Rahul Talele, 43 yrs male Case History 2001 Hepatitis detected in February ----- 2-4 weeks treatment taken 2003 December --- jerky injury to spine (sacrum) while travelling on a two- wheeler. Complaints of lower Back pain and paravertebral muscle stiffness since then. Also sacro- iliac joint pain started. 2004 Dysentry on and off every month since March. Has taken symptomatic and anti- ameobic treatment in multiple courses. August - referred to Gastroenterologist Dr. Gopanpallikar, Aurangabad. Colonoscopy and Biopsy of Colon done. Impression - ??? Ulcerative Colitis.. ??? IBD.. ??? IBS Episodes of Dysentry continued with pain in abdomen, repeated aphthous ulcers and associated with weight loss. Treatment taken - Capsule Colorex 750 (treatment in attack -- then tapered and stopped) and Vibact DS. 2005 15 Feb - X Ray - LS Spine, AP/Lateral. Spondylolysis of L5 with slight spondylolisthesis of L5 over S1. March --- Loose motions with pain in abdomen and weight loss (20 kgs) since last six months. Endoscopy done by Dr. Gopanpallikar at Aurangabad. Scope passed upto Splenic Flexure. Transverse Colon, Ascending Colon, Caecum and terminal Ileum not studied due to pain. Impression - ??? Ulcerative Colitis.. ??? IBD.. ??? IBS .. ???Caise - Treatment taken - Capsule Colorex 750 (treatment in attack -- then tapered and stopped) and Vibact DS. April----Ocular Inflammation - treatment anti-infective eyedrops Admitted and Endoscopy done - scope passed upto mid-transverse colon. Impression - Ulcerative colitis in remission. July----High grade fever and shivering twice a day (first episode) This complaint has continued since then. 12 Aug 2005 ---Admitted with complaints of fever with chills. WBC,ESR & CRP raised. No symptom relief. Discharged ??? PUO Sept 2005---Colonoscopy done by Dr. Gopanpallikar -- Ulcerative Colitis, Colonic Ulcer, IBD ??? Pseudo Membranous Colitis. Again admitted to Bhatia Hospital, Mumbai. Investigations - USG - abdomen - mild hepatomegaly 2D Echo , Doppler - LVEF 60% Bronchoscopy - Normal Metabolic Profile - SGPT 15 Unit/Litre -- ↓ SGOT 16 Unit/Lit LDH 87 -- ↓ ESR 112 ↑ Hb count 11.02 gm % RBC count 4.04 ↓ RBC Morphology - hypochromasia +, Anisocytosis + Total WBC count 16101 ↑ Neutrophils (Absolute count) 10949 ↑ Eosinophils (absolute count) 644 ↑ Lymphocytes (absolute count) 3381 ↑ Total Platelet Count 526100 ↑ Widal Test -ve HLA B27 -ve Bactec culture of body fluid (blood) -- no growth Tuberculin test -ve Anti-ds DNA antibody -ve Anti nuclear antibody -ve Bronchoalveolar lavage -- mycobacterial DNA PCR -- not detected HR CT Scan of Chest -- suggested an interstitial lung pattern which may be related to ulcerative colitis. No confirmed Diagnosis ??? PUO Treatment - Colorex, B-plex forte, Tab Off 200 Fever with Chills Continued. Oct 2005 Admitted to Jaslok Hospital under Dr. Sainani for c/o fever with chills. Laprotomy performed for removal of Mesentric Lymphnodes. Investigation -- T3, T4 and TSH -- normal Serum Ferritin 400 ng/ml ↑ HBsAg -ve HCVAb -ve HIV 1& 2 Ab -ve Blood Culture & Sensitivity report - NIL Culture & Sensitivity report (pus from mesentric lymphnode) -- no organism isolated. Biochemical Reports - Chloride 106.3 mMol/l ↑ Bi-carbonate 22.8 mMol/l ↓ Phosphorous 6.4 mg/dl ↑ Uric Acid 12 mg/dl ↑ Serum Alkaline Phosphatase 291 U/l ↑ Urine Routine RBC - occasional, pus cells - 6-7 /hpf, epithelial cells 2- 3/hpf, hyline casts - occasional. Bone marrow biopsy - no evidence of disease Bone marrow aspiration - reactive marrow with mild shift to left. No evidence of lymphoma. ANA/ANF -ve 24 hr urine report - volume 2300 ml , proteins 378mg ↑ CRP 96 mg/l ↑ LDH normal Prothombin time 15 sec ↑ Partial thromboplastin time ↑ CT-Scan abdomen & pelvis- porta hepatic, perigastric, mesentric and few retroperitoneal lymphnodes with hepatomehgaly. Etiology ??? lymphoma ??? USG Neck normal Histopath mesentric lymphnode (Dr. Chitale)- Abscess of mesentric lymph node Histopath mesentric lymphnode (2nd opinion by Dr. Anita Borges) Inflammatory process ??? Whipple's Disease Discharge from Jaslok Hospital with diagnosis of PUO Empiric AKT given for 6 months. Fever with chills still continued. Nov. 2005 Taken Ayurvedia medicine from Anand, Gujarat. Fever with chills subsided. Backache still on. April 2006 Incisional hernia occurred - operated for hernia repair. 2006 - 2007 --- Ayurvedic medicine taken. Aug 2007 Recurrence of incisional hernia - Laprotomy performed and Meshplasty done 3-4 days later - severe abdominal pain ??? intestinal colic. Admitted and symptomatic treatment given. Platelet count very high - 892000 Treatment given - Trendal, Clopitab, Colorex, Rabicip, Zanocin oz given for 5 days. Ayurvedic treatment continued. 2008 Again fever with chills, but frequency less. 2008-2009 Homeopathy treatment taken. During this period muscle weakness increased. Fever with chills continued (2 episodes per week). 