Summary (imrad) :
Results (chronology from 2019-18) pending thematic analysis :
Detailed minutes data date wise :
Minutes of today's meeting 11th may 2019We began with updating the audience about this patient E logged by the PG here: https://sufialmas.blogspot.com/2019/05/65-year- old-male-farmer-by-occupation. html?m=1 and presented in the last meeting by Dr Bhawani, Intern and Dr Anusha, SR.Currently the patient is still comatose on ventilator and his sepsis has again worsened.Clinical Audit:
The handwritten referral register kept with the Nursing superintendent, where residents from all departments make a note of the reason for referral was studied to identify the competency gaps with a plan to make it a regular real time audit presentation from each PG during the audit component of the meeting.In today's meeting we read out from the images of the referral register shared in advance in the web log central group for the PGs to prepare their answers.Referral 1:The referral done in view of lack of equipment here to isolate a tuberculosis patient was explained in detail by Professor and HOD Microbiology and it was concluded that an N95 mask for the caregivers and ordinary mask for the patient would suffice. It was decided to make a note of this to the administration and ma'am shall also share a link to the guidelines for active TB isolation here. Later in the online shared guideline it was pointed out that the N95 is mandatory for MDR TB and not all TB.Prof of Microbiology: "Proper control of ventilation to lessen the load of bacteria in AIIR is required. This is through proper engineering control of isolation room. But CDC recommend Respirator usage as infection preventive measure for HCW working in isolation room for Tuberculosis . One more thing is whether it is MDR or non MDR, it is Mycobacterium that will get transmitted by air born route .Prof Medicine: Thanks ma'am. Let's specify our requirements to prevent TB contagion to the administration here so that we don't have to refer our active TB patients to higher centers who are assumed to be currently able to meet those requirements better than us.Let's find out and specify here what equipment they have which we don't and then let's debate the evidence based justification for that equipment here.Referral 2The referral for anterior abdominal wall necrotising fascitis was due to unfamiliarity with the condition and inability to take the decision on further management around this patient as it was a relatively rare presentation. This was as discussed by Dr Nikhil SR Surgery and Prof Prabhakar, Pediatric Surgery.Discussion minutes on cases presented on May 11, 2019
Two mortality cases were discussed for two hours and the third case of morbidity couldn't be discussed due to time and was postponed.
Discussion minutes on cases presented April 23, 2019
Chronic Morbidity:
39M with a chronic cheek ulcer and post operative pancytopenia with cheek excision biopsy results still awaited.
Presenters: PGs and staff from the department of Otolaryngology along with PGs and staff of pathology.
2) Acute Morbidity
19 year old woman with recent onset fever, shortness of breath, abdominal pain treated as cerebral malaria underwent ventilation for ARDS along with tracheostomy.
Insert images of chest X-rayPresenters: Dr Vinuthna, Dr Deepak, PGY-2 from department of Medicine along with Dr Sudheer, consultant incharge of the patient from department of Medicine.
b) 70 year old man with altered sensorium, left sided flailing involuntary movements and a blood sugar of 700 along with renal failure
Presenters: Dr Pavani, Intern, ICU, Dr Deepak, PGY 2, Dr Keerti, PGY2 and Dr Anusha, Dr Sudheer from the department of Medicine
The M&M meeting also continues in a blended learning online Web log central platform frequented by faculty (few) and students (lurkers) and following are some of the online conversational minutes shared in and around the date of the "face to face" meeting on April 21, 2019:"The piece here by veekayvee (kindly shared by our medical superintendent) makes this important point that "Evidenced based medicine" is never taught in our medical schools. How many of us or our students know the NNTs of any of the drugs we keep prescribing with godlike impunity each day? Isn't it time we started teaching and learning "Evidence based Medicine" in both UG and PG at least in our own Institute?The first step to learning EBM is to encourage our students to ask questions as to what is the efficacy of an intervention that we are about to deliver (in a godlike manner perhaps at an ungodly hour).The second step would be to structure the question in a PICO format such as how many (P)atients had been trialled on with this intervention in the past? What was the exact (I)ntervention they received? How many people were there in the (C)omparator (placebo) group and finally what were the (O)utcomes in the placebo vs the intervention group.All our M&M meetings are held with the sole purpose of instilling this question asking ability in our students. After one year we have been able to push some of them to at least start asking questions even if not in the PICO format. We have a long way to go.All our PG presenters are encouraged to ask us these questions around the patient they are supposed to present way before the meeting date but they are almost always unable to communicate their questions on whatsapp well in advance before the presentation. We can help them to formulate the PICO questions and search the answers to the questions only if they share their patient data with us way before the presentation."
