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Case History and Clinical Findings  C/O ALTERED SENSORIUM SINCE 3 DAYS C/O ULCER OVER LEFT FOOT SINCE 3 MONTHS C/O BURNING MICTURITION SINCE 15 DAYS  HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND HE HAD ULCER OVER THE LEFT FOOT-3RD TOE NO H/O TRAUMA,INJURY BURNING MICTURITION SINCE 15 DAYS,ALTERED SENSORIUM SINCE 3 DAYS H/O IRRELAVANT TALK,NOT ABLE TO RECOGNISE ATTENDERS9ALTERED SENSORIUM MORE DURING EVENING) N/H/O FEVER,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS  PAST HISTORY: K/C/O TYPE 2 DMSINCE 25YRS ON INJ HUMAN MIXTARD 10-100 SINCE 20 YRS K/C/O HTN SINCE 20 YRS ON TAB TELMA-H PO/OD PERSONAL HISTORY :  SLEEP-ADEQUATE DIET-MIXED APETITE-NORMAL ADDICTIONS-OCCASIONAL ALCOHOL CONSUMPTION ,H/O SMOKING ,STOPPED 1 YR BACK ALLERGIES-NONE O/E PATIENT IS CONSCIOUS, IRRITABLE, ORIENTED TO TIME, PLKACE, PERSON NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA  VITALS : TEMP-96.8 F BP-120/70 MMHG PR-78 BPM GRBS-171 MG/DL SPO2-97 ON RA CVS :S1,S2 HEARD,NO M

Case History and Clinical Findings  A 60 YEAR OLD MALE WAS BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE YESTERDAY NIGHT PATIENT WAS APPARENTLY ASYMPTOMATIC 10YEARS BACK THEN HE DEVELOPED DM-2 SIMILAR EPISODE THEN HE DIAGNOSED TO HAVE DM-2 AND STARTED ON OHA LATER AFTER FEW YEARS PATIENT WAS SHIFTED TO INSULIN 4YEARS BACK PATIENT DEVELOPED GIDDINESS AND WHILE WORKING PT HAF FALL, FRACTURE RT UL &RT LL, DIAGNOSED WITH HTN ( ON TAB.METOSARTAN CH50, METOPROLOL 50, TELMA 40 ) 2 YEARS BACK PT DEVELOPED SIMILAR COMPLAINTS OF ALTERED SENSORIUM AND WAS HAVING HYPERGLYCEMIA AT PRIVATE HSPTL THEN WAS DIAGNOSED TO HAVE ? DKA ; -GIVEN INSULIN AND TREATEDAFTER THAT;10 DAYS BACK PATIENT DEVELOPED SWELLING OF LOWER LIMBS AND ULCERATION ON RT TOE AND PLANTAR ASPECT OF FOOT FOR WHICH HE WENT TO PUT PRACTITIONER AND DIAGNOSED TO HAVE DIABETIC FOOT AND WAS TREATED WITH REGULAR DRESSINGS AND ANTIBIOTICS LATER 4 DAYS BACK PATIENT DEVELOPED NAUSEA , VOMITING - 2 EPISODES / DAY ASSOCIATED WITH FOOD INT

Case History and Clinical Findings  C/O ALTERED SENSORIUM SINCE 3 DAYS C/O ULCER OVER LEFT FOOT SINCE 3 MONTHS C/O BURNING MICTURITION SINCE 15 DAYS  HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND HE HAD ULCER OVER THE LEFT FOOT-3RD TOE NO H/O TRAUMA,INJURY BURNING MICTURITION SINCE 15 DAYS,ALTERED SENSORIUM SINCE 3 DAYS H/O IRRELAVANT TALK,NOT ABLE TO RECOGNISE ATTENDERS9ALTERED SENSORIUM MORE DURING EVENING) N/H/O FEVER,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS  PAST HISTORY: K/C/O TYPE 2 DMSINCE 25YRS ON INJ HUMAN MIXTARD 10-100 SINCE 20 YRS K/C/O HTN SINCE 20 YRS ON TAB TELMA-H PO/ODPERSONAL HISTORY : SLEEP-ADEQUATE DIET-MIXED APETITE-NORMAL ADDICTIONS-OCCASIONAL ALCOHOL CONSUMPTION ,H/O SMOKING ,STOPPED 1 YR BACK ALLERGIES-NONE O/E PATIENT IS CONSCIOUS, IRRITABLE, ORIENTED TO TIME, PLKACE, PERSON NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA  VITALS : TEMP-96.8 F BP-120/70 MMHG PR-78 BPM GRBS-171 MG/DL SPO2-97 ON RA CVS :S1,S2 HEARD,NO MUR