2010 Weight Loss, fever with chills, Hb 6.3 gm %, Vitamin A 14.86 microg/dl ↓ Vitamin B1 1.2 micro g/dl normal Vitamin D3 8.6 pg/ml ↓ Serum Protein Electrophoresis Albumin 2.65 g/dl ↓ α1 0.53 g/dl ↑ α2 1.32 g/dl ↑ γ 2.05 g/dl ↑ A Diffused band is seen in the γ globulin region. Serum Folic Acid 2.2 mg/ml ↓ Lipid Profile - HDL 26 mg/dl ↓, Cholestrol HDL ration 5.2 ↑, LDL/HDL ratio 3.4 ↑, Serum Alanine amino transferase 22 unit/l ↓ Serum Alkaline Phosphatase 506 U/l ↑ Bilirubin Direct .33 ↑ Serum Lactate Dehydrogenase 80 U/l ↓ Albumin 2.5 g/dl ↓ Globulin 5 g/dl ↑ Serum Creatinine 0.8 mg/dl ↓ Hb 9.2 gm % ↓ Platelet count 457000 ↑ WBC 15500 ↑ PET Scan Whole Body Hepatospleenomegaly with multiple legions. multiple enlarged lymphnodes. Minimum Pericardial effusion. ??? Granulomatous disease ??? Sarcoidosis, ?? Lymphoma Dec 2010 Admitted to Poona Hospital for Malnutrition. Ascitic Fluid -- Inflammatory cytology. Coagulum present. Xanthochromia +, Protein 4.2 g/dl. Albumin 2 g/dl, sugar 98 mg/dl Total nucleated cells - 900 / cumm. RBC present Ascitic Fluid Culture sensitivity report - no growth. Multiple Hepatic Lesion Biopsy - mild chronic interface hepatitis with microabscesses. Second Opinion by Dr. Anita Borges - Chronic Hepatitis - investigate for Viral, Auto-immune and Granulomatus Disease. Third opinion by Double Helix Clinical Cytogenetics and Reproductive and Immunology Center -- Immunological evaluation revealed the presence of mycobacterium Tuberculosis Complex. MTBrRNA complex by PCR - not detected Bone marrow aspirate and biopsy - mild hypercellular bone marrow with mild lymphocytosis. Chest CT Scan - Few minimally enlarged mediastinal lymphnodes and small pericardial effusion. CT Scan Abdomen and Pelvis - Hepatomegaly with scattered multiple lobe attenuation hepatic lesions. Lobulated spleeno megaly with few ill-defined hypodense lesions. Periportal, peripancreatic and retroperitoneal lymphnodes. Diagnosis -- ??? Granulomatous disease ???sarcoidosis, ?? lymphoma Second Recurrence of Incisional Hernia -- not repaired till date. Decided not to operate till confirmed diagnosis of pathology is done and as muscle weakness also increased Whole Body Gallium Scan - No evidence of active inflammation or infection. Treatment - Tab Becozine, Syrup Bevon, High protein diet, 2011 Referred to Dr. Suresh Shinde (Physician) - Treatment - (from 31/01/2011 to 19/06/2011) - Inj. Steptomycin .75 gm, Tab Levofloxacin 500mg, Mycobutol 600 mg Feb 2011 Started Steroids -- Tab Medrol 8mg April 2011 Added Tab Osteofos (weekly), Cap Beneficiale OD May 2011 Added Sazo EN 1000 - 1 bd, Tab Colospa Retard - 1 bd Chest X-ray -- increased bronchovascular markings bilaterally. Tab Medrol 4mg (tapered down) USG abdomen & pelvis- Liver is normal in size and echotexture and No focal lesions noted. Spleen is normal in size and echotexture and No focal lesions noted. Recurrence of hernia noted. June 2011 High grade fever with chills started. (Dr. Shinde) Hb - 12.5 gm%, WBC 27600 /cumm. Neutrophilia 88%, Plasmodium Vivax and Falciparum, Widal -- -ve Bone Scan report - Inflammatory Spondyloarthritis Liver colloid Scan report - Subtle features of chronic liver disease. Dr.Shinde referred Rahul to Dr.Vijay Ramanan at Yashoda Haematology centre, Pune in June 2011 10/6/2011- Serum By Nephelometry (bone marrow report) IgG 988 normal; IgM 161 normal; IgA 303 normal C4 31.7 mg/dl normal ; C3 180 mg/dl borderline %CD3 + CD45 + T cells 67.1 normal Absolute CD3 + lymphocyte count 2145 (high) % CD3+CD4+T helper cells 53.1% (high) Absolute CD4 + lymphocyte 1699 ↑↑↑ %CD3 + CD8 + T superior cells 13.9% ↓↓ CD4/ CD8 ratio 3.82 ↑↑ He was then Referred to Dr. Mukesh Desai (Haematologist) in Mumbai to rule out MSMD (Mendelian Susceptibility to Mycobacterial disease), ALPS (Autoimmune lymphoproliferative syndrome) & LAD (Leucocyte Adhesion Defect) Anti nuclear AB-IFA, HEP2, serum - negative Liver, Kidney- Micro ABS - 0.3 Normal Coomb's test (direct & indirect)- Negative Prothrombin time- High (15.4 sec) Neutrophils by Nitroblue Tetrazolium (NBT) slide test- 98% Normal CD3/HLA DR- % Lymphocyte -3.6; Absolute lymphocyte count- 245 ↑ CD4 / CD25-- % Lymphocyte - 56 CD8, CD19, CD20, CD16, CD56, CD25, HLA-DR - done Impression-- Possibility of mutation in IL 10 & IL 10 R is a possibility. There is a possibility of NOD2 mutation. July 2011 Added Tab Azoran 50, Cap UbiQ 100; Tab Medrol 2mg Sept 2011 Azoran discontinued due to reduction in sperm count. Nov 2011 last week -- Tab Medrol discontinued. Dec 2011 High Grade fever with chills started. Also associated with dizziness while walking, nausea and anorexia Admitted to Poona Hospital on 27/12/2011due to steroid withdrawl effects Angiotensin Converting Enzyme level - 41 U/l (normal) Antineutrophil cytoplasmic antibodies ANCA-P -ve (4.20), ANCA-C borderline (4.73) Impression - infectious disease. MDCTSCAN of Chest - enlarged mediastinal lymphnodes bilateral minimul pleural reactions. Small pericardial effusions and calcification. ANA Blot profile -ve. Thyroid Panel - T3 - 0.894 ng/ml (raised) ; T4 - 9.12 ug/dl normal TSH -- 5.22 uIU/ml (raised) Procalcitonin 1.3 ng/ml (raised) CRP 18.2 mg/dl (raised) RA factor < 10.1 IU/ml -ve Serum iron 16 mcg/dl (low) Serum TIBC 177 mcg/dl (low) Biochemical Level - Serum Sodium 134 mEq/l (low), Serum Calcium 8.7 mg/dl (low) Total Bilirubin 1.34 mg/dl (high) Direct Bilirubin .92 mg/dl (high) Serum Albumin 2.2 mg/dl (low) Serum Alkaline Phosphatase 306 U/L (high) Serum Ferritin 641.83 ng/ml (high) Hematology:- Hb 8.9 gm% (low), WBC 22100/cumm (high), Neutrophilia 82% , Lymphocytes 14%, ESR 116 (high); Prothrombin time 20.2 sec (high) 2D Echo - normal chamber dimensions. LVEF 60%. Mild pericardial effusion. Weilfelix Test - Antigen OX-K - No agglutination seen even in titre 1:80. Antigen OX-19 - agglutination seen in titre 1:160. Antigen OX-2 - agglutination seen in titre 1:160. Result ---- +ve 28/12/2011 - Brucella - IgG Ab -ve IgM Ab - Borderline (0.084) Discharged on 04/01/2012 with diagnosis of PUO ??? Auto - immune, ??? Vasculytic syndrome ??? brucella + anemia Treatment - Tab Medrol 4mg started, Nudoxy 100 1bd, Faromen 200 1bd, Shelcal DS 1 bd, Cap Autrin 1 od, Calcirol sachet 1 weekly. 14 Jan 2012 - Referred to Dr. Arvind Chopra (Rheumatologist) Suspicion of Whipple's Disease, Treatment - Medrol 4 mg, Doxy 100 1BD, Hydroxychloroquine 400 OD 2 Feb 2012 Added Proxym XT 1HS At Poona Hospital: Histopath of Jejunal Biopsy - near normal Duodenal & Gastric biopsy - moderate nonspecific duodenitis, acute gastric ulcer, No evidence of Whipple's disease. Second opinion for Duodenal & Gastric biopsy- Dr Anita Borges- Sections show gastric and duodenal mucosa with chronic inflammatory cell infiltrate in the lamina. The gastric mucosa shows ulceration with overlying acute inflammatory exudate and regenerative atypia. No evidence of Whipple's disease 23/4/2012 Hb 13.2 gm%, WBC 19600 (high), ESR high, CRP +ve, Serum Alkaline Phosphatase 210 IU/l (high); SGPT 55 IU/l (high) Added Zyncovit. 19/06/2012 Synovial Fluid Analysis - normal Added E-diclopar, Livogen Oct 2012 Chronic throat infection with fever and knee pain. Referred to Dr. Shinde. Treated with Zifi turbo and Winolap (5). Nov 2012 Hb 10.1 gm% (low), WBC 15700 /cumm (high), Nutrophilia PET Scan - impression - chronic liver disease. 2013 Routine haematology investigations done. No change from previous readings Treatment of Whipples ds. discontinued. 17/5/2013- Post subcapsular cataract detected. Tab Medrol tapered to 2 mg by Dr.Shinde 14/7/2013 - Hb - 14.4 gm%, WBC- 19800 high Cataract operated (right eye) on 15/7/2013 22/7/2013- Cataract operated (left eye) 2014 01/03/2014 HLA - B27 by Flowcytometry (negative) - 108 LMF Sr. RA factor -ve Again referred to Dr. Arvind Chopra for seronegative spondyloarthritis & use of biological agents Treatment started- DFZ 6 mg, HCQS 400 mg and Doxy 100 mg, Neurobion, Shelcal 500 mg, D 360 satchet, Proxym XT 10/5/2014- Tab Ezycoxib added but not consumed by patient Ezycoxib started in August for 8 days. BP started rising, C/O Breathlessness. Hence stopped. Dytor 5 mg started and given for 3 weeks. then tapered and stopped 10/09/2014 T3 0.77 ng/dl ↓ T4 7.36 ug/dl normal Ultra TSH 8.23 ↑↑ Sr. Protein 5.3 gm/dl ↓ Sr. Calcium 7.7 mg/dl ↓ Sr. Cholesterol121 mg/dl ↓ Sr. Alk Phos 186 ↑↑ Plasma Homocysteine`15.26 umol/L ↑↑ PTH 14.38 pg/ml borderline low 11/09/2014 USG Abdomen & Pelvis - Marginal hepatomegaly with altered coarse echostructure of Liver. Splemomegaly with mild simple small cysts and a haemangioma in it. Incisional Hernia 17/09/2014 -Ultra TSH 4.5 uIU/L normal 10/12/2014- Deflazacort discontinued 14/12/2014 Admitted for Acute dysentry with moderate dehydration Stool Examination - Pus cells 150-200 /hpf ↑↑↑ RBC 18-20 /hpf ↑↑ R-substance -ve Plasmodium Vivax & falciparum Ag -ve Hb count 9.1gm%, WBC - 7500/cumm (normal), Neutrophils - 78, Ionic Calcium, Sr. Na+, K+, Cl- normal Treated with IV Tobramycin and IV metrogyl + IV fluids. 17/12/2014 Hb count 8.8gm%, WBC - 5500/cumm (normal), Neutrophils - 70 (normal) Stool examination R substance - +ve Pus cells 10-12 /hpf RBC Nil Fat globules ++ Chest Radiograph - bilateral hilar prominence 18/12/2014 USG Abdomen & Pelvis Mild hepatomegaly with liver parenchymal disease. Moderate to gross Splenomegaly with splenic cyst. 19/12/2014 Operated ↓ GA for piles (prolapsed strangulated) Milligan Morgan haemorrhoidectomy done. 20/12/2014 Severe backache started for which he was referred to Dr. Anil Khadke, Jalgaon (orthopedician) MRI Scan of both hips and S1 joints- Multiple small benign cysts in pelvic bones. Minimal right hip joint effusion. Hyperintense signal intensity areas seen in bilateral gluteal muscles ??? muscle contusions/edema 31/12/2014 Urine -- Protein +nt; Pus cells occasional, Epithelial cells 2-3/hpf CR - Protein Assay - weak positive (Latex aggulatination) Total protein & Sr. Albumin ↓ Sr. Alkaline Phosphatase 187 (normal) Sr. Potassium 3.2 ↓ Hb - 9 gm%, WBC - 12900/cumm, Neutrophils - 57% (normal) Mild hypochromia, microcytes ++, Anisocytosis TSR ↑↑ 46 mm after 1 hr. 05/01/2015 Total protein & Sr. Albumin ↓; Sr. ALk, Phosphotase 449 ↑↑ Hb 9.5 gm%, WBC 24200/cumm ↑↑, Neutrophils 75% ↑ Mild hypochromia, microcytes ++, Anisocytosis 09/01/2015 Referred to Dr. Arvind Chopra regarding hospital admission & complaints of dysentry, backache and operated piles. Dr. Chopra suggested CT scan of Thorax, abdomen and pelvis. CT Scan of Thorax - A tiny fibronodular opacity in the right middle lobe. ??? granuloma CT Scan of Abdomen & Plevis - mild hepatomegaly with cirrhotic changes with multiple ring enhancing hypodence lesions of varying size scattered in both lobes of the liver. Moderately enlarged spleen with lobulated surface and few small cyctic lesions within. Eccentric wall thickening in the ascending colon. Few subcentimeter sized nodes in the pre and para aortic, aortocaval and ciliac regions. Dr. Chopra suggested to have liver biopsy. He referred to Dr. Vinay Thorat in Poona Hospital. 