diabetes and a refractory skin ulcerations

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here december 2016 after collecting informed patient consent (form downloadable here) by BMJ Elective Student.

Diabetic's Data Visualization & Queries -1

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here december 2016 after collecting informed patient consent (form downloadable here) by BMJ Elective Student.

History :- https://bmjcaselogvivek.blogspot.in/2017/11/23-years-old-women-with-diabetes-and.html?m=1




Questions:-

+91 91406 54820:-  3 straight lines = 90 , 100 & 130 for reference to Normal FBS and normal PPBS
+91 91406 54820: moving trend lines to show average update of blood glucose level.
+91 91406 54820: lowest - 51 near fatal?
 +91 91406 54820: taking proper insulin + medicine and diet control but blood sugar level (graphs) rarely in normal range
+91 91406 54820: aren't medicine/insulin+drugs intervention expected to keep blood glucose levels withing normal range?
 +91 91406 54820: are they failing here?
 +91 91406 54820: 5, 7, 15, 23, 30 a patter shown that around gap of 1 week her ppbs2 going very high. is she taking sweets / high sugar after avoiding/controling few days. ( sweets are addictive )
+91 91406 54820: FBS , PPBS, PPBS2 are so much out of normal range but PPBS1 is so close always. any insights about this?

Questions:-
+91 91406 54820: same data from JAN 2016.
+91 91406 54820: is it a better visualization (clinical significance) of varying blood glucose levels?
+91 91406 54820: showing better way, how far patient is from normal and for how much duration in a month.
+91 91406 54820: need to find an algorithm or design a custom one to do some mathematics on this. will update about that in someday late.

Need Advice on Blood Reports

42/F, married, 12.5 yr T2D (gestational), hypothyroidism (Hashimoto), Lichen Planus in the mouth and steadily extending below the neck region, history of Bell's palsy that reversed, multiple off n on events of hypotension and hypoglycemias ..  

HbA1c remains 8.5 on average ....

Hb remains 10 on average ...microcytic hypochromic anaemia on PBS

Also has multiple degenerative lumbar discs and cervical spondylosis 

Completed Tests/Profiles :
1. ALKALINE PHOSPHATASE, SERUM
2. CALCIUM ; SERUM
3. CREATININE; SERUM
4. GLUCOSE FASTING :PLASMA
5. GLUCOSE PP : PLASMA
6. Lipid Profile;BASIC; SERUM
7. Liver Function Test (LFT)Serum
8. PHOSPHOROUS;SERUM
9. UREA BLOOD
10. URIC ACID ; SERUM
11. CBC ( COMPLETE BLOOD COUNTS), BLOOD
12. ERYTHROCYTE SED. RATE (WG) BLOOD
13. GLYCOSYLATED HAEMOGLOBIN-HBA1C
14. PERIPHERAL SMEAR (PBF)
15. Thyroid Profile ,Total;T3,T4,TSH Ultrasensitive ;THYROID PANEL IV

De-Identifying patient data

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528047/figure/fig1/

UDHC Citizen Science

This is a citizen science approach in medical science to engage school (and college) students to learn clinical problem solving.

A Doctor (clinician) takes history from patient and then try to find out clues as symptops and events in life of a person and take help of medical reports to come to a diagnosis and help to cure it. Same way our citizen scientist will work with these steps.

1) A Signed Informed Consent Form - this is a form to ask permission from patient/patient family to collect their health information/data and share it in UDHC Netrowk.

2) Taking History - A history of a patient don't need to be always a list of medical jargon, any student can talk to a patient and collect information about their story, like what happened, when happened, what treatment started etc... simply need is to create story of patient's journey with any disease in a text format and one more important thing is add if patient have any specific question/need. ( do not hesitate about adding anything that patient tells you, best way is to add all information they say.)

3) Taking Medical Records - Simply take pics of all important medical records ( or all if you don't understand what important and what not ) and De-Identify them. De-Identify means hide all information that gives, patient's identity as given here. How to De-Identify is given here).

4) Update all information in a Blog and share in UDHC network so that all can engage and try to solve patient problems/questions.


