Linci gunaseelan
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Linci gunaseelan
Presenting complaints:
Known case of SLE since 2007,
Pulmonary hypertension,
Interstitial lung disease,
Mitral regurgitation,
Polyartralgia,
Past history:
H/O Rt CVA recovered 2007,
H/O Lupus nephrits,
H/O lupus pleurits,
Known DM,HTN,Dysdipidemia,
Total Hysterectomy, cholecytectomy done
Seizure disorder(febrile)
Post herpatic neuralgia-2007
B.P: 140/90 mmhg
Pulse:97/min
Heart:murmur
Investications:
Blood reports
Random blood sugar:87 mgs
Urea:21.22 mgs
Creatinine:1.22mgs
Cholesterol:219 mgs
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Uric acid:5.26 mgs
C.R.P:+ve in in 7.84 mgs
R.A:Negative
c.p.k:40.00 IU/l
H.B:11.8 gms
ESR:8/22 mmhr
Platlet count:2.3 lks
TC:6,800 cells/cumm
Dc :P 66%L32%E2%
Urine routine:
Albumin:+
Deposits:5-10 pus cells,3-5 epi cells
Sugar : nil
Liver funcution test:
Bilirubin (total):0.42 mgs
Direct:0.18 mgs
S.G.O.T: 34 IU/L
S.G.P.T:31IU/L
Alkaline phosphatase:126.0 u/l
Total protein:7.36 mgs
Albumin :3.22mgs
A/G ratio:0.77 ratio
Micro albumin:82.69 mgs
C3-1.71 gm/dl
C4 :0.24gm /dl
Hba1c:6.8%
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ABG:165 mgs
ANA WESTERN BLOT:strong +ve for PCNA,DsDNA,Nucleosomes,histones
Can occurs in SLE in SLE,RA,Drug induced lupus erythematous.
Chest x ray PA view
Cardiomegaly
ECG: sinus tachy cardia,
Antero septal myocardial infarction (possibly Recent V1,V2,V3,V4)
Excessive overload of lt atrium.
CT-Chest: Air space opacities with interstitial thickening fibrosis in basal segments
of bilateral lower lobe minimal fibrosis.Loss of volume in rt middle.
Pneumonitis with secondary cardiac failure changes in lung with early ILD
Mild bilateral pleural effusion
Moderate cardio megaly noted.
ECHO: Normal lt ventricular systolic funcution
LVEF:73%
Mild lt ventricular dysfunction
Mitral regurgitation moderate
Mobile Echogenic mass 3.5*0.76 size attached just below the posterior mitral leaflet
with a membranous portion causing on eccentric obsrtution in the lv cavity during
systolic resulting in dynamic mild lt ventricular outflow obstruction.
Pulmonary HTN_Mild
Pulmonary regurgitation mild
Tricuspid regurgitation-mild
treatment
NAME:Dana sekaran
Presenting complaints:
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Weakness of both upper limb,lower limb.
Sudden onset,not of progressive nature
No h/o fever,diarrhoea
Had h/o frequent urination before onset.
No dysartria
No dysphagia,
Bladder bowel intact
Past history
No DM,HTN
No APD
Smoking,alcohol occ
No surgeries
On examination
Plantar:mute (B/L)
Muscle power:0/5( B/L)
Upper &lower limb
Hand grip:1/5(B/L)
DTR:ABSENT(B/L)
Diagnosis:GBS
Urusthamba ,sarvanga vatam.
Investications
Blood report
RBS:132mgs
Urea:50.00 mgs
Creatinine:1.00mgs
Cholesterol:231 mgs
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Uric acid:6.53mgs
C.R.P:-ve in 5.63 mgs
S.G.P.T:63 IU/L
C.P.K:29.00
HB:14 gms
ESR:2/6 mmhr
TC:8100cells/cumm
Dc:p 60%L35%E5%
Plt.count:2.4 lakhs
Billirubin:total 1.24 mgs
Direct:0.46 mgs
T.F.T- normal
USG-Abdomen &pelvis taken
Mild splenomegaly
Rest of the visualized abdominal organs normal
CT-Brain
Imp:Normal study
MRI Cervical spine
Imp:normal study
NCS
Interpretation:Features suggestive of asymmetrical acquired motor neuropathy of
axonal type.motor neuropathy.
Treatment
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Internally
Ashta varga kashayam- 60 ml 3 times before food
Lasuna ksheera kashayam-100ml at night after food
Resonadi vati-2-0-2(after food)
Bhallataka grutam-10 ml with milk kashayam at night(after food)
Ashwagandharistam 25 ml BD( A.F)
Kasturi gulika 2-0-2 (A.F)
Purna chandrodayam 1-0-1(A.F)
Externally,
I phase:Udwartanam(triphala churnam)
IIphase:Abhyangam ,jambeera pinda svedam(sahacharadi kuzhambu)
IIIphase:Pizhichal,matra vasti (saha vp)
IVphase:Kashaya vasti(Dvi pancha muladi vasti)
Vphase:Abhyangam kashayadhara
Ganeshan
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Moderate kypokinesia of septal antero septal &anterior walls.
Dilated lt ventricle < atrium
Moderate lt ventricular systolic dysfunction
LVEF:27%
Mild lt ventricular diastolic dysfunction
Rheumatic heart disease
Aortic regurgitation severe.
Treatment principle
Sophaharam,hrydyam,vata anulomanam,moothralam
Treatment
I phase:
Bruhatyadi kashayam- 60 ml 3 times (B.F)
Maha dhanwantaram gulika -2-2-2 with kashayam(B.F)
Arjuna ksheera kashayam -60 ml at night (A.F)
Nerinjil satavari paneeyam-200ml/day
Dasamoola haritaki-20 gms at night(A.F)
IIPhase:
Arjunaristam -25 ml morning & night after food
Marutham caps-2-2-2 (A.F)
Maha kasturi gulika 3-3-3(A.F)
Nayopaya kashayam-60 ml 3 times (B.F)
Triphala churnam -2 tsp with hot water at night (A.F)
Chandra praba vati-2-0-2(A.F)
Svarna bhasmam-
IIIphase:
Srnga bhasmam-25 mg twice a day after food
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Ardha vilva paneeyam -200 ml /day
Punarnavadi kashayam 60 ml 3 times (B.F)
Kushmanda rasayanam-1 tsp 2 times (A.F)
Prabakara vati -2-2-2(A.F)
Sapta vimsati guggulu -2-0-2(A.F)