Clinical Audit:
The handwritten referral register kept with the Nursing superintendent, where residents from all departments make a note of the reason for referral was studied to identify the competency gaps with a plan to make it a regular real time audit presentation from each PG during the audit component of the meeting.No sample E-log notices to concerned PGs were shared that week.Discussion minutes on cases presented April 23, 2019
1) Chronic Morbidity:
DISCUSSION PLAN:
25 yr old primi gravida with 31wks 4 days gestational age with severe preeclampsia with oligohydromnios with IUGR with absent diastolic flow on 4/4/2019
Presenters: PGs and faculty of unit 4, OBGyAdditional discussion inputs by pre eclampsia and oligohydramnios thesis students Dr Alekhya and Dr Anjali
2) Acute Morbidity
49 year old woman presented to pulmonary medicine department on 2/4/2019 with diabetes mellitus and miliary tuberculosis and also had a sudden myocardial infarction.
Presenters and discussants:PGs and staff of the department of Pulmonary Medicine.
The M&M meeting also continues in a blended learning online Web log central platform frequented by faculty and students and following are some of the online conversational minutes shared in and around the date of the "face to face" meeting on April 16, 2019:A published report Posted by Medical Superintendent for the benefit of the PGs managing our patients:
Clinical Audit:
The handwritten referral register kept with the Nursing superintendent, where residents from all departments make a note of the reason for referral was studied to identify the competency gaps with a plan to make it a regular real time audit presentation from each PG during the audit component of the meeting.No sample E-log notices to concerned PGs were shared that week.Discussion minutes on cases presented April 16, 2019
1) Chronic Morbidity:
A father, daughter and grandson with squint since childhood.
Discussants: PGs and faculty from department of Ophthalmology
2) Acute Morbidity (with mortality)
60 year with type 2 diabetes since 6 years presents with complaints of fever since 4 days, decreased urine output since 2 days, burning micturition since 2 days and loose stools since 2 days. Is currently on Hemodialysis.
Discussants: Dr Sandeep, Dr Ramesh, Dr Arvind and faculty of Nephrology and Gen Medicine.
The M&M meeting also continues in a blended learning online Web log central platform frequented by faculty and students and following are some of the online conversational minutes shared in and around the date of the "face to face" meeting on April 9, 2019:Prof Medicine: "The tug of war between guideline based defensive medicine and "evidence based medicine" continues."
Prof ENT: "Guidelines must have been on proper evidence only. Why will responsible associations give wrong guidelines."
Clinical Audit:
The handwritten referral register kept with the Nursing superintendent, where residents from all departments make a note of the reason for referral was studied to identify the competency gaps with a plan to make it a regular real time audit presentation from each PG during the audit component of the meeting.No sample E-log notices to concerned PGs were shared that week.Discussion minutes on cases presented April 9, 2019
1) Chronic Morbidity:
A 15 years old girl with involuntary movements and inability to walk since five years.
Discussants: PGs and faculty from department of Orthopedics 2nd unit
Referrals:Opthal PGs and faculty to discuss corneal findings in this patient along with it's differentialsPediatric PGs and faculty to discuss the diagnosis and management of a common differential for this disorder.
2) Acute Morbidity (with mortality)
59M admitted in Pulmonary Medicine with acute hypotension and respiratory distress on 24th March with chronic cough and shortness of breath since last 5 years.
Discussants: PGs and staff of department of pulmonary medicine regarding critical care management and diagnosis of the reason for his acute exacerbation and hypotension.
Referrals:General Medicine PGs and faculty of general medicine to discuss the possible causes for his severe hepatitis and hypotension.Nephrology PGs and faculty to discuss the reason for his renal failure and hypotension.The pulmonary medicine PG, Dr Mudassir presented the patient followed by a few factual questions from the students and faculty in the audience which was answered by the pulmonary medicine PG.The question about the cause for his Hepatitis was answered in detail by the Nephro PG Dr Manasa as she went into the etiology and diagnostic clues to ischemic hepatitis and it's associations such as heart failure.
M&M clinical audit, Minutes of Meeting for 26th March, 2019
These meetings are solely focused on identifying "hospital competency gaps" and improving patient care services using "Evidence based medical audit," through a blended learning, online E log and offline meeting platform.