Consent forms:-
Signed informed consent from the patients have been taken using the consent forms. 

for training/implementation of this contact me at - avi33tbtt@gmail.com or +917318510434 (whatsapp)

7 Life stages

Medical Cases at Various Life Stages

1 - Fetal stage - Hydrocephalus in a 7-month-old fetus and currently a healthy new born baby  http://bmjcaselogvivek.blogspot.com/2017/10/hydrocephalus-in-7-month-old-fetus-and.html

2 - Neonate - A 49 days old infant baby with persistent Jaundice since 3 weeks http://bmjcaselogvivek.blogspot.com/2017/10/a-49-day-old-neonate-baby-girl-with.html

3 - Child - An 18 Year Old Girl with Recurrent Fever http://bmjcaselogvivek.blogspot.com/2017/10/an-18-year-old-girl-with-recurrent-fever.html
Continued back pain of my daughter aged six and half years Past three months http://care.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=331

4 - Adult - Pregnancy that changed her life http://sivapuramsai.blogspot.in/2017/05/pregnancy-that-changed-her-life.html?m=1

5 - Middle age - Suspected diaphragm palsy http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1313

6 - Old age - Dolls eye movement http://sivapuramsai.blogspot.com/2017/05/copd-with-infarct-dvt-pneumo-thorax.html

7 - Death - 60F with Coma, E Coli sepsis and upper motor neuron signs with albumino cytological dissociation in CSF. http://classworkdecjan.blogspot.in/2016/12/60f-with-coma-e-coli-sepsis-and-upper.html?m=1


1) Empathy (Text Prose Poetry)
2) Sketches. Paintings
3) Sculptures, sand/clay/stone art
4) Music
5) Video
6) Drama
7) Innovation

Consent Forms for BMJ Elective Students

- consent form Online Forum English - here
- consent form BMJ  English - here

- consent form BMJ Telegu - here
- consent form Online Forum Telegu - here

- consent form Online Forum Hindi - here
- consent form BMJ Hindi - here

- consent form Online Forum Bengali - here
- consent form BMJ Bengali - here

Using Fever Chart

There are regular monitoring of patients in ICU for fever and also sometimes patients are advised to make a fever chart so that clinician can better understand the disease and condition of patient.

Here is a temperature chart made with excel to plot it automatically and accurately.

1) click link to get access temperature chart

https://docs.google.com/spreadsheets/d/1nkemyO_WaB0TMWbpKfhUVcnbfZco8l-MZ0XwJFSZIZc/edit#gid=0


2) For each new patient go on top left in chart, click on File, then click on make a copy.
A new copy of fever chart will open, rename it as anything you want.  (not recommended to rename based on patient identifier as that not HIPAA compliant).

3) now in Time column enter date time as (mm/dd/yyyy) 1/22/2017 14:00:00 and in temperature column enter temperature as degree F

4) Chart will be made automatically. only enter 4 hourly values if need 4 hourly chart.



Fig 1- Hourly chart


Fig2- 4 hourly chart

64 - year old patient with recent diarrhoea after a stroke and past diabetes

Disclaimer:-

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here december 2016 after collecting informed patient consent (form downloadable here) by BMJ Elective Student.

43 F- Familial polyposis ( colectomy or polypectomy?)

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here december 2016 after collecting informed patient consent (form downloadable here) by BMJ Elective Student.

Haemoglobin very low everytime <4, blood in stools, since 6-7 years

aviced- colectomy by one surgeon, polypectomy by another. needs discussion.

Telemedicine - 62 F - Hip fracture, multiple surgeries and failure for same with long term complications

A 62 year F Hip fracture, multiple surgeries and failure for same with long term complications

Disclaimer:-

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here december 2016 after collecting informed patient consent (form downloadable here) by BMJ Elective Student.

I was unable to stand up while sitting, so dr. said some problem in spinal cord and gave medicine, i also started using commode etc in lifestyle.

around 1 year ago i fell down and broke my hip joint, since then i had multiple surgeries and all failed, i am bed ridden, doctor asked me to try walking without a walker but i was not even stand without walker and its even difficult to walk with a walker. so i am always on bed, sitting. i was a working female but now i can't even stand.

after 1st surgery in few months i became unable to move my knee also but after physiotherapy it went fine but again in sometime it went bad and more surgeries happened for my hip.

 observation:- reflexes are normal, always having pain, more while trying to moove,

Had some spinal problems - 8 years ago

Hip fracture fracture 1 year ago

after 1st surgery

some days after 1st surgery

in 3 months, it became extremely difficult to moove left knee, started physiotherapy

informed by another doctor about failed surgery

second surgery (6 month after 1st)

failure of 2nd surgery in a month

3rd surgery

Crack in cement of 3rd surgery in 6 month.

some spinal X-Rays