitis
- I have learnt about importance of daily routine of the patient and any significant deviation from the daily routine led to disease.
 -I have learnt how a proper communication is necessary to arrive at a proper diagnosis.
-I have learnt about the impact of chronic alcohol consumption on various organs.
-I have learnt how to reach patient oriented diagnosis in a case by clinical examination

[11/28, 3:22 PM] 

15.Sravani


Long case : 29/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Case :diabetic neuropathy 
Learning points :
 I have  learnt how to approach a patient and how to communicate with patients attendant.
I have learnt importance of clinical examinations to  arrive  at a  diagnosis , importance of diet and exercise in treating diabetic patient .I have learnt about sarcopenic obesity .


16.Poojitha Bhavanam

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 5/10

Long case :Peripheral neuropathy

Learning points:
-i have learnt about the pathology behind the diabetic foot.
-i have learnt how diabetes can lead to perpheral neuropathy and inturn to diabetic foot.
- I have leart the importance of having good history and clinical examination to to elicit the diagnosis.
-i have learnt how it is vert important to have a good follow up of the patient to treat and the patient and to also to know the compliance.
-i have learnt how visceral fat can lead to many metabolic disorders.


17.Bhavya Ranjan

Long case : 33/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Long case : ascites due to chronic liver disease.
Today learnt about-
-how alcoholism can lead to chronic liver disease.
-importance of proper history taking and clinical examination
-importance of AETCOM
-management of ascites
-apart from alcoholism what other conditions cause chronic liver disease

18.Ananya bhukya


[11/28, 3:19 PM] Rakesh Biswas: 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10



19.Lavanya


[11/28, 3:16 PM] Rakesh Biswas: 


Long case : 25/60

Osce : 10/25

AETCOM : 3/5

Log book : 6/10

B.Lavanya roll no 19 
Long case : monoplegia with anemic case 
I have learnt about how to approach to patient and importance of how to examine a patient based on detailed history  that I have taken 
I have also learnt to differentiate between causes and relate info with. Diagnosis
I have also improve my communication skill


21.B.Varshitha




[11/28, 3:08 PM] Rakesh Biswas: 


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10




22.B. Vaishnavi


[11/28, 3:14 PM] Rakesh Biswas: 


Long case : 32/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Long case: Diabetic foot ulcer
Learning points: 
- Effects of diabetes on different organs
-Importance of amputation
-Importance of supportive care in addition to medical management
- Sensory examination with eliciting signs of meningitis helped in coming to final diagnosis
- Importance of proper communication and history taking




23.Divya.B


[11/28, 2:53 PM] Rakesh Biswas: 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10

Long case: acute pancreatitis
- I have learnt about importance of daily routine of the patient and any significant deviation from the daily routine led to disease.
 -I have learnt how a proper communication is necessary to arrive at a proper diagnosis.
-I have learnt about the impact of chronic alcohol consumption on various organs.
-I have learnt how to reach patient oriented diagnosis in a case by clinical examination



24.Prannai Reddy

[11/28, 2:45 PM] Rakesh Biswas: Long case : 25/60

Osce : 12/25

AETCOM : 3/5

Log book : 4/10


Prannai reddy.ch
ROLL-:24
LONG CASE -: pneumonia along with pedal edema and alzhiemers 
-I have learnt about pneumonia and its effects  in the community and its effects on our body
-i have learnt about risk factors that may lead to pneumonia 
-i have learnt about importance of breath sounds in pneumonia and also  auscultatory findings in it 
-I have also learnt how to approach to a case of pneumonia
-i have also learnt about severe signs of pneumonia
-i have learnt about x-ray findings in pneumonia
-I have also learnt about multifactorial causes of pedal edema 
-i have also  learnt about importance of cns examination in case of alzhiemers disease.


25.Varshini reddy

[11/28, 2:35 PM] Rakesh Biswas: 


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

Learning points:

-I have learnt about how to localise the apex beat on examination. 
-I have learnt about different metabolic effect that are caused due to accumulation of adiposites at various sites 
- I have learnt about the importance of clinical examination in order to get to a diagnosis and to treat them accordingly.

[11/28, 5:13 PM] : Tanmayee 2017

1701006150

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Long case: chronic kidney disease 
Learning points
- I have learnt about the importance of AETCOM
- Realistic solutions to patient care
-I’ve learnt the importance of a detailed personal history to come to the final diagnosis

[11/28, 8:09 PM] Rakesh Biswas: Is this linked case report of the same patient we saw in the AmC bed 6 today? 

What was she receiving radiation for? 

What was the cause of her low back ache? 

Very well maintained log book 👏👏


[11/28, 8:14 PM] Rakesh Biswas: Okay @⁨~Tanmayee Reddy⁩ You are from 2017.

I find that you began your log book from Nov 2022. Following which there was a gap but this October 2023 you have done a good job. Only wish you had shared these with your questions in the group earlier so that we could have helped those patients too.

Rohith
1701006063

Long case 30/60

OSCE 13/25

AETCOM 3/5

Logbook 6/10


[11/28, 9:43 PM] Rakesh Biswas: @⁨~Rohith J⁩ Why was your patient here👇
getting antibiotic piptaz?

[11/28, 10:00 PM] Rohith : Sir she had severe Vomitings and abdominal pain when she came here. She had an infected and distended gall bladder. Suspected Pancreatitis

[11/28, 10:06 PM] Rakesh Biswas: What clinical features of infection she had that necessitated adding iv high end antibiotics?

[11/28, 10:16 PM] Rohith : Sir She was complaining of fever and burning micturition and she was a known case of TB five years back

[11/29, 6:53 AM] Rakesh Biswas: Complaining of fever and burning urination is a valid reason for starting iv piptaz without any objective evidence of urinary infection?


[11/29, 9:13 AM]: 

27.Naga Tarun

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10

[11/29, 9:13 AM] : 

28.Chikatla Laharisha

Long case : 35/60

Osce : 14/25

AETCOM : 3/5

Log book : 6/10

Name:Ch.Laharisha
Roll no.28

Case-CVA WITH RIGHT SIDED HEMIPARESIS

Learning points:

-I have learnt how to localize lesions of the brain clinically without any investigation

- Formulating OSCE is equally important especially for my patient who is struggling to regain normal vision 

-I have learnt how to apply theoretical knowledge practically to help the patient


-Educated the patient about the prognosis of the disease by suggesting them alternative therapies


11/29, 8:37 PM] Rakesh Biswas: What is your CNS localization for this patient?

[11/29, 8:04 PM] Laharisha: 

Millard gubler syndrome??
Millard-Gubler syndrome, also known as ventral pontine syndrome, is a neurological condition caused by damage to the ventral part of the pons, a region in the brainstem. This damage typically results from a lesion affecting the corticospinal fibers, abducens nucleus, and facial nerve fibers in the pons.

Key features of Millard-Gubler syndrome include:

Ipsilateral Facial Nerve Palsy: Facial weakness or paralysis on the same side as the lesion due to involvement of the facial nerve fibers.

Contralateral Hemiplegia: Paralysis on the opposite side of the body due to damage to the corticospinal fibers, which cross in the brainstem.

Abducens Nerve Involvement: Impaired lateral gaze due to damage to the abducens nucleus, which controls the lateral rectus muscle of the eye

These symptoms arise because the affected structures are located close to each other in the ventral part of the pons. The syndrome is a result of lesions, often vascular in origin, affecting this specific region. It's important to note that the clinical presentation may vary depending on the size and location of the lesion

[11/29, 10:18 PM] Rakesh Biswas: Abducens which side? 