Following are the past presentation minutes of the offline face to face meeting.
Minutes of meeting on 26th March, 2019:
Patient Updates: None shared by any department.
Audit:
The handwritten referral register kept with the Nursing superintendent, where residents from all departments make a note of the reason for referral was studied to identify the competency gaps with a plan to make it a regular real time audit presentation from each PG during the audit component of the meeting.Although the audit system in our current workflow appears to be suboptimal we continue to hold this slot to reiterate the vital need in the hope of a clinical audit program with more volunteer trainees.
The current failures of the audit meeting was discussed in the past as being due to non-participation in the form of poor sharing of the departmental cases that didn't allow the audit team any opportunity to prepare the cases for discussion as well as derive meaningful insights from the number of cases presenting to the hospital every week. A dedicated clinical audit team formed from members like interns or any other volunteers from every department unit to ensure case sharing was proposed and it was suggested that one could even develop the first clinical audit academic program in India pending approval from the management.
Discussion minutes on cases presented tuesday 26tj March 2019
1) Chronic Morbidity:
" An 8 year old boy with refractory seizures was presented and discussed both by the PGs of the pediatrics and Psychiatry department and many PGs from different departments were made to ask questions which ranged from factual ones such as what does one do if a child has seizures at home to evidence based ones such as efficacy of certain antiepileptics. The treatment of this child was optimized in a manner to reduce the frequency of his seizures.
2) Acute Morbidity (with mortality)
This was a 30 year old woman with pain abdomen admitted under surgery as acute cholecystitis but later as the patient developed sepsis and ARDS the patient was transferred to pulmonary medicine for management of ARDS.
There were some questions raised by department of surgery faculty as the presentation appeared deficient in certain clinical information around the patient.Minutes of meeting on 23rd March, 2019:
The meeting began with many of the faculty objecting to a late paper based notice. They were informed that the notice had been deposited in MS office for circulation on the 20th of March but they had perhaps forgotten to circulate it. The notice had at the same time been circulated in the Web log central group on the 20th of March itself. Faculty members were requested to check our notices from the Web log central group.Patient Updates: None shared by any department.
Audit:
There was a plan and request for the Microbiology department in auditing the current sterilization practices around simple day to day usage of plastic and fibre optic devices such as PFT mouthpieces, endoscopes and biopsy guns. This plan was generated around discussing the first case who was retrovirus positive once it was clarified that universal precautions were the only intervention necessary for all such patients with viral marker positivity.Although the audit system in our current workflow appears to be suboptimal we continue to hold this slot to reiterate the vital need in the hope of a clinical audit program with more volunteer trainees.
The current failures of the audit meeting was discussed in the past as being due to non-participation in the form of poor sharing of the departmental cases that didn't allow the audit team any opportunity to prepare the cases for discussion as well as derive meaningful insights from the number of cases presenting to the hospital every week. A dedicated clinical audit team formed from members like interns or any other volunteers from every department unit to ensure case sharing was proposed and it was suggested that one could even develop the first clinical audit academic program in India pending approval from the management.
Discussion minutes on cases presented tuesday 23rd March 2019
1) Chronic Morbidity:
"A 45 years old woman living with retroviral disease since 6 years of husband’s diagnosis, on HAART since 4 years presented to DVL currently complaining of swollen digits, stiffness of skin and shortness of breath since 2 years.
Discussants: Dr. Shravya, Dr. Praveen, Dr. Swetha, PGY1, Dr. Vennela, Dr. Ravikanth PGY2, Dr. Navaneetha and Dr. Vijay Bhaskar, Asst. Professor and Associate Prof Dr. Vidya Sagar and Professor, Dr. (Col) Ashok Rao Matety, Department of DVL with inputs from Psychiatry around this patient’s coping strategies for living with retroviral disease.Soon after the case presentation by Dr Shravya the PGs were asked to put forward their queries and just one or two PGs came forward spontaneously. This can be made a regular feature so that the discussion around the patient can develop further based on the queries of the PGs especially if they are well prepared by reviewing the case details even as they receive the circular for the meeting. All PGs need to be given an equal opportunity to ask their questions and provide their inputs, serially one by one based on their seating arrangement. We look forward to developing this learning arrangement further positively over the coming months.