11/01/2015 BP ↓↓ (80/45 mmHg), Fever (high grade) ?? Deflacort withdrawl effect Admitted to Poona Hospital on 12/01/2015 under Dr. Vinay Thorat (Gastroentrologist) to plan for liver biopsy. Investigations - Sr. Calcium 77 mg/dl ↓ Hb 9.2 gm% ↓, WBC - 22200/cumm ↑↑, Neutrophils 75 (normal) Platelets 4.26 (normal), lymphocytes 17 ↓ ESR 105 mm ↑↑, Sr. Urea 23 mg/dl (normal) Sr. Creatinine 1.3 mg/dl borderline Sr. Sodium 132 mEg/L ↓ Sr. Potassium 3.9 mEg/L (normal) Sr. Chloride 97mEg/L ↓ LFT Total Bilirubin 0.85 mg/dl (normal) Direct Bilirubin 0.53 mg/dl ↑ Indirect Bilirubin 0.32 mg/dl (normal) SGPT 22 U/L ↓ SGOT 15 U/L borderline Sr. Total Protein 5.76 gm/dl ↓ Sr. Albumin 214 gm/dl ↓ Sr. Globulin 3.62gm/dl ↑ Sr. Alkaline Phosphatase 323 ↑↑ Tropomin - T test 0.152 ng/ml (+ve) C.K. ((MB) 66 U/L ↑ Chest X-ray sitting AP - normal ESR 127 mm ↑↑ CRP 12.3 mg/dl ↑ PT 17.2 sec ↑ INR 1.46 ↑ Sr. Magnesium 1.2 mg/dl ↓ Sr. Calcium 8.2 mg/dl ↓ Sr. Iron 70 mg/dl normal TIBC 164 mcg/dl ↓↓ Sr. Ferritin 326.89 ng/dl ↑ 13/01/2015 2D Echo - Dilated RA & RV, large anteroseptal , apical & mid-posterior wall akinesia. LVEF 35%. Early diastolic dysfunction. All cardiac valves normal. Minimal mitral regurgitation. Mild tricuspid regurgitation. Mild pulmonary hypertension. RVSP - 45 mm/Hg ??? cardiomyopathy ?? Ischemic 15/01/2015 Stool exam - mucus +nt; Pus cells 10-15/hpf and in large clumps within mucus flakes.; RBC 0- 1/hpf and in mucus flakes, Budding yeast cells +. Hb 8.2 gm%, ↓ WBC 12400/cumm ↑ Neutrophils 80; lymphocytes 16 ↓ Albumin 2.51 g/dl ↓; α1 and α2 normal β 0.49 g/dl ↓ total 5.71 g/dl ↓; Ratio A/G 0.79 borderline Angiotensin Converting enzyme 49 U/L -- normal 16/01/2015 2D Echo - large anterosepta Akinesia. Moderate LV systolic dysfunction, EF 35%. Mild pulmonary hypertension. Discharged on 17/01/2015 with T/t - Shelcal, Neurobion, UbiQ, Flavidon MR, Magrion forte, Tab. Wysolone 10mg 1 OD 27/01/2015 High grade fever, hypotension (89/42 mm/hg) Repeat episode on 30/01/2015 + breathlessness while walking and standing. Admitted to Poona Hospital on 31/01/2015 under Dr. Shinde 2D Echo done - LVEF - 60%; No pulmonary hypertension Hb- Low , WBC count - High. Rest investigations similar situation 15/5/2015- D12 collapsed so 2 rods and 10 screws of titanium implants in spine (osteoporosis was -4.6 because of steroids). 16/8/2017 Admitted to Poona Hospital for Pneumonia. whole body PET CT scan - Impression- Pyrexia under investigation- this study shows FDG avid abdominopelvic lymphnodes, diffused splenic hypermetabolism. MD CT scan of abdomin and pelvis - Impression - 1. Hepatomegaly with irregular liver surface suggest cronic liver parenchymal disease. No arterial enhancing lesion in the parenchyma. 2. moderate spleenomegaly 3. multiple hypo-enhancing focal lesons in both lobes of liver and spleen with retroperitonial and mesentric lymphadinopathy are highly suggestive of disseminated Koch's infection. Other possibility of sarcoidosis can not be excluded. 4. No spleenic abscesses seen. 5. Bulky pancrease without focal abnormility or peripancreatic inflammatory changes 6. minimal pelvic ascites MD CT scan of chest- Impression- 1. Bilateral mild basal pleural effusion with underlying collapsed- consodillation in the posterobasal segments of both lower lobes. 2. A few marginally enlarged mediastinal lymphanodes of doubtful significant. 3. fixator divice in lower thoracic spine with D6, D12 compression factor. MR cholangiopancreatography- impression- Hepatospleenomegaly and multiple nodular T2 hyper intense lesions in liver and spleen along with extensive retroperitoneal and mesentric lymphadenopathy. In view of history disseminated tuberculosis is likely. Histopathology report by dr. Anita borges Speciman- 1.paracaval lymphnode - benign reactive lymphnode and no granulomas are seen 2. paraaortic lymphnode - non necrotising granulomatous inflammation of undetermined etiology. Special stains for acid fast bacilli and fungi are negative 3. right iliac lymphnode biopsy - reactive lymphadenitis Comment- In the absense of demonstrableacid fast bacillis, there is no histological way to distinguish non- necrotising tuberculosis from sarcoidosis. Blood Reports Haemoglobin - 8.8 WBCs - 22800 ESR - 118 Plateletes - 383000 Urea - 19 Creatinine - 1.02 Sodium - 134 22/1/2019 Dischrge summary provisional diagnosis on admission ??.hepatic encephalopathy with acute left ventricular faillure. in known case of cronic liver parenchymal disease, myeloproliferative disorder. Ischemic heart disease. Final Diagnosis- 1. septic shock(blood culture enterococcus) 2. acute left