A middle aged woman with BMI 32 and painful menstrual period

Name - Passiflora Faetida - 3 Age - 43 y Sex - F

Originally the case was shared by our community health worker at the following link: http://736146.blogspot.in/2018/01/name-passiflora-faetida-3-age-43-y-sex-f.html?m=1

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57 Year Old female with goiter and thyrotoxicosis

This 57 year olf lafy presented with neck swelling, anxiety and tremor. Her medical information is attached below: We need to take a decision on this lady. To operate or not to operate. Now that our clinical suspicions of thyroticosis have been proved and malignancy not proved (not disproved either) what would be the next best step? Medical management for her thyrotoxicosis or still get an excision biopsy with sub total thyroidectomy (and subtotal thyroidectomy other than disproving malignancy will also become treatment for her hyperthyroidism). So which one should we prefer (if the family has no reservations from their side)?

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A 55 year old man with childhood asthma and Acute exacerbation of COPD

This is a 55 year old man in ICU with severe hypercapnia refractory to positive pressure ventilation with PCO2 ranging from 100-120 mm of Hg after 24 hours of ventilation. He appeared to have a history of Bronchial asthma since childhood. Perhaps for the last 45 years. His last three years appear to have been spent in perennial shortness of breath and wheeze. He has a barrel shaped chest and his CXR pa shows pushed down diaphragms. He was referred from a nursing home on a ventilator ambulance and his ABG during admission was showing a PCO2 of 90. After 24 hours of ACMV with a RR of 20 and tidal volumes of 400 ml his PCO2 increased to 120s. This case of AECOPD with resp. Acidosis on mechanical ventilator was found to have total WBC count increasing overtime (15300 (ICU 2nd Day)/ 18500/ 27500/ 35600 (13th day). So, we started empirically with Clavum & Augmentin and later on planned for meropenam & Colistin antibiotic based on further deterioration in Total WBC Count....

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