2) Acute Morbidity (with mortality)
50 year old man admitted in Medicine from 07.03.19 to 15.03.19 with past history of low backache and arthritis and presently progressive left thigh pain for one month followed by on current admission gangrene developing in muscles of the vastus medialis that was sent for biopsy by Orthopedic team and patient had to be ventilated for ARDS and dialyzed for AKI. He was later noted to have peripheral gangrene in limbs due to critical limb ischemia due to bilateral femoral artery thrombosis by the Surgery and Radiology team that was thrombolyzed intra-arterially by EMD team.
Discussants: Dr. Satish, PGY 1, Dr. Vinuthna PGY-II, and Dr. Anusha, Senior Resident/Asst. Professor department of Medicine along with inputs from Dr. Bhanu Rekha Department of Orthopedics, Dr Khatija, Dr Kaarthik, Dr Fatima, Department of Pathology, PGs radiology around the patient’s skeletal X ray findings as well as Doppler and EMD team around the intra-arterial thrombolytic therapy procedure in comparison to femoral end-arterectomy.Soon after the case presentation by Dr Satish, the PGs were asked to summarize the learning points from the case and share their queries but none was forthcoming. The Orthopedic consultant who had seen this patient during life related his experience with the case and various hypothesis for his cause of the disease was put forward by members of the audience (also in the pharma E log group) but no definitive conclusion could be reached. A proper post mortem autopsy would have been necessary to understand his problem better.
M&M clinical audit, Minutes of Meeting for 19th March, 2019
These meetings are solely focused on identifying "hospital competency gaps" and improving patient care services using "Evidence based medical audit," through a blended learning, online E log and offline meeting platform.
Following are the past presentation minutes of the offline face to face meeting.
Minutes of meeting on 19th March, 2019,
Patient Updates: None shared by any department.
Audit: Although the audit system in our current workflow appears to be suboptimal we continue to hold this slot to reiterate the vital need in the hope of a clinical audit program with more volunteer trainees.
The current failures of the audit meeting was discussed in the past as being due to non-participation in the form of poor sharing of the departmental cases that didn't allow the audit team any opportunity to prepare the cases for discussion as well as derive meaningful insights from the number of cases presenting to the hospital every week. A dedicated clinical audit team formed from members like interns or any other volunteers from every department unit to ensure case sharing was proposed and it was suggested that one could even develop the first clinical audit academic program in India pending approval from the management.
Discussion minutes on cases presented tuesday 19th March 2019
1) Chronic Morbidity:
"20 yrs old woman/G2A1/32 weeks of GA/hypothyroidism/ with thrombocytopenia and leucocytosis
Discussants: Dr Sindusha PGY1 and Dr Amrita, Asst Professor, OBG
2) Acute Morbidity (with mortality)
36 M EMD 02.03.19 to 09.03.19 06:05 AM ? EPTOIN OVER DOSE WITH AKI WITH RESPIRATORY FAILURE REFRACTORY HYPOTENSION and METABOLIC ACIDOSIS Dr.Ravi PG-II
Discussion minutes on cases presented tuesday 12th March 2019
1) Chronic Morbidity:
"60 yr old male pt agricultural laborer residing at Nalgonda District presented to the OPD with shortness of breath and pedal edema since three weeks and on examination had findings in the respiratory, cardiovascular, musculoskeletal and neurological systems.
Discussants: Elective Intern Sanjana Kurimella, Dr Keerti, PGY2 and Dr Sufiya along with medicine senior residents and faculty along with Orthopedics faculty, Dr Haranadh.
The discussion proceeded to ask the following questions:
what is the cause of this transudative effusion?why did he develop right heart failure?
is that due to pulmonary arterial hypertension?? what is the reason for developing PAH? just his ankylosing spondylitis causing restrictive lung disease? is ankylosing spondyloarthropathy because of fluorosis? if so, whats the diagnostic criteria to confirm its because of fluorosis?just epidemology? just bony changes? Are there any differentiating features in the skeletal changes of ankylosing spondylosis and that of fluorosis? if so, what are they? what more can be added to diagnostic criteria? How to manage this patient??
These were answered competently by the participant interns, pgs and faculty.
Dr Sufiya was asked about the LVEDP and RVEDP in addition while she was discussing pulmonary hypertension and she promised to look it up and let us know in the next meeting.
Dr Menon raised a very interesting possibility of tackling the persistent fluoride in the patient's body using novel techniques. Dr Haranadh emphasized the importance of prevention. Another faculty member from orthopedics pointed out the possibility of fluoride exposure from crops and agricultural activities even while the patient may be on DE fluorinated water. The entire case is E logged and shared in the central E log group for future reference.
