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OSTEOARTHRITIS SCENARIO:
Here is a 55 yrs old female patient hospitalized for 10 days . CHIEF COMPLAINTS : Pain in left knee since 15 days . Swelling B/L lower limb since 8 days . HISTORY OF PRESENT ILLNESS : Patient complains of pain in left knee which is gradually progressive, throbbing type aggravates on moving and relieves on taking rest. PAST MEDICAL HISTORY : k/c/o Type 2 DM since 1 month. PAST MEDICATION HISTORY : Tab Metformin 500mg
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LABORATORY INVESTIGATIONS :
PERSONAL HISTORY : Menopause – 3 years back LABORATORY INVESTIGATIONS : GRBS at the time of admission is 239 mg/dL CBC TEST VALUE NORMAL RANGE WBC 16,500 cumm cumm Haemoglobin 9.5 g/dl 11-14 g/dl Neutrophils 82 40-60 MCH 24.8 g/dl 32-36 g/dl MCHC 28.3 g/dl ESR 90 mm/hr < 20 mm/hr
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SOAP Note : Subjective : Here is a 55 years old female patient complaining of pain in left knee and swelling of lower limb . Objective : WBC is increased to 16,500 cumm which is due to infection or inflammation . Hb decreased to 9.5 g/dl which implies anaemia MCH is decreased to 24.8 g/dl which indicates hypochromia MCHC is decreased to 28.8 g/dl which also indicates hypochromia ESR is increased to 90 mm/hr which is due to inflammation. GRBS increased to 239 mg/dL which suggests diabetes mellitus.
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Antibiotic sensitivity testing :- (pus samples)
Organism – Methicillin resistant Staphylococcus aureus. Sensitive to Erythromycin, Tetracycline, Cloxacillin, Amoxiclav, ceferoxime. Diagnosis : Osteoarthritis Assessment : Pain in knee : Due to osteoclast activity release of vasoactive peptide and matrix metalloproteinase, neovascularisation increased permeability of the adjacent cartilage, which leads to cartilage degradation and eventually cartilage loss resulting in pain. Swelling : Due to release of inflammatory mediators synovitis occurs which causes swelling. Osteoarthritis : Due to progressive deterioration and loss of articular cartilage.
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PROBLEM GOALS OF TREATMENT DRUGS & MOA DOSAGE Osteoarthritis Relieve pain and stiffness Improve joint mobility Limit functional impairment Acetaminophen :- they inhibit PG synthesis which causes algesia. NSAIDS :- Diclofenac inhibits PG synthesis where PG’s are mediators of pain 325mg TID mg/day
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Plan : TRADE NAME GENERIC NAME DOSAGE 1 2 3 4 5 6 7 8 9 10
Inj.Contramol Tramadol 100ml 1-0-1 Y T.Neusaid Aceclofenac+ paracetamol 1-0-1 T.Rabsure Rabeprazole 40mg T.Phlogam Trypsin , brome lain, rutoside trihydrate 1-1-1 T.Neuromine Merobalamine 0-1-0 T.Zifi turbo Linezolide T. Melmet Metformine 500mg Syp.Heam up Ferrous sulphate 5ml Inj.Tazomac Pipercillin 4g
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DISCHARGE DRUGS : T. Reboron T. Melmet SR 500mg DRUG INTERACTIONS : Tramadol + linezolide – Major interaction Nausea , sweating , increased heart rate , serotonin syndrome PATIENT COUNSELLING: While using Metformin might feel a little irritation in GIT Weight control Reduce protein in diet Rabeprazole should be taken before food
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