Case History and Clinical Findings  A 60 YEAR OLD MALE WAS BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE YESTERDAY NIGHT PATIENT WAS APPARENTLY ASYMPTOMATIC 10YEARS BACK THEN HE DEVELOPED DM-2 SIMILAR EPISODE THEN HE DIAGNOSED TO HAVE DM-2 AND STARTED ON OHA LATER AFTER FEW YEARS PATIENT WAS SHIFTED TO INSULIN 4YEARS BACK PATIENT DEVELOPED GIDDINESS AND WHILE WORKING PT HAF FALL, FRACTURE RT UL &RT LL, DIAGNOSED WITH HTN ( ON TAB.METOSARTAN CH50, METOPROLOL 50, TELMA 40 ) 2 YEARS BACK PT DEVELOPED SIMILAR COMPLAINTS OF ALTERED SENSORIUM AND WAS HAVING HYPERGLYCEMIA AT PRIVATE HSPTL THEN WAS DIAGNOSED TO HAVE ? DKA ; -GIVEN INSULIN AND TREATEDAFTER THAT;10 DAYS BACK PATIENT DEVELOPED SWELLING OF LOWER LIMBS AND ULCERATION ON RT TOE AND PLANTAR ASPECT OF FOOT FOR WHICH HE WENT TO PUT PRACTITIONER AND DIAGNOSED TO HAVE DIABETIC FOOT AND WAS TREATED WITH REGULAR DRESSINGS AND ANTIBIOTICS LATER 4 DAYS BACK PATIENT DEVELOPED NAUSEA , VOMITING - 2 EPISODES / DAY ASSOCIATED WITH FOOD INT

Case History and Clinical Findings  PATIENT WAS BROUGHT TO CASUALTY WITH COMPLAINTS OF PAIN ABDOMEN SINCE 4 DAYS AND SWELLING OF LEFT LOWER LIMB SINCE 4 DAYS  HOPI:  PATIENT WAS APPARENTLY ASYMPTOMATIC 4 DAYS AGO THEN SHE DEVELOPED PAIN ABDOMEN WHICH IS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE. NO AGGRAVATING AND RELEIVING FACTORS. SQUEEZING TYPE OF PAIN PRESENT. H/O FEVER CONTINUOUS TYPE AND RELEIVED ON MEDICATION H/O ANOREXIA,NAUSEA PRESENT NO H/O VOMITINGS H/O ITCHING PRESENT OVER LEFT LEG 5 DAYS AGO K/C/O HTN AND ON REGULAR MEDICATIONN/K/C/O TB,ASTHMA,DM,CVA,CAD,THYROID DISORDERS,EPILEPSY PERSONAL HISTORY:APPETITE IS NORMALDIET IS MIXEDSLEEP ADEQUATEBOWEL AND BLADDER REGULARADDICTIONS- NO FAMILY HISTORY: NO RELAVANT FAMILY HISTORY GENERAL EXAMINATION: PATIENT IS CONSCIOUS, COHERENT,COOPERATIVE.MODERATELY BUILT AND NOURISHEDNO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,LYMPHEDENOPATHY, VITALS:TEMP: 98.6FPR: 78BPMBP: 130/90MMHGRR: 18CPM CVS: S1S2 HEARDRS: BAE+ P/A: SOFT AND NON TENDER