Please share the reference links for each of your borrowed texts here


[11/29, 10:23 PM] Laharisha: Ipsilateral abducens nerve sir


[11/29, 10:28 PM] Rakesh Biswas: 

Agreed 

ipsilateral facial, abducens and contralateral hemiplegia 

In your patient the limb hemiplegia, facial palsy and abducens palsy are all contralateral?

[11/29, 9:14 AM] : 29.Ch. Janani

Long case : 30/60

Osce : 10/25

AETCOM : 3/5

Log book : 3/10

11/29, 6:25 PM] : Name :Janani
Roll no 29

Case : chronic kidney disease

Learning points
I have learnt about importance of daily routine of the patient
I have learnt how proper a communication is necessary to arrive at a proper diagnosis
I have learnt how to reach patient oriented diagnosis in a case by clinical examination
Iam able to correlate symptoms with a set of differential diagnosis and narrow them down further
I have learnt about the causes and complications of ckd


[11/29, 9:15 AM]: 30.Ch Hansika Reddy

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10

11/29, 7:47 PM]: https://30hansikareddy.blogspot.com/2023/11/a-52-year-old-male-co-bilateral-lower.html                                 .

Name :- Ch.Hansika Reddy 
Rollno.:- 30

Case :- Chronic kidney disease with polycystic kidney disease 


Learning points:-

-I have learnt how a proper communication is necessary to arrive at a proper diagnosis.
-I have learnt How important is the previous surgical scar in the history
-I have learnt the possible causes of CKD , types of polycystic kidney disease and it's progression
-I have learnt the importance of IVC diameter in CKD patients, which indicates the fluid overload in these patients and how Lasix(furosemide) acts to decrease the overload.
-I have learnt how to reach patient oriented diagnosis in a case by clinical examination


[11/29, 9:15 AM]: 31.Snehitha

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10


11/29, 8:56 PM] :


NAME: CH. Snehitha
LONG CASE: Megaloblastic anemia
CASE LINK: 

LEARNING POINTS:

I've learnt how important it is to take proper detailed personal history.

I've learnt about approach to anemia, anemia workup as in history, clinical evaluation, investigations for pathogenesis, evaluation of blood loss and hemolysis.

I've learnt how patient's diet is important in illness, in preventing chronic noncommunicable diseases.

[11/29, 9:18 AM] : 32 Ch. Srilekha


Long case : 35/60

Osce : 12/25

AETCOM : 3/5

Log book : 7/10



Name : Ch. Srilekha
Roll.no : 32

Case - CVA with right sided hemiparesis 
Case link: 

Learning points:

-I have learned about how important is to know the past history which helps in assessing the present condition of the patient.

-I have learnt how a patient with posterior cerebral artery lesions presents with. 

-I have learned about the lesions which affect the vision.

-How to localize the  lesions affecing vision with cranial nerve palsies.

[11/29, 9:18 AM]: 

33.Srinaini

Long case : 35/60

Osce : 14/25

AETCOM : 3/5

Log book : 7/10

11/29, 5:53 PM]: Name- Ch Srinaini
Roll no:- 33

Case:- Chronic liver disease
 
Case link:-

Learning Points :-


-I  have learnt how to clinically assess direction of blood flow in dilated abdominal veins 

-I have gained understanding of how chronic liver disease due to chronic alcoholism made a way to complications like ascites ,portal hypertension 
& pedal edema 

-I have learned how to check for apraxia which is a symptom indicating that patient developed hepatic encephalopathy 

-I have learnt how important it is to listen to patients complaints carefully and doing a proper head to toe clinical examination before sending to  investigations and come to a diagnosis



[11/29, 9:22 AM] : 

34.D Vijaya ratna

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 7/10


Name : D Vijaya ratna 
Roll no.34
Long case : MEGALOBLASTIC ANEMIA


Learning points

I've learnt 
- To establish rapport with the patient
- How to analyse all the complaints to make Differential diagnosis
- How dietary changes play an important role and understood it's significance 
- Importance of treatment plan in preventing complications



[11/29, 9:23 AM] : 

35.Rishitha

Long case : 25/60

Osce : 10/25

AETCOM : 2/5

Log book : 3/10


11/29, 6:36 PM] Rishitha Kims 2019: Name: Rishitha 
Roll no. : 35
Long Case: Chronic Pancreatitis. 

Learning Points: 

- i have learnt how lifestyle management can affect the treatment outcome. 
- i can now clinically assess cardiac and bronchial asthma before jumping into treating any asthma as a bronchial asthma. 


- i have learnt how a single clinical examination and proper history taking can affect the diagnosis and  treatment plan.


11/29, 7:26 PM] : 

Name : Enduri tejaswi 
Roll no : 36 

Case : cerebro vascular accident leading to right side hemiparesis 
Medial rectus palsy in the left eye 
Lateral rectus palsy in the right eye


Long case : 45/60

Osce : 20/25

AETCOM : 3/5

Log book : 7/10

[11/29, 7:27 PM] : I have learnt how to approach a cns case based on the clinical findings .
I have also learnt how a detailed history is very important and how it can help in the diagnosis of the patient . 
I learnt how to localise the lesions and what specific symptoms each lesion presents with . 
I also learnt how a  manifestion in patient might have different reasons pointing towards . 
I also learnt about some syndromes through the osce questions . 
I realised how important it is to cater to the needs of the patient first and how to be show empathy and resolve there doubts regarding the disease and their recovery

[11/29, 7:34 PM]: About How hypertension could cause cva? 

Hypertension can cause stroke through the following mechanism A high intraluminal pressure will lead to extensive alteration in endothelium and smooth muscle function in intracerebral arteries. The increased stress on the endothelium can increase permeability over the blood-brain barrier and local or multifocal brain oedema. Endothelial damage and altered blood cell-endothelium interaction can lead to local thrombi formation and ischaemic lesions. Fibrinoid necrosis can cause lacunar infarcts through focal stenosis and occlusions.




[11/29, 7:45 PM]: About the localisation of lesion ? 
 For any lesion location 3 questions have to be asked ? 
What is the lesion ? UMN or LMN 
What is the anatomical location associated ? 
Why has the lesion occurred ? 

Hemiplegia can result from a unilateral lesion of the brain stem, internal capsule, or cerebral cortex. Brain stem lesions result in crossed hemiplegia. For example, a left pontine lesion will result in left facial weakness of lower motor neuron type and right-sided hemiplegia. Similarly, a lesion in the left midbrain will result in left-sided oculomotor weakness with right hemiparesis and right facial weakness of upper motor neuron type. This constellation of signs is called Weber syndrome. Lesions above the level of the brainstem result in uncrossed hemiplegia. For example, a lesion in the left internal capsule would result in right hemiplegia and right facial weakness of the upper motor neuron type. A left cortical lesion may also result in cortical dysfunction in addition to right hemiparesis and facial weakness of upper motor neuron type

This suggests our patient might be    A case of weber syndrome . 




[11/29, 7:49 PM] : Weber syndrome

Weber syndrome, classically described as a midbrain stroke syndrome and superior alternating hemiplegia, involves oculomotor fascicles in the interpeduncular cisterns and cerebral peduncle, thereby causing ipsilateral third nerve palsy with contralateral hemiparesis. It most commonly results from the occlusion of a branch of the posterior cerebral artery.

