DEPARTMENT OF NEUROMEDICINE

DIAGNOSIS:
* LIMB-GIRDLE MYOPATHY * DM * HTN

CONSULTANT:
(CONSULTING DOCTOR) (REFERAL DOCTOR ) (REFERAL DOCTOR )

DR. ALIM AKHTER BHUIYAN (ADULT NEUROLOGY) DR. NAZMUL ISLAM (DIABETOLOGY) DR. MOHAMMED MOHIUDDIN ARAF (PHYSICAL MEDICINE)

CASE SUMMARY
* * * * *

C/C:
NUMBNESS OF BOTH LOWER LIMBS FOR 8 YRS WEAKNESS OF THE BOTH L/E FOR 6 YRS NUMBNESS OF BOTH UPPER LIMBS FOR 4 YRS WEAKNESS OF LEFT U/E FOR 1 YR INABILITY TO MOVE BOTH L/E FOR 4 MONTHS

PATIENTS BRIEF HISTORY:

MRS. MONOWARA BEGUM, 42 YRS OLD, KNOWN DIABETIC PT WAS ADMITTED IN AHD WITH THE PROGRESSIVE H/O NUMBNESS OF BOTH LOWER LIMBS FOR 8 YRS,WEAKNESS OF THE BOTH L/E FOR 6 YRS,NUMBNESS OF BOTH UPPER LIMBS FOR 4 YRS,WEAKNESS OF LEFT U/E FOR 1 YR,INABILITY TO MOVE BOTH L/E FOR 4 MONTHS. DIABITES HYPERTENSION CAD PERSONAL HISTORY BOWEL BLADDER HABBITS YES YES NO NORMAL

PHYSICAL EXAMINATION: * GENERAL PHYSICAL EXAMINATION

BUILD CLUBBING ANAEMIA ICTERUS CYANOSIS OEDEMA AVERAGE ABSENT ABSENT ABSENT ABSENT ABSENT

GLANDS OTHERS

NP RBS-15 MMOL/L 100/MIN 180/110 MM OF HG S1+S2+0 20/MIN VESICULAR NAD NORMAL ABSENT INTACT INTACT POWER - 0/5 IN BOTH LOWER LIMBS, 3/5 IN LT LIMB & 5/5 IN RT UPPER LIMB

* CARDIOVASCULAR SYSTEM
HEART RATE & RHYTHM B.P. SUPINE B.P. STANDING

* RESPIRATORY SYSTEM
RATE & TYPE BREATH SOUNDS
*

ABDOMEN
OTHERS

* CENTRAL NERVOUS SYSTEM

SPEECH TREMORS CRANIAL NERVES SENSORY SYSTEM MOTOR SYSTEM UPPER

INVESTIGATIONS:
DATE & TIME: 30/07/2006 04:36 PM

HB (HAEMOGLOBIN) RBC COUNT PCV [PACKED CELL VOLUME] MCV MCH MCHC PLATELET COUNT TLC BASOPHIL EOSINOPHILS LYMPHOCYTES MONOCYTES POLYMORPHS
DATE & TIME : 30/07/2006 05:13 PM

: : : : : : : : : : : : : : : : : UNIT MG/DL MG/DL MG/DL

14.6 GM % 5.1 MILL/CMM 43.0 % 85.0 FL 29.0 GM % 34.0 % 2.75 LAKH(S)/CUMMU 13700 /CMM 00 % 01 % 30 % 03 % 66 % 144 M MOL/L 3.4 M MOL/L 108 M MOL/L 29 M MOL/L

SODIUM (NA+)-SERUM POTASSIUM (K+)-SERUM CHLORIDE (CL-) -SERUM BICARBONATES (HCO3) - SERUM LIVER FUNCTION TEST / PROFILE-SERUM INVESTIGATION S. BILIRUBIN TOTAL DIRECT INDIRECT RESULT 0.6

REFERENCE VALUE ADULT<=1.0 NEW BORN : <=12.0 ADULT<=0.6 NEW BORN : <= 2.0

ALT(SGPT) AST(SGOT) ALKALINE PHOSPHATASE 32 - 195 GGT TOTAL PROTEIN S. ALBUMIN S. GLOBULIN
TOTAL CPK

22 19 50 31 7.3 3.7 3.6

IU/L IU/L U/L IU/L G/DL G/DL G/DL

M:10 - 40, F:5 - 35 M:15 - 45, F:10 - 30 ADULT: 32 - 92, CHILD: 10 - 50 6.0 - 8.0 3.5 - 5.0 2.0 - 4.0
: 220 U/L

DATE & TIME : 30/07/2006 06:44 PM

ALDOLASE
DATE & TIME : 30/07/2006 07:11 PM

: 7.6 U/L : 35 MM (1ST HR.) : 14.2 MMOL/ L 218.0 MG/DL MG/DL MG/DL MG/DL <150 >40 <130 <200

ESR
DATE & TIME : 31/07/2006 08:58 AM

GLUCOSE ( FASTING )
LIPID PROFILE -SERUM

S.TOTAL CHOLESTEROL S.TRIGLYCERIDE HDL-CHOLESTEROL LDL-CHOLESTEROL 124.0 42.0 122.0

ATHEROSCLEROSIS INDEX T.CHOLESTEROL / HDL 5.2

DATE & TIME : 31/07/2006 01:41 PM

GLUCOSE ( POST PRANDIAL )

: 17.0 MMOL/ L

HOSPITAL COURSE:

1.TAB. PANTONIX 40 MG-- 1+0+0 BEFORE MEAL 2.TAB. BEOVIT 100 MG-- 1+0+1 3.TAB. AMDOCAL 5 MG-- 0+0+1.5 4.TAB. OSARTIL 50 MG-- 1+0+0 5.INJ. ACTRAPID HM (U 100)-- 10 U + 0 + 6 U 6.INJ. INSULATARD (U 100)-- 8 U + 0 + 12 U ( MIX & INJECT 30 MINUTE BEFORE MEAL)

TREATMENT ON DISCHARGE: DIET: LOW SALT, LOW FAT, DIABETIC MEDICINE:

1.TAB. PANTONIX 40 MG-- 1+0+0 BEFORE MEAL-----------1 MONTH 2.TAB. BEOVIT 100 MG-- 1+0+1-------------CONT 3.TAB. AMDOCAL 5 MG-- 0+0+1.5-------------CONT 4.TAB. OSARTIL 50 MG-- 1+0+0-----------CONT 5.INJ. ACTRAPID HM (U 100)-- 10 U + 0 + 6 U-------CONT 6.INJ. INSULATARD (U 100)-- 8 U + 0 + 12 U ( MIX & INJECT 30 MINUTE BEFORE MEAL)----------CONT

ADVICE ON DISCHARGE:
# PLEASE TAKE THE PRESCRIBED MEDICINE REGULARLY # PLEASE FOLLOW THE ALL INSTRUCTIONS AS ADVISED #PLEASE DO FBS & 2 HOURS ABF & CONSULT LOCAL DIABETOLOGIST # PLEASE FOLLOW UP AT NEURO-OPD AFTER 2 MONTH WITH THE REPORTS OF THE FOLLOWING INVESTIGATIONS: * FBS & 2 HOURS ABF * S. CR * FASTING LIPID PROFILE