ventricular faillure, EF- 45% 3.acute kidney injury(recovered) 4. in known case of cronic liver disease 5. ?? autoimmune disorder 6. myeloproliferative disorder 7. Ulcerative collitis blood reports- Haemoglobin - 8.8 WBCs - 48871 Plateletes - 183000 creatinine - 1.64 urea - 46 Total billirubin - Direct billirubin - 1.27 Indirect billirubin - 1.01 SGPT - 18 Total Proteins - 5.22 Albumin - 1.97 Globulin - 3.25 SGOT - 36 Alkaline phosphate - 215 16/1/2020 Admitted for pneumonia in bhusawal. after discharge went to pune for consultation 31/1/2020 Investigations liver elastography - Impression- Severe fibrosis X-ray Abdomin - Impression - Rt.basal solitary nodule, need further evaluation by CT chest and abdomin USG abdomin and thorax - Impression - 1. Diffused fatty hepatomegaly with spleenomegaly(early cirrotic) 2. very minimal ascites without signs of portal hypertension 3. large ventral hernia MD CT scan of chest - impression - 1.well defined round to oval shaped nodular lesion in anterobasal segment of right lower lobe. Disease of intermediate aetiology. This is mostly suggestive of benign nodule. Follow up and SOS histopathological corelation is suggested. 2.Multiple old calcified granulomas are seen scattered in bilateral upper, lower lobes, right middle lobe and lingula. 3.visualised bones appears osteopanic. 4.Old fractures of anterior ends of right third and forth ribs, manubrium sternum. 5.Anterior wedging of T4,T6,T7,T9,T10,T12 vertebral bodies. 6.Internal fixator devices are seen in situ in lower dorsal spine. Bone Density Report- BMD - -4.1 CT guided biopsy of nodule in right lower lobe of lung is done on 7/2/2020 Histopathology(core biopsy) speciman right lung lesion trucut biopsy-Impression - Organizing exudate with surrounding sclerosis and mild cronic inflammation. No granuloma or malignancy. At the time of biopsy pneumothorax was occured and admitted in MJM hospital for observation. on 8/3/2020 again admitted for pneumonia, After 10 days treatment discharged with medicine. After 2 weeks,breathlessness and plural effusion seen in right lung, so drain was inserted and 2liter fluid removed. At that time fluid is milky. Average 1liter fluid discharged daily. After one week dr. Jaswant Patil's homeopathic treatment was started. Slowly fluid discharge redused and becomes yellowish transperant fluid. Finally drain removed after one month. Now I m suffering from itching and rashes on skin. current allopathic treatment- Levigress 500mg OD Mesacol 400mg OD Shelcal 500mg OD Deflaxacort (DFZ) 6mg OD Dytor 5mg BDS Multivitamin OD 31-3-2020 There is large homogeneous radio-opacity in right lower zone, silhoutting the right costophrenic angle, diaphragmatic silhouette, and cardiac silhouette. 1-4-2020 Tapping is done from back, plural effision removed appro. 600ml. 5-4-2020 WBCs - 22400 HB - 9.6 Plattelates - 242000 Neutro. - 78 lymphocites - 20 Eos. - 0 ESR - 33 Biochemistry reports Blood urea- 59 S. Creatinine - 1.9 SGOT - 47 Urine Analisys reaction is acidic, protien present (++), Ephithelial cells- 3-4, pus cells - 1-2 Chest PA There is large homogeneous radio-opacity in right lower zone, silhoutting the right costophrenic angle, diaphragmatic silhouette, and cardiac silhouette. Drain was inserted into right side. 2 liters fliud discharged at that time. 9-4-2020 chest PA There is large homogeneous radio-opacity in right lower zone, silhoutting the right costophrenic angle, diaphragmatic silhouette, and cardiac silhouette. WBCs - 29000 HB - 10.3 Plattelates - 237000 Neutro. - 87 lymphocites - 10 Eos. - 0 ESR - 33 Blood urea- 55 S. Creatinine - 1.9 10-4-2020 Drain reinserted. Plural effusion removed was 1.9 liters. First appointment of Dr. Jasvant Patil was taken by vedio conferancing and homeopathy medicine started. 11-4-2020 discharge of Plural effusion in morning was 1.8 liters. 12-4-2020 discharge of Plural effusion in morning was 1.15 liters. 13-4-2020 discharge of Plural effusion in morning was 950ml. 14-4-2020 discharge of Plural effusion in morning was 825ml. 15-4-2020 discharge of Plural effusion in morning was 1550ml. 16-4-2020 discharge of Plural effusion in morning was 1050ml. 17-4-2020 discharge of Plural effusion in morning was 450ml. 18-4-2020 discharge of Plural effusion in morning was 700ml. 19-4-2020 discharge of Plural effusion in morning was 1150ml. 20-4-2020 discharge of Plural effusion in morning was 650ml. 21-4-2020 discharge of Plural effusion in morning was 800ml. 22-4-2020 discharge of Plural effusion in morning was 1150ml. 23-4-2020 discharge of Plural effusion in morning was 1050ml. 24-4-2020 discharge of Plural effusion in morning was 425ml. 25-4-2020 Due to muscle weakness the drain was automatically removed. After taking homeopathy power dose there was no plural effusion discharge. X-ray taken was normal. drain was changed but no fluid was there at that time. but after one hour there will be, one liter fluid discharge in 5 Minutes.Also lot of pain in right side of chest and short breathing happening. Lot of siffness in stomach. Immediate allopathy treatment given as follows- Inj Derriphyline Inj Lasix Inj Hydrocortisone sodium succinate was given SPO2 was 91. so external oxygen was given. After 2 hours everything will be fine and oxygen mask also removed. Next day everything will be normal. There was skin infection due to that lot of itching was there. discharge of Plural effusion in morning was 1100ml. 26-4-2020 discharge of Plural effusion in morning was 750ml. 27-4-2020 discharge of Plural effusion in morning was 250ml. 28-4-2020 discharge of Plural effusion in morning was 50ml. 29-4-2020 discharge of Plural effusion in morning was 25ml. 5-5-2020 X-ray was normal. Drain was removed. 