A lesion in the ventromedial portion of midbrain leads to Weber syndrome. The midbrain receives its blood supply from the paramedian mesencephalic branches (basilar), peduncular perforating branches (posterior cerebral artery) as well as from the superior cerebellar artery, and the choroidal arteries.


Antecedent history of hypertension, diabetes, hypercholesterolemia is often associated with Weber syndrome, like other stroke



[11/29, 8:40 PM] Rakesh Biswas: Share the scientific reference for each statement. The link you have shared is a review article and you will need to check the cross references for each statement claim


[11/29, 8:45 PM] : The lesion is located in the midbrain region supplied by the peduncular peforated arteries of the posterior cerebral artery .

[11/29, 8:46 PM] Rakesh Biswas: The question was around localization of the anatomical tracts and pathways explaining his right abducens palsy and left oculomotor palsy? 

Is his current facial palsy due to pontine nucleus involvement or facial nerve tract involvement above the nucleus (supranuclear facial palsy)?

[11/29, 8:52 PM] : His current paralysis is most likely supra nuclear facial palsy sir .
In pontine syndrome it is contralateral palsy and ipisilateral abducens but here in his patient the same side as hemiparesis abducens is affected 



[11/29, 8:54 PM] Rakesh Biswas: So his abducens palsy is also supranuclear!!? 

But that is unknown?


[11/29, 8:59 PM] Rakesh Biswas: So is his abducens palsy nuclear in the brainstem or in the peripheral abducens nerve?

[11/29, 9:39 PM]: Its is abducens nuclear palsy sir .
Involvement of the sixth nerve nucleus causes ipsilateral gaze palsy. The absence of contralateral adduction helps distinguish a nuclear lesion from a fascicular or nonnuclear lesion.



[11/29, 10:00 PM] Rakesh Biswas: How would you then explain the hemiparesis on the same side? 🙂


[11/29, 10:28 PM] : Sir it might actually be a weber syndrome where its is  left midbrain stroke with right hemiparesis and left oculomutor nerve palsy . 

The right abducens can probably be due to another lesion in right abducens nuclear region sir

[11/29, 10:30 PM] Rakesh Biswas: If the right abducens had to be another right nuclear then shouldn't he have had a left hemiparesis too and in effect have quadriparesis? But your clinical findings don't suggest that do they?


[11/29, 10:38 PM] 

Rakesh Biswas: NEET MCQ :

Abducens nerve palsy:

Is a false localizing sign 

It's the nerve with the longest intracranial course 

It's prone to getting stretched and paralyzed due to any cause of raised intracranial pressure 

Raised intracranial pressure causing abducens nerve palsy can be long lasting (as in our patient)?


[11/29, 10:52 PM] : Yess sirr  patient is a known case of HTN and one of the extra cranial causes of  raised intracranial pressure  is HTN which might be causing the abducens palsy 

The weber syndrome can explain probably explain the hemiparesis on left and oculomotor palsy on right side . 

So only one lesion and the other maifestation might be due to ict .


[11/29, 10:54 PM] Rakesh Biswas: Any reference link for persistent abducens nerve palsy following and after recovery from raised ICT as suspected in our patient?

[11/29, 11:11 PM]: No sir , 

[11/30, 1:33 PM] Rakesh Biswas: Please quote the relevant portion



Name :G Jagadeesh 
Roll no : 37

Long case : 35/60

Osce : 14/25

AETCOM : 3/5

Log book : 6/10


Learning points

I have learnt how important it is to do temperature charting 4 hourly to assess and treat the fever

I came to know approach towards fever
I learned how to motivate my patient to stay back in the hospital and get treated completely

[11/30, 9:30 PM] Rakesh Biswas: Don't use this version of the consent form with multiple pages and never upload it in the online learning portfolio!!

Use single page of the the signed informed consent form downloadable from http://medicinedepartment.blogspot.com/2020/05/informed-patient-consent-and.html?m=1


The case reporter needs to ensure that the informed consent is signed by each of their logged patients and emailed  to this address  informedconsentpajr@gmail.com asap and ensure that s/he gets a reply to that email 


The signed informed consent needs to be emailed along with the patient's signature, their name and complete contact details along with signature and contact details of witness along with the case report and PaJR link in that email else the people who are archiving this data will not be able to correlate who's it is 

[11/30, 9:31 PM] Jagdeesh : Ok sir

 
Name :G.Nandini                          
roll no:38     

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10
                                                    https://38nandinigandla.blogspot.com/?m=

  Learning points:    
 
I have learnt the pathogenesis behind the cause of decreased platelets in dengue.     

I also learnt about the hess test which is positive in my patient.   

Ihave also learnt that it is important to educate the patient and patient attenders about the condition and also about the complications so that they seek medical help before complications occur.  

I also observed how anxious the patient attenders about the condition  so it is very important to let them know about her condition.


11/29, 5:43 PM]: 

Name: Bhavana
Roll no : 39
Long case: Megaloblastic Anemia 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Learning points:

- I have learnt how a single change in daily routine ( mainly diet) can cause  such a health problem.

- I have also learnt how a good communication is needed to gain all the information about the condition.which is very helpful to diagnose the condition clinically.

-I have also learnt that there's a lot to know.

-I have also learnt that how a proper treatment plan is needed to cure or to differentiate / exclude the condition from other conditions.



G.Akshara kruthi 
Roll no : 40 

Long case : 25/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Case : chronic pancreatitis 
Learning points :
- I have learnt proper history and inspectory findings are atmost important in diagnosing the case 

 - I have learnt the importance of daily routine 

- I have learnt how  important  it to   correlation between the investigations and clinical examination 

- I have also learnt that both  life style changes and medications are important in management of my patient 
As my patient is alcoholic which has lead to this condition .

- I have also learnt to correlate all the systems and look for complications caused by the disease .



11/29, 5:05 PM] Pravalika 2019: 

Name : G Pravallika
Roll no :41 

Long case : 35/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10



Learning points 

-I have learnt to apply the theoritical knowledge of immune reactions in viral fevers to understand the cause of haemorrhagic manifestations of dengue 

- I have learnt the importance of monitoring in a hospital setting in preventing complications and supporting the patient through symptomatic treatment. 

- I have understood that involving the patient and patient attenders in treatment process encourages them to adhere to the treatment regimen and understand the illness


Name: G. Supriya reddy
Roll no. 42

Case:Chronic liver disease with ascites


11/29, 1:21 PM] :  Supriya roll no. 42 .

 Splenorenal shunts has low risk of rebleeding and hepatic encephalopathy of refractory ascites

Long case : 30/60

Osce : 10/25

AETCOM : 3/5

Log book : 5/10

Learning points
-I have learnt about advantage of spleno renal shunt over TIPS

-I have learnt about how a bed side examination can help in diagnosis 

-I have learnt how to clinically see the direction of blood flow in dilated engorged veins

-I have learnt the importance of ascitic tapping which helps the patient to feel comfortable 

-I have learnt the importance of general examination which helps in finding other issues and other causes for ascites.