Case History and Clinical Findings  C/O ABDOMINAL DISTENSION SINCE 4 MONTHS ON AND OFF SHORTNESS OF BREATH SINCE 4MONTHS   HISTORY OF PRESENTING ILLNESS PATIENT WAS APPARENTLY ASYMOTOMATIC 4 MONTHS AGO THEN HE STARTED C/O ABDOMINAL DISTENSION WHICH WAS DISTENSION WHICHWAS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE SINCE 1 MONTH ABDOMINAL DISTENSION IS PROGRESSIVE IN NATURE FOR WHICH HE VISITED GANDHI HOSPITAL AND WAS DIAGNOSD AS ALD WITH PORTAL HTN WITH DECOMPENSATED LIVER LIVER DISEASE WITH HEPATIC ENCEPHALOPATHY GRADE 1 WITH RT PLEURAL EFFUSION -MILD.PEDAL EDEMA SINCE 4 MONTHS INSIDIOUS IN ONSET GRADUALIIY PROGRESSIVE ,RELIEVED AT NIGHT ,AGGRAVATED IN THE MORNING [PITTING EDEMA] -SOB DUE TO ABDOMINAL DISTENSON , PRESENT EVEN ON REST ORTHOPNEA AND PND PRESENT NO CHEST PAIN,PALPITATION. C/O DECREASED URINE OUTPUT SINCE 1 MONTH PATIENT IS ON FOLEYS CATHETER SINCE THEN-K/C/O DM 2 SINCE 15 YEARS-OPERATED FOR ILIOPSOAS ABSCESS [10MONTHS AGO]  TREATMENT HISTORY INJ.MIXTARDBD FOR DM2 SURGE

Case History and Clinical Findings  54 year male came to casualty on 27-10-22 with complaints of hiccups since 5 days and altered sensorium since morning  HOPI:  Pt was apparently asymptomatic 5 days back then he had continuous hiccups since 5 days Altered sensorium since morning (He had ? up rolling of eyeballs and frothing 1 episode in the morning not associated with any involuntary movements or involuntary micturition or tongue bite) No h/o fever,headache,giddiness,vomiting No other complaints  Past history :  He had similar episode 6 months back2 months back he was admitted in hospital with similar complaints and was found out to have dyselectrolytemia - treated symptomatically K/c/o DM since 7 years ( he had trauma 5 years back to foot which was not healing properly so he went to the hospital and was diagnosed as diabetic) Initially he took medication but his sugars were not under control Then he was switched to insulin under doctor’s advice 20U in the morning and 15 units in the

Case History and Clinical Findings Altered behaviour since1 hr Difficulty in swallowing since 4 days 65 year old female patient non diabetic non hypertensive who is a Telugu tutor at home and was able to do all her house hold works on her own till 2006 then from 2006 she was getting water from step well then she got her hipand knee pains from 2008 where they took to hospital they suggested for surgery but Attendors neglected it because of financial issues then from that time patient was slowly walking from 1 year she started walking with the support(wall) and do her own works then from few days she is walking with walker . Patient had odynophagia since 4 days then she did not take food and on the day of admission she got up in the mrng and was oriented to place time and person then after some time she was not oriented to person since afternoon then they brought patient to the hospital with complaints of Altered behaviour since1 hrDifficulty in swallowing since 4 days Past history : N/K

Case History and Clinical Findings  C/O FEVER SINCE 10 DAYS HEADACHE WITH GIDDINESS SINCE 10 DAYS HOPI-:  PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK,THEN DEVELOPED FEVER,HIGH GRADE,ASSOCIATED WITH CHIILS,INSIDIOUS IN ONSET,GRADUALLY PROGRESSIVE,ASSOCIATED WITH HEADACHE,GIDDINESS SINCE 10 DAYS. C/O HEADACHE DECREASED SINCE 2 DAYS H/O BURNING MICTURITION H/O DECREASED URINE OUTPUT PRESENT H/O PEDAL EDEMA O AND OFF SINCE 10 DAYS,SINCE 6-7 MONTHS NO H/O COUGH COLD NO H/O CKD N/K/C/O HTN,DM,CAD,CVA,THYROID DISORDER,EPILEPSY  Investigation  HEMOGRAM HB-6.3GM/DL TC-19500 N-86 L-10E-2 M-2 B-00 SMEAR-NORMOCYTIC NORMOCHROMIC HIV-NEGATIVE HBSAG-NEGATIVE HCV-NEGATIVE Diagnosis  AKI ON CKD SECONDARY SEPSIS ?NSAID ABUSE   Treatment Given  1) IVF 1 NS@75ML/HR  2) INJ.LASIX 20MG IV BD  3) INJ.NODOSIS 500MG PO/BD  4) INJ.NEOMOL 1G IV  5) MONITOR VITALS 4TH HRLY  6) INFORM SOS   Advice at Discharge  LAMA NOTES PATIENT ATTENDERS HAVE BEEN EXPLAINED IN THEIR OWN UNDERSTANDABLE LANGUAGE ABOUT THE CON

