BMJ Elective Case Log

This is a 8-years-old boy who has speach impairement, unable to communicate and low eye contact. From the first year of age, he started talking slowly and progressively able to speak well, sing a song, could talk over phone. When he was 3 years old, he had been locked into a room for over 30 minutes and was speaking so loudly from inside adressing his father and finally his father was able to broke the doors and he was so scared while hugging his father. He used to even play crickets and enjoy interacting with people till the age of 4 when his social interaction was gradually decreasing, started geting angry and not able to speak. He cannot tolerate cow voice, ballon and any loud sounds. He had low birth weight (according to his father) and was born 20 days prior to the normal delivery date. At the age 1.5 years, he had a diarrhea for 1-2 days for which doctor provided him some antibiotic injections.  Parents are planning to take the patient to India all the way from banglad...

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....

This 23 years old woman except myalgia, ocassional cough, fever, and headache was completely alright before march 2015 when she started having loose motion and associated problems such as body pain, headache, skin problem. In 2016, except for loose motion and skin problem, her other symptoms were reduced. Her weight at birth was 1.2 Kg and until 12 years of age she was thin but after that she started gaining weight. She started loosing weight gradually before her first presentation at the opd as she was describing her weight used to be high. Currently being treated as type 1 with insulin since the last 1 and half years. She did tolerate oral hypoglycemics for the first 6 months though. Her mother also got diagnosed as type 2 around the same time ( correction: not around the same time, but her mother developed diabetes shortly a few months after she (our current patient) was diagnosed with diabetes). and her control is worse and she doesn't monitor her sugars regularly either. ...