[11/29, 6:21 PM] :




Name : G Preethi Reddy 
Roll No : 43 


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Case : chronic kidney disease 


Learning points 
- I have learnt how important is to take detailed history before jumping into conclusions 

I have learnt how important is the daily routine and and his occupation ( place of work and what type of work he does ) to know the cause 

I have learnt that the not only NSAIDs but exposure to toxic gases from many years at his work place has led to CKD 

And i have learnt how essential it is to build communication with the patient and gain his confidence for treating the patient

11/29, 6:51 PM]: 

Name: G.Jyothi Reddy 
Roll mo:44


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

Case : Acute Pancreatitis




Learning points :
I have learnt how to build rapport with patient  so that  he gives detailed personal history to get to know the right diagnosis 
I have learnt how to exclude the differential diagnosis based on clinical examination
I got to know the effects of alcohol on various organs of body



[11/29, 1:10 PM] : Shreya Roll no 45 ..

My case for today is ascites secondary to chronic liver kidney . According to surveys.. Due to complications of hepatic encephalitis with TIPS procedure. Splenorenal shunt is a little better procedure compared to TIPS

[11/29, 6:56 PM] : Name-  G. shreya 
Roll no 45 

Case - Chronic Liver Disease

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10



Case chronic liver disease
Learning points:- 
I have learned about importance of taking conset, Proper communication with patient. 
I have learned about the causes, physiology, presenting features in chronic liver disease and ascites case. 
Learnt about the method and importance of each -puddle sign, fluid thrill and shifting dullness in ascites case. 
Also learned about difference in direction blood flow in veins in IVC obstruction and portosystemic shunt. 
Other causes of swan neck deformity
Complications of CLD, ascites and features of hepatic encephalopathy 
Management of Ascitic case-ascitic tap, TIPS, splenorenal shunt.


[11/29, 8:29 PM]

: Name::- G.chaitanya
Rollno :47

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

Long case:- Chronic kidney disease with ADPKD 
Learning points:-I have learned that how important the past History which is helpful to assess the present condition 
I have learnt how important the previous surgical scars in treatment history
I have learnt importance of family History,which help for early diagnosis in family members
I have learnt types of ADPKD and its progressionand how3to clinically assess it


Name:-G.pranay Kumar
Roll:-48

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

 Long case:- Acute pancreatitis

I have learnt how sudden excessive consumption   of alcohol  lead to 
 an acute episode of  pancreatitis 

-i have learnt  that how important it is to take a brief history and know the daily routine of the patient to know exactly the root cause( i.e,deviation from the routine ) which lead into an acute episode 

- I have learnt how important it is to do a proper clinical examination before sending for investigations


Roll num: 49
Name: I.Aasritha 
Long case: Megaloblastic anemia
Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


LEARNING POINTS:

I have learnt that communication with patients and patient attendants to know detailed history leads to accurate diagnosis

I also learnt how sudden change in lifestyle and diet can effect the quality of life

I also learnt proper treatment is required to decrease the rate of recurrences of the disease


[11/29, 10:45 PM]: Name: P.Jahnavi
Roll no: 183

Case: Megaloblastic anemia 


Long case : 25/60

Osce : 10/25

AETCOM : 1/5

Log book : 2/10




Learning points:
- I have learnt the importance of taking history in order to get the correct diagnosis .
- I have learnt the importance of correlating the pathophysiology in order to exclude differential diagnosis .
- With respect to the case, i have also learnt the importance of a  investigation like schilling test to determine the cause behind vitamin b12 defficiency.

11/29, 10:24 AM] : 2018 special batch 

Name:VS DINESH
REGD NO:1801006182

Long case : 25/60

Osce : 10/25

AETCOM : 2/5

Log book : 3/10

[11/29, 10:25 AM]: 2018 special batch 


[11/29, 10:25 AM]: Dushyanth 1801006089

Long case : 25/60

Osce : 10/25

AETCOM : 2/5

Log book : 3/10

[11/29, 10:27 AM]: 2018 special batch :


Long case : 25/60

Osce : 10/25

AETCOM : 2/5

Log book : 3/10


51.Jella Mounika



52.Prasannakalyan

Absent 

53.Kamatham Sneha

Long case : 25/60

Osce : 10/25

AETCOM : 3/5

Log book : 4/10

54. K Rohit



55.Kanakam Aravind

K Aravind 
Roll no 55

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Case link;

Osce and learning points;


56 Mahendra



57 K Vinila Bhavani

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


58.Sri Harshitha


59.. Rithika Vasantha

Long case : 35/60

Osce : 14/25

AETCOM : 3/5

Log book : 6/10

K. Rithika
Roll no. 59
Ht no. 1901006079

Blog ID:

Blog case link:


OSCE learning points link:



Comment on the last link :

What are the reference links? Are these your own statements? 

Also we were expecting some organic chemistry formula breakdown of sugar and fat conversion!?? 

Who were the others we had given this assignment?

60.Kundana Kanumilli



61.K. Lahari

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


62.subba reddy

Absent 

63.Srinija Karnekanti



64.Lekhana

Name :K. Lekhana
Roll no:64

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


Blog link:

Osce link:


65.Suchitha Kola

Name: SUCHITHA KOLA
Roll No: 65

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10
 
-BLOG LINK:



-OSCE and LEARNING POINTS LINK:


-PaJR GROUP LINK:



66. KVN Sudheer Kumar



67.K. Sai Likhitha



68.Naga Meghana



69Likitha Godavarthi



70.Luckshetty Nitin Kumar



71. Laxmi Sowmya



72.M. Sri Chakra

Name- M Sri Chakra
Roll no-72

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Blog link


OSCE link



73.M. Yashwitha




OSCE : 


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

 -Case: CKD with maintenance hemodialysis with anemia and Hypertension .

My learning points :

- I have learnt , importance of history taking for the diagnosis and treatment of the patient.


-  I have learnt about the role of NSAIDS  for causing acute renal failure .


-I have learnt importance of urea and creatinine level in monitoring the CKD patients .

- I learnt that how to approach a patient with back pain.

- I learnt about compressive myelopathy relation with back pain.

74.Madam Sneha



75.Sudarsan Sai Mallarapu




11/30, 8:35 PM]: 

Name: Easha 
Roll 76


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Learning points:

•I've learnt about different types of pneumonia and how it effects the patients on a personal level 

•i have learnt how proper history taking help in easy and appropriate diagnosis of the condition 

•i have learnt about various organisms causing community acquired pneumonia in great detail .
•i can now make out difference between bronchial and vesicular breathing and various adventitious sounds 
•ive learnt about ecmo 
•i've learnt about different treatment modalities

Osce:

Roll 77 absent on Friday 01/12/23


12/1, 7:27 AM]: 

Name : Md Asjad Alam
Roll no. : 78

Long case : 35/60

Osce : 15/25

AETCOM : 3/5

Log book : 8/10
.



Osce question link



12/1, 7:22 AM] : 

Name : M. Koushiki
Rollno :79


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

Learning points :


▪︎ What is the role and importance of a ventilator in patient with low saturation levels but can have his own breaths 

▪︎how to read the breaths  supported by  ventilator  and the patient own breaths in the monitor 

▪︎ types of lung collapse - due to bronchus  lung collapse  and peripheral collapse and various conditions of lung collapse 

• different types of breathe sounds and their ausculatory findings 

•Treatment modalities for a patient with pneumonia 

Osce pajr link  


 List of problems: tightness of abdomen , tingling sensation and  weakness , dysphagia might be due to upper respiratory  infection 

•how furosemide is causing muscle cramps and weakness  this drug is helpful to patient to relieve pedal edema  ,  decrease abdominal distention but giving  muscle cramps .