2) Acute Morbidity (with mortality)
48 M RESP 18.02.19 20.02.19 02:15 AM B/L CONSOLIDATION DUE TO PTB WITH RVD +VE WITH TYPE I RESPIRATORY FAILURE WITH ? SEPTIC SHOCK RESPIRATORY FAILURE Dr.Anusha Rao PG-I
Dr Anusha presented the case and questions were raised by the Surgery faculty around font size and RVD, septic shock and need for mentioning stool for ova cyst in the same line.
The presentation was stopped and the faculty commented that these presentations could be detrimental to everyone.
One solution to this is to make the junior faculty responsible for the presentation of their PGs and the senior faculty responsible for their junior faculty. All departments can be given a twice weekly fixed slot on a roster to present their own M&M cases similar to what is currently existent with the clinical meeting (although in clinical meetings competencies are highlighted rather than competency gaps). The other solution which has already failed currently is to encourage more E logging of their cases by the PGs so that the M&M Team can help select and guide the PGs well in advance. We are miles away from the ideals of "inter professional education" in the WHO document circulated weeks back with the minutes and notice of a past M&M meeting but we need to keep moving.
Minutes of meeting on 9th March, 2019,
Patient Updates: Chronic peritonitis patient operated and gall bladder perforation with thick pus around the gall bladder fossa peritoneum confirmed.
Cases for discussion on Saturday 9th March 2019
1) Chronic Morbidity:
"45 yr old man with chronic renal failure and on dialysis for 1 year that was stooped since last four months after becoming HCV positive. Discussants: PGY 2 Dr Keerti, PGY1 Dr Radha, Dr Sufiya along with medicine senior residents and faculty along with Nephrology faculty.
2) Acute Morbidity (with mortality)
57 M NEPH 21.02.19 22.02.19 04:37AM AKI ON CKD WITH PRERENAL SEPSIS DUE TO BRONCHO PNEUMONIA SEVERE HYPOVOLEMIC SHOCK WITH METABOLIC ACIDOSIS AND AKI ON CKD WITH SEPSIS WITH BRONCHO PNEUMONIA, Dr.Siphora PG-II
Minutes of meeting on 5th March, 2019,
Patient Updates: Colonic carcinoma patient operated and developed a post operative complication of right upper limb monoparesis with MRI showing pneumocephalus. The pneumocephalus was assumed to be unrelated to the monoparesis and possibly related to his epidural catheter. The update was also shared in the central Web log group on March 2nd 2019
Case discussion on Tuesday 5th March 2019
1) Chronic Morbidity:
"65 yr old male came with complaints of abdominal distention and ascites with signs of peritonitis and a diagnosis of gall bladder perforation was confirmed by the radiology on the third CT abdomen within a month of his initial presentation. Discussants: PGY 1 Dr Sufiya and senior resident Dr Anusha and PG Radiology.
2) Acute Morbidity (with mortality)
35 year old woman with ZN phosphide poisoning and anterior wall myocardial infarction along with atrial fibrillation. Discussants PG and SR EMD.
The discussion focused on causes of myocardial infarction in phosphide poisoning and a consensus was reached that it was possibly a direct effect on the myocardium. A question was raised on the usage and utility of streptokinase in this patient as one member from audience said there were studies where empirical administration of streptokinase was shown to be effective in patients presenting with cardiac arrest with EcG not showing changes of definitive MI. This approach was discouraged by another member of the audience and a proper trial in this phosphide poisoning group would be needed to reach a better conclusion.
Minutes of meeting on 23rd February, 2019,
Patient Updates: There were no patient updates shared by any department
Audit: The audit meeting had been E logged as a prescription audit and had been discussed in the pharmacology E log group. It was about a patient who presented to ENT department with Methotrexate toxicity and her previous prescriptions showed glaring issues during the audit.
Case discussion 23rd February
1) 44F Nullipara with incidental adnexal mass. Diagnostic and therapeutic challenges.
Discussion expert: OBG Team managing this patient. Dr Sindhu and Dr Amrita
Discussion Expert: Radiology Team interpreting the USG and MRI of this patient. Dr Venkat, Dr Harish.
The first case was very well presented by the PG and discussed by the consultant OBG with regard to the challenges faced during meeting the patient's diagnostic requirements also in response to the questions posed by the moderator. The Radiology consultant felt that the minor issue for which this lady had to undergo MRIs twice was not worth discussing.
