online learning portfolio

Intern assessment and extension sample:
 
Name : Harsha ch.

Posted from 11/8/2022 till 11/10/2022


Current online learning portfolio (OLP) linked here 👉http://chennaharsha.blogspot.com/
 Cases have been discussed by
Dr. Rakesh Biswas sir
Dr. Adithya
Dr. Raveen
Dr. Sai Charan
Dr. Mansa
Dr.pavani
Dr. Bharat
Dr. Pavan 
 
Learning impact assessment from cases recorded  in OLP :


1) 13yr old male with multiple clinical events 
Link:
http://chennaharsha.blogspot.com/2022/08/13-year-old-boy-with-multiple-clinical.html

Learning impact--

 It's due to portal hypertension and the spleen here is actually taking in all the pressures protecting his varices from rupturing. 

TIPs can be tried and other than helping to measure his portal pressures the shunt may also ease the burden on the portal system

https://pubmed.ncbi.nlm.nih.gov/2944377/

Three cases of idiopathic portal hypertension associated with Hashimoto's disease are described. All of the cases were middle-aged Japanese women showing splenomegaly, esophageal varices and pancytopenia in the absence of extrahepatic portal obstruction, and cirrhosis of the liver. Two patients were euthyroid with goiter, one of which revealed diffuse lymphocytic infiltration, obliteration of thyroid follicles, and fibrosis on histological examination of the thyroid; the third suffered from myxedema without goiter. Antithyroid microsomal antibody was positive in all patients and antithyroglobulin antibody was positive in none. These findings might imply an immunological role in the pathogenesis of idiopathic portal hypertension.

There is a general agreement that splenomegaly is a common feature in PAD but its consequences are not well understood [19]. Here, we confirmed our previous data [20] showing a spleen enlargement in 71/117 patients (61%) of our cohort. Spleen diameter was highly correlated with portal vein diameter (R2 = 0.5; P < 0.0001) (Figure 1) suggesting that an increased splenic venous flow secondary to splenomegaly could contribute to determining a condition of portal superflux. At ultrasound, 30 out of 117 patients (25.6%) had signs of portal vein enlargement but only 1/6 of these had portal hypertension/INCPH, with portal systemic collaterals (Figure 2). Longitudinal assessment of abdominal ultrasounds demonstrated that portal vein enlargement and splenomegaly slightly increased in the observation period

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988706/

Thirty patients (28 CVID, 2 XLA) had portal vein enlargement detected by ultrasounds, an indirect index of portal hypertension. Four of these patients (3 CVID and 1 XLA) had esophageal varices (3 small and one large) at upper gastrointestinal endoscopy and one patient had portal vein collaterals detected by CT scan. None of the patients had portal hypertensive gastropathy. These five patients underwent liver biopsy, which excluded cirrhosis and thus they fulfilled the diagnostic criteria for INCPH [12]. In the remaining 25 patients with portal vein enlargement without other clinical or radiological signs of portal hypertension the liver biopsy was not performed for ethical reasons.

idiopathic non cirrhotic portal hypertension with splenomegaly


2) A case of 16 yr old male who required SDP
Link:http://chennaharsha.blogspot.com/2022/08/16-yr-old-male.html

@⁨Bhavani Akula Kmni⁩ @⁨Shashikala Ma'am⁩ Is this is same patient we discussed today afternoon who was treated with our UG students platelets? 

Two issues were left out I guess? 

1) The Issue of why we discourage relatives from donating 

2) Did he need the SDP 

For 1 go through this 👉https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798441/,
 article that we had discussed in the past @⁨Chandana Srikanth⁩ ? and share your thoughts @⁨saicharankulakarni⁩ as to how we may justify our not taking relatives bloods but keep taking from our UGs


3) 33yr old female with groin pain
Link:http://chennaharsha.blogspot.com/2022/09/a-case-of-33-yr-old-female.html

Learning impact--

Sir can it be comparison of pinprick vs monofilament in determining peripheral neuropathy??

 @⁨+91 90308 24645⁩ You were going to share the rationale for monofilament testing today (as opposed to cotton wisp)?

 Our aim of this article was to clinically compare the accuracy of three different modalities for testing sensory neuropathy in the diabetic and non-diabetic population. Our tests included the pin-prick testing (PPT); Semmes􏰳 Weinstein 5.07/10 g monofilament testing (SWMT), and the rapid-current perception threshold (R-CPT) measurements using the Neurometer†.


In our study cohort of 54 patients (108 feet), there were 61 feet with DFP ( diabetic foot pathology) and 47 with normal feet.

In pathological foot out of 61 feet 30 were detected to have peripheral neuropathy using pinprick against 29 on monofilament testing and 54 on R-CPT neurometer

https://www.researchgate.net/figure/Comparison-of-pin-prick-testing-507-SemmesAWeinstein-monofilament-testing-and-rapid_fig7_221683581

 This is a study done with 54 patients of DM to evaluate the usefulness of 3 methods
i.e
1) pinprick test
2) monofilament 10g
3) R-CPT Neurometer
[30/09, 10:12 am] Divya Chennamadhavuni: Of the normal 47 feet 
24 were detected to have peripheral neuropathy using pinprick test
26 on performing monofilament testing
40 using R- CPT neurometer.

4) 59 yr old male with chief complaints of loose stools
Link: http://chennaharsha.blogspot.com/2022/09/59-yr-old-male.html
Was treated for gastritis 
Cryptosporidiosis and it's correlation with WBC count in HIV positive patients: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708188/


5) 70 yr old male
Link:http://chennaharsha.blogspot.com/2022/09/case-of-70yr-old-male.html

Learning impact -
Profound Iron Deficiency Anemia and Irreversible Dilated Cardiomyopathy 
https://www.hindawi.com/journals/cric/2019/7513782/

Prevalence, risk factors, and significance of iron deficiency and anemia in nonischemic heart failure patients 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310070/

The Cardiomyopathy of Iron Deficiency
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592266/

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