•strict abstinence of alcohol and patient have to be supersvised  at home properly 

•Iv fluids are adviced without causing fluid overload





12/1, 7:04 AM]: 


Name : M. Soumya
Roll number : 80

PaJR group link:

log case:


OSCE:

Long case : 32/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Learning points:


1.I came to know the possible mechanisms of injuries to kidney due to exposure to NSAIDs

, toxins Aluminum phosphide , zinc phosphide etc 

And what tissue inflammation glomerular or tubular and its influence on the concentration of urine

2.Indications of dialysis and factors indicating the therapeutic outcome of dialysis

3.Learn about hyperuricemia and its clinical manifestation as gout and its precipitating etiological factors and treatment

4.Also faced problem to ask a detailed history of patient especially about his Rat poisoning ,a psychological entity


12/1, 7:47 AM]: 


M.Devi Sree 
Roll:81

Long case : 30/60

Osce : 12/25

AETCOM : 2/5

Log book : 4/10


Blog:


Pajr:



Name:- Vivek
Roll no. 82 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

Long case:-


OSCE and learning points:


85.Morampudi varshith

Name -varshith 
Roll no -85 

Long case : 30/60

Osce : 10/25

AETCOM : 2/5

Log book : 5/10

Osce and learning points:


  Long case


[11/30, 7:19 PM] : 


Mohammed wahaaj 
Roll no : 83 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10
 


12/1, 8:15 AM]: 

Name: Moovika
Roll 84

Long case : 28/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10



[11/30, 7:21 PM]

 Name : M Siddu 
Roll no : 86 

Long case : 35/60

Osce : 14/25

AETCOM : 3/5

Log book : 5/10





12/1, 7:50 AM]: 

M.Shwetha
Roll No.:87


Blog link:

12/1, 10:58 PM] : 

Name: M.Shwetha
Roll no.:87

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Blog link:

Learning points:
 
- I have learnt about the hess test which is positive in my patient and also importance of hematocrit value in dengue treatment.

-I have learnt input of fluids and output charting of fluids is important in management of this case.

- I have learnt Importance of treatment plan to avoid complications like dengue shock syndrome.

OSCE link:





[11/30, 7:41 PM]

Name : M. Aishwarya
Roll No : 89

Long case : 32/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10




12/2, 12:44 AM] : 

Name : M. Aishwarya
Roll No : 89


OSCE link :


OSCE Q&A :

1) I have learnt about the difference between bronchial and cardiac asthma

2) I've learnt of how adipokines can cause reduced insulin sensitivity and related obesity, metabolic syndrome and diabetes

3) I've learnt how to differentiate between rapid acting and intermediate acting insulins based on their appearance alone and how to administer them.

4) I have learnt the 4 steps of management of asthma, difference between a hospital vs a non hospital setting.

5) I've learnt the importance of following up the patient's diet plan, post-treatment to make sure her diabetes is under control to negligible.


[12/1, 6:44 AM]: 


Name : M. Raghavendra
Roll number : 90


Long case : 35/60

Osce : 13/25

AETCOM : 3/5

Log book : 7/10


Log book link:


pajr group link:


Learning points:

1. Importance of occupational impact on health
2. Indications of dialysis
3. Differentiation between arthritis and arthrgia clinically
4. To rule out other differentials based on history given
5.  To differentiate between joint pain, muscle pain and bone pain
6. Rat poisoning effect on renal and other systems 



12/1, 10:03 PM]: 


Name:-N.Jasmisri
Rollno-91

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

My blog link:-



My learning points :-

-I have learnt that Regular Bp monitoring importance in dengue

- I have also learnt the importance of investigations like hess test, hemotrict value ,platelet count monitoring

-Pathogenesis of platelets detoriation in dengue


OSCE link:-



[12/1, 7:44 AM] :

Sneha Nadipi 
Roll 92

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Blog

PaJR


N. Lavanya  Roll 93 

Long case : 25/60

Osce : 12/25

AETCOM : 3/5

Log book : 5/10

  





Name P Charitha
ROLL no 95

Long case : 32/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Blog link


Pajr link

12/1, 9:25 AM]: 


P. Sri Sai Sanjana
Roll no. 96

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Log book link:


12/1, 7:41 AM] : 

Name : P.V. Abhigna 
Roll no: 97 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10




Case learning points : 

1. Cardiac Asthma: I have that asthma can have pulmonary or cardiac cause. A CCF can mimic the symptoms of bronchial asthma so it's crucial to explore CVS as well. 

2. Adipokines and their role in the development of DM2, and metabolic syndrome.

3. The mechanism of action of Biguanides and long and short acting insulin.

4. Steps in management of acute severe asthma 

5. Recognising the clinical features of asthma. 

6. Learnt about follow up regarding educating the patient about their diet and  counselling them regarding dietary modifications.



[12/1, 8:39 AM] : 


Name: P. Chandana
Roll no:98

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Log book link: 


Learning points:

- Today I learnt that the metabolic disorders can be known and can make a diagnosis by just looking at the person.

- I learnt that the asthma can also be associated with cardiac symptoms and cardiac asthma can also be diagnosed.

- Adipokines can be related to the insulin sensitivity and diabetes 

- Management of bronchial asthma 

- Regular checkup and follow up of the patient is as important as treating the person.



[12/1, 6:56 AM]: 

Name : p.vaishnavi
Roll number:99

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10



Log book link:

12/2, 10:53 AM]: 


Name : p.vaishnavi 
Roll no : 99 
Learning points:
I have learnt , importantance of history taking to know the main cause of the disease

How exposure to toxins effects the health

How Frequent use of NSAlDs 
Causes injury to kidney and impair its function

Learnt about indications of dialysis
Learnt about renal parenchymal disease



[12/1, 9:01 AM]: 

Name : P.Vasavi 
Roll.no : 100

Long case : 32/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

PaJR:


Case report 



 


101-

Name :P Rakesh
Roll.no:101


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10



OSCE and learning points:







104- Jeshmitha Perumalla - https://jeshmitha104.blogspot.com/

Name : P.Jeshmitha
Rollno:104

Long case : 32/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Learning points  - 
STATUS EPILEPTICUS 
*maintenance and loading dose of phenytoin 
* structural causes of CNS in epilespy
* importance of levitirecetam in status epilepticus 

- community acquired pneumonia: auscultation-
characteristic difference between inspiratory and expiratory bronchial breath sounds (gushing & hollow sounds respectively) 

-Differential diagnosis of bull neck 
-In ckd patient - percussion of distended abdomen & shifting dullness





105- Pranathi Reddy Zillella - https://pranathi105.blogspot.com/

Long case :


Long case : 32/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


Osce - 


Learning points

• I have learnt about the various organisms causing pneumonia and their clinical manifestations. 

• I have learnt to differentiate  between coarse and fine crackles on ascultation. 