1-5-2020 Due to lockdown 3 weeks homeopathy medicine was taken. 21-5-2020 There will be no plural effusion so allopathy treatment was stopped, only steroid deflazacort 3mg is on. After taking treatment of homeopathy for itching there will bw no relief and skin dryness increased. From last 5-6 days, there will bw lot of acidity and have to go for toilet 5-6 times a day. Appetite will bw low. 29-5-2020 There will be no change from last week. 5-6-2020 HB - 8.2 WBCs - 11700 Neutrophil - 8400 Plattelate - 218000 ESR - 120 Biochemistry Blood urea - 28.53 S. creatinine - 1.11 A. phosphate - 174.1 Albumin - 2.77 Globulin - 3.55 Urine analysis Reaction was acidic, proteins preasent (+++). There will be no change as compared to last week. 12-6-2020 After taking last week medicines there will be no change in itching and dryness of skin. Dysentry was reduced. Lot of backace and knee pain. 19-6-2020 As compared to last week there was 20 % improvement in itching and dryness.There will be lot of acidity and weakness. There will be change in posture of back. 26-6-2020 Again there will be 15% improvement in itching and dryness. Inflammation in left knee. Lot of weakness, low appettite. 30-6-2020 HB - 9.2 WBCs - 12500 Neutrophil - 8600 Plattelate - 237000 ESR 16 Biochemisrty Blood urea - 42.56 S. creatinine - 1.77 A. phosphate - 240.7 Albumin - 3.30 Uric acid - 10 S. sodium - 150 10-7-2020 Lot of improvement in itching and acidity.Weahness was there. At that time whatever will eatten , will be omitted. low appettite. WBCs - 12600 HB - 8 Plattelate - 223000 Thyroid T4 - 201.2 Biochemistry Blood urea - 42 S. creatinine - 2.6 S. uric acid - 11.5 17-7-2020 Itching increased, dysentry and omitting will be as it is thats way there will be lot of weakness. There will be lot of breathlessness while walking. Low appettite. 27-7-2020 WBCs - 9400 HB - 7.5 Plattelate - 206000 ESR - 34 Biochemistry Blood urea - 48.38 S. creatinine - 1.43 A. phosphate - 225.8 Albumin - 2.91 Globulin - 3.53 T4 - 13.24 UTSH - 0.05 Urine analysis reaction acidic, protein present(+++). 5-8-2020 70% improvement, but dryness was there. Digesion improved. Weakness will be reduced. Deflaxacort 6 mg started. 3-9-2020 My report of RT PCR will positive. HB - 8.8 WBCs - 16100 Neutrophil - 12700 Plattelate - 262000 ESR- 62 Prothrombin time - 15.4 s Control prothrombin time - 13 s Biochemistry Blood urea - 47.53 S.creatinine - 1.12 SGPT - 18.50 A. phosphate - 229.7 Albumin - 3.33 Globulin - 2.59 LDH - 141.5 CRP - 63.62 DDimmer - 1672.88 Ferritinine - 101.45 6-9-2020 Chest PA was done, it was within normal limit. 7-9-2020 HR CT Impression - single ground glass opacity seen in superior segment of right lower lobe. 10-9-2020 80% improvement. I was asymptomatic carrier. Knee is paining and stucking while walking. Appettite is average. SpO2 was 97%. 12-9-2020 80% improvement, knee was ok, feeling some cough, SPO2 96%, DDimmer 1019 CRP 35 14-9-2020 Some wet cough and headace. There will be fever upto 102.5, i was in tension becoz my daughter was not feeing good. SPO2 92%. 15-9-2020 No Cough, no headace, no fever. 90% improvement. no new symptoms except knee stucking. SPO2 95%. 16-9-2020 SPO2 95% No new symptoms seen. 25-9-2020 HB - 8.4 WBCs -17800 Neutrophil - 14600 Plttelate 232000 ESR - 80 CRP - 46.26 DDimmer - 2037.14 Ferritinine - 114.88 Biochemistry Bloo urea - 42.32 S. creatinine - 1.38 A. phosphate - 162.2 Albumin - 3.32 Globulin - 3.08 S. uric acid - 9.91 LDH - 513.2 29-9-2020 90% improvement. No corona symptoms. Muscle distrophathy. SPO2 96%. HB - 8.8 WBCs - 15500 Neutrophil - 11600 ESR - 38 DDimmer - 1527 3-10-2020 90% improvement. No corona symptoms. Muscle distrophathy. SPO2 96. Spine posture was tilt in front side. HB - 9 WBCs - 17100 Neutrophil - 13400 ESR - 38 DDImmer - 1668 Plattelate - 155000 7-10-2020 IL6 - 2093 DDimmer - 1365.45 LDH - 425.5 CRP - 11.14 HB - 9.2 WBCs - 1500 Neutrophil - 13300 Plattelate - 186000 ESR - 48 Anti Sars - cov-2 total reactive 16.5. 10-10-2020 80% improvement, no corona symptoms. swelling on left knee. Suffering from backace, headace, bodyace. Fever 103.1. Paracetamol 650 was taken. SPO2 was 92%. 