Vamsi Roll no 23

  THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS PUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT 75 yrs old male came to the OPD with CC:vomiting since 10 days ,Sob since 20 days Bilateral pedal oedema since 30 days .  HOPI:  Patient was apparently asymptomatic 30 days back then he developed  Bilateral pedal oedema which is insidious in  onset,  gradually progressive  , pitting type , extending from knee to foot , no agrrevating and relieving factors .  Shortness of breath which is insidious in onset gradually progressive, grade 4 , agrrevates on walking Vomiting - 4- 5 / day  , non bilious , non blood stained , immediately after taking water and food .  No history of fever , chills and rigor , burning mi

24 yrs old male came to the medicine OPD with cheif complaint of unstable gait and tremors since 10 days   HISTORY OF PRESENT ILLNESSES  Patient was apparently asymptomatic 12 years ago he started drinking alcohol after  his mother passed away in a tragic accident , to alleviate that stress.  He started taking alcohol in the form of ARRACK drinking every alternative day about 1-2 glasses a day Over the next few months his consumption gradually increased to 3 glasses a  day further to 6 glasses a day.This continued upto 5 years after he started drinking .  Around 5 years later he shifted to WHISKY  due to ARRACK being banned by the government.He drink around 2 units of whisky daily before going to work and upon returning in the evening he used to feel tired thus used to drink again. In a few months time his drinking increased upto 12 units a day . patient also started chewing tobacco since the last 9 years , around 1 packet every 2-3 days He also complains of sleep disturbances,decrease