•  I got an oppurtunity to learn about ECMO - extracorporeal membrane oxygenation , its working priniciple and its significance in respiratory failure

•  learnt about Changes occuring at the level of alveoli in ARDS

•  In one of the dengue case presented by our peers, i got to learn about various mortality rates associated with different viruses

Name : Pranathi Reddy.Z
Roll no: 105




Name -  Ananya P.
Roll number - 106

Long case : 32/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


 OSCE questions and learning points -



107



108
R.Koushik Chandra

Name:Koushik 
Roll no:108

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

Longcase:



109-R Sumanth raj



Name:- R sumanth raj
Roll no:-109

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10




110



111
Riddhi Bhalla



112
Rishika Koloti

Pre-final examination 
Date -2/12/23

Name : Rishika Koloti 
Roll : 112 


Long case : 40/60

Osce : 14/25

AETCOM : 4/5

Log book : 8/10





113
Riya Gupta


114
Sai Ajay Bompalli


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

115
Sai Charitha Reddy

Name: Sai Charitha Reddy M
Roll no : 115


Long case:


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


Osce and learning pionts:


116
Sai Praneeth Bathineedi

Name: Sai praneeth.B
Roll no: 116

Long case:

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

OSCE AND Learning points:


117
Sai Prasanna Kasam

Name :Sai prasanna Kasam
Roll no :117



Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10



118
Sai Sudhindra Babu Kusu

Long case : 28/60

Osce : 10/25

AETCOM : 3/5

Log book : 5/10


119
Sandela Roopesh

Long case : 28/60

Osce : 10/25

AETCOM : 3/5

Log book : 5/10

120
S. Nikhil Kumar

Name: S.Nikhil Kumar
Roll.no:120


Long Case:-


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

OSCE and Learning Points:-




Pajr Group link:-


121
Sanjay Bandaru

Long case : 25/60

Osce : 10/25

AETCOM : 3/5

Log book : 5/10


122
Vanshika Savla

Long case : 25/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10


123
Seemala Anjali

Name : Seemala Anjali
Roll no. 123


Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10
  
Osce and learning points:


124
Shaardul Shivam Jha

Name- Shaardul Shivam Jha 
Roll no.- 124 

Long case : 35/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10




125
Afrin. Sk




Name : sk. Afrin 
Roll. No: 125 

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10

Learning points and OSCE :

Roll 139 150 151 153 154  156 157
163 164 169 172 173 174   176 181 184 186 190 194 195 196 197 were absent for the 2019 pre final held from Nov 28 to Dec 7

126

Singareddy Manasa

Long case : 35/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


127
Soumyadeep Biswas

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


128
Subhiksha.R

Long case : 30/60

Osce : 12/25

AETCOM : 3/5

Log book : 6/10



129
Chandana Tallamraj

Long case : 35/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



130 
Tejomayi Algubelli

Long case : 28/60

Osce : 12/25

AETCOM : 3/5

Log book : 4/10


131
T. Durga

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


132
T. Gowthami

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



133
Thota Vaishnavi

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10




134 
Tvisha D

Long case : 32/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



135 UMR.Akanksha

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

136.
Dedeepya Vemuri

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



137
Ujwala

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



138
Vagisha Rani

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10





139
Vamshitha Reddy

 Absent 





140
Vana Mounika

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



141
Vikram adithya

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

Name: vikram.                                  Roll no: 141.                                      



142
Vanka Divyasree

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



143
Vankadoth Sai Teja

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


144
Varshitha Kalidindi

Long case : 25/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


145
Veebhuthi Dilliswar

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


146
Venkata Meghana Badam

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10




147
Viswanath Garudadhri

Long case : 25/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


148
ADLA GREESHMA

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

149
AKKETI RITHVIKA


150
BADDAM HIMASRI REDDY

Long case : 25/60

Osce : 10/25

AETCOM : 3/5

Log book : 5/10


151






153

Absent 

154 CHINTHAKUNTLA SOWMYA RANI

Absent 

155.CILIVERU JASWANTH  RAJ

 



155. Jaswanth raj

https://jaswanthraj30.blogspot.com/?m=1

Long case : 30/60

Osce : 11/25

AETCOM : 3/5

Log book : 6/10


OSCE answers


156.GANTA BHANU SRI

Absent 

157.GUNDABATHUNI SAI KIRAN


Absent 

158.I AKHILA

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



159.IRUGURALA RAVALI

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



160.JARPLA RISHITHA



161.K SAI HARSHITHA

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



162.KALLEM ALKEYA

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


163.KALLEM SHIVANI

Absent 

164.KANDI SHIVANI

Absent 

165.KEERTHI J MALLYA

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



166.KOMIRESHETTY MANIDEEP

Long case : 31/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



167.KOTHA KAVYA

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



168.KOTTEKOLA SREEJA

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


169.LAKSHMI PRASANNA BADDAM

Absent 

170.MAHANANDI MAHESH

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



171.MANKAR ANJALI VILASRAO


172.MARUPAKULA HAARIKA

Absent 

173.MAYAKALA AJAY KUMAR

Absent 


174.MD BILLAUDDIN

 Absent 

175.MOHAMMED KHIZER UDDIN

MOHAMMED KHIZER
Roll no: 175

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



OSCE AND LEARNING POINTS




Rollno 77 VAISHNAVI 

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10


176.MOTTE JAHNAVI


Referred 



177.NAWAZ SAIF ALI SHAIK

Long case : 35/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10




178.NITHIN REDDY GAMIDI





179.NOMIKA ALLI

Long case : 35/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



180.PASHIKANTI MADHAV




181.PISIPATI ABHIRAM


Refered 

182.PUJALA NIKHILA


183.PULAPARTHI  JAHNAVI

Appeared earlier on 29th November (scroll up) 

  


184.RUGVEDH NAIDU YALLA
 Refered 



185.S JESWANTH



186.SAMA SOWMYA SRI
Refered 



Sk.ishrath Parveen 
Roll no.187

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



BLOG LINK:


PRE FINAL LEARNING OSCE QUESTION:


188.SHIVANI KOMMERA


189.THATIKONDA SHARATH

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10

TSharath.                                     
 Roll No:-189.                              
  Hall no:-1901006179.                                                                         
Case link:-https://sharath189.blogspot.com/2023/12/60-year-old-female-with-ckd-on.html?m=1                                        


190.VANGA TARUN VENKATA  LAKSHMI NAGAMANI


Refered 

191.VUTLAPALLY HITESH


Rollno:191
Name :Hitesh 
Hall ticket no:1901006198

Long case : 40/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10



Case link:


Osce and learning points link:


192.YADAVALLI JAYA SRUJANA





193.YELAGANDULA SIDDHARTHA




194.TURGAA SATYA SRIDEVI KRISHNA HARIKA

Refered

195. K. KAVYA SREE
Refered

196. BELLAM SOWMYA
Refered

197. KALLEPALLI NEEHA SRUTHI
Refered

198. PALAGONI DIVYA


Name: Divya Polagoni
Roll No: 198 

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10
 
Pre Final Blog Link:

Osce Learning Points:



Long case : 20/60

Osce : 10/25

AETCOM : 3/5

Log book : 4/10


200  POTTI SAI KIRAN

P Saikiran.    Roll no 200
Hall ticket no : 1801006133

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10
 


Blog case link :

OSCE AND LERANING POINTS:



201.P. MAYUKA

roll no. 201 
name : P. Mayukha 

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10
 




202.Syed sadat Hussain

Syed sadath hussaini
Roll no.: 202

Long case : 30/60

Osce : 13/25

AETCOM : 3/5

Log book : 6/10
 







HEMIPLEGIA: OSCE AND LEARNING POINTS






Posted by at No comments:

Monday, November 27, 2023

MBBS General Medicine revised practical exam plan from NMC and KNRUHS

There has been a recent change of exam conduct plan and marks for MBBS General Medicine


Previously the marks allotted for practicals were 100 only for 1 long case and 2 short cases and the candidate had to obtain more than 50 marks to pass the exam. 