13-10-2020 Blood urea - 76.78 S. creatinine - 1.4 HB -8.5 WBCs - 14700 Neutrophil - 12200 Plattelate - 196000 ESR - 76 CRP - 65.38 DDimmer - 2263.87 15-10-2020 CT scan of chest Moderate right plural effusion with underline segmental collapse of lower lobe. HB - 9.1 WBCs - 29800 Neutrophil - 27300 Plattelate - 201000 ESR - 52 Blood sugar random - 169.1 S. creatinine - 1.66 Billirubin Total - 1.09 Globulin - 2.08 LDH - 313.3 CRP - 96.37 Widal Test - S. TYphi 'O' - 1:320 S. Typhi 'H' - 1:160 Test for maleria P. Falciparum negative. P. vivax negative. Prothrombin Time 20 s Control prothrombin time 13s DDimmer - 4009 Ferritinine - 118.94 IL6 - 649.5 Test for dengue are negative. MRI scan of brain Above described finding in the right frontal region most likely represent granuloma...posibility of NCC is more likely than tuberculoma. Similar hyper intense area seen in bilateral parietal regions without contrast enhancement... edema/evolving granuloma. No e/o venous sinus thrombosys. Chest PA Ill-defined hasiness is seen in rlz. Obscuring the CP angle...s/o plural effusion. Admitted to hospital for allopathic treatment. 19-10-2020 No corona symptoms. 80% improvement. No headace. No fever. Left knee is paining and swelling on it. SPO2 was 98%. HB - 9 WBCs - 20200 PCV - 28.2 Plattelate - 236000 Neutrophil - 86 LDH - 971 CRP - 12.2 Random blood sugar - 98 Blood urea - 54 S. creatinine - 1.3 Total Billirubin - 0.97 Direct Billirubin - 0.21 Indirect Billirubin - 0.76 DDimmer - 3800 22-10-2020 80% improvement. No headace, no fever, no bodyace. Left knee is paining. Pulse reduced to 49. SPO2 94%. HB - 9.2 WBCs - 19900 Plattelate - 250000 CRP - 34 IL6 - 4.53 LDH - 531 TSH - 7.5 PCT(procalcitonine) - 0.553 24-10-2020 SPO2 - 93% HB - 10 WBCs - 19600 Neutrophil - 15200 ESR - 22 Plattelate - 212000 CRP - 196 DDimmer - 1519 31-10-2020 90% improvement. Methyl predinisolone reduced to 8mg. Wet coughing and breathlessness reduced. left knee paining a lot thats why i am struggling to walk. SPO2 95%. HB - 9.1 WBCs - 15000 Neutrophil - 12100 ESR - 20 Plattelate - 100000 Uric acid - 9.19 Blood urea - 55.72 S. creatinine - 1.33 2-11-2020 90% improvement. Methyl predinisolone 8mg shifted to 6mg Deflazacort. SPO2 95%. DDimmer 1020 Left knee X-ray was done. Knee replacement suggested in future. 4-11-2020 90% improvement. Left knee paining. Sinus pain increased. Solid wet coughing. SPO2 93%. 9-11-2020 80% improvement. Left knee paining. Suffering for bodyace having fever 101.8 and wet coughing reduced. Headace atright back side. SPO2 95% HB - 9.8 WBCs - 13900 Neutrophil - 10300 Platellate - 116000 ESR - 76 Blood urea - 43.27 S.creatinine - 1.19 A. phosphate - 170 Total protein - 4.82 Albumin - 2.96 Globulin - 1.86 DDimmer - 3189.97 17-11-2020 70% improvement. Today fever was 102.3. Some coughing from yesterday. Bodyace and breathlessness. 6mg Deflazacort is on. Left knee is paining so suffering to walk. Lower backace. Sleep was not good last night. Energy leveland appettite is low. SPO2 is 93%. HB - 8.9 WBCs - 19900 Neutrophil - 15400 Plattelate - 276000 ESR - 120 Blood urea - 45.86 S. creatinine - 1.41 A. phosphate - 203 Total protein - 4.36 Albumin - 2. 72 Globulin - 1.64 DDimmer - 3569.33 19-11-20 Chest X-ray - PA view E/o Homogeneous opacity in RLZ with blunting of right CP angle and part of right diaphragmatic contour. S/o patch of consolidation? Plural effusion on right side. E/o non-homogeneous opacity in LMZ, LLZ. D-Dimmer - 1020 26-11-20 HB - 10.7 WBCs - 25409 Neutrophil - 23500 Plattelate - 276000 ESR - 26 uric acid - 8.8 Blood urea - 48.29 S. creatinine - 1.64 A. phosphate - 127.7 Total protein - 4.55 Albumin - 2.83 Globulin - 1.72 DDimmer - 3133 Ferritin - 138.10 LDH - 889.1 CRP - 2.77 X-ray chest PA - The lesion of cosolidation with? Plural effusion on right side is increased in size as compared to previous CXR 19-11-20. 28-11-20 E/o opaque right hemi thorax. Lesion of right plural effusion with basalconsolidation is increased in size, as compared to previous X-rays. 1-12-20 HB - 9.9 WBCs - 24700 Neutrophil - 21100 Plattelate - 143000 ESR - 60 Uric acid - 7.94 Blood urea - 54.36 S. creatinine - 1.38 A. phosphate - 145 Total protein - 4.03 Albumin - 3.36 Globulin - 0.67 LDH - 570 7-12-20 E/o mild right plural effusion with basal consolidation with drain in situ. Inner end of the drain is not visualised on X-ray. 10-12-20 HB - 9.7 WBCs - 21100 Neutrophil - 18100 Plattelate - 216000 ESR - 84 Blood urea - 97.5 S. creatinine - 1.47 Uric acid - 8.49 A. phosphate - 82.92 Total protein - 3.88 Albumin - 2.15 Globulin - 1.73 14-12-20 HB - 10.2 WBCs - 14200 Neutrophil - 11300 Plattelate - 238000 ESR - 130 Blood urea - 50.59 S. creatinine - 1.49 uric acid - 6.16 A. phosphate - 170.3 Total protein - 3.11 Albumin - 2.43 Globulin - 0.68 S.Sodium - 139.9 S.pottasium - 5.82 18-12-20 E/o mild right plural effusion with ICD in situ ( inner end of the ICD not seen on X-ray.) 21-12-20 HB - 10.1 WBCs - 19800 Neutrophil - 17000 Plattelate - 345000 ESR - 58 Blood urea - 83.5 S. creatinine - 1.70 uric acid - 7.22 A. phosphate - 178 Total protein - 3.53 Albumin - 1.79 Globulin - 1.74 S.Sodium - 132.1 S.pottasium - 5.28 26-12-20 HB - 11.6 WBCs - 30200 Neutrophil - 27200 Plattelate - 375000 ESR - 130 Blood urea - 91.1 S. creatinine - 1.75 uric acid - 7.37 A. phosphate - 227.2 Total protein - 3.85 Albumin - 1.87 Globulin - 1.98 S.Sodium - 138 S.pottasium - 6.42 Culture and sensitivity report Sample - Plural fluid Impression - Given plural fluid is sterile. X-ray chest PA - E/o ICD in situ on right side. E/o collapsed right lung with right hydro-pneumothorax and mediastinal shift to left. 31-12-20 HB - 12.5 WBCs - 12700 Neutrophil - 10500 Plattelate - 254000 ESR - 120 Blood urea - 96.7 S. creatinine - 2.17 uric acid - 8.07 A. phosphate - 201.2 Total protein - 3.60 Albumin - 1.16 Globulin - 2.44 S.Sodium - 132 S.pottasium - 6.36 5-1-21 HB - 10.7 WBCs - 17200 Neutrophil - 12700 Plattelate - 184009 ESR - 110 Blood urea - 111.2 S. creatinine - 1.66 uric acid - 7.86 A. phosphate - 204.3 Total protein - 3.44 Albumin - 2.80 Globulin - 1.34 S.Sodium - 138 S.pottasium - 5.11 10-1-21 X-ray chest PA Right ICD in situ. E/o mild to moderate right plural effusion with right basal and upper zone consolidation. 