Case History and Clinical Findings CHIEF COMPLAINTS : C/O DRY COUGH SINCE 7 DAYS C/O SOB SINCE 4 DAYS C/O ABDOMINAL DISTENSION SINCE 4 DAYS C/O DECRAESED URINE OUT PUT SINCE 4 DAYS HOPI PATIENT WAS APPARENTLY ALRIGHT 7 DAYS BACK THEN SHE DEVELOPED FEVER ASSOCIATED WITH CHILLS AINSIDIOUS IN ONSET NOT ASSOCIATED WITH MYALGIA OR ARTHRALGIA H/O DRY COUGH SINCE 7 DAYS , NO SEASONAL VARIATION OR DIURNAL VARIATION, NOT ASSOCIATED WITH BLOOD,FEVER ASSOCIATED WITH DECREASE IN APPETITE ON DAY 1 OF ILLNESS SHE SOUGHT CONSULTATION FOR RMP AND WAS TAKING TREATMENT ON DAY3 OF ILLNESS SHE WAS HAVING SOB GRADUALLY PROGRESSIVE FROM GRADE 1 TO 5 ON NYHA H/O ABDOMINAL DISTENSION SINCE 4 DAYS GRADUALLY PROGRESIVE TO PRESENT SIZE ASSOCIATED WITH ABDOMINAL PAIN H/O DECRESED URINARY OUT PUT SINCE 4 DAYS NO HEMATURIA, BLOOD IN STOOLS, OR OTHER BLEEDING MANIFESTATIONS COMPLAINTS PAST HISTORY : K/C/O DM SINCE 1 YEAR NOT A K/C/O DM, TB, ASTHMA, TB, EPILEPSY, HYPERTENSION PERSONAL HISTORY : APPETITE : NORMAL DIE

Case History and Clinical Findings 52YEAR OLD MALE CAME WITH THE CHIEF COMPLAINTS OF GIDDINESS SINCE 3 DAYS VOMITINGS 2 DAYS BACK LOOSE STOOLS 2 DAYS BACK INVOLUNTARY MOVEMENTS OF BILATERAL UPPER LIMBS SINCE YESTERDAY MORNING   HOPI PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN HE DEVELOPED GIDDINESS , SUDDEN IN ONSET , MORE ON STANDING AND LATER PROGRESSED TO GIDDINESS ON SUPINE POSITIONVOMITINGS 2 DAYS AGO 3 TO 5 EPISODES /DAY FOOD PARICLES AS CONTENTS, NON BILIOUS, PROJECTILE AND NON BLOOD STAINED LOOSE STOOLS 2 DAYS AGO ABOUT 3 TO 5 EPISODES PER DAY NON BULKY, NON FOUL SMELLING INVOLUNTARY MOVEMENTS OF HANDS AND FINGERS SINCE MORNING NO H/O LOSS OF CONSCIOUSNESS, UPROLLING OF EYES, INVOLUNTARY MICTURITION OR DEFECATION AND HEADACHE  PAST H/OK/C/O HTN, SINCE 5 TO 6 YEARS AND ON MEDICATION TELMISARTAN 40 MG PAST H/O CVA PRESENT 2 YEARS BACK NOT A K/C/O DM,TB, ASTHMA, EPILEPSY, THYROID DISORDERS, CVA OR CAD ON  GENERAL PHYSICAL EXAMINATION-: PATIENT IS CONSCIOUS, COHERENT AND CO

Case History and Clinical Findings  PATIENT WAS BROUGHT TO THE CASUALTY INSTATE OF SUDDEN ONSET OF ALTERED SENSORIUM SINCE 5AM ON 24-01-23 HOPI : PATIENT WAS APPARENTLY ALRIGHT UNTILL 5AM ON 24-01-23 , HE WOKE UP THEN AND WENT TO OPEN THE DOOR AND HE LEANED ON TOTHE DOORAND DIDNOT OPEN THE DOOR. HE THEN PASSED URINE INVOLUNTARILY AND SINCE THEN HE IS NOT RECOGNISING HIS FAMILY MEMBERS .HE IS AGITATED WITH MOVING ALL UPPER AND LOWER LIMBS AND PT IS IN CONFUSED STATE WITH GCS E2V2M4 - E4V4M4-E4V5M6. NO NECK STIFFNESSNO H/O LOSS OF CONSCIOUSNESS/VOMITINGS/DEVIATION OF MOUTH/NO UPROLLING OF EYEBALLS/NO TONIC OR CLONIC SEIZURES/ TRAUMA/FEVER PAST HISTORY-:  PATIENT IS A KNOWN CASE OF DIABETES MELLITUS TYPE 2 USING T METFORMIN 500 MG PO /OD ( ON REGULAR MEDICATION ) AND HYPERTENSION SINCE 9 YEARS (FOR HYPERTENSION PATIENT'S ATTENDANT DOESNT KNOW) PATIENT HAD CEREBRO VASCULAR ACCIDENT 9 YEARS BACK WITH LEFT HEMIPERESIS AND PATIENT RECOVERED NOW WITH MILD WEAKNESS OF LEFT UPPER AND LOWER L