In the revised November 2023 plan, the total marks has increased to 200 and there is separate formally assessable slots not only for long cases and short cases (which contains the same 100 marks as previous with just another addition of 10 marks as long case is now 60 marks and two short cases amount to 50 at 25 each) but also there is currently marks for testing student's competences on OSCEs (25 marks), AETCOM (5 marks) and logbook (20 marks).

Previously viva used to be 20 marks and added to theory marks and currently the viva has been made 40 and we presume will be taken into the practical total marks. 




The long, short case and viva are traditionally established practice and we shall go with the established tradition but we need to introduce a few points about osce, AETCOM and log book as they haven't been commonly assessed traditionally.   

OSCE (25 marks) : 

Introduction: 

Most learning is a process of objectively structuring subjective complex multidimensional real life data (blooms level 3-5) into a two dimensional space (blooms level 1 aka knowledge) that can be stored forwarded asynchronously and modeled conceptually to gain understanding (blooms level 2) through further analysis ( level 4) and evaluation (level 5) and then relooped into the learning ecosystem as creative communication/publication (level 6). This learning is cyclic and one can keep moving in and out of these levels at any entry or exit point regardless of level numbers. 

More about bloom levels in a past lecture here :


Problem statement :

Objectively structured clinical evaluations OSCEs have been regarded as a medical educational assessment tool for many decades and at some point threatened the long case into extinction. (1-2) 

However gradually people may have realized that traditional OSCEs are simplified simulations that disregard real world complexities and create an illusion of certainty for learners and assessors alike. (1-2)

Solution: Modification of traditional format preserving realism and clinical complexity developed through candidate's ability toward Socratic questioning also leading to further analysis and evaluation of the long case leading to Bloom level 6 learning insights  on the case not just as a one time summative assessment over a short period of hours but over days of the patients stay in the hospital and subsequent follow up at home all the while continuing the student's evaluation through direct 360 degree observation by multiple evaluators and their feedback inputs around the patient serving as valuable assessment indicators during thematic analysis. (2) 


Methods :

We have developed a modification of traditional format preserving realism and clinical complexity developed through candidate's ability toward Socratic questioning also leading to further analysis and evaluation of the long case leading to Bloom level 6 learning insights  on the case


AETCOM (5 marks) :

The attitude, ethical sensibilities and communication skills of a student can be evaluated based on their reflections of their past patient experiences as illustrated here :



And for the entire batch here :


LOG BOOK (paper based offline as well as online learning portfolios) 20 marks 

We have encouraged all our students to maintain their regular learning logs in online learning portfolios and in the link below to our CBBLE dashboard here : https://medicinedepartment.blogspot.com/2022/02/?m=0, one can find thousands of "online learning portfolios" of our medical students from five and more batches  with their logged and regularly evaluated patient narratives toward their formative assessment that goes to formulate their internal assessments marks and is also an evolving question bank for the university final and NEET exams. 

CBBLE stands for case based blended learning ecosystem first described here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/

Long case and short case (60+25+25 marks )

For more about the university and NMC (regulators body) guidelines for conducting the final MBBS practical viva exams click here

 : https://medicinedepartment.blogspot.com/2021/03/final-university-mbbs-medicine.html?m=0

Quoting from the above link :

Long and short cases (60+25+25 marks)

"Emphasis should be on candidate’s capability to elicit history, demonstrate physical signs, write a case record, analyze the case and develop a management plan.

Viva (40 marks) 
 
Viva/oral examination should assess approach to patient management, emergencies, attitudinal, ethical and professional values. Candidate’s skill in interpretation of common investigative data, X-rays, identification of specimens, ECG, etc. is to be also assessed."


Please find the details of the previous exam and marks from 2022-21 here: https://medicinedepartment.blogspot.com/2022/06/brief-chart-on-time-allotted.html?m=1


MCI examination guidelines PDF linked below:


Finally we come to how exactly we wish to conduct the examination here locally so that 

1) There is minimal intrusion in the local patient centered workflow thus not harming patients 

2) There is maximal utilization of this additional learning in the regular workflow thus actually benefiting patients."


Link to the recordings of our Medicine MBBS and MD university exams 👇


Link to our CBBLE dashboard here : https://medicinedepartment.blogspot.com/2022/02/?m=0, which contains thousands of "online learning portfolios" of our medical students from five and more batches  with their logged and regularly evaluated patient narratives toward their formative assessment that goes to formulate their internal assessments marks and is also an evolving question bank for the university final and NEET exams. 

CBBLE stands for case based blended learning ecosystem first described here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/
Posted by at No comments:

Friday, November 10, 2023

Notice of Sunday holiday for faculty and students

 


Posted by at No comments:

Saturday, October 28, 2023

Ongoing project: Plant and animal models of distributed meta cognition and parallels with distributed medical meta cognitive systems such as UDHC

"What we understand by mind, or cognition, is the result of a very complex interaction between the elements that constitute the living body, where these continuously adjust their relations through time and in an ongoing exchange with the environment (Bateson 1972; Maturana and Varela 1980)."


Plant models :

"Plants also sense and perceive fluctuations in their environments, registering several kinds of environmental cues and multiple interactions among these simultaneously (Trevawas 2003, 2004, 2005; Karban 2015). These are not merely phenomena of sensation and perception, of signaling and communication, but that they could constitute part of extended plant cognition (EPC)."


TIFR CUBE conversational learning transcripts :

[10/27, 10:40 PM] Rakesh Biswas: Can we use this 👇


as a model system for plant meta cognition

[10/28, 4:38 AM] Nagarjun Thota: Mirabilis Jalapa expressing Codominance or incomplete dominance.. differing from mendel’s theory.. does environment affect expression of genes!!? I was very fond of this plant in younger ages.. especially due to its grenade shaped seeds😁.. one observation made was it’s seeds get thinner as days go on.. my opinion this plant can be a potential subject for plant cognition and gene expression studies.. any cubist interested to pitch in..collaborate for gene expression studies??

[10/28, 4:41 AM] Nagarjun Thota: Long back picture took on 28.04.2019 at chattisgarh by Dr Nagarjun.. currently I’m not holding any seeds of it.. need to search like we did for Cardamine

[10/28, 4:45 AM] Nagarjun Thota: Also did you remember we discussing about red and non red varieties among various plants.. anyone up to collaborate.. can observe for uniparental inheritance and environmental effects..


[10/28, 4:47 AM] Nagarjun Thota: Further can explore on non-nuclear gene expressions..

[10/28, 7:11 AM] Himanshu Joshi Cube Nimhans: Good to know about the expression of co dominance or incomplete dominance ( I guess the colour of flowers), which makes this plant an exception to mendel theory.. 
Why does this happen? Does    mirabilis Jalapa inheritance through non nuclear genes? 
If yes then *Inheritence without nuclear genes* sounds interesting! 
But how exactly does it happen in this plant. 
How can you introduce *plant cognition* in this regard? 
@⁨Nagarjun Thota⁩

[10/28, 8:07 AM] Prof Farhan : This plant is common in Mumbai, in fact even I used to cross pollinate manually and then collect their seeds to study expression of flower colour. It's amazing to work with this plant. Flowers come in different colors.

[10/28, 8:43 AM] Prof Arunan TIFR CUBE : Let's *get hold of seeds of this plant* and simultaneously understand *what you mean by Plant Cognition*.😇 @⁨Nagarjun Thota⁩

[10/28, 4:43 PM] Urmi : This is amazing. This whitefly, a herbivorous insect acquires a plant gene by HGT to neutralise plant’s defence to itself. 