12-1-21 X-ray chest PA E/o Right ICD in situ. Inner end of the ICD is seen in soft tissue planes of the chest wall. HB - 10 WBCs - 11700 Neutrophil - 9100 Plattelate - 308000 ESR - 110 Blood urea - 102 S. creatinine - 1.83 uric acid - 12 A. phosphate - 164.7 Total protein - 3.74 Albumin - 2.21 Globulin - 1.53 S.Sodium - 142 S.pottasium - 5.05 15-1-21 CT scan of chest Moderate hydro-pneumothorax is seen on right side with underline segmental collapse of upper and lower lobes. The fluid appeares loculated and with suspicious septae. 16-1-21 Drain (ICD in chest) removed. HB - 9.2 WBCs - 22900 Plattelate - 201000 Blood urea - 42 S. creatinine - 1.3 A. phosphate - 108 Total protein - 5.4 Albumin - 2.90 Globulin - 2.50 S.sodium - 126 S.pottasium - 4.4 S.chloride - 101 19-1-21 HB - 10.4 WBCs - 12900 Neutrophil - 7400 Plattelate - 338000 ESR - 90 Blood urea - 79.6 S. creatinine - 1.83 uric acid - 11.7 A. phosphate - 175 Total protein - 4.2 Albumin - 2.04 Globulin - 2.16 27-1-21 HB - 10.0 WBCs - 12800 Neutrophil - 8700 Plattelate - 324000 ESR - 46 Blood urea - 71.80 S. creatinine - 2 uric acid - 9.8 A. phosphate - 144.8 Total protein - 4.57 Albumin - 1.99 Globulin - 2.58 S.Sodium - 142.3 S.pottasium - 3.59 Plsma prothrombin time - 20.3 sec X-ray chest Pa - E/o mild plural effusion with mild basal consolidation. 3-2-21 HB - 9.5 WBCs - 12400 Neutrophil - 8300 Plattelate - 266000 ESR - 89 Blood urea - 59.1 S. creatinine - 1.78 uric acid - 10.9 A. phosphate - 124.9 Total protein - 4.95 Albumin - 1.92 Globulin - 3.03 S.Sodium - 142.9 S.pottasium - 4.29 10-2-21 HB - 9.8 WBCs - 16400 Neutrophil - 13700 Plattelate - 343000 ESR - 84 Blood urea - 57.8 S. creatinine - 1.76 uric acid - 10.7 A. phosphate - 98.48 Total protein - 4.9 Albumin - 1.93 Globulin - 2.97 S.Sodium - 141.9 S.pottasium - 3.48 S.Phosphorus - 1.34 16-2-21 HB - 9.1 WBCs - 17300 Neutrophil - 13400 Plattelate - 385000 ESR - 110 Blood urea - 59.8 S. creatinine - 2.48 uric acid - 10.9 S.Sodium - 130 S.pottasium - 4 S. phosphorus - 4.32 24-2-21 HB - 8.6 WBCs - 20400 Neutrophil - 15300 Plattelate - 333000 ESR - 76 Blood urea - 64 S. creatinine - 3.26 uric acid - 12.2 A. phosphate - 102 Total protein - 3.31 Albumin - 1.64 Globulin - 1.67 S.Sodium - 139 S.pottasium - 4.28 3-3-21 HB - 9 WBCs - 20900 Neutrophil - 15400 Plattelate - 316000 ESR - 48 Blood urea - 72.1 S. creatinine - 2.56 uric acid - 11.6 A. phosphate - 139.3 Total protein - 3.33 Albumin - 2.21 Globulin - 1.12 S.Sodium - 144.2 S.pottasium - 4.69 9-3-21 HB - 8.7 WBCs - 16500 Neutrophil - 12600 Plattelate - 308000 ESR - 30 Blood urea - 79 S. creatinine - 2.41 uric acid - 11.4 A. phosphate - 154 Total protein - 3.40 Albumin - 1.95 Globulin - 1.45 S.Sodium - 135.2 S.pottasium - 5.05 18-3-21 COVID- 19 tested second time(previous in september 2020) positive. HB - 9.2 WBCs - 18000 Neutrophil - 14600 Plattelate - 260000 ESR - 62 Blood sugar - 61.3 Blood urea - 65.2 S. creatinine - 2.13 A. phosphate - 156 Total protein - 6.10 Albumin - 2.20 Globulin - 3.9 S.Sodium - 139 S.pottasium - 5.88 LDH - 503 CRP - 37.2 26-3-21 HB - 8.8 WBCs - 22700 Neutrophil - 16600 Plattelate - 223000 ESR - 81 Blood sugar - 62.1 Blood urea - 90.9 S. creatinine - 1.72 A. phosphate - 122.8 Total protein - 4.23 Albumin - 2.42 Globulin - 1.81 S.Sodium - 146 S.pottasium - 6.17 LDH - 587 CRP - 1.8 DDimmer - 5620 29-3-21 X-ray chest PA E/o mild to moderate right plural effusion with basal consolidation. 2-4-21 HB - 9 WBCs - 19100 Neutrophil - 14000 Plattelate - 205000 ESR - 33 Blood Sugar - 64 Blood urea - 70.7 S. creatinine - 1.54 uric acid - 8.8 A. phosphate - 120 Total protein - 4.13 Albumin - 2.52 Globulin - 1.61 S.Sodium - 146 S.pottasium - 6.17 LDH - 719 CRP - 4.1 14-4-21 HB - 9.9 WBCs - 12800 Neutrophil - 10300 Plattelate - 176000 ESR - 38 Blood sugar - 64 Blood urea - 73 S. creatinine - 1.52 uric acid - 9.3 A. phosphate - 136 Total protein - 4.13 Albumin - 2.70 Globulin - 1.87 S.Sodium - 137.3 S.pottasium - 5.12 LDH - 581 CRP - 4.1 Ddimmer - 5220 T3 - 1.02 T4 - 4.11 TSH - 18.7 22-4-21 HB - 9 WBCs - 13800 Neutrophil - 10300 Plattelate - 176000 ESR - 60 Blood sugar - 84 Blood urea - 57.4 S. creatinine - 1.28 uric acid - 8.5 A. phosphate - 149 Total protein - 5.43 Albumin - 2.47 Globulin - 2.96 S.Sodium - 143 S.pottasium - 5.23 29-4-21 HB - 8 WBCs - 10900 Neutrophil - 8100 Plattelate - 173000 ESR - 62 Blood sugar - 72.9
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