Case History and Clinical Findings CHEIF COMPLAINTS: PATIENT CAME WITH C/O NOT PASSING URINE SINCE YESTERDAY EVENING C/O FEVER - 1SPIKE YESTERDAY MORNING  HOPI:  PATIENT WAS APPARENTLY ASYMPTOMATIC 20 DAYS BACK THEN HE DEVELOPED FEVER, ON AND OFF TYPE, WITH URINARY INCONTINENCE SYMPTOMS. FEVER IS HIGH GRADE, WITH JAUNDICE FOR WHICH HE TOOK TREE MEDICATION; AND FEVER WAS INTERMITTENT IN NATURE, WITH CHILLS AND RIGORS, RELIEVED ON TAKING ON MEDICATION. ANURIA SINCE LAST NIGHT PATIENT WAS BROUGHT IN GASPING STATE TO CASUALTY BY HIS ATTENDERS, AND ON PRESENTATION BP WAS UNRECORDABLE.  PAST HISTORY:  NOT A KNOWN CASE OF DM, HTN, CAD,CVA, EPILEPSY,TBPERSONAL HISTORY APPETITE : NORMAL DIET: MIXED BOWEL AND BLADDER MOVEMENTS : REGULAR OCCASSIONAL DRINKER FAMILY HISTORY NOT SIGNIFICANT GENERAL PHYSICAL EXAMINATION NO SIGNS OF PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA VITALS TEMP : AFEBRILE PR 147BPM RR 16CPM BP : 80/60MMHG SPO2 98% AT RA SYSTEMIC EXAMINATION CVS S1 AND S2 HEA

Case History and Clinical Findings  C/O DECREASED URINE OUTPUT SINCE 4 MONTHS.  HOPI-  PATINT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS BACK THEN DEVELOPED DECRESD URINE OUTPUT.  PAST HISTORY PATIENT IS A K/C/O DM TYPE-2 SINCE 10YEARS AND IS ON MEDICATION.  N/K/C/O HTN, TB , ASTHMA, EPILEPSY , CVA, CAD, THYROID DISORDERS.  GENERAL AND PHYSICAL EXAMINATION: PATIENT IS CONSCIOUS ,COHERENT,COOPERATIVE NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY EDEMA+  VITALS: TEMP-97.4 F PR-84 BPM RR-18 CPM BP-100/70 MMHG SPO2-99% ON ROOM AIR CVS-S1 S2 HEARD,NO MURMURS  RS-BAE+,NVBSCNS-NFND  P/A- SOFT,NON TENDER,BOWEL SOUNDS HEARD   Investigation  CBP HB TC N L E M B PLT SMEAR RFT UR CR UA CA+2 P NA+ K+ CL- HIV HBSAG  BLOOD UREA12-09-2023  107 mg/dl SERUM CREATININE 6.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 12-09-2023 SODIUM 128 mEq/L POTASSIUM 3.4 mEq/L CHLORIDE 94 mEq/L CALCIUM IONIZED 1.27 mmol/LAnti HCV Antibodies - RAPID12-09-2023 11:22:AMNon Reactive HBsAg-RAPID