[10/28, 6:59 PM] Rakesh Biswas: Earlier discussion around this in this group last year archived here👇


The metapsych meta cognition connection between plant and animal intelligence?

Animal model :

Snail :

[10/26, 10:13 PM] CUBE chatshala : Today we are discussed the feeding behavior of a snail.  

Previous discussions archived here :




[10/27, 7:56 AM] Rakesh Biswas: This will become an animal model for our ongoing medical metapsych metacognition project. 

Original article here👇


Human :

Other than routine medical cognition tools of  system 1 eyeballing pattern recognition, we use routine tools of system 2 asynchronous intelligence aka primordial AI aka academic learning to solve real patient problems.

Developing the Medical metacognition problem statement at the beginning of the introduction to all our ongoing projects is because, it's at the core of all our projects using both system 1 and 2 cognitive processing:

System 2 thinking began as an asynchronous academic tool to make communication and thinking slower to suit our individual workflows. 

However this essence of academics also makes our three dimensional existential reality two dimensional as that helps to somehow better analyze our three dimensional existence manifest in daily random events and even manipulate the randomness toward apparently improved outcome events.

Of all the routine system 2 tools, we have been largely enamoured by a few that we have written about  in the past and  continue to use them daily in our community patient follow up and family adoption through online PaJR groups which are the online components of our case based blended learning ecosystem CBBLE and the two have evolved from what has been often described in the past as "user driven healthcare" which has it's own big fat text book here :  https://www.amazon.in/User-Driven-Healthcare-Narrative-Medicine-Collaborative/dp/1609600975
as well as had a journal with the same name since 2011 here: https://www.igi-global.com/journal/international-journal-user-driven-healthcare/41022

More about our tryst with "using medical cognition tools to optimize clinical complexity" in this 2023 guest lecture at AIIMS, Bhopal archived here: https://medicinedepartment.blogspot.com/2023/10/medicine-department-presentations-2023.html?m=1

Ethical clearance obtained for this major project stem here : http://medicinedepartment.blogspot.com/2023/04/?m=0

Clinical professional development CPD organized on the theme of optimizing clinical complexity is 

Completed and published medical cognition projects :

Clinical complexity and PaJR tools 2023:  https://pubmed.ncbi.nlm.nih.gov/37335625/


Five ongoing old projects on the above theme :

1) Creating dynamic user driven ontologies : http://userdrivenhealthcare.blogspot.com/2022/?m=0





5) Collective, user driven conversational contextual peer review of real time open access research submissions and creation of dynamic user driven learning community ontologies UDLCO 



Current journal UDLCO :

Dr Tella Shruthi :



Ongoing projects previously shared in  2021 in the dsir template on request :


We can broadly divide our "medical cognition" into the right and left path. 

The right path projects are reasonably understandable from a modern perspective, while the left path projects are slightly post modern and may not be included in the offical departmental lists although they will still be linked appropriately in case someone visiting this site is curious. 




Posted by at No comments:

Healthy Harvard plate in Telugu

 

The copyright belongs to Harvard institution and this translation has been done by our patient advocates purely to help spread the message available in their publicly available (but not globally translated) webpage here :  https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/



Telegu :

మన శరీర బరువు పెరగకుండా మరియు మన పొట్ట పొడవు 80 సెం.మీ కంటే తక్కువగా ఉండేలా మన ఆహారం ఉండాలి. ఏమి తినకూడదు? చక్కెర మరియు పిండితో కూడిన ఆహారం పూర్తిగా నిలిపివేయబడింది. బిస్కెట్లు మరియు బ్రెడ్ పిండితో తయారు చేస్తారు, కాబట్టి బిస్కెట్లు మరియు బ్రెడ్ తినడం మానేయండి. నెలకు 500 గ్రాముల కంటే ఎక్కువ నూనె వినియోగించరాదు. ఏమి తినాలి ఫుడ్ ప్లేట్‌లో 40% వివిధ ఆకుపచ్చ కూరగాయలు మరియు 10% వివిధ రంగుల పండ్లు. మిగిలిన సగంలో బియ్యం, గోధుమలు మొదలైన తెల్లటి గింజలు మరియు దుంపలు (బంగాళదుంపలు) ఉంటాయి.

Mana śarīra baruvu peragakuṇḍā mariyu mana poṭṭa poḍavu 80 seṁ.Mī kaṇṭē takkuvagā uṇḍēlā mana āhāraṁ uṇḍāli. Ēmi tinakūḍadu? Cakkera mariyu piṇḍitō kūḍina āhāraṁ pūrtigā nilipivēyabaḍindi. Biskeṭlu mariyu breḍ piṇḍitō tayāru cēstāru, kābaṭṭi biskeṭlu mariyu breḍ tinaḍaṁ mānēyaṇḍi. Nelaku 500 grāmula kaṇṭē ekkuva nūne viniyōgin̄carādu. Ēmi tināli phuḍ plēṭ‌lō 40% vividha ākupacca kūragāyalu mariyu 10% vividha raṅgula paṇḍlu. Migilina saganlō biyyaṁ, gōdhumalu modalaina tellaṭi gin̄jalu mariyu dumpalu (baṅgāḷadumpalu) uṇṭāyi.







Posted by at No comments:

Wednesday, October 4, 2023

Variety of diet plates shared in PaJR from different parts of India


Telangana 



http://manikaraovinay.blogspot.com/2023/02/25m-with-chest-pain-and-sob.html


https://chandanavishwanatham19.blogspot.com/2023/01/18-m-with-post-covid-mis-c.html




http://amilidutta137.blogspot.com/2022/12/17f-suffering-from-pcod.html

Posted by at No comments:

Faculty reverie on learning ecosystem optimization

We consultants, PGs, interns, UGs are all part of a system that needs optimization. 



Looking back to when I was a PG (we didn't have UGs or interns in that program), I realize the only way I learned Medicine was to make a log of what were the patient events on meticulous history and my examination findings. 



Computers or internet were a rarity and most of our learning happened on the patient's file  (analogous to our current PaJR groups) where as PGs our job was to meticulously record everything on the file and I remember getting feedback from my seniors during my causalty postings through my file notes. 


We had continuous casualty and EMD ward postings for a month, where we did all procedures that are done here in ICU and there was no separate department of EMD. 


I still remember feeling nice when seniors appreciated my line drawings of the clinical images that I sketched in my file case reports before I transferred my patients from the casualty and I have forgotten the toxicity that I faced from them although there is a theory that perhaps that toxicity that I encountered myself as a trainee doctor may have gone a long way to subconsciously shape my own current toxicity! 


What I witness now in the PGs is that the task that we thought most important for our post graduate intellectual development, that of learning asynchronously through the paper based ecosystem by working hard to log our own inputs in the paper based files has been relegated to the UGs and interns by the current PGs who are not even realizing what a vital component of their training they are missing! 



As a result we are forced to treat the interns as our PGs because the PGs cannot possibly present anything useful in the rounds if they haven't made any effort to develop their knowledge of patient's particular requirements! 


Off course even if we are forced to treat the UGs and interns that way they are allowed by the curriculum to spend too less time to learn and contribute anything substantial. 


A simple overhaul of medical training into the previous apprenticeship pattern that is currently threatened by a decadent, static, theory driven curriculum all over India can go a long way to solve the problem



Posted by at No comments:
Subscribe to: Posts (Atom)