2) 60M with colonic carcinoma (long distance patient) with emergency ileostomy to relieve intestinal obstruction done one month ago is back since one week and awaits definitive surgery in the form of resection anastomosis and tumor removal but OT has been delayed due to poor fitness as the patient is malnourished from his chronic disease.
Discussion Experts: Anesthesia Department, Dr Gopal Reddy, Dr. Vinay, Senior Resident and PG Surgery department and senior resident and Professor Transfusion Medicine department.
The second case was well discussed by the three departments and the consensus was in favor of enteral nutrition than parenteral. There was a debate on the half life of commercially available albumin with the Transfusion Medicine senior resident asserting that it was 19-21 days while the moderator said that it was just 12-16 hours and promised to share a reference for the same which is now shared below:
https://www.ncbi.nlm.nih.gov/
Quoting below from the article linked above:
"The half-life of endogenous albumin is about 3 weeks, while that of blood-derived albumin is only 12–16 hours and is reduced notably in conditions of increased capillary permeability."
Quoting from another article below that explores why natural in vivo endogenous albumin half life is different from commercially available blood derived albumin
"Albumin has an extended serum half-life of 3 weeks because of its size and FcRn-mediated recycling that prevents intracellular degradation, properties shared with IgG antibodies* Engineering the strictly pH-dependent IgG-FcRn interaction is known to extend IgG half-life. However, this principle has not been extensively explored for albumin."
https://www.ncbi.nlm.nih.gov/
3) An 18 year old woman with chronic diarrhoea, significant weight loss, hypoalbuminemia and poorly defined colonic granulomas.
Discussion Expert: Department of Medicine managing this patient Dr Vinuthna, Dr Sufiya, Dr Anusha
The third case was well presented by Dr Sufiya, Medicine PG and the consensus arrived for her patient's diagnostic and therapeutic uncertainty was that the patient can be treated with antitubercular therapy as in our country as the chances of it's being TB are high and treating it as Crohn's particularly with immunosuppresives may result in exacerbation of underlying TB.
Cases for discussion on Tuesday 5th March 2019
1) Chronic Morbidity:
"65 yr old male came with complaints of abdominal distention and ascites with signs of peritonitis and a diagnosis of gall bladder perforation was confirmed by the radiology on the third CT abdomen within a month of his initial presentation. Discussants: PGY 1 Dr Sufiya and senior resident Dr Anusha and PG Radiology.
2) Acute Morbidity (with mortality)
35 year old woman with ZN phosphide poisoning and anterior wall myocardial infarction along with atrial fibrillation. Discussants PG and SR EMD.
The morbidity meeting scheduled for 29th January 2019 (Tuesday) 2.00 pm, Room No. – 111, 1st floor Hospital (Clinical Lecture Hall).
A 65 year old male presented with complaints of difficulty in swallowing and swelling on right side of face since 3 days .
I.P. No. 201902607 to be presented by Department of ENT.
A 65 year old male presented with complaints of difficulty in swallowing and swelling on right side of face since 3 days ,was taken for surgery ,intraoperative difficulty in intubation
I.P. No. 201902607 to be presented by Department of Anaesthesia.
A 2 month old male baby presented with respiratory distress ,cold and cough with regurgitation of milk
I.P. No. 201901530 to be presented by Department of Pediatrics.
A 38 year old male alcoholic brought to casuality in an unconscious sate,intubnated outside.
I.P. No. 201901855 to be presented by Department of Emergency Medicine.
A 65 year old male presented with pain in left hip region,a known case of CKD with history of falls.
I.P. No. 201902570 to be presented by Department of Orthopeadics.\
6. A 65 year old male came with complaints of exertional dyspnea,low back ache and neck stiffness
k/c/o tuberculosis
I.P. No. 201923987 to be presented by Department of Medicine.
Note: All patient related Histopathology, Microbiology and Radiology to be discussed by the respective Pathology, Microbiology and Radiology departmental faculty and presenting clinical PGs should discuss with PGs of Radiology and Pathology, Microbiology well ahead in advance
The presenting PGs are request to consult Dr. Rakesh Biswas from Monday to Thursday evening to prepare their presentations adequately.
The morbidity meeting scheduled for 2nd November 2018 (Friday) 2.00 pm, Room No. – 111, 1st floor Hospital (Clinical Lecture Hall).