Case History and Clinical Findings  C/O SHORTNESS OF BREATH SINCE 3 DAYS HOPI:  PATIENT WAS APPARENTLY ALRIGHT 20 DAYS BACK, AND HAD H/O GIDDINESS AND H/O FALL AND SUSTAINED INJURY TO RIGHT HIP AND WAS DIAGNOSED WITH RIGHT INTERTROCHANTERIC FRACTURE. PATIENT WAS ADMITTED AND SYMPTOMATIC TREATMENT WAS GIVEN. PATIENT WAS BEDRIDDEN AFTER THE FRACTURE AND DEVELOPED GRADE 2-3 BEDSORES OVER RT GLUTEAL REGION WHICH HAS BEEN NOTICED YESTERDAY. PATIENT DEVELOPED GENERALISED WEAKNESS AND HAD NO FOOD INTAKE SINCE YESTERDAY. SHE DEVELOPED SOB EVEN ON REST, ORTHOPNEA +, PND+. NO RELIEVING FACTORS NOTED , AGGRAVATED ON TALKING. H/O COUGH WITH MUCOID EXPECTORATION YESTERDAY.NO C/O FEVER, COLD, BURNING MICTURITION, CHEST PAIN, PALPITATIONS, DECREASED URINE OUTPUT, PEDAL EDEMA.  PAST HISTORY :  NOT A K/C/O HTN, DM, CVA, CAD, TB, EPLIEPSY, ASTHMA.  GENERAL EXAMINATION:  PATIENT IS C/C/C BP= 140/80 MMHG PR = 118 BPM RR = 20 CPM SPO2 = 80 % TEMP = 99.2 F GRBS = 114 MG/DL  SYSTEMIC EXAMINATION:  RS = BAE+,

Case History and Clinical Findings  CHIEF COMPLAINTS; PATIENT WAS BROUGHT WITH CHIEF COMPLAINT OF UNABLE TO STAND AND EAT ON HIS OWN SINCE 20 DAYS URINARY INCONTINENCE SINCE 15 DAYS HISTORY OF PRESENT ILLNESS; HOPI  PATIENT WAS APPARENTLY NORMAL 20 DAYS BACK THEN SUDDENLY DEVELOPED INABILITY TO STAND ON HIS OWN AND ALSO INAILITY TO EAT ON HIS OWN GRADUALLY PROGRESSIVE INITIALLY PATIENT USED TO DO HIS OWN ACTIVITIES BUT GRADUALLY STOPPED DOING HIS WORK AND GOT BED RIDDENC/O URINARY INCONTINENCE SINCE 15 DAYS BEFORE THAT PATIENT INFORMED ABOUT HIS URINATION BUT SINCE 15 DAYS HE IS PASSING URINE INVOLOUNTARILY ATTENDERS ALSO COMPLAIN OF PATIENT SELF TALKING AND ALSO PATIENT POINTING ONTO SOMETHING AND TALKING[HALLUCINATIONS-VISUAL] NO H/O FEVER ,SOB,CHEST PAIN,PAIN ABDOMEN SLURRING OF SPEECH SINCE 15 TO 20 DAYS,LAST ALCOHOL BINGE 20 DAYS BACK H/O SIMILAR COMPLAINTS IN THE PAST IN NOV 2022,HE WAS TAKEN TO A LOCAL HOSPITAL 6 TO 7 YEARS BACK STAYED FOR 2 MONTHS AND STARTED CONSUMING ALCOHOL

Case History and Clinical Findings  PATIENT CAME WITH C/O LOWER BACK ACHE SINCE 3 WEEKS RADIATING TO LEFT LOWER LIMB  HOPI:PATIENT WAS APPARENTLY ASYMPTOMATIOC 3 WEEKS BACK SINCE THEN, PATIENT COMPLAINTS OF LOWER BACK ACHE WHICH IS SUDDEN ONSET,NON PROGRESSIVE,AGRAVATES ON MOVEMENT RELEIVES ON REST H/O TRAUMA(SLIP AND FALL FROM STEPS) 3 WEEKS BACK ,WAS TAKEN TO OUTSIDE HOSPITAL FOUND TO HAVE L5 BURST FRACTURE ON CT PELVIS AND CAME HERE FOR FURTHER MANAGEMENT NO H/O LIFTING OF HEAVY WEIGHTS,FEVER BURNING MICTURITION BOWEL AND BLADDER INCONTINENCE PAST HISTORY OF RIGHT PROXIMAL FEMUR FRACTURE AND DONE IMILN 10 YEARS BACK. H/O PTCA DONE ONE AND HALF YEAR BACK AND IS ON REGULAR MEDICATION  K/C/O DM II SINCE 20 YEARS AND IS ON T. METFORMIN 500 MG + T. VOGLIBOSE 0.2 MG + T. GLIMIPERIDE 2 MG GENERALEXAMINATION:  PATIENT IS CONSCIOUS,COHERENT AND CO OPERATIVE NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,EDEMA AND LYMPHADENOPATHY  VITALS: TEMP:AFEBRILE BP: 110/80MMHG PR:80BPM RR:18CPM  SYSTEMIC