1. A 40yr old man with poison consumption, tachycardia and dilated pupils.
I.P. No. 201837080 to be presented by Dr. Sufia Almas 1st year General Medicine PG, Dr. Rajesh, Asst. Prof, Dept. of General Medicine.
A 24 year old woman G3P2L2 with 2 previous LSCS with 37 weeks 3 days GA with mild anemia
Uncertain history about cough and medication used.
I.P. No. 201836050 to be presented by Dr. Bindu 1st year OBGY PG, Dr. Dedeepya 3rd year OBGY PG and Dr. Rama Rao Asst. Prof of OBGY, Department of Pediatrics, General Medicine, Pulmonary Medicine, EMD, Pathology.
.
A 3 month old Baby with severe bronchopneumonia with metabolic acidosis.
I.P. No. – 201835759. To be presented by Dr. Thomas, Prof & HOD of Pediatrics
Note: All patient related Histopathology, Microbiology and Radiology to be discussed by the respective Pathology, Microbiology and Radiology departmental faculty.
The presenting PGs are request to consult Dr. Rakesh Biswas from Monday to Thursday evening to prepare their presentations adequately.
The morbidity meeting scheduled for 19th October 2018 (Friday) 2.00 pm, Room No. – 111, 1st floor Hospital (Clinical Lecture Hall).
A 42yr old man with Fever, cough and rapidly progressive breathlessness.
I.P. No. 201836187 to be presented by Dr. Aditya Samitinjay PGY-1, Dr. M. Manasa Reddy PGY-1, Dr. L. Srujan Reddy PGY-3 and Dr. Varun, Senior Resident, Dept. of General Medicine.
2. An 80 year old man with intermittent breathlessness since 15 years, admitted with sudden progressive breathlessness
I.P. No. 201835306 to be presented by Dr. Anusha, Dr. Mudassir, Dr. Surabhi and Dr. Srikanth, Asst. Prof., Dept. of Pulmonology
.
A 28 year old primi gravida with PPH (Postpartum Hemorrhage) and PPCM (Peripartum Cardiomyopathy)
I.P. No. – 201836617. To be presented by Dr. Sriveni, PGY-2, Dept. of OBG, Dr. Vamshi, PGY-3, Dept. of EMD and Dr. Sunita, Assoc. Prof., Dept. of OBG
Note: All patient related Histopathology, Microbiology and Radiology to be discussed by the respective Pathology, Microbiology and Radiology departmental faculty.
The presenting PGs are request to consult Dr. Rakesh Biswas from Monday to Thursday evening to prepare their presentations adequately.
The morbidity meeting scheduled for 12th October 2018 (Friday) 2.00 pm, Room No. – 111, 1st floor Hospital (Clinical Lecture Hall).
1. An 80 year old man with terminal ileal gangrene with proximal transverse colon perforation.
IP number 201831810 to be presented by Dr . Anand PG Surgery and Dr. Ramesh Asst. Prof of General Surgery Unit - IV.
2. A 70 year old man with lower limb cellulitis, with resistant hypertension and acute on chromic kidney injury since 2 months with type-2 diabetes mellitus since 10 years.
IP number 201833765 to be presented by Dr. Vamshi PG Surgery and Dr Manasa, Dr. Aditya,
Dr. Srujan PG Medicine along with Dr. Lakshmi Narsamma Prof of Surgery and Dr. Rakesh Biswas Prof of Medicine.
3. A 3 Months old child with dextrocardia, cardiogenic shock and septicemia: short discussion by faculty pediatrics.
Note: All patient related Histopathology, Microbiology and Radiology to be discussed by the respective Pathology, Microbiology and Radiology departmental faculty.
The presenting PGs are request to consult Dr. Rakesh Biswas from Monday to Thursday evening to prepare their presentations adequately.
Morbidity Meeting
The morbidity meeting scheduled for 5th October 2018 (Friday) 2.00 pm, Room No. – 111, 1st floor Hospital (Clinical Lecture Hall).
1. 63 year old man with diabetes, facial paralysis and ear pain.
IP number 201834584 to be presented by Dr . Soundarya, Intern along with Medicine PG and ENT PG
2. 52 year old woman with lower limb pruritus since 2 years
IP number 201834133 to be presented by Dr Hina, Intern along with Dermatology, Surgery and Medicine PGs.
Note: The presenting PGs are request to consult Dr. Rakesh Biswas from Monday to Thursday evening to